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Bersanelli M, Cortellini A, Leonetti A, Parisi A, Tiseo M, Bordi P, Michiara M, Bui S, Cosenza A, Ferri L, Giudice GC, Testi I, Rapacchi E, Camisa R, Vincenzi B, Caruso G, Rauti AN, Arturi F, Tucci M, Santo V, Ricozzi V, Burtet V, Sgargi P, Todeschini R, Zustovich F, Stucci LS, Santini D, Buti S. Systematic vitamin D supplementation is associated with improved outcomes and reduced thyroid adverse events in patients with cancer treated with immune checkpoint inhibitors: results from the prospective PROVIDENCE study. Cancer Immunol Immunother 2023; 72:3707-3716. [PMID: 37638980 PMCID: PMC10576732 DOI: 10.1007/s00262-023-03522-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/10/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Hypovitaminosis D can have a negative prognostic impact in patients with cancer. Vitamin D has a demonstrated role in T-cell-mediated immune activation. We hypothesized that systematic vitamin D repletion could impact clinical outcomes in patients with cancer receiving immune-checkpoint inhibitors (ICIs). METHODS We planned a prospective observational study (PROVIDENCE) to assess serum vitamin D levels in patients with advanced cancer receiving ICIs (cohort 1 at treatment initiation, cohort 2 during treatment) and the impact of systematic repletion on survival and toxicity outcomes. In an exploratory analysis, we compared the clinical outcomes of cohort 1 with a control cohort of patients followed at the participating centers who did not receive systematic vitamin D repletion. RESULTS Overall, 164 patients were prospectively recruited in the PROVIDENCE study. In cohort 1, consisting of 101 patients with 94.1% hypovitaminosis (≤ 30 ng/ml) at baseline, adequate repletion with cholecalciferol was obtained in 70.1% at the three months re-assessment. Cohort 2 consisted of 63 patients assessed for vitamin D at a median time of 3.7 months since immunotherapy initiation, with no patients having adequate levels (> 30 ng/ml). Even in cohort 2, systematic supplementation led to adequate levels in 77.8% of patients at the three months re-assessment. Compared to a retrospective control group of 238 patients without systematic vitamin D repletion, PROVIDENCE cohort 1 showed longer overall survival (OS, p = 0.013), time to treatment failure (TTF, p = 0.017), and higher disease control rate (DCR, p = 0.016). The Inverse Probability of Treatment Weighing (IPTW) fitted multivariable Cox regression confirmed the significantly decreased risk of death (HR 0.55, 95%CI: 0.34-0.90) and treatment discontinuation (HR 0.61, 95%CI: 0.40-0.91) for patients from PROVIDENCE cohort 1 in comparison to the control cohort. In the context of longer treatment exposure, the cumulative incidence of any grade immune-related adverse events (irAEs) was higher in the PROVIDENCE cohort 1 compared to the control cohort. Nevertheless, patients from cohort 1 experienced a significantly decreased risk of all grade thyroid irAEs than the control cohort (OR 0.16, 95%CI: 0.03-0.85). CONCLUSION The PROVIDENCE study suggests the potential positive impact of early systematic vitamin D supplementation on outcomes of patients with advanced cancer receiving ICIs and support adequate repletion as a possible prophylaxis for thyroid irAEs.
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Affiliation(s)
- Melissa Bersanelli
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
- Gruppo Oncologico Italiano Di Ricerca Clinica (GOIRC), Parma, Italy
| | - Alessio Cortellini
- Operative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Alvaro del Portillo N° 200, 00128, Rome, Italy.
- Department of Surgery and Cancer, Hammersmith Hospital Campus, Imperial College London, London, UK.
| | - Alessandro Leonetti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
- Gruppo Oncologico Italiano Di Ricerca Clinica (GOIRC), Parma, Italy
| | - Alessandro Parisi
- Department of Oncology, Università Politecnica Delle Marche-AOU Delle Marche, 60121, Ancona, Italy
| | - Marcello Tiseo
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
- Gruppo Oncologico Italiano Di Ricerca Clinica (GOIRC), Parma, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Paola Bordi
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Maria Michiara
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Simona Bui
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Agnese Cosenza
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Leonarda Ferri
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Giulia Claire Giudice
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Irene Testi
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Elena Rapacchi
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Roberta Camisa
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Bruno Vincenzi
- Operative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Alvaro del Portillo N° 200, 00128, Rome, Italy
| | - Giuseppe Caruso
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | | | - Federica Arturi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Marco Tucci
- Department of Interdisciplinary Medicine (DIM), University of Bari "Aldo Moro", Bari, Italy
| | - Valentina Santo
- Operative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Alvaro del Portillo N° 200, 00128, Rome, Italy
| | - Valentina Ricozzi
- Operative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Alvaro del Portillo N° 200, 00128, Rome, Italy
| | - Vanessa Burtet
- UOC Farmacia Ospedaliera, Aulss N.1 Dolomiti, Belluno Hospital, Belluno, Italy
| | - Paolo Sgargi
- Cancer Registry of Parma Province, University Hospital of Parma, Parma, Italy
| | | | - Fable Zustovich
- UOC Oncologia, Aulss N.1 Dolomiti, Belluno Hospital, Belluno, Italy
| | | | - Daniele Santini
- Oncologia Medica A, Policlinico Umberto 1, La Sapienza Università Di Roma, Rome, Italy
| | - Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
- Gruppo Oncologico Italiano Di Ricerca Clinica (GOIRC), Parma, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
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2
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Leonetti A, Peroni M, Agnetti V, Pratticò F, Manini M, Acunzo A, Marverti F, Sulas S, Rapacchi E, Mazzaschi G, Perrone F, Bordi P, Buti S, Tiseo M. Thirty-day mortality in hospitalised patients with lung cancer: incidence and predictors. BMJ Support Palliat Care 2023:spcare-2023-004558. [PMID: 37666650 DOI: 10.1136/spcare-2023-004558] [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: 08/11/2023] [Accepted: 08/14/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVES Patients with lung cancer experience high rates of hospitalisation, mainly due to the high risk of complications that emerge during the natural history of the disease. We designed a retrospective, single-centre, observational study aimed at defining the clinical predictors of 30-day mortality in hospitalised patients with lung cancer. METHODS Clinical records from the first admission of patients with lung cancer to the oncology ward of the University Hospital of Parma from 1 January 2017 to 1 January 2022 were collected. RESULTS 251 consecutive patients were enrolled at the time of data cut-off. In the univariate analysis, baseline clinical predictors of 30-day mortality were Eastern Cooperative Oncology Group performance status (ECOG PS) (≥2 vs 0-1: 27.5% vs 14.8%, p=0.028), high Blaylock Risk Assessment Screening Score (BRASS) (high vs intermediate-low: 34.3% vs 11.9%, p<0.001), presence of pain (yes vs no: 24.4% vs 11.7%, p=0.009), number of metastatic sites (≥3 vs <3: 26.5% vs 13.4%, p=0.017) and presence of bone metastases (yes vs no: 29.0% vs 10.8%, p=0.001). In the multivariate analysis, high BRASS remained significantly associated with increased 30-day mortality (high vs intermediate-low; OR 2.87, 95% CI 1.21 to 6.78, p=0.016). CONCLUSION Our results suggest that baseline poor ECOG PS, high BRASS, presence of pain, high tumour burden and presence of bone metastases could be used as clinical predictors of 30-day mortality in hospitalised patients with lung cancer. In particular, the BRASS scale should be used as a simple tool to predict 30-day mortality in hospitalised patients with lung cancer.
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Affiliation(s)
| | - Marianna Peroni
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Virginia Agnetti
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Fabiana Pratticò
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Martina Manini
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Alessandro Acunzo
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Simone Sulas
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Elena Rapacchi
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Giulia Mazzaschi
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Fabiana Perrone
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Paola Bordi
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Marcello Tiseo
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
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3
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Bersanelli M, Gnetti L, Pilato FP, Varotti E, Quaini F, Campanini N, Rapacchi E, Camisa R, Carbognani P, Silini EM, Rusca M, Leonardi F, Maestroni U, Rizzo M, Brunelli M, Buti S, Ampollini L. Retrospective immunophenotypical evaluation of MET, PD-1/PD-L1, and mTOR pathways in primary tumors and pulmonary metastases of renal cell carcinoma: the RIVELATOR study addresses the issue of biomarkers heterogeneity. Explor Target Antitumor Ther 2023; 4:743-756. [PMID: 37720351 PMCID: PMC10501858 DOI: 10.37349/etat.2023.00165] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/21/2023] [Indexed: 09/19/2023] Open
Abstract
Aim In renal cell carcinoma (RCC), tumor heterogeneity generated challenges to biomarker development and therapeutic management, often becoming responsible for primary and acquired drug resistance. This study aimed to assess the inter-tumoral, intra-tumoral, and intra-lesional heterogeneity of known druggable targets in metastatic RCC (mRCC). Methods The RIVELATOR study was a monocenter retrospective analysis of biological samples from 25 cases of primary RCC and their paired pulmonary metastases. The biomarkers analyzed included MET, mTOR, PD-1/PD-L1 pathways and the immune context. Results High multi-level heterogeneity was demonstrated. MET was the most reliable biomarker, with the lowest intratumor heterogeneity: the positive mutual correlation between MET expression in primary tumors and their metastases had a significantly proportional intensity (P = 0.038). The intratumor heterogeneity grade was significantly higher for the mTOR pathway proteins. Combined immunophenotypical expression patterns and their correlations with the immune context were uncovered [i.e., mTOR expression in the metastases positively correlated with PD-L1 expression in tumor-infiltrating lymphocytes (TILs), P = 0.019; MET expression was related to PD-1 expression on TILs (P = 0.041, ρ = 0.41) and peritumoral lymphocytes (RILs; P = 0.013, ρ = 0.49)], suggesting the possibility of predicting drug response or resistance to tyrosine kinase, mTOR, or immune checkpoint inhibitors. Conclusions In mRCC, multiple and multi-level assays of potentially predictive biomarkers are needed for their reliable translation into clinical practice. The easy-to-use immunohistochemical method of the present study allowed the identification of different combined expression patterns, providing cues for planning the management of systemic treatment combinations and sequences in an mRCC patient population. The quantitative heterogeneity of the investigated biomarkers suggests that multiple intralesional assays are needed to consider the assessment reliable for clinical considerations.
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Affiliation(s)
| | - Letizia Gnetti
- Pathologic Anatomy Unit, University Hospital of Parma, 43126 Parma, Italy
| | | | - Elena Varotti
- Pathologic Anatomy Unit, Azienda Socio-Sanitaria Territoriale di Cremona, 26100 Cremona, Italy
| | - Federico Quaini
- Medicine and Surgery Department, University of Parma, 43126 Parma, Italy
| | - Nicoletta Campanini
- Pathologic Anatomy Unit, University Hospital of Parma, 43126 Parma, Italy
- Medicine and Surgery Department, University of Parma, 43126 Parma, Italy
| | - Elena Rapacchi
- Medical Oncology Unit, University Hospital of Parma, 43126 Parma, Italy
| | - Roberta Camisa
- Medical Oncology Unit, University Hospital of Parma, 43126 Parma, Italy
| | - Paolo Carbognani
- Medicine and Surgery Department, University of Parma, 43126 Parma, Italy
- Thoracic Surgery Unit, University Hospital of Parma, 43126 Parma, Italy
| | - Enrico Maria Silini
- Pathologic Anatomy Unit, University Hospital of Parma, 43126 Parma, Italy
- Medicine and Surgery Department, University of Parma, 43126 Parma, Italy
| | - Michele Rusca
- Medicine and Surgery Department, University of Parma, 43126 Parma, Italy
| | | | | | - Mimma Rizzo
- Medical Oncology Unit, Azienda Ospedaliero Universitaria Consorziale Policlinico, 70124 Bari, Italy
| | - Matteo Brunelli
- Pathologic Anatomy Unit, University Hospital of Verona, 37126 Verona, Italy
- Medicine and Surgery Department, University of Verona, 37126 Verona, Italy
| | - Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, 43126 Parma, Italy
- Medicine and Surgery Department, University of Parma, 43126 Parma, Italy
| | - Luca Ampollini
- Medicine and Surgery Department, University of Parma, 43126 Parma, Italy
- Thoracic Surgery Unit, University Hospital of Parma, 43126 Parma, Italy
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4
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Musolino A, Pellegrino B, Isella L, Tommasi C, Pucci F, Leonetti A, Rapacchi E, Leonardi F, Bizzoco S, Affanni P, Veronesi L, Sgargi P, Maglietta G, Michiara M. 1587P SARS-CoV-2 infection risk and COVID-19 prevalence in cancer patients during the first wave of COVID-19 pandemic in a Northern Italy’s virus epicenter area. Ann Oncol 2021. [PMCID: PMC8454340 DOI: 10.1016/j.annonc.2021.08.1580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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5
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Bui S, Pelosi A, Mazzaschi G, Tommasi C, Rapacchi E, Camisa R, Binovi C, Leonardi F. Burnout and Oncology: an irreparable paradigm or a manageable condition? Prevention strategies to reduce Burnout in Oncology Health Care Professionals. Acta Biomed 2021; 92:e2021091. [PMID: 34212933 PMCID: PMC8343755 DOI: 10.23750/abm.v92i3.9738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/11/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Burnout is a stress-induced occupational related syndrome, characterized by Emotional Exhaustion (EE), feeling of depersonalization (DP) and low sense of professional accomplishment (PA). The aim of this study is to analyse the effectiveness of interventions in decreasing health professionals Burnout as well as work and life-style risk factors. Methods: A survey in Medical Oncology Department in the University Hospital of Parma was conducted using the validated Maslach Burnout Inventory (MBI) and two additional questionnaires exploring lifestyle and work factors. An 8-months intervention involved fortnight meetings by facilitators, incorporated elements of reflection, shared experiences and managing emotions. Six months after the end of the intervention a second survey was performed among the participants using MBI and the same questionnaires mentioned above. Results: EE resulted the most problematic score in Day Hospital: after the 8-month intervention we described a significant decreasing in EE score especially for Day Hospital operators (from 16.7 to 10.9) and a considerable reduction in DP score. In the Oncology Ward a correlation between lack of collaboration among different health categories and DE score was detected; in the Day Hospital the absence of solid working teams was related to higher EE scores. Conclusion: The Oncology professional health care personnel are at the greatest risk of Burnout. Our study in Oncology Department shows that specific intervention should be used to prevent and reduce Burnout. Effective personal health care strategies should be incorporated into routine oncology care to prevent and treat Burnout.
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Affiliation(s)
- Simona Bui
- azienda ospedaliero universitario di Parma.
| | | | | | | | | | | | - Cinzia Binovi
- Medical Oncology Unit, University Hospital of Parma.
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6
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Minari R, Bonatti F, Mazzaschi G, Dodi A, Facchinetti F, Gelsomino F, Cinquegrani G, Squadrilli A, Bordi P, Buti S, Bersanelli M, Leonetti A, Cosenza A, Ferri L, Rapacchi E, Quaini F, Ardizzoni A, Tiseo M. PD-L1 SNPs as biomarkers to define benefit in patients with advanced NSCLC treated with immune checkpoint inhibitors. Tumori 2021; 108:47-55. [PMID: 34002648 DOI: 10.1177/03008916211014954] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 11/16/2022]
Abstract
OBJECTIVE To investigate the role of CTLA-4, PD-1 (programmed death-1), and PD-L1 (programmed death-ligand 1) single nucleotide polymorphisms (SNPs) in predicting clinical outcome of patients with advanced non-small cell lung cancer (NSCLC) treated with immune checkpoint inhibitors (ICIs). METHODS A total of 166 consecutive patients were included. We correlated SNPs with clinical benefit, progression-free survival, time to treatment failure, and overall survival and evaluated the incidence of SNPs in nonresponder and long clinical benefit groups. RESULTS Considering the entire cohort, no correlation was found between SNPs and clinical outcome; however, PD-L1 rs4143815 SNP and the long clinical benefit group showed a statistically significant association (p = 0.02). The nonresponder cohort displayed distinctive PD-L1 haplotype (p = 0.05). CONCLUSION PD-L1 SNPs seem to be marginally involved in predicting clinical outcome of NSCLC treated with ICI, but further investigations are required.
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Affiliation(s)
- Roberta Minari
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | | | - Giulia Mazzaschi
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy.,Department of Medicine & Surgery, University of Parma
| | | | - Francesco Facchinetti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy.,Université Paris-Saclay, Institut Gustave Roussy, Inserm, Biomarqueurs Prédictifs et Nouvelles Stratégies Thérapeutiques en Oncologie, Villejuif, France
| | | | | | - Anna Squadrilli
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Paola Bordi
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | | | | | - Agnese Cosenza
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Leonarda Ferri
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Elena Rapacchi
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | | | - Andrea Ardizzoni
- Medical Oncology, AOU Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Marcello Tiseo
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy.,Department of Medicine & Surgery, University of Parma
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7
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Bersanelli M, Zielli T, Perrone F, Casartelli C, Pratticò F, Rapacchi E, Camisa R, Tognetto M, Clemente A, Giannarelli D, Rebuzzi SE, Leonetti A, Bordi P, Tiseo M, Buti S. Clinical impact of COVID-19 in a single-center cohort of a prospective study in cancer patients receiving immunotherapy. Immunotherapy 2020; 12:1139-1148. [PMID: 32933369 PMCID: PMC7493722 DOI: 10.2217/imt-2020-0211] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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] [Indexed: 12/24/2022] Open
Abstract
Aim: Evaluating the incidence and course of COVID-19 in cancer patients treated with immunotherapy. Patients & methods: We reported the influenza-like illness events with diagnosis of COVID-19 within the patient cohort enrolled in the prospective observational multicenter INVIDIa-2 study in the single center of Parma. Results: Among 53 patients, eight experienced influenza-like illness during the influenza season 2019/2020, and three of them had diagnosis of COVID-19. They were males, elderly, with cardiovascular disease. Radiological features of COVID-19 pneumonitis were found in all of three cases, although the pharyngeal swab resulted positive in only two. Two of these three patients died due to respiratory failure. Conclusion: Cancer patients are at high risk of severe events from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.
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Affiliation(s)
- Melissa Bersanelli
- Medical Oncology Unit, University of Parma, 43126, Parma, Italy.,Medicine & Surgery Department, University of Parma, Parma, Italy
| | - Teresa Zielli
- Medical Oncology Unit, University of Parma, 43126, Parma, Italy
| | - Fabiana Perrone
- Medical Oncology Unit, University of Parma, 43126, Parma, Italy
| | | | - Fabiana Pratticò
- Medicine & Surgery Department, University of Parma, Parma, Italy
| | - Elena Rapacchi
- Medical Oncology Unit, University of Parma, 43126, Parma, Italy
| | - Roberta Camisa
- Medical Oncology Unit, University of Parma, 43126, Parma, Italy
| | | | - Alberto Clemente
- Biostatistics & Clinical Research Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014, Meldola, Italy
| | - Diana Giannarelli
- Biostatistical Unit, Regina Elena National Cancer Institute, IRCCS, 00144, Rome, Italy
| | | | - Alessandro Leonetti
- Medical Oncology Unit, University of Parma, 43126, Parma, Italy.,Medicine & Surgery Department, University of Parma, Parma, Italy
| | - Paola Bordi
- Medical Oncology Unit, University of Parma, 43126, Parma, Italy
| | - Marcello Tiseo
- Medicine & Surgery Department, University of Parma, Parma, Italy
| | - Sebastiano Buti
- Medical Oncology Unit, University of Parma, 43126, Parma, Italy
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8
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Mazzaschi G, Minari R, Ferri V, Bordi P, Gnetti L, Bersanelli M, Cavazzoni A, Buti S, Leonetti A, Zecca A, Cosenza A, Ferri L, Rapacchi E, Mori C, Petronini P, Missale G, Quaini F, Tiseo M. 1929O Soluble PD-L1 and circulating CD8+PD1+ and NK cells enclose a highly prognostic and predictive immune effector score in immunotherapy treated NSCLC patients. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1322] [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: 11/16/2022] Open
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9
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Mazzaschi G, Minari R, Zecca A, Cavazzoni A, Ferri V, Mori C, Squadrilli A, Bordi P, Buti S, Bersanelli M, Leonetti A, Cosenza A, Ferri L, Rapacchi E, Missale G, Petronini PG, Quaini F, Tiseo M. Soluble PD-L1 and Circulating CD8+PD-1+ and NK Cells Enclose a Prognostic and Predictive Immune Effector Score in Immunotherapy Treated NSCLC patients. Lung Cancer 2020; 148:1-11. [PMID: 32768804 DOI: 10.1016/j.lungcan.2020.07.028] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [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: 06/05/2020] [Revised: 07/15/2020] [Accepted: 07/24/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Upfront criteria to foresee immune checkpoint inhibitors (ICIs) efficacy are far from being identified. Thus, we integrated blood descriptors of pro-inflammatory/immunosuppressive or effective anti-tumor response to non-invasively define predictive immune profiles in ICI-treated advanced non-small cell lung cancer (NSCLC). METHODS Peripheral blood (PB) was prospectively collected at baseline from 109 consecutive NSCLC patients undergoing ICIs as first or more line treatment. Soluble PD-L1 (sPD-L1) (immunoassay), CD8+PD-1+ and NK (FACS) cells were assessed and interlaced to generate an Immune effector Score (IeffS). Lung Immune Prognostic Index (LIPI) was computed by LDH levels and derived Neutrophil-to-Lymphocyte Ratio (dNLR). All these parameters were correlated with survival outcome and treatment response. RESULTS High sPD-L1 and low CD8+PD-1+ and NK number had negative impact on PFS (P < 0.001), OS (P < 0.01) and ICI-response (P < 0.05). Thus, sPD-L1high, CD8+PD-1+low and NKlow were considered as risk factors encompassing IeffS, whose prognostic power outperformed that of individual features and slightly exceeded that of LIPI. Accordingly, the absence of these risk factors portrayed a favorable IeffS characterizing patients with significantly (P < 0.001) prolonged PFS (median NR vs 2.3 months) and OS (median NR vs 4.1) and greater benefit from ICIs (P < 0.01). We then combined each risk parameter composing IeffS and LIPI (LDHhigh, dNLRhigh), thus defining three distinct prognostic classes. A remarkable impact of IeffS-LIPI integration was documented on survival outcome (PFS, HR = 4.61; 95%CI = 2.32-9.18; P < 0.001; OS, HR=4.03; 95%CI=1.91-8.67; P < 0.001) and ICI-response (AUC=0.90, 95%CI=0.81-0.97, P < 0.001). CONCLUSION Composite risk models based on blood parameters featuring the tumor-host interaction might provide accurate prognostic scores able to predict ICI benefit in NSCLC patients.
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Affiliation(s)
- G Mazzaschi
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy; Department of Medicine & Surgery, University of Parma, Italy
| | - R Minari
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy.
| | - A Zecca
- Infectious Diseases and Hepatology Unit, Laboratory of Viral Immunopathology, University Hospital of Parma, Italy
| | - A Cavazzoni
- Department of Medicine & Surgery, University of Parma, Italy
| | - V Ferri
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - C Mori
- Infectious Diseases and Hepatology Unit, Laboratory of Viral Immunopathology, University Hospital of Parma, Italy
| | - A Squadrilli
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - P Bordi
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - S Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - M Bersanelli
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - A Leonetti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - A Cosenza
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - L Ferri
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - E Rapacchi
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - G Missale
- Department of Medicine & Surgery, University of Parma, Italy; Infectious Diseases and Hepatology Unit, Laboratory of Viral Immunopathology, University Hospital of Parma, Italy
| | - P G Petronini
- Department of Medicine & Surgery, University of Parma, Italy
| | - F Quaini
- Department of Medicine & Surgery, University of Parma, Italy
| | - M Tiseo
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy; Department of Medicine & Surgery, University of Parma, Italy
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10
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Mazzaschi G, Minari R, Ferri V, Gnetti L, Bersanelli M, Cavazzoni A, Bordi P, Squadrilli A, Buti S, Cosenza A, Ferri L, Rapacchi E, Petronini P, Missale G, Quaini F, Tiseo M. Genetic, tissue and circulating PD-L1 profiling to predict the response to immuno-checkpoint inhibitors in advanced NSCLC. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz447.008] [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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11
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Facchinetti F, Veneziani M, Buti S, Gelsomino F, Squadrilli A, Bordi P, Bersanelli M, Cosenza A, Ferri L, Rapacchi E, Mazzaschi G, Leonardi F, Quaini F, Ardizzoni A, Missale G, Tiseo M. Clinical and hematologic parameters address the outcomes of non-small-cell lung cancer patients treated with nivolumab. Immunotherapy 2019; 10:681-694. [PMID: 29882691 DOI: 10.2217/imt-2017-0175] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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: 01/04/2023] Open
Abstract
AIM This prospective study aimed to envisage the putative prognostic significance of clinical and hematologic parameters in advanced non-small-cell lung cancer patients treated with nivolumab. MATERIALS & METHODS Correlations of several parameters with disease control and survival outcomes were provided. RESULTS A total of 54 patients were included. An ECOG performance status 0-1, the lack of liver and bone metastases and a timeframe from the last systemic treatment ≥4 months correlated with better disease control. The same was observed for baseline low levels of white blood cells and neutrophils, for high levels of NK cells and a neutrophil/lymphocyte ratio <4. The mentioned parameters were also associated with longer overall survival. CONCLUSION Nivolumab efficacy in non-small-cell lung cancer patients is influenced by clinicopathological parameters and specific leucocyte subsets.
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Affiliation(s)
- Francesco Facchinetti
- Medical Oncology Unit, University Hospital of Parma, Via Gramsci, 14, 43126 Parma, Italy
| | - Michele Veneziani
- Medical Oncology Unit, University Hospital of Parma, Via Gramsci, 14, 43126 Parma, Italy
| | - Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Via Gramsci, 14, 43126 Parma, Italy
| | - Francesco Gelsomino
- Medical Oncology Unit, University Hospital of Parma, Via Gramsci, 14, 43126 Parma, Italy
| | - Anna Squadrilli
- Medical Oncology Unit, University Hospital of Parma, Via Gramsci, 14, 43126 Parma, Italy
| | - Paola Bordi
- Medical Oncology Unit, University Hospital of Parma, Via Gramsci, 14, 43126 Parma, Italy
| | - Melissa Bersanelli
- Medical Oncology Unit, University Hospital of Parma, Via Gramsci, 14, 43126 Parma, Italy
| | - Agnese Cosenza
- Medical Oncology Unit, University Hospital of Parma, Via Gramsci, 14, 43126 Parma, Italy
| | - Leonarda Ferri
- Medical Oncology Unit, University Hospital of Parma, Via Gramsci, 14, 43126 Parma, Italy
| | - Elena Rapacchi
- Medical Oncology Unit, University Hospital of Parma, Via Gramsci, 14, 43126 Parma, Italy
| | - Giulia Mazzaschi
- Department of Medicine & Surgery, University Hospital of Parma, Parma, Italy
| | - Francesco Leonardi
- Medical Oncology Unit, University Hospital of Parma, Via Gramsci, 14, 43126 Parma, Italy
| | - Federico Quaini
- Department of Medicine & Surgery, University Hospital of Parma, Parma, Italy
| | - Andrea Ardizzoni
- Medical Oncology Unit, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | - Gabriele Missale
- Infectious Diseases & Hepatology Unit, Laboratory of Viral Immunopathology, University Hospital of Parma, Parma, Italy
| | - Marcello Tiseo
- Medical Oncology Unit, University Hospital of Parma, Via Gramsci, 14, 43126 Parma, Italy
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12
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Bersanelli M, Giannarelli D, Castrignanò P, Fornarini G, Panni S, Mazzoni F, Tiseo M, Rossetti S, Gambale E, Rossi E, Papa A, Cortellini A, Lolli C, Ratta R, Michiara M, Milella M, De Luca E, Sorarù M, Mucciarini C, Atzori F, Banna GL, La Torre L, Vitale MG, Massari F, Rebuzzi SE, Facchini G, Schinzari G, Tomao S, Bui S, Vaccaro V, Procopio G, De Giorgi U, Santoni M, Ficorella C, Sabbatini R, Maestri A, Natoli C, De Tursi M, Di Maio M, Rapacchi E, Pireddu A, Sava T, Lipari H, Comito F, Verzoni E, Leonardi F, Buti S. INfluenza Vaccine Indication During therapy with Immune checkpoint inhibitors: a transversal challenge. The INVIDIa study. Immunotherapy 2019; 10:1229-1239. [PMID: 30326787 DOI: 10.2217/imt-2018-0080] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [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: 01/04/2023] Open
Abstract
AIM Considering the unmet need for the counseling of cancer patients treated with immune checkpoint inhibitors (CKI) about influenza vaccination, an explorative study was planned to assess flu vaccine efficacy in this population. METHODS INVIDIa was a retrospective, multicenter study, enrolling consecutive advanced cancer outpatients receiving CKI during the influenza season 2016-2017. RESULTS Of 300 patients, 79 received flu vaccine. The incidence of influenza syndrome was 24.1% among vaccinated, versus 11.8% of controls; odds ratio: 2.4; 95% CI: 1.23-4.59; p = 0.009. The clinical ineffectiveness of vaccine was more pronounced among elderly: 37.8% among vaccinated patients, versus 6.1% of unvaccinated, odds ratio: 9.28; 95% CI: 2.77-31.14; p < 0.0001. CONCLUSION Although influenza vaccine may be clinically ineffective in advanced cancer patients receiving CKI, it seems not to negatively impact the efficacy of anticancer therapy.
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Affiliation(s)
| | - Diana Giannarelli
- Biostatistical Unit, Regina Elena National Cancer Institute, Rome, Italy
| | | | - Giuseppe Fornarini
- Medical Oncology Unit 1, IRCCS Policlinico San Martino Hospital, Genova, Italy
| | - Stefano Panni
- Medical Oncology Unit, ASST - Istituti Ospitalieri Cremona Hospital, Cremona, Italy
| | | | - Marcello Tiseo
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Sabrina Rossetti
- SSD Oncologia Clinica Sperimentale Uro-Andrologica, Dipartimento Corp-S Assistenziale dei Percorsi Oncologici Uro-Genitale, Istituto Nazionale Tumori "Fondazione G. Pascale", IRCCS, Napoli, Italy
| | - Elisabetta Gambale
- Department of Medical, Oral & Biotechnological Sciences & CeSI-MeT, University G. D'Annunzio, Chieti-Pescara, Italy
| | - Ernesto Rossi
- Medical Oncology, Catholic University of Sacred Heart, Rome, Italy
| | - Anselmo Papa
- Department of Medical & Surgical Sciences & Biotechnology, University "La Sapienza", Latina, Italy
| | - Alessio Cortellini
- Department of Biotechnological & Applied Clinical Sciences, St Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | - Cristian Lolli
- Medical Oncology, Scientific Institute of Romagna for the Study & Treatment of Tumors (IRST) IRCCS, Meldola, Italy
| | - Raffaele Ratta
- Genito-Urinary Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori of Milan, Milano, Italy
| | - Maria Michiara
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Michele Milella
- Oncology Unit 1, Regina Elena National Cancer Institute, Rome, Italy
| | - Emmanuele De Luca
- Medical Oncology, Ordine Mauriziano Hospital, University of Turin, Torino, Italy
| | | | | | - Francesco Atzori
- Department of Medical Sciences "M. Aresu", Medical Oncology, University Hospital & University of Cagliari, Cagliari, Italy
| | | | - Leonardo La Torre
- Medical Oncology Department, Santa Maria della Scaletta Hospital, Imola, Italy
| | | | | | - Sara Elena Rebuzzi
- Medical Oncology Unit 1, IRCCS Policlinico San Martino Hospital, Genova, Italy
| | - Gaetano Facchini
- SSD Oncologia Clinica Sperimentale Uro-Andrologica, Dipartimento Corp-S Assistenziale dei Percorsi Oncologici Uro-Genitale, Istituto Nazionale Tumori "Fondazione G. Pascale", IRCCS, Napoli, Italy
| | | | - Silverio Tomao
- Department of Medical & Surgical Sciences & Biotechnology, University "La Sapienza", Latina, Italy
| | - Simona Bui
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Vanja Vaccaro
- Oncology Unit 1, Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppe Procopio
- Genito-Urinary Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori of Milan, Milano, Italy
| | - Ugo De Giorgi
- Medical Oncology, Scientific Institute of Romagna for the Study & Treatment of Tumors (IRST) IRCCS, Meldola, Italy
| | | | - Corrado Ficorella
- Department of Biotechnological & Applied Clinical Sciences, St Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | | | - Antonio Maestri
- Medical Oncology Department, Santa Maria della Scaletta Hospital, Imola, Italy
| | - Clara Natoli
- Department of Medical, Oral & Biotechnological Sciences & CeSI-MeT, University G. D'Annunzio, Chieti-Pescara, Italy
| | - Michele De Tursi
- Department of Medical, Oral & Biotechnological Sciences & CeSI-MeT, University G. D'Annunzio, Chieti-Pescara, Italy
| | - Massimo Di Maio
- Medical Oncology, Ordine Mauriziano Hospital, University of Turin, Torino, Italy
| | - Elena Rapacchi
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Annagrazia Pireddu
- Department of Medical Sciences "M. Aresu", Medical Oncology, University Hospital & University of Cagliari, Cagliari, Italy
| | - Teodoro Sava
- Medical Oncology, Camposampiero Hospital, Padova, Italy
| | - Helga Lipari
- Medical Oncology, Cannizzaro Hospital, Catania, Italy
| | - Francesca Comito
- Division of Oncology, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Elena Verzoni
- Genito-Urinary Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori of Milan, Milano, Italy
| | | | - Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
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13
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Bordi P, Del Re M, Minari R, Rofi E, Buti S, Restante G, Squadrilli A, Crucitta S, Casartelli C, Gnetti L, Azzoni C, Bottarelli L, Petrini I, Cosenza A, Ferri L, Rapacchi E, Danesi R, Tiseo M. From the beginning to resistance: Study of plasma monitoring and resistance mechanisms in a cohort of patients treated with osimertinib for advanced T790M-positive NSCLC. Lung Cancer 2019; 131:78-85. [PMID: 31027702 DOI: 10.1016/j.lungcan.2019.03.017] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 03/16/2019] [Accepted: 03/18/2019] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Analysis of circulating tumor DNA (ctDNA) for the identification of T790M mutation in advanced EGFR-mutated NSCLC patients can replace tissue re-biopsy for resistance characterization and, being non-invasive, may be applied for disease monitoring. We analysed ctDNA during osimertinib treatment to correlate mutational levels with clinical outcome and to predict pattern of resistance. MATERIALS AND METHODS Forty patients with advanced NSCLC receiving osimertinib for T790M + disease after previous EGFR-TKI were enrolled in a pilot study to collect plasma at baseline and every 12 weeks until progression. Molecular analysis of ctDNA was performed by ddPCR and Therascreen®. When feasible at progression, tissue re-biopsy and NGS analysis were performed. RESULTS Thirty-eight patients had baseline plasma samples suitable for molecular analysis. Patients with low levels of the EGFR activating mutation in ctDNA [< 2200 copies/mL or allele frequency (AF) < 6.1%] showed better progression-free survival (17.8 or 17.8 months vs. 4.3 or 2.7, p = 0.022 or p = 0.018, respectively) and overall survival (23.6 or 23.6 vs. 7.7 or 7.3, p = 0.016 or p = 0.013, respectively) than patients with high levels (≥ 2200 copies/mL or AF ≥ 6.1%). Patients with detectable EGFR mutations in plasma (shedders) presented worse outcome than negative subjects (non-shedders). Low levels of T790M, higher T790M/activating mutation ratio and complete clearance after 2 months were associated with a trend towards better outcome. Tissue re-biopsy at resistance showed 3 patients with EGFR C797S, 1 with MET amplification, 1 with MYC amplification, 1 with PTEN loss, 3 with SCLC transformation. CONCLUSIONS The mutational analysis performed on plasma plays a significant role in prognostic stratification, especially for the EGFR activating mutation, since patients with absence or low levels of mutations presented a better outcome to osimertinib. At progression, tissue re-biopsy remains a crucial issue for the identification of resistance mechanisms.
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Affiliation(s)
- Paola Bordi
- Medical Oncology Unit, University Hospital of Parma, Italy
| | - Marzia Del Re
- Clinical Pharmacology and Pharmacogenetics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Roberta Minari
- Medical Oncology Unit, University Hospital of Parma, Italy.
| | - Eleonora Rofi
- Clinical Pharmacology and Pharmacogenetics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | | | - Giuliana Restante
- Clinical Pharmacology and Pharmacogenetics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | | | - Stefania Crucitta
- Clinical Pharmacology and Pharmacogenetics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | | | - Letizia Gnetti
- Pathology Unit, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Cinzia Azzoni
- Pathology Unit, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Lorena Bottarelli
- Pathology Unit, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Iacopo Petrini
- Department of Translational Medicine and New Technologies, University of Pisa, Italy
| | - Agnese Cosenza
- Medical Oncology Unit, University Hospital of Parma, Italy
| | - Leonarda Ferri
- Medical Oncology Unit, University Hospital of Parma, Italy
| | - Elena Rapacchi
- Medical Oncology Unit, University Hospital of Parma, Italy
| | - Romano Danesi
- Clinical Pharmacology and Pharmacogenetics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Marcello Tiseo
- Medical Oncology Unit, University Hospital of Parma, Italy; Department of Medicine and Surgery, University of Parma, Parma, Italy
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14
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Bersanelli M, Gnetti L, Varotti E, Ampollini L, Carbognani P, Leonardi F, Rusca M, Campanini N, Ziglioli F, Dadomo CI, Pilato FP, Cortellini A, Rapacchi E, Caruso G, Silini EM, Maestroni U, Buti S. Immune context characterization and heterogeneity in primary tumors and pulmonary metastases from renal cell carcinoma. Immunotherapy 2019; 11:21-35. [PMID: 30702014 DOI: 10.2217/imt-2018-0097] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Aim: The knowledge of the immune context of renal cell carcinoma (RCC) is useful to predict benefit from immunotherapy. We retrospectively characterized the immune context of RCC patients underwent primary nephrectomy and pulmonary metastasectomy. Materials & methods: Intratumoral infiltrating lymphocytes and peritumoral renal infiltrating lymphocytes, lymphocyte subpopulations (CD4+, CD8+), PD-1, PD-L1 were explored in paired samples of primary RCC (T) and respective pulmonary metastases (M). Results: The immune variables demonstrated intralesional and intratumoral heterogeneity. Intralesional lymphocyte heterogeneity reached 76% of cases in T, 28% in M. The heterogeneity rate for PD-L1 expression was from 44% (T) to 56% (M); it correlated with better survival. Conclusion: The immune context of RCC is highly variable both within a given tumor and among primary and metastases.
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Affiliation(s)
- Melissa Bersanelli
- Department of Medical Oncology, University Hospital of Parma, Parma, 43126, Italy
| | - Letizia Gnetti
- Department of Pathological Anatomy & Histology, University Hospital of Parma, Parma, 43126, Italy
| | - Elena Varotti
- Department of Pathological Anatomy & Histology, University Hospital of Parma, Parma, 43126, Italy
| | - Luca Ampollini
- Department of Thoracic Surgery, University Hospital of Parma, Parma, 43126, Italy
| | - Paolo Carbognani
- Department of Thoracic Surgery, University Hospital of Parma, Parma, 43126, Italy
| | - Francesco Leonardi
- Department of Medical Oncology, University Hospital of Parma, Parma, 43126, Italy
| | - Michele Rusca
- Department of Thoracic Surgery, University Hospital of Parma, Parma, 43126, Italy
| | - Nicoletta Campanini
- Department of Pathological Anatomy & Histology, University Hospital of Parma, Parma, 43126, Italy
| | - Francesco Ziglioli
- Department of Urology, University Hospital of Parma, Parma, 43126, Italy
| | - Clara I Dadomo
- Department of Pathological Anatomy & Histology, University Hospital of Parma, Parma, 43126, Italy
| | - Francesco P Pilato
- Department of Pathological Anatomy & Histology, University Hospital of Parma, Parma, 43126, Italy
| | - Alessio Cortellini
- Department of Biotechnological & Applied Clinical Sciences, Medical Oncology, St Salvatore Hospital, University of L'Aquila, L'Aquila, 67100, Italy
| | - Elena Rapacchi
- Department of Medical Oncology, University Hospital of Parma, Parma, 43126, Italy
| | - Giuseppe Caruso
- Department of Medical Oncology, University Hospital of Parma, Parma, 43126, Italy
| | - Enrico M Silini
- Department of Pathological Anatomy & Histology, University Hospital of Parma, Parma, 43126, Italy
| | - Umberto Maestroni
- Department of Urology, University Hospital of Parma, Parma, 43126, Italy
| | - Sebastiano Buti
- Department of Medical Oncology, University Hospital of Parma, Parma, 43126, Italy
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15
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Bersanelli M, Gnetti L, Azzoni C, Bottarelli L, Sverzellati N, Campanini N, Varotti E, Corrado M, Parziale R, Rapacchi E, Caruso G, Leonardi F, Silini EM, Buti S. Loss of heterozygosity of key tumor suppressor genes in advanced renal cancer patients treated with nivolumab. Immunotherapy 2018; 10:743-752. [PMID: 30008256 DOI: 10.2217/imt-2017-0160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM We studied the possible clinical significance of loss of heterozygosity (LOH) at key tumor suppressor genes loci in advanced renal cancer patients treated with nivolumab. METHODS LOH study was performed on 3p14.2 (FHIT gene); 3p21.3-21.2; 9p21 (BDMF gene); 9p22 (SH3GL2 gene). RESULTS Of 12 patients, 8 (67%) had LOH. The most affected gene was FHIT. All five patients with LOH at FHIT locus had good outcome, mean progression free survival of 6.8 months. The patients LOH negative at FHIT locus had mean progression free survival of 4 months, 67% were treatment refractory. Overall, 75% of patients with LOH of at least one gene had benefit; 75% of LOH negative cases were refractory. CONCLUSION LOH at key tumor suppressor genes should be further investigated as predictive for immunotherapy.
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Affiliation(s)
- Melissa Bersanelli
- Medical Oncology, University Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Letizia Gnetti
- Pathologic Anatomy Unit, University Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Cinzia Azzoni
- Pathologic Anatomy Unit, University Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Lorena Bottarelli
- Pathologic Anatomy Unit, University Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Nicola Sverzellati
- Radiology Unit, University Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Nicoletta Campanini
- Pathologic Anatomy Unit, University Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Elena Varotti
- Pathologic Anatomy Unit, University Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Michele Corrado
- Radiology Unit, University Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Raffaele Parziale
- Radiology Unit, University Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Elena Rapacchi
- Medical Oncology, University Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Giuseppe Caruso
- Medical Oncology, University Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Francesco Leonardi
- Medical Oncology, University Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Enrico Maria Silini
- Pathologic Anatomy Unit, University Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Sebastiano Buti
- Medical Oncology, University Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy
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16
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Tiseo M, Facchinetti F, Buti S, Gelsomino F, Veneziani M, Squadrilli A, Bordi P, Bersanelli M, Cosenza A, Ferri L, Rapacchi E, Mazzaschi G, Leonardi F, Quaini F, Ardizzoni A, Missale G. Circulating immune-profile as predictor of outcome in advanced NSCLC patients treated with Nivolumab. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx426.019] [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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17
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Tiseo M, Facchinetti F, Gelsomino F, Buti S, Veneziani M, Squadrilli A, Bordi P, Bersanelli M, Cosenza A, Ferri L, Rapacchi E, Mazzaschi G, Leonardi F, Quaini F, Ardizzoni A, Missale G. Circulating immune-profile as predictor of outcome in advanced NSCLC patients treated with nivolumab. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx390.015] [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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18
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Tiseo M, Veneziani M, Gelsomino F, Buti S, Facchinetti F, Squadrilli A, Bordi P, Bersanelli M, Cosenza A, Ferri L, Rapacchi E, Mazzaschi G, Leonardi F, Quaini F, Ardizzoni A, Missale G. Circulating immune-profile as predictor of outcome in advanced NSCLC patients treated with nivolumab. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e14514] [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
e14514 Background: Detection of predictive markers of anti-PD-1/PD-L1 antibodies activity is of pivotal interest in non-small cell lung cancer (NSCLC). This study aimed to identify a circulating immuno-profile as predictor of outcome in NSCLC patients treated with nivolumab Methods: A peripheral blood immuno-profile evaluation was performed at baseline (T0), after 2 (T1) and 4 cycles (T2) of bi-weekly nivolumab in advanced pre-treated NSCLC patients from two Italian Institutions. First tumor assessment was performed after 4 cycles and then every 2 months. FACS analysis of lymphocyte subpopulations [CD3, CD4, CD8, NK (CD56), Treg (FOXP3) and MDSC] was performed. Absolute and % changes of lymphocyte subsets together with their functional and proliferative activity were assessed. Quali-quantitative leucocyte composition at baseline and its variation during therapy were correlated with tumor response and survival. Results: In the overall population of 54 treated patients, baseline Neutrophil-to-Lymphocyte ratio and NK count, lymphocyte count and CD4 variations during therapy showed a statistically significant prognostic role (p < 0.001; p = 0.012; p < 0.001; p = 0.010, respectively). Among 31 patients (squamous carcinoma, n = 17; adenocarcinoma, n = 14) in which all 3 time-points samples were available, 19 were responders (response and stable disease) and 12 non-responders. In responders, absolute numbers of total NK and NKCD56dim subset were higher at baseline and their increase between T0 and T1 was statistically significant (p < 0.05). Responders also displayed increased cytotoxic capability as shown by a higher baseline expression of CD3ζ, perforin and granzyme in NKCD56dim subset. No significant variation was documented in absolute number and functional activity of CD4+ and CD8+ lymphocytes. A higher percentage of CD8+PD-1+ cells at baseline was observed in responders, while non-responders showed a statistically significant increase in the absolute number of MDSC during therapy (p < 0.05). Conclusions: The number and function of NKs and the frequency of PD-1 expression in CD8+ cells could represent predictive peripheral immuno-biomarkers for nivolumab treatment in advanced NSCLC.
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Affiliation(s)
- Marcello Tiseo
- University Hospital of Parma, Medical Oncology Unit, Parma, Italy
| | | | | | - Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | | | | | - Paola Bordi
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | | | | | | | - Elena Rapacchi
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Giulia Mazzaschi
- Department of Medicine, University Hospital of Parma, Parma, Italy
| | | | - Federico Quaini
- Department of Medicine, University Hospital of Parma, Parma, Italy
| | | | - Gabriele Missale
- Unit of Infectious Diseases and Hepatology, University Hospital of Parma, Parma, Italy
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19
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Tiseo M, Veneziani M, Gelsomino F, Facchinetti F, Bordi P, Rapacchi E, Squadrilli A, Buti S, Missale G, Ardizzoni A. Circulating immune-profile as predictor of outcome in NSCLC patients treated with nivolumab. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx089.001] [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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Bersanelli M, Gnetti L, Vaglio A, Sverzellati N, Campanini N, Galetti M, Incerti M, Varotti E, Parziale R, Corrado M, Bottarelli L, Azzoni C, Rapacchi E, Caruso G, Cosenza A, Ferri L, Silini EM, Leonardi F, Buti S. Correlations between tumor-infiltrating and circulating lymphocyte subpopulations in mRCC patients treated with immune-checkpoint inhibitors. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.6_suppl.494] [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
494 Background: In clinical trials with immune-checkpoint inhibitors (CKI), histological features such as tumor-infiltrating lymphocites (TILs) are investigated as potential predictive biomarkers, with the possible limit of an outdated parameter for a typically dynamic element. Methods: This explorative study compared, in metastatic renal cell carcinoma (mRCC) patients, basal pathological data about TILs on diagnostic histological specimens with circulating lymphocyte subpopulations measured before and during therapy with nivolumab, with the primary aim to assess their concordance. Secondarily, with the limit of a small sample size, a possible relation with treatment outcome was explored. Results: Of 11 mRCC patients, 5 had low presence of TILs (L-TILs), 3 moderate amount (M-TILs), and 3 high number (H-TILs). Overall, 8 patients had low intratumoral pathological CD4+/CD8+ ratio (LIPR) ≤ 1 and 3 cases high intratumoral pathological ratio (HIPR) ≥ 2. Of 8 patients with LIPR, only 2 cases matched with low circulating CD4+/CD8+ ratio (LCR) ≤1, whilst 5 cases had high circulating ratio (HCR) ≥ 2 (1 undetermined). All 3 cases with HIPR (≥ 2) conversely had LCR (≤ 1). Unexpectedly, independently from the clinical outcome, circulating CD4+/CD8+ ratio remained unchanged during therapy with CKI in each patient, maintaining the same value after 8 weeks (mean -0.12). The respective percentage values of CD4+ and CD8+ circulating T cells also remained stable during treatment (mean variation 0%); the absolute value of CD4+ was more likely to increase (mean +46.3/mm3); the level of CD8+ tended to slightly decrease (mean -6.5/mm3). No correlation of lymphocyte subpopulations with treatment outcome was found. Conclusions: Of note, this study did not evidence any correspondence between histopathological and circulating findings in terms of T-lymphocyte subpopulations in mRCC patients undergoing treatment with CKI, also suggesting the inconsistency of circulating data in terms of relative variations. Considering the likely high dynamism of TILs, rebiopsy before CKI therapy might be the most reliable way to assess the utility of TILs characterization for predictive purpose.
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Affiliation(s)
| | | | | | - Nicola Sverzellati
- Department of Surgical Sciences, Section of Radiology, University of Parma, Parma, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
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