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Speranza D, Sapuppo E, Aprile G, Auriemma A, Bergamo F, Bianco R, Bordonaro R, Brandi G, Brunetti O, Carnaghi C, Ciliberto D, Cinieri S, Corallo S, De Vita F, Di Donato S, Ferraù F, Fornaro L, Barucca V, Giommoni E, Lotesoriere C, Luchini C, Masini C, Niger M, Pisconti S, Rapposelli IG, Rimassa L, Rognone C, Rodriquenz MG, Corsini LR, Santin D, Scarpa A, Scartozzi M, Soto Parra H, Tonini G, Tortora G, Tralongo P, Silvestris N. The Italian Rare Biliary tract Cancer initiative (IRaBiCa): A multicentric observational study of Gruppo Oncologico dell'Italia Meridionale (GOIM) in collaboration with Gruppo Italiano Colangiocarcinoma (GICO). Tumori 2024:3008916231222761. [PMID: 38326240 DOI: 10.1177/03008916231222761] [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] [Indexed: 02/09/2024]
Abstract
INTRODUCTION About 90% of cholangiocarcinomas are adenocarcinomas with glandular or tubular structures lined by epithelial cells, with no bile production and with a variable degree of differentiation, arising in the background of desmoplastic stroma. The remaining 10% is represented by rarer histological variants of which there is little knowledge regarding the biological behavior, molecular characterization, and sensitivity to the various possible therapies, including molecular-based treatments. Such rare tumors are described only in case reports or small retrospective series because of their exclusion from clinical trials. This national initiative, here presented, aims to address the following knowledge gap: a) how much does histological diversity translate into clinical manifestation variety? b) are those chemotherapy regimens, recommended for conventional biliary tract cancers, potentially active in rare variants?Therefore, epidemiological, pathological, and clinical characterization of series of rare biliary histotypes/variants, for which therapeutic and follow-up data are available, will be collected. METHODS An Italian task force on rare tumors of the biliary tract (IRaBiCa) has been created, whose initiative is a multicenter retrospective study involving 34 Italian cancer centers.Clinical data from approximately 100 patients will be collected and analyzed. Continuous variables will be presented as median ± standard deviation, while categorical variables will be expressed in terms of frequency. Kaplan-Maier analyses will be used to compare disease free, progression free and overall survival, according to the different histotypes. CONCLUSIONS We expect to gather novel data on rare histotypes of biliary tract cancer that will be useful to support their molecular and immunological characterization.
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Affiliation(s)
- Desirèe Speranza
- Medical Oncology Unit, Department of Human Pathology G. Barresi, University of Messina, Messina, Sicily, Italy
| | - Elena Sapuppo
- Medical Oncology Unit, Department of Human Pathology G. Barresi, University of Messina, Messina, Sicily, Italy
| | - Giuseppe Aprile
- Department of Oncology, San Bortolo General Hospital, ULSS 8 Berica-Vicenza, Vicenza, Veneto, Italy
| | - Alessandra Auriemma
- Medical Oncology Section, Department of Medicine, University of Verona, Verona, Veneto, Italy
| | - Francesca Bergamo
- Medical Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padova, Veneto, Italy
| | - Roberto Bianco
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Campania, Italy
| | | | - Giovanni Brandi
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Emilia-Romagna, Italy
- Alma Mater Studiorum - University of Bologna - Department of Medical and Surgical Sciences, Bologna, Emilia-Romagna, Italy
| | - Oronzo Brunetti
- Medical Oncology Unit, IRCCS Istituto Tumori Giovanni Paolo II, Bari, Apulia, Italy
| | - Carlo Carnaghi
- Clinical Trials Unit, Istituto Clinico Humanitas, Centro Catanese di Oncologia, Catania, Sicily, Italy
| | | | - Saverio Cinieri
- Medical Oncology Unit, Ospedale di Summa A. Perrino, Brindisi, Apulia, Italy
| | - Salvatore Corallo
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Lombardia, Italy
| | - Ferdinando De Vita
- Division of Medical Oncology, Department of Precision Medicine, School of Medicine, University of Campania Luigi Vanvitelli, Naples, Campania, Italy
| | - Samantha Di Donato
- Medical Oncology Department ASL Toscana Centro, Santo Stefano Hospital Prato
| | - Francesco Ferraù
- St. Vincent Hospital, Division of Medical Oncology, Taormina, Messina, Sicily, Italy
| | - Lorenzo Fornaro
- Medical Oncology Unit 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Tuscany, Italy
| | - Viola Barucca
- UOC Oncologia, Azienda Ospedaliera San Camillo- Forlanini, Roma, Lazio, Italy
| | - Elisa Giommoni
- Medical Oncology Unit, Careggi University Hospital, Florence, Tuscany, Italy
| | - Claudio Lotesoriere
- Oncology Unit of National Institute of Gastroenterology - IRCCS Saverio de Bellis, Research Hospital Castellana Grotte, Bari, Apulia, Italy
| | - Claudio Luchini
- Department of Diagnostics and Public Health, Section of Pathology, and ARC-Net Research Center, University and Hospital Trust of Verona, Verona, Veneto, Italy
| | - Cristina Masini
- Medical Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Emilia-Romagna, Italy
| | - Monica Niger
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Lombardy, Italy
| | | | - Ilario Giovanni Rapposelli
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Emilia-Romagna, Italy
| | - Lorenza Rimassa
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Lombardy, Italy
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Lombardy, Italy
| | - Chiara Rognone
- Department of Oncology, University of Turin, AO Ordine Mauriziano Hospital, Turin, Italy
| | | | - Lidia Rita Corsini
- Section of Medical Oncology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Sicily, Italy
| | - Daniele Santin
- Oncology Unit (UOC) Oncologia A, Department of Radiological, Oncological and Anathomo-patological Science, Policlinico Umberto I, Sapienza University of Rome, Rome, Lazio, Italy
| | - Aldo Scarpa
- Department of Diagnostics and Public Health, Section of Pathology, and ARC-Net Research Center, University and Hospital Trust of Verona, Verona, Veneto, Italy
| | - Mario Scartozzi
- Medical Oncology, University and University Hospital, Cagliari, Sardinia, Italy
| | - Hector Soto Parra
- Department of Oncology, Medical Oncology, University Hospital Policlinico-San Marco, Catania, Sicily, Italy
| | - Giuseppe Tonini
- Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Lazio, Italy
- Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Lazio, Italy
| | - Giampaolo Tortora
- Medical Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Lazio, Italy
- Università Cattolica del Sacro Cuore, Rome, Lazio, Italy
| | - Paolo Tralongo
- Medical Oncology Unit, Medical Oncology Department, Umberto I Hospital, RAO, Siracusa, Sicily, Italy
| | - Nicola Silvestris
- Medical Oncology Unit, Department of Human Pathology G. Barresi, University of Messina, Messina, Sicily, Italy
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Catalano M, Lavacchi D, Giommoni E, Shabani S, Guidolin A, Brugia M, Petrioli R, Ramello M, Pillozzi S, Antonuzzo L, Roviello G. Prognostic role of sodium levels in colorectal cancer patients receiving aflibercept plus FOLFIRI. Future Oncol 2023; 19:2537-2546. [PMID: 38050741 DOI: 10.2217/fon-2023-0610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023] Open
Abstract
Aim: To investigate the impact of natremia in metastatic colorectal cancer (mCRC) patients treated with aflibercept plus folinic acid, 5-fluorouracil, oxaliplatin and irinotecan (FOLFIRI). Patients & methods: A total of 84 mCRC patients receiving aflibercept plus FOLFIRI as second-line treatment were enrolled and divided into two groups based on their median sodium value. Progression-free survival and overall survival were analyzed. Results: Patients with sodium levels ≥140 mEq/l had significantly longer median progression-free survival (4.1 vs 2 months; p < 0.01) and median overall survival (12 vs 7.3 months; p < 0.01) compared with those with lower levels. Conclusion: This study suggests that higher pretreatment serum sodium levels are associated with improved outcomes in mCRC patients receiving aflibercept and FOLFIRI, potentially serving as a prognostic marker to aid treatment management.
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Affiliation(s)
- Martina Catalano
- Department of Health Science, University of Florence, Florence, 50134, Italy
| | - Daniele Lavacchi
- Clinical Oncology Unit, Careggi University Hospital, Florence, 50134, Italy
| | - Elisa Giommoni
- Clinical Oncology Unit, Careggi University Hospital, Florence, 50134, Italy
| | - Sonia Shabani
- Clinical Oncology Unit, Careggi University Hospital, Florence, 50134, Italy
| | - Alessia Guidolin
- Clinical Oncology Unit, Careggi University Hospital, Florence, 50134, Italy
| | - Marco Brugia
- Clinical Oncology Unit, Careggi University Hospital, Florence, 50134, Italy
| | - Roberto Petrioli
- Oncology Unit, Azienda Ospedaliera Universitaria Senese, Siena, 53100, Italy
| | - Monica Ramello
- Oncology Unit, Department of Medical, Surgical & Health Sciences, University of Trieste, Trieste, 34129, Italy
| | - Serena Pillozzi
- Department of Experimental & Clinical Medicine, University of Florence, Florence, 34129, Italy
| | - Lorenzo Antonuzzo
- Clinical Oncology Unit, Careggi University Hospital, Florence, 50134, Italy
- Department of Experimental & Clinical Medicine, University of Florence, Florence, 34129, Italy
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Militello AM, Orsi G, Cavaliere A, Niger M, Avallone A, Salvatore L, Tortora G, Rapposelli IG, Giordano G, Noventa S, Giommoni E, Bozzarelli S, Macchini M, Peretti U, Procaccio L, Puccini A, Cascinu S, Montagna C, Milella M, Reni M. Clinical outcomes and response to chemotherapy in a cohort of pancreatic cancer patients with germline variants of unknown significance (VUS) in BRCA1 and BRCA2 genes. Cancer Chemother Pharmacol 2023; 92:501-510. [PMID: 37725113 DOI: 10.1007/s00280-023-04585-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 08/22/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE The clinical outcome and the efficacy of chemotherapy in pancreatic cancer patients with BRCA1/2 Variants of Unknown Significance (VUS) is unknown. We explored the effects of chemotherapy with or without Platinum in non metastatic and metastatic pancreatic cancer patients with BRCA1/2 VUS. METHODS A retrospective analysis of non-metastatic or metastatic pancreatic cancer patients with gBRCA1/2 VUS treated in 13 Italian centers between November 2015 and December 2020 was performed. All patients were assessed for toxicity and RECIST 1.1 response. Metastatic patients were evaluated for survival outcome. RESULTS 30 pancreatic cancer patients with gBRCA1/2 VUS were considered: 20 were M+ and 10 were non-M+. Pl-CT was recommended to 16 patients: 10 M+ (6 FOLFIRINOX and 4 PAXG) and 6 non-M+ (3 FOLFIRINOX and 3 PAXG); 11 patients received Nabpaclitaxel-Gemcitabine (AG; 8 M+) and 3 patients (2 M+) were treated with Gemcitabine (G). The RECIST 1.1 response rate was 27% for AG and 44% for Pl-CT (22% for (m) FOLFIRINOX and 71% PAXG). 1 year Progression-Free Survival was 37.5% for patients treated with AG and 33% in the Pl-CT subgroup. Median Overall Survival (OS) was 23.5 months for patients treated with AG and 14 months for the Pl-CT subgroup. 1 Year and 2 Year OS were numerically better for AG (1 Year OS: 75% vs 60% and 2 Year OS: 50% and 20% in AG and Pl-CT subgroups, respectively) as well. CONCLUSIONS Pl-CT does not seem to be associated with a better outcome compared to AG chemotherapy in PDAC patients with BRCA 1/2 VUS.
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Affiliation(s)
- Anna Maria Militello
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20123, Milan, Italy
- Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Milan, Italy
| | - Giulia Orsi
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20123, Milan, Italy
- Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Cavaliere
- Department of Oncology, University of Torino, Candiolo, Italy
- Candiolo Cancer Institute, FPO - IRCCS Candiolo, Candiolo, Italy
| | - Monica Niger
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori Di Milano, Milan, Italy
| | - Antonio Avallone
- Biologia Cellulare e Bioterapie, Istituto Nazionale per lo Studio e la Cura dei Tumori ''Fondazione Giovanni Pascale'' - IRCCS, Naples, Italy
| | - Lisa Salvatore
- Unit of Medical Oncology, Comprehensive Cancer Center, Fondazione Policlinico Universitario, Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giampaolo Tortora
- Unit of Medical Oncology, Comprehensive Cancer Center, Fondazione Policlinico Universitario, Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ilario Giovanni Rapposelli
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ''Dino Amadori'', Meldola, Italy
| | - Guido Giordano
- Unit of Medical Oncology and Biomolecular Therapy, Policlinico Riuniti, Foggia, Italy
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Silvia Noventa
- Department of Medical Oncology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Elisa Giommoni
- Medical Oncology Division, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Silvia Bozzarelli
- Department of Medical Oncology and Hematology, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Marina Macchini
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20123, Milan, Italy
- Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Milan, Italy
| | - Umberto Peretti
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20123, Milan, Italy
- Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Milan, Italy
| | - Letizia Procaccio
- Medical Oncology 1 Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
| | - Alberto Puccini
- University of Genoa, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Stefano Cascinu
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20123, Milan, Italy
- Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Milan, Italy
| | - Cristina Montagna
- Department of Radiation Oncology and Genomic Instability and Cancer Genetics, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Michele Milella
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Michele Reni
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20123, Milan, Italy.
- Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Milan, Italy.
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Procaccio L, Merz V, Fasano M, Vaccaro V, Giommoni E, Pretta A, Noventa S, Satolli MA, Giordano G, Zichi C, Pinto C, Zecchetto C, Barsotti G, De Vita F, Milella M, Antonuzzo L, Scartozzi M, Zaniboni A, Spadi R, Casalino S, Bergamo F, De Toni C, Melisi D, Lonardi S. The role of nanoliposomal irinotecan plus fluorouracil/leucovorin in the continuum of care of patients with metastatic pancreatic ductal adenocarcinoma. Cancer Med 2023. [PMID: 37278395 DOI: 10.1002/cam4.6111] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/01/2023] [Accepted: 05/07/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND The NAPOLI-I trial showed better outcome of nanoliposomal irinotecan (nal-IRI) plus 5-fluorouracil/leucovorin (5-FU/LV) compared to 5-FU/LV in patients with advanced pancreatic ductal adenocarcinoma cancer (advPDAC) progressed to gemcitabine-based therapy. This study aims to explore the real-world efficacy and safety of 5-FU/LV-nal-IRI. METHODS This is a retrospective multicenter analysis including advPDAC patients receiving 5-FU/LV-nal-IRI after failure of gemcitabine-based therapy. Survival analyses were performed using Kaplan-Meier method, univariate and multivariate analyses by Cox regression. RESULTS A total of 296 patients (median age 64.4 years, ECOG PS ≥1 in 56% of cases) were treated at 11 Italian institutions between 2016 and 2018. 34% of them underwent primary tumor resection, and 79% received gemcitabine-nabpaclitaxel as first line. 5-FU/LV-nal-IRI was administered as second-line in 73% of cases. Objective response and disease control rate were 12% and 41%, respectively. Treatment was well tolerated with dose reductions in 50% of patients but no one permanent discontinuation; the commonest grade ≥3 toxicities were neutropenia (14%) and diarrhea (12%). Median PFS and OS from 5-FU/LV-nal-IRI initiation was 3.2 and 7.1 months, respectively. CONCLUSIONS These real-world data confirm the 5-FU/LV-nal-IRI efficacy and safety in advPDAC patients progressed to gemcitabine-based therapy, with outcomes comparable to NAPOLI-1, even in a less-selected population and with more modern therapeutic algorithm.
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Affiliation(s)
- Letizia Procaccio
- Medical Oncology 1 Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Valeria Merz
- Digestive Molecular Clinical Oncology Research Unit, Università degli Studi di Verona, Verona, Italy
| | - Morena Fasano
- Medical Oncology Unit, Department of Precision Medicine, School of Medicine, University of study of Campania "L. Vanvitelli", Naples, Italy
| | | | - Elisa Giommoni
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - Andrea Pretta
- Medical Oncology Department, University Hospital, University of Cagliari, Cagliari, Italy
| | - Silvia Noventa
- Medical Oncology Unit, Casa di Cura Poliambulanza, Brescia, Italy
| | - Maria Antonietta Satolli
- Department of Oncology, University of Turin, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Turin, Italy
| | - Guido Giordano
- UO di Oncologia Medica, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Clizia Zichi
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, Turin, Italy
| | - Carmine Pinto
- High-Complexity Oncology Unit, Clinical Cancer Center, IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Camilla Zecchetto
- Digestive Molecular Clinical Oncology Research Unit, Università degli Studi di Verona, Verona, Italy
| | - Giulia Barsotti
- Medical Oncology 1 Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Ferdinando De Vita
- Medical Oncology Unit, Department of Precision Medicine, School of Medicine, University of study of Campania "L. Vanvitelli", Naples, Italy
| | | | - Lorenzo Antonuzzo
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Mario Scartozzi
- Medical Oncology Department, University Hospital, University of Cagliari, Cagliari, Italy
| | - Alberto Zaniboni
- Medical Oncology Unit, Casa di Cura Poliambulanza, Brescia, Italy
| | - Rosella Spadi
- Medical Oncology 1, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Turin, Italy
| | - Simona Casalino
- Digestive Molecular Clinical Oncology Research Unit, Università degli Studi di Verona, Verona, Italy
| | - Francesca Bergamo
- Medical Oncology 1 Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Chiara De Toni
- Medical Oncology 1 Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Davide Melisi
- Digestive Molecular Clinical Oncology Research Unit, Università degli Studi di Verona, Verona, Italy
- Investigational Cancer Therapeutics Clinical Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Sara Lonardi
- Medical Oncology 3 Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
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Lavacchi D, Roviello G, Guidolin A, Romano S, Venturini J, Caliman E, Vannini A, Giommoni E, Pellegrini E, Brugia M, Pillozzi S, Antonuzzo L. Evaluation of Fruquintinib in the Continuum of Care of Patients with Colorectal Cancer. Int J Mol Sci 2023; 24:ijms24065840. [PMID: 36982913 PMCID: PMC10051170 DOI: 10.3390/ijms24065840] [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: 02/18/2023] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
The management of patients with metastatic colorectal cancer (mCRC) has the continuum of care as the treatment paradigm. To date, trifluridine/tipiracil, a biochemically modulated fluoropyrimidine, and regorafenib, a multi-kinase inhibitor, remain the main options for the majority of patients who progressed to standard doublet- or triplet-based chemotherapies, although a tailored approach could be indicated in certain circumstances. Being highly selective for vascular endothelial growth factor receptor (VEGFR)-1, -2 and -3, fruquintinib demonstrated a strong anti-tumor activity in preclinical models and received approval from China's National Medical Products Administration (NMPA) in 2018 for the treatment of patients with chemo-refractory mCRC. The approval was based on the results of the phase III FRESCO trial. Then, in order to overcome geographic differences in clinical practice, the FRESCO-2 trial was conducted in the US, Europe, Japan, and Australia. In a heavily pretreated patient population, the study met its primary endpoint, demonstrating an advantage of fruquintinib over a placebo in overall survival (OS). Here, we review the clinical development of fruquintinib and its perspectives in gastrointestinal cancers. Then, we discuss the introduction of fruquintinib in the continuum of care of CRC paying special attention to unmet needs, including the identification of cross-resistant and potentially susceptible populations, evaluation of radiological response, and identification of novel biomarkers of clinical benefit.
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Affiliation(s)
- Daniele Lavacchi
- Clinical Oncology Unit, Careggi University Hospital, 50134 Florence, Italy
| | | | - Alessia Guidolin
- Clinical Oncology Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Silvia Romano
- Clinical Oncology Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Jacopo Venturini
- Clinical Oncology Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Enrico Caliman
- Clinical Oncology Unit, Careggi University Hospital, 50134 Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
| | - Agnese Vannini
- Clinical Oncology Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Elisa Giommoni
- Medical Oncology Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Elisa Pellegrini
- Medical Oncology Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Marco Brugia
- Medical Oncology Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Serena Pillozzi
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
- Medical Oncology Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Lorenzo Antonuzzo
- Clinical Oncology Unit, Careggi University Hospital, 50134 Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
- Medical Oncology Unit, Careggi University Hospital, 50134 Florence, Italy
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6
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Reni M, Giommoni E, Bergamo F, Milella M, Cavanna L, Di Marco MC, Spada M, Cordio S, Aprile G, Cardellino GG, Maiello E, Bernardini I, Ghidini M, Bozzarelli S, Macchini M, Orsi G, De Simone I, Rulli E, Porcu L, Torri V, Pinto C. Guideline Application in Real world: multi-Institutional Based survey of Adjuvant and first-Line pancreatic Ductal adenocarcinoma treatment in Italy. Primary analysis of the GARIBALDI survey. ESMO Open 2023; 8:100777. [PMID: 36731325 PMCID: PMC10024128 DOI: 10.1016/j.esmoop.2022.100777] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 10/31/2022] [Revised: 12/04/2022] [Accepted: 12/19/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Information about the adherence to scientific societies guidelines in the 'real-world' therapeutic management of oncological patients are lacking. This multicenter, prospective survey was aimed to improve the knowledge relative to 2017-2018 recommendations of the Italian Association of Medical Oncology (AIOM). PATIENTS AND METHODS Treatment-naive adult patients with pancreatic adenocarcinoma were enrolled. Group A received adjuvant therapy, group B received primary chemotherapy, and group C had metastatic disease. The results on patients accrued until 31 October 2019 with a mature follow-up were presented. RESULTS Since July 2017, 833 eligible patients of 923 (90%) were enrolled in 44 Italian centers. The median age was 69 years (range 36-89 years; 24% >75 years); 48% were female; 93% had Eastern Cooperative Oncology Group (ECOG) performance status (PS) score of 0 or 1; group A: 16%, group B: 30%; group C: 54%; 72% Nord, 13% Center, 15% South. In group A, guidelines adherence was 68% [95% confidence interval (CI) 59% to 76%]; 53% of patients received gemcitabine and 15% gemcitabine + capecitabine; median CA19.9 was 29 (range 0-7300; not reported 15%); median survival was 36.4 months (95% CI 27.5-47.3 months). In group B, guidelines adherence was 96% (95% CI 92% to 98%); 55% of patients received nab-paclitaxel + gemcitabine, 27% FOLFIRINOX, 12% gemcitabine, and 3% clinical trial; median CA19.9 was 337 (range 0-20220; not reported 9%); median survival was 18.1 months (95% CI 15.6-19.9 months). In group C, guidelines adherence was 96% (95% CI 94% to 98%); 71% of patients received nab-paclitaxel + gemcitabine, 16% gemcitabine, 8% FOLFIRINOX, and 4% clinical trial; liver and lung metastases were reported in 76% and 23% of patients, respectively; median CA19.9 value was 760 (range 0-1374500; not reported 9%); median survival was 10.0 months (95% CI 9.1-11.1 months). CONCLUSIONS The GARIBALDI survey shows a very high rate of adherence to guidelines and survival outcome in line with the literature. CA19.9 testing should be enhanced; nutritional and psychological counseling represent an unmet need. Enrollment to assess adherence to updated AIOM guidelines is ongoing.
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Affiliation(s)
- M Reni
- Department of Medical Oncology, Vita e Salute University, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - E Giommoni
- Medical Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - F Bergamo
- Unit of Medical Oncology 1, Department of Clinical and Experimental Oncology, Istituto Oncologico Veneto, IRCCS, Padua, Italy
| | - M Milella
- Oncology Verona, Policlinico Universitario G.B. Rossi Borgo Roma, Verona, Italy
| | - L Cavanna
- Oncology and Hematology Department, Oncology Unit, Piacenza General Hospital, Piacenza, Italy
| | | | - M Spada
- Unit of Oncology, San Raffaele G. Giglio Institute, Contrada Pietrapollastra - Pisciotto, Cefalù, Italy
| | - S Cordio
- ARNAS Garibaldi Nesima - Catania, Italy
| | - G Aprile
- San Bortolo General Hospital, ULSS8 Berica Est District - Vicenza, Italy
| | - G G Cardellino
- Department of Oncology, University & General Hospital, Udine Pz.le S. Maria della Misericordia 15, Udine, Italy
| | - E Maiello
- Medical Oncology, Hospital Casa Sollievo Della Sofferenza-San Giovanni Rotondo, Foggia, Italy
| | - I Bernardini
- Department of Oncology, Carpi and Mirandola Hospitals, Carpi e Mirandola, Italy
| | | | - S Bozzarelli
- Clinical Institute Humanitas - Rozzano (Milan), Milan, Italy
| | - M Macchini
- Department of Medical Oncology, Vita e Salute University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - G Orsi
- Department of Medical Oncology, Vita e Salute University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - I De Simone
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Er Rulli
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - L Porcu
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - V Torri
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - C Pinto
- AUSL-IRCCS Clinical Cancer Center of Reggio Emilia - Reggio Emilia, Italy
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7
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Lepri G, Catalano M, Bellando-Randone S, Pillozzi S, Giommoni E, Giorgione R, Botteri C, Matucci-Cerinic M, Antonuzzo L, Guiducci S. Systemic Sclerosis Association with Malignancy. Clin Rev Allergy Immunol 2022; 63:398-416. [PMID: 36121543 DOI: 10.1007/s12016-022-08930-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2022] [Indexed: 12/17/2022]
Abstract
The association of systemic sclerosis (SSc) and cancer is well known from several decades suggesting common genetic and environmental risk factors involved in the development of both diseases. Immunosuppressive drugs widely used in SSc may increase the risk of cancer occurrence and different SSc clinical and serological features identify patients at major risk to develop malignancy. In this context, among serological features, presence of anti-RNA polymerase III and anti-topoisomerase I autoantibodies seems to increase cancer frequency in SSc patients (particularly lung and breast cancers). Lung fibrosis and a long standing SSc pulmonary involvement have been largely proposed as lung cancer risk factors, and the exposure to cyclophosphamide and an upper gastrointestinal involvement have been traditionally linked to bladder and oesophagus cancers, respectively. Furthermore, immune checkpoint inhibitors used for cancer therapy can induce immune-related adverse events, which are more frequent and severe in patients with pre-existing autoimmune diseases such as SSc. The strong association between SSc and cancer occurrence steers clinicians to carefully survey SSc patients performing periodical malignancy screening. In the present review, the most relevant bilateral relationships between SSc and cancer will be addressed.
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Affiliation(s)
- Gemma Lepri
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology, AOUC & Scleroderma Unit, Florence, Italy.
| | - Martina Catalano
- Medical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - Silvia Bellando-Randone
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology, AOUC & Scleroderma Unit, Florence, Italy
| | - Serena Pillozzi
- Medical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - Elisa Giommoni
- Medical Oncology Unit, Careggi University Hospital, Florence, Italy
| | | | - Cristina Botteri
- Medical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology, AOUC & Scleroderma Unit, Florence, Italy.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, Milan, Italy
| | - Lorenzo Antonuzzo
- Medical Oncology, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Serena Guiducci
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology, AOUC & Scleroderma Unit, Florence, Italy
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8
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Caliman E, Fancelli S, Ottanelli C, Mazzoni F, Paglialunga L, Lavacchi D, Michelet MRG, Giommoni E, Napolitano B, Scolari F, Voltolini L, Comin CE, Pillozzi S, Antonuzzo L. Absolute eosinophil count predicts clinical outcomes and toxicity in non-small cell lung cancer patients treated with immunotherapy. Cancer Treat Res Commun 2022; 32:100603. [PMID: 35792426 DOI: 10.1016/j.ctarc.2022.100603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/15/2022] [Accepted: 06/28/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Immune checkpoint inhibitors (ICIs) have led to a paradigm shift in non-small cell lung cancer (NSCLC) treatment. We investigated absolute eosinophil count (AEC) as a predictor of clinical outcomes and toxicity in NSCLC patients receiving ICIs. MATERIALS AND METHODS AEC was retrospectively collected at baseline and during treatment from 158 advanced NSCLC patients treated with single agent anti-PD1/anti-PDL1 monoclonal antibody in first or subsequent line of therapy at Medical Oncology Unit, Careggi University Hospital, Florence (Italy), between January 2016 to October 2020. RESULTS We found a significant association between high baseline AEC (≥130/μL) and better clinical outcomes. The response rates were 64.4% and 35.6% for patients with high and low AEC, respectively (p = 0.009). The high-AEC group showed a significantly longer PFS and OS than the low-AEC group (mPFS = 7.0 months, 95% CI 5.0-10.0 vs 2.5 months, 95% CI 2.0-4.0, p = 0.007 and mOS = 9.0 months, CI 95% 7.0-15.0 vs 5.5 months, 95% CI 4.0-8.0, p = 0.009, respectively). An increased risk of immune-related adverse events (irAEs) was reported in the high-AEC group (p = 0.133). IrAEs resulted an independent prognostic factor for both better outcomes (mPFS = 8.0 months, 95% CI 7.0-12.0 vs 2.0 months, 95% CI 2.0-3.0, p<0.001; mOS = 13.0 months 95% CI 9.0-19.0 vs 4.0 months 95% CI 3.0-6-0, p<0.001) and response to ICIs (response rate = 33.8% vs 14.9%, disease control rate = 72.0% vs 32.1%, p<0.001). CONCLUSION High baseline AEC value (≥130/μL) is a predictive biomarker of clinical benefit and irAEs occurrence in NSCLC patients treated with ICIs.
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Affiliation(s)
- Enrico Caliman
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Sara Fancelli
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Italy
| | | | | | - Luca Paglialunga
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - Daniele Lavacchi
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy
| | | | - Elisa Giommoni
- Medical Oncology Unit, Careggi University Hospital, Florence, Italy
| | | | - Federico Scolari
- Medical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - Luca Voltolini
- Department of Experimental and Clinical Medicine, University of Florence, Italy; Thoracic Surgery Unit, Careggi University Hospital, Florence, Italy
| | - Camilla Eva Comin
- Department of Experimental and Clinical Medicine, University of Florence, Italy; Section of Surgery, Histopathology and Molecular Pathology, University of Florence, Italy
| | - Serena Pillozzi
- Medical Oncology Unit, Careggi University Hospital, Florence, Italy.
| | - Lorenzo Antonuzzo
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Italy; Medical Oncology Unit, Careggi University Hospital, Florence, Italy
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9
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Cremolini C, Rossini D, Lonardi S, Antoniotti C, Pietrantonio F, Marmorino F, Antonuzzo L, Boccaccino A, Randon G, Giommoni E, Pozzo C, Moretto R, De Grandis MC, Viola MG, Passardi A, Buonadonna A, Formica V, Aprile G, Boni L, Masi G. Modified FOLFOXIRI plus panitumumab (mFOLFOXIRI/PAN) versus mFOLFOX6/PAN as initial treatment of patients with unresectable RAS and BRAF wild-type metastatic colorectal cancer (mCRC): Results of the phase III randomized TRIPLETE study by GONO. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.17_suppl.lba3505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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
LBA3505 Background: The association of a chemotherapy doublet (FOLFOX/FOLFIRI) with an anti-EGFR monoclonal antibody (cetuximab or panitumumab) is an upfront option for the treatment of RAS and BRAF wt mCRC patients. Phase II studies investigating the combination of the triplet FOLFOXIRI with an anti-EGFR reported promising activity results and an acceptable safety profile when lower doses of 5FU and irinotecan were adopted. The added value of intensifying the upfront chemotherapy when combined with a targeted agent in a molecularly selected population is not established. Methods: TRIPLETE is a prospective, open label, phase III trial in which previously untreated patients with unresectable RAS and BRAF wt mCRC were randomized to receive mFOLFOX6/pan (arm A) or mFOLFOXIRI (irinotecan 150 mg/sqm, oxaliplatin 85 mg/sqm, L-leucovorin 200 mg/sqm, 5-fluoruracil 2400 mg/sqm 48 h infusion)/pan (arm B) up to 12 cycles, followed by 5FU/LV/pan until disease progression. The primary endpoint is overall response rate (ORR) according to RECIST 1.1 criteria. Secondary endpoints include safety profile, R0 resection rate, PFS and OS. Under the assumption of an ORR of 60% in arm A, to detect an increase of at least 15% in arm B, a sample size of 432 cases provided approximately 90% power to a two-sided chi square test for heterogeneity at the 0.05 significance level. Results: From September 2017 to September 2021, 435 pts were enrolled (arm A/B: 217/218) in 67 Italian sites. Main pts’ characteristics were (arm A/B): median age 59/59, ECOG PS 0 80%/84%, left-sided 88%/88%, synchronous metastases 88%/87%, prior adjuvant 2%/6%, resected primary 43%/51%, liver-only 37%/39%. Main grade > 2 adverse events were diarrhoea 7%/23%, stomatitis 7%/7%, neutropenia 20%/32%, febrile neutropenia 3%/6%, fatigue 2%/7%, skin rash 29%/19%. 160 (73%) out of 218 patients in arm B and 165 (76%) out of 217 patients in arm A achieved RECIST response (OR 0.87, 95%CI 0.56-1.34, p=0.526). No interaction effect between treatment arm and disease spread (liver-limited vs not-liver limited) was evident. No differences in early tumor shrinkage (arm A/B 58%/57%, p=0.878) and deepness of response (median arm A/B: 47%/48%, p=0.845) were reported, nor in R0 resection rate (arm A/B 29%/25%, p=0.317). At a median follow up of 26.5 mos, 305 (arm A/B: 157/148) PFS events were collected, with no significant difference between arms (median PFS: 12.7 vs 12.3 months, HR: 0.88, 95%CI 0.70-1.11, p=0.277). Conclusions: The intensification of the upfront chemotherapy backbone in combination with panitumumab in molecularly selected and mostly (88%) left-sided mCRC patients does not provide any benefit in terms of treatment activity at the price of a non-negligible increase in gastrointestinal toxicity. Clinical trial information: NCT03231722.
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Affiliation(s)
- Chiara Cremolini
- Department of Translational Research and New Technologies in Medicine and Surgery-Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Daniele Rossini
- Department of Translational Research and New Technologies in Medicine and Surgery-Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Sara Lonardi
- Medical Oncology 3, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Carlotta Antoniotti
- Department of Translational Research and New Technologies in Medicine and Surgery-Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Filippo Pietrantonio
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Federica Marmorino
- Department of Translational Research and New Technologies in Medicine and Surgery-Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Lorenzo Antonuzzo
- Clinical Oncology Unit, Careggi University Hospital - Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Alessandra Boccaccino
- Department of Translational Research and New Technologies in Medicine and Surgery-Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Giovanni Randon
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elisa Giommoni
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - Carmelo Pozzo
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Roberto Moretto
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | | | | | - Alessandro Passardi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
| | - Angela Buonadonna
- Medical Oncology Unit, Centro di Riferimento Oncologico di Aviano, Istituto di Ricovero e Cura a Carattere Scientifico, Aviano, Italy
| | - Vincenzo Formica
- Medical Oncology Unit, Tor Vergata University Hospital, Rome, Italy
| | - Giuseppe Aprile
- Department of Oncology, San Bortolo General Hospital, Azienda ULSS8 Berica, Vicenza, Italy
| | - Luca Boni
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Gianluca Masi
- Department of Translational Research and New Technologies in Medicine and Surgery-Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
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10
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Biagioni A, Peri S, Schiavone N, Giommoni E, Papucci L. Editorial: Redox Potential and Metabolic Behavior in Gastrointestinal Cancers. Front Oncol 2022; 12:882237. [PMID: 35574349 PMCID: PMC9092526 DOI: 10.3389/fonc.2022.882237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/05/2022] [Indexed: 11/21/2022] Open
Affiliation(s)
- Alessio Biagioni
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Firenze, Italy
| | - Sara Peri
- Department of Experimental and Clinical Medicine, University of Florence, Firenze, Italy
| | - Nicola Schiavone
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Firenze, Italy
| | - Elisa Giommoni
- Medical Oncology Unit, Department of Oncology and Robotic Surgery, AOU Careggi, Firenze, Italy
| | - Laura Papucci
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Firenze, Italy
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11
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Polvani S, Pepe S, Tempesti S, Tarocchi M, Marroncini G, Bencini L, Ceni E, Mello T, Picariello L, Simeone I, Grappone C, Dragoni G, Antonuzzo L, Giommoni E, Milani S, Galli A. Isoforms of the orphan nuclear receptor COUP‑TFII differentially modulate pancreatic cancer progression. Int J Oncol 2022; 60:55. [PMID: 35348189 PMCID: PMC8997336 DOI: 10.3892/ijo.2022.5345] [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: 09/08/2021] [Accepted: 02/07/2022] [Indexed: 12/24/2022] Open
Abstract
The expression of the nuclear receptor transcription factor (TF) COUP-TFII is broadly associated with cell differentiation and cancer development, including of pancreatic ductal adenocarcinoma (PDAC), a devastating disease with one of the poorest prognoses among cancers worldwide. Recent studies have started to investigate the pathological and physiological roles of a novel COUP-TFII isoform (COUP-TFII_V2) that lacks the DNA-binding domain. As the role of the canonical COUP-TFII in PDAC was previously demonstrated, the present study evaluated whether COUP-TFII_V2 may have a functional role in PDAC. It was demonstrated that COUP-TFII_V2 naturally occurs in PDAC cells and in primary samples, where its expression is consistent with shorter overall survival and peripheral invasion. Of note, COUP-TFII_V2, exhibiting nuclear and cytosolic expression, is linked to epithelial to mesenchymal transition (EMT) and cancer progression, as confirmed by nude mouse experiments. The present results demonstrated that COUP-TFII_V2 distinctively regulates the EMT of PDAC and, similarly to its sibling, it is associated with tumor aggressiveness. The two isoforms have both overlapping and exclusive functions that cooperate with cancer growth and dissemination. By studying how PDAC cells switch from one isoform to the other, novel insight into cancer biology was gained, indicating that this receptor may serve as a novel possible target for PDAC management.
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Affiliation(s)
- Simone Polvani
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences ‘Mario Serio’, University of Florence, I-50134 Florence, Italy
| | - Sara Pepe
- Core Research Laboratory, Institute for Cancer Research and Prevention, I-50139 Florence, Italy
| | - Sara Tempesti
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences ‘Mario Serio’, University of Florence, I-50134 Florence, Italy
| | - Mirko Tarocchi
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences ‘Mario Serio’, University of Florence, I-50134 Florence, Italy
| | - Giada Marroncini
- Endocrinology Research Unit, Department of Experimental and Clinical Biomedical Sciences ‘Mario Serio’, University of Florence, I-50139 Florence, Italy
| | - Lapo Bencini
- Oncology General Surgery, Azienda Ospedaliero Universitaria Careggi, I-50139 Florence, Italy
| | - Elisabetta Ceni
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences ‘Mario Serio’, University of Florence, I-50134 Florence, Italy
| | - Tommaso Mello
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences ‘Mario Serio’, University of Florence, I-50134 Florence, Italy
| | - Lucia Picariello
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences ‘Mario Serio’, University of Florence, I-50134 Florence, Italy
| | - Irene Simeone
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences ‘Mario Serio’, University of Florence, I-50134 Florence, Italy
| | - Cecilia Grappone
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences ‘Mario Serio’, University of Florence, I-50134 Florence, Italy
| | - Gabriele Dragoni
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences ‘Mario Serio’, University of Florence, I-50134 Florence, Italy
| | - Lorenzo Antonuzzo
- Department of Experimental and Clinical Medicine, University of Florence, I-50139 Florence, Italy
| | - Elisa Giommoni
- Medical Oncology, Azienda Ospedaliero Universitaria Careggi, I-50139 Florence, Italy
| | - Stefano Milani
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences ‘Mario Serio’, University of Florence, I-50134 Florence, Italy
| | - Andrea Galli
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences ‘Mario Serio’, University of Florence, I-50134 Florence, Italy
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12
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Lavacchi D, Giommoni E, Cianchi F, Antonuzzo L. Treatment Strategy for Oligometastatic Gastric Cancer: Brief Considerations. J Gastrointest Cancer 2022; 54:6-8. [PMID: 35094291 DOI: 10.1007/s12029-021-00792-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Daniele Lavacchi
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - Elisa Giommoni
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - Fabio Cianchi
- Unit of Digestive Surgery, Careggi University Hospital, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Lorenzo Antonuzzo
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy. .,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
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13
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Giommoni E, Lavacchi D, Tirino G, Fornaro L, Iachetta F, Pozzo C, Satolli MA, Spallanzani A, Puzzoni M, Stragliotto S, Sisani M, Formica V, Giovanardi F, Strippoli A, Prisciandaro M, Di Donato S, Pompella L, Pecora I, Romagnani A, Fancelli S, Brugia M, Pillozzi S, De Vita F, Antonuzzo L. Results of the observational prospective RealFLOT study. BMC Cancer 2021; 21:1086. [PMID: 34625033 PMCID: PMC8499559 DOI: 10.1186/s12885-021-08768-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 07/26/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Perioperative FLOT (5-fluorouracil, oxaliplatin and docetaxel) has recently become the gold standard treatment for fit patients with operable gastric (GC) or gastroesophageal (GEJ) adenocarcinoma, getting a 5-year overall survival (OS) of 45%, over 23% with surgery alone. METHODS RealFLOT is an Italian, multicentric, observational trial, collecting data from patients with resectable GC or GEJ adenocarcinoma treated with perioperative FLOT. Aim of the study was to describe feasibility and safety of FLOT, pathological complete response rate (pCR), surgical outcomes and overall response rate (ORR) in an unselected real-world population. Additional analyses evaluated the correlation between pCR and survival and the prognostic role of microsatellite instability (MSI) status. RESULTS Of 206 patients enrolled that received perioperative FLOT at 15 Italian centers, 124 (60.2%) received at least 4 full-dose cycles, 190 (92.2%) underwent surgery, and 142 (68.9%) started the postoperative phase. Among patients who started the postoperative phase, 105 (51.0%) received FLOT, while 37 (18%) received de-intensified regimens, depending on clinical condition or previous toxicities. pCR was achieved in 7.3% of cases. Safety profile was consistent with literature. Neutropenia was the most common G 3-4 adverse event (AE): 19.9% in the preoperative phase and 16.9% in the postoperative phase. No toxic death was observed and 30-day postoperative mortality rate was 1.0%. ORR was 45.6% and disease control rate (DCR) was 94.2%. Disease-free survival (DFS) and OS were significantly longer in case of pCR (p = 0.009 and p = 0.023, respectively). A trend towards better DFS was observed among MSI-H patients. CONCLUSIONS These real-world data confirm the feasibility of FLOT in an unselected population, representative of the clinical practice. pCR rate was lower than expected, nevertheless we confirm pCR as a predictive parameter of survival. In addition, MSI-H status seems to be a positive prognostic marker also in patients treated with taxane-containing triplets.
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Affiliation(s)
| | | | - Giuseppe Tirino
- Division of Medical Oncology, Department of Precision Medicine, University of Study of Campania "L. Vanvitelli", Naples, Italy
| | - Lorenzo Fornaro
- Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Francesco Iachetta
- Medical Oncology Unit, Clinical Cancer Center, AUSL-IRCCS, Reggio Emilia, Italy
| | - Carmelo Pozzo
- Medical Oncology, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Rome, Italy
| | | | | | - Marco Puzzoni
- Medical Oncology Department, University Hospital, University of Cagliari, Cagliari, Italy
| | - Silvia Stragliotto
- Oncology Unit - Dipartimento di Oncologia Clinica e Sperimentale Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | | | - Vincenzo Formica
- Internal Medicine Department "Tor Vergata" University Hospital, Rome, Italy
| | - Filippo Giovanardi
- Medical Oncology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Antonia Strippoli
- Medical Oncology, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Rome, Italy
| | - Michele Prisciandaro
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Samantha Di Donato
- Medical Oncology, Department Nuovo Ospedale-Santo Stefano Istituto Toscano Tumori, Prato, Italy
| | - Luca Pompella
- Division of Medical Oncology, Department of Precision Medicine, University of Study of Campania "L. Vanvitelli", Naples, Italy
| | - Irene Pecora
- Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | | | | | - Marco Brugia
- Medical Oncology Unit, AOU Careggi, Florence, Italy
| | | | - Ferdinando De Vita
- Division of Medical Oncology, Department of Precision Medicine, University of Study of Campania "L. Vanvitelli", Naples, Italy
| | - Lorenzo Antonuzzo
- Medical Oncology Unit, AOU Careggi, Florence, Italy. .,Department of Experimental and Clinical Medicine, University of Firenze, Florence, Italy. .,Clinical Oncology Unit, AOU Careggi, Largo Brambilla 3, 50134, Florence, Italy.
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14
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Orsi G, Di Marco M, Cavaliere A, Niger M, Bozzarelli S, Giordano G, Noventa S, Rapposelli IG, Garajova I, Tortora G, Rodriquenz MG, Bittoni A, Penzo E, De Lorenzo S, Peretti U, Paratore C, Bernardini I, Mosconi S, Spallanzani A, Macchini M, Tamburini E, Bencardino K, Giommoni E, Scartozzi M, Forti L, Valente MM, Militello AM, Cascinu S, Milella M, Reni M. Chemotherapy toxicity and activity in patients with pancreatic ductal adenocarcinoma and germline BRCA1-2 pathogenic variants (gBRCA1-2pv): a multicenter survey. ESMO Open 2021; 6:100238. [PMID: 34392104 PMCID: PMC8371213 DOI: 10.1016/j.esmoop.2021.100238] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/15/2021] [Accepted: 07/20/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Germline BRCA1-2 pathogenic variants (gBRCA1-2pv)-related pancreatic ductal adenocarcinoma (PDAC) showed increased sensitivity to DNA cross-linking agents. This study aimed at exploring safety profile, dose intensity, and activity of different chemotherapy regimens in this setting. PATIENTS AND METHODS gBRCA1-2pv PDAC patients of any age and clinical tumor stage who completed a first course of chemotherapy were eligible. A descriptive analysis of chemotherapy toxicity, dose intensity, response, and survival outcomes was performed. RESULTS A total of 85 gBRCA1-2pv PDAC patients treated in 21 Italian centers between December 2008 and March 2021were enrolled. Seventy-four patients were assessable for toxicity and dose intensity, 83 for outcome. Dose intensity was as follows: nab-paclitaxel 72%, gemcitabine 76% (AG); cisplatin 75%, nab-paclitaxel 73%, capecitabine 73%, and gemcitabine 65% (PAXG); fluorouracil 35%, irinotecan 58%, and oxaliplatin 64% (FOLFIRINOX). When compared with the literature, grade 3-4 neutropenia, thrombocytopenia, and diarrhea were increased with PAXG, and unmodified with AG and FOLFIRINOX. RECIST responses were numerically higher with the three- (81%) or four-drug (73%) platinum-containing regimens that outperformed AG (41%) and oxaliplatin-based doublets (56%). Carbohydrate antigen 19.9 (CA19.9) reduction >89% at nadir was reported in two-third of metastatic patients treated with triplets and quadruplets, as opposed to 33% and 45% of patients receiving oxaliplatin-based doublets or AG, respectively. All patients receiving AG experienced disease progression, with a median progression-free survival (mPFS) of 6.4 months, while patients treated with platinum-containing triplets or quadruplets had an mPFS >10.8 months. Albeit still immature, data on overall survival seemed to parallel those on PFS. CONCLUSIONS Our data, as opposed to figures expected from the literature, highlighted that platinum-based regimens provoked an increased toxicity on proliferating cells, when dose intensity was maintained, or an as-expected toxicity, when dose intensity was reduced, while no change in toxicity and dose intensity was evident with AG. Furthermore, an apparently improved outcome of platinum-based triplets or quadruplets over other regimens was observed.
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Affiliation(s)
- G Orsi
- Medical Oncology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - M Di Marco
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola - Malpighi University Hospital, Bologna, Italy
| | - A Cavaliere
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - M Niger
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - S Bozzarelli
- Department of Medical Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Research Center - IRCCS, Rozzano (Milan), Italy
| | - G Giordano
- Unit of Medical Oncology and Biomolecular Therapy, Policlinico Riuniti, Foggia, Italy; Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - S Noventa
- Department of Medical Oncology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - I G Rapposelli
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori" - IRST, Meldola, Italy
| | - I Garajova
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - G Tortora
- Unit of Medical Oncology, Comprehensive Cancer Center, Fondazione Policlinico Universitario, Agostino Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - M G Rodriquenz
- Oncology Unit, Ospedale IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy
| | - A Bittoni
- Oncology Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi di Ancona, Ancona, Italy
| | - E Penzo
- Medical Oncology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - S De Lorenzo
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - U Peretti
- Medical Oncology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - C Paratore
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, Turin, Italy
| | - I Bernardini
- Medical Oncology Unit, Ospedale Ramazzini, Carpi (MO), Italy
| | - S Mosconi
- Oncology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - A Spallanzani
- Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - M Macchini
- Medical Oncology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - E Tamburini
- Medical Oncology and Palliative Care Department, Azienda Ospedaliera Cardinale G. Panico, Tricase-Lecce, Italy
| | - K Bencardino
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - E Giommoni
- Medical Oncology Division, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | - M Scartozzi
- Medical Oncology, University and University Hospital, Cagliari, Italy
| | - L Forti
- Medical Oncology Division, Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
| | - M M Valente
- Medical Oncology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - A M Militello
- Medical Oncology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - S Cascinu
- Medical Oncology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - M Milella
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - M Reni
- Medical Oncology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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15
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Paderi A, Gambale E, Botteri C, Giorgione R, Lavacchi D, Brugia M, Mazzoni F, Giommoni E, Bormioli S, Amedei A, Pillozzi S, Matucci Cerinic M, Antonuzzo L. Association of Systemic Steroid Treatment and Outcome in Patients Treated with Immune Checkpoint Inhibitors: A Real-World Analysis. Molecules 2021; 26:molecules26195789. [PMID: 34641331 PMCID: PMC8510096 DOI: 10.3390/molecules26195789] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 09/15/2021] [Accepted: 09/15/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Immune-related adverse events (irAEs) are inflammatory side effects, which can occur during immune-checkpoint(s) inhibitors (ICIs) therapy. Steroids are the first-line agents to manage irAEs because of their immunosuppressive properties. However, it is still debated whether or when steroids can be administered without abrogating the therapeutic efforts of immunotherapy. Methods: We retrospectively evaluated 146 patients with metastatic non-small cell lung cancer (NSCLC), melanoma and renal cell carcinoma (RCC) treated with ICIs. We assessed the progression-free survival (PFS) of patients treated with steroids due to an irAE compared to a no-steroid group. Results: The early treatment with steroid (within the first 30 days from the beginning of immunotherapy) was not related to a shorter PFS (p = 0.077). Interestingly, patients who were treated with steroids after 30 days from the start of immunotherapy had significantly longer PFS (p = 0.017). In a multivariate analysis, treatment with steroids after 30 days was an independent prognostic factor for PFS (HR: 0.59 [95% CI 0.36–0.97], p = 0.037). Conclusions: This retrospective study points out that early systemic steroids administration to manage irAEs might not have a detrimental effect on patient clinical outcome in NSCLC, melanoma and RCC patients.
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Affiliation(s)
- Agnese Paderi
- Medical Oncology Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy; (A.P.); (E.G.); (C.B.); (R.G.); (D.L.); (M.B.); (F.M.); (E.G.); (S.P.)
| | - Elisabetta Gambale
- Medical Oncology Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy; (A.P.); (E.G.); (C.B.); (R.G.); (D.L.); (M.B.); (F.M.); (E.G.); (S.P.)
| | - Cristina Botteri
- Medical Oncology Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy; (A.P.); (E.G.); (C.B.); (R.G.); (D.L.); (M.B.); (F.M.); (E.G.); (S.P.)
| | - Roberta Giorgione
- Medical Oncology Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy; (A.P.); (E.G.); (C.B.); (R.G.); (D.L.); (M.B.); (F.M.); (E.G.); (S.P.)
| | - Daniele Lavacchi
- Medical Oncology Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy; (A.P.); (E.G.); (C.B.); (R.G.); (D.L.); (M.B.); (F.M.); (E.G.); (S.P.)
| | - Marco Brugia
- Medical Oncology Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy; (A.P.); (E.G.); (C.B.); (R.G.); (D.L.); (M.B.); (F.M.); (E.G.); (S.P.)
| | - Francesca Mazzoni
- Medical Oncology Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy; (A.P.); (E.G.); (C.B.); (R.G.); (D.L.); (M.B.); (F.M.); (E.G.); (S.P.)
| | - Elisa Giommoni
- Medical Oncology Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy; (A.P.); (E.G.); (C.B.); (R.G.); (D.L.); (M.B.); (F.M.); (E.G.); (S.P.)
| | - Susanna Bormioli
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy; (S.B.); (A.A.); (M.M.C.)
| | - Amedeo Amedei
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy; (S.B.); (A.A.); (M.M.C.)
| | - Serena Pillozzi
- Medical Oncology Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy; (A.P.); (E.G.); (C.B.); (R.G.); (D.L.); (M.B.); (F.M.); (E.G.); (S.P.)
| | - Marco Matucci Cerinic
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy; (S.B.); (A.A.); (M.M.C.)
| | - Lorenzo Antonuzzo
- Medical Oncology Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy; (A.P.); (E.G.); (C.B.); (R.G.); (D.L.); (M.B.); (F.M.); (E.G.); (S.P.)
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy; (S.B.); (A.A.); (M.M.C.)
- Correspondence:
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16
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Lavacchi D, Roviello G, Giommoni E, Dreoni L, Derio S, Brugia M, Amedei A, Pillozzi S, Antonuzzo L. Aflibercept Plus FOLFIRI as Second-Line Treatment for Metastatic Colorectal Cancer: A Single-Institution Real-Life Experience. Cancers (Basel) 2021; 13:cancers13153863. [PMID: 34359764 PMCID: PMC8345481 DOI: 10.3390/cancers13153863] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 07/25/2021] [Accepted: 07/27/2021] [Indexed: 12/21/2022] Open
Abstract
Simple Summary The continuum of care for mCRC might include anti-angiogenic drug as anti-VEGF/VEGFR moAb and recombinant proteins in combination with fluoropyrimidine-based regimens in first- and second-line treatment, and multikinase inhibitors in refractory patients. The addition of aflibercept to FOLFIRI has been demonstrated to improve survival in patients with metastatic colorectal cancer (mCRC) who progressed after receiving a standard oxaliplatin-based regimen. In this retrospective, single-institution, observational study we collected clinical data from mCRC patients who received aflibercept in combination with FOLFIRI in routine clinical practice to describe feasibility and efficacy of this regimen in a real-world population. Aflibercept-FOLFIRI is a feasible second-line treatment for mCRC in a real-life setting, and PFS in first-line therapy >12 months resulted as the only predictive marker of better survival. Abstract The addition of aflibercept to FOLFIRI has been demonstrated to improve survival in patients with metastatic colorectal cancer (mCRC) who progressed after receiving a standard oxaliplatin-based regimen. In this retrospective, single-institution, observational study we collected clinical data from mCRC patients who received aflibercept in combination with FOLFIRI in routine clinical practice from October 2012 to March 2021 to describe feasibility and efficacy of this regimen in a real-world population. Forty-nine patients receiving aflibercept-FOLFIRI as second-line treatment were identified, 40.8% of whom were aged over 65 years. The majority of patients had multi-organ metastases (73.5%), and had previously received bevacizumab in combination with chemotherapy (CT) as first-line treatment (79.6%). Median overall survival (OS) and progression-free survival (PFS) were 13 and 6 months, respectively; overall response rate (ORR) and disease control rate (DCR) were 12.3% and 49.1%, respectively. Several factors were associated with survival in univariate analysis, including PFS in first-line therapy, number of metastatic sites, bone metastases and others. However, in multivariate analysis, only PFS in first-line CT over 12 months was significantly associated with better OS (HR 0.32; 95% CI 0.13–0.79; p = 0.01). Hypertension was the most commonly reported grade (G) 3–4 adverse event (AE), affecting 18.4% of the overall population. Thromboembolic events were observed in 16.3% of patients, hemorrhagic events in 10.2%, and proteinuria in 8.2%. Neutropenia was the most frequently observed hematological G3–4 AE with an incidence of 10.2%. Aflibercept-FOLFIRI has been confirmed as a feasible second-line treatment for mCRC in a re-al-life setting, and PFS in first-line therapy >12 months resulted as the only predictive marker of better survival.
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Affiliation(s)
- Daniele Lavacchi
- Clinical Oncology Unit, Careggi University Hospital, 50134 Florence, Italy; (D.L.); (E.G.); (L.D.); (S.D.); (M.B.); (S.P.)
| | | | - Elisa Giommoni
- Clinical Oncology Unit, Careggi University Hospital, 50134 Florence, Italy; (D.L.); (E.G.); (L.D.); (S.D.); (M.B.); (S.P.)
| | - Lorenzo Dreoni
- Clinical Oncology Unit, Careggi University Hospital, 50134 Florence, Italy; (D.L.); (E.G.); (L.D.); (S.D.); (M.B.); (S.P.)
| | - Silvia Derio
- Clinical Oncology Unit, Careggi University Hospital, 50134 Florence, Italy; (D.L.); (E.G.); (L.D.); (S.D.); (M.B.); (S.P.)
| | - Marco Brugia
- Clinical Oncology Unit, Careggi University Hospital, 50134 Florence, Italy; (D.L.); (E.G.); (L.D.); (S.D.); (M.B.); (S.P.)
| | - Amedeo Amedei
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy;
| | - Serena Pillozzi
- Clinical Oncology Unit, Careggi University Hospital, 50134 Florence, Italy; (D.L.); (E.G.); (L.D.); (S.D.); (M.B.); (S.P.)
| | - Lorenzo Antonuzzo
- Clinical Oncology Unit, Careggi University Hospital, 50134 Florence, Italy; (D.L.); (E.G.); (L.D.); (S.D.); (M.B.); (S.P.)
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy;
- Correspondence:
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17
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Giommoni E, Maiello E, Vaccaro V, Rondini E, Vivaldi C, Tortora G, Toppo L, Giordano G, Latiano TP, Lamperini C, Pillozzi S, Boni L, Antonuzzo L, Di Costanzo F. Activity and Safety of NAB-FOLFIRI and NAB-FOLFOX as First-Line Treatment for metastatic Pancreatic Cancer (NabucCO Study). Curr Oncol 2021; 28:1761-1772. [PMID: 34066784 PMCID: PMC8161763 DOI: 10.3390/curroncol28030164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 04/30/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Relevant improvement in first-line treatment of metastatic pancreatic cancer (mPC) was provided by FOLFIRINOX and by gemcitabine (gem) plus nab-paclitaxel (Nab-p) regimens. Regardless of the first-line treatment survival benefit, most patients survive less than 1 year. AIM The objectives of this multicenter phase I/II study were to evaluate as first-line chemotherapy (CT) two modified regimens of FOLFIRINOX, replacing either oxaliplatin (Oxa) or irinotecan with Nab-p, in patients with mPC. METHODS The primary objectives of phase 1 were the definition of the dose limit binations, while for phase II they were the characterization of safety and activity of Nab-FOLFIRI and Nab-FOLFOX in mPC. RESULTS Sixty-three patients received Nab-FOLFIRI or Nab-FOLFOX in phase I. We defined MTD at 120 mg/m2 for Nab-p with FOLFIRI and 160 mg/m2 with FOLFOX. In phase II, we randomized 42 patients for each arm with the following results: (1) overall response rate (ORR) was 31% for both schedules; (2) a clinical benefit rate (CBR) of 69% and 71%; (3) 1-year survival was 41% and 50%; (4) progression free survival (PFS) was 6 months and 5.6 months; (5) median overall survival (OS) was 10.2 and 10.4 months for Nab-FOLFIRI and Nab-FOLFOX, respectively. (6) Neutropenia was the most common grade ≥3 adverse event in our regimens, significantly lower than that reported for the FOLFIRINOX triplet. CONCLUSION Nab-FOLFIRI and Nab-FOLFOX might be hopeful first-line CT options for mPC patients, with promising activity and a good safety profile.
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Affiliation(s)
- Elisa Giommoni
- Medical Oncology Unit, Careggi University Hospital, 50134 Florence, Italy; (C.L.); (S.P.); (L.A.); (F.D.C.)
- Correspondence:
| | - Evaristo Maiello
- Medical Oncology Unit, IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy; (E.M.); (T.P.L.)
| | - Vanja Vaccaro
- Medical Oncology Unit, Istituto Nazionale Tumori Regina Elena, 00144 Roma, Italy;
| | - Ermanno Rondini
- Oncology Unit, Ospedale Santa Maria Nuova—IRCCS, 42100 Reggio Emilia, Italy;
| | - Caterina Vivaldi
- Medical Oncology Unit 2, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy;
| | - Giampaolo Tortora
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata, 37134 Verona, Italy;
| | - Laura Toppo
- Medical Oncology Unit, ASST Cremona, 26100 Cremona, Italy;
| | - Guido Giordano
- Oncology Unit, Ospedale “Sacro Cuore di Gesù” Fatebenefratelli, 82100 Benevento, Italy;
| | - Tiziana Pia Latiano
- Medical Oncology Unit, IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy; (E.M.); (T.P.L.)
| | - Cinzia Lamperini
- Medical Oncology Unit, Careggi University Hospital, 50134 Florence, Italy; (C.L.); (S.P.); (L.A.); (F.D.C.)
| | - Serena Pillozzi
- Medical Oncology Unit, Careggi University Hospital, 50134 Florence, Italy; (C.L.); (S.P.); (L.A.); (F.D.C.)
| | - Luca Boni
- Clinical Trial Coordinating Center, Careggi University Hospital, 50134 Florence, Italy;
| | - Lorenzo Antonuzzo
- Medical Oncology Unit, Careggi University Hospital, 50134 Florence, Italy; (C.L.); (S.P.); (L.A.); (F.D.C.)
| | - Francesco Di Costanzo
- Medical Oncology Unit, Careggi University Hospital, 50134 Florence, Italy; (C.L.); (S.P.); (L.A.); (F.D.C.)
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18
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Giorgione R, Pillozzi S, Mela MM, Giommoni E, Paderi A, Doni L, Pellegrini E, Di Costanzo A, Antonuzzo L. Absolute eosinophil count as predictive biomarker of irAEs in patients with metastatic renal cell carcinoma (mRCC) treated with immune checkpoint inhibitors (ICIs). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.6_suppl.345] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
345 Background: Nivolumab and ipilimumab are associated with immune-related adverse events (irAEs) and, to date, few biomarkers predictive of ICIs toxicity are reported in mRCC. Methods: We conducted a single-center, observational, retrospective study at Clinical Oncology Unit, Careggi University Hospital, Florence, Italy. We evaluated 43 patients (pts) with mRCC treated with ICIs from April 2013 to May 2020. Absolute Eosinophil Counts (AEC, N°/μL) were registered at baseline and at time of occurrence of irAEs. This study aims to evaluate whether the AEC could be a predictive biomarker of irAEs in patients with mRCC treated with ICIs. Results: Median age was 65 years and males were 81.4%. 10 pts received Nivolumab+Ipilimumab, while 33 pts received Nivolumab single agent. 74.4% pts (32/43) developed at least 1 irAE, 11.6% with G3-G4 irAEs. The most frequent first irAE was endocrine event (40.6% pts; 37.5% with hypo-/hyper-thyroidism). The baseline mean AEC was 163.1/μL in our cohort, in particular 132.2/μL in pts who did not develop irAEs and 176.7/μL in pts who developed irAEs (p=0.134). Among the pts who developed irAEs, the mean AEC was lower in pts with G1-G2 (153.1/μL) than in those with G3-G4 (330/μL; p=0.0013) irAEs. At the time of onset of the first irAE, the mean AEC increased to 247/μL (Δ 140.1%). Analyzing the trend of AEC from baseline to time of occurrence of irAE for the 32 pts who had developed at least one irAE, 53.1% (17 pts) showed an increasing trend; among these pts, the most frequent irAEs were endocrine occurring in 4/17 pts (23.6%). An increasing trend was also observed in the majority of pts who developed G1-2 (14/27, 51.9%) and G3-4 (3/5, 60.0%) irAEs. Additional analyzes are ongoing to identify appropriate cut-offs of AEC to better stratify patients. Conclusions: There is little evidence in the literature about the potential role of absolute eosinophil counts as a predictive biomarker of irAEs in patients with solid tumors treated with ICIs, and most refer to patients with melanoma. In this study we observed that the baseline AEC values in patients that will develop irAEs are higher than in those without irAEs and, among the former, the values are lower for patients with toxicity G1-G2 vs G3-G4. We also found an increase of the mean AEC from baseline to the onset of the first irAE. Of the patients who experience toxicity, most have an upward trend in AEC at the onset of the first irAE. Compatibly with all the limitations of a retrospective analysis, our is the first experience exploring the role of the eosinophil count in the development of irAEs in mRCC patients treated with ICIs, and a prospective study is ongoing in our Unit to confirm the role of the eosinophil count in patients treated with ICIs.
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Affiliation(s)
- Roberta Giorgione
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - Serena Pillozzi
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy
| | | | - Elisa Giommoni
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - Agnese Paderi
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - Laura Doni
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - Elisa Pellegrini
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy
| | | | - Lorenzo Antonuzzo
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy
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Reni M, Bergamo F, Giommoni E, Milella M, Cavanna L, Di Marco M, Artioli F, Silvestris N, Spada M, Ghidini M, Maiello E, Cardellino G, Macchini M, Orsi G, Manai C, Valente M, Torri V, Porcu L, Giugliano V, Beretta G. 1562P Observational prospective study of Italian guidelines application for patients with pancreatic ductal adenocarcinoma. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.2045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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20
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Silvestris N, Brunetti O, Bittoni A, Cataldo I, Corsi D, Crippa S, D’Onofrio M, Fiore M, Giommoni E, Milella M, Pezzilli R, Vasile E, Reni M. Clinical Practice Guidelines for Diagnosis, Treatment and Follow-Up of Exocrine Pancreatic Ductal Adenocarcinoma: Evidence Evaluation and Recommendations by the Italian Association of Medical Oncology (AIOM). Cancers (Basel) 2020; 12:E1681. [PMID: 32599886 PMCID: PMC7352458 DOI: 10.3390/cancers12061681] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 04/29/2020] [Revised: 06/21/2020] [Accepted: 06/22/2020] [Indexed: 12/12/2022] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is the fourth leading cause of cancer-related death in women (7%) and the sixth in men (5%) in Italy, with a life expectancy of around 5% at 5 years. From 2010, the Italian Association of Medical Oncology (AIOM) developed national guidelines for several cancers. In this report, we report a summary of clinical recommendations of diagnosis, treatment and follow-up of PDAC, which may guide physicians in their current practice. A panel of AIOM experts in upper gastrointestinal cancer malignancies discussed the available scientific evidence supporting the clinical recommendations.
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Affiliation(s)
- Nicola Silvestris
- Medical Oncology Unit–IRCCS IstitutoTumori “Giovanni Paolo II” of Bari, 70124 Bari, Italy; (N.S.); (O.B.)
- Department of Biomedical Sciences and Human Oncology-University of Bari Medical School, 70124 Bari, Italy
| | - Oronzo Brunetti
- Medical Oncology Unit–IRCCS IstitutoTumori “Giovanni Paolo II” of Bari, 70124 Bari, Italy; (N.S.); (O.B.)
| | - Alessandro Bittoni
- Oncology Clinic, AOU Ospedali Riuniti, Polytechnic University of Marche, 60121 Ancona, Italy;
| | - Ivana Cataldo
- Department of Pathology, Hospital Cà Foncello of Treviso, 31100 Treviso, Italy;
| | - Domenico Corsi
- Medical Oncology Unit Azienda Ospedaliera San Giovanni Calibita Fatebene fratelli Roma, 00186 Roma, Italy;
| | - Stefano Crippa
- Division of Pancreatic Surgery, Vita-Salute University, San Raffaele Scientific Institute, 20132 Milan, Italy;
| | - Mirko D’Onofrio
- Department of Radiology, G. B. Rossi University Hospital, University of Verona, 37129 Verona, Italy;
| | - Michele Fiore
- Radiation Oncology, Campus Bio-Medico University, 00128 Rome, Italy;
| | - Elisa Giommoni
- Medical Oncology Unit, Department of Oncology and Robotic Surgery, AOU Careggi, 50139 Florence, Italy;
| | - Michele Milella
- Section of Medical Oncology, Department of Medicine, University of Verona and University Hospital Trust, 37129 Verona, Italy;
| | - Raffaele Pezzilli
- Department of Gastroenterology, San Carlo Hospital, 85100 Potenza, Italy;
| | - Enrico Vasile
- Division of Medical Oncology, Pisa University Hospital, 56124 Pisa, Italy;
| | - Michele Reni
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
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21
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Di Bartolomeo M, Raimondi A, Cecchi F, Catenacci DVT, Schwartz S, Sellappan S, Tian Y, Miceli R, Pellegrinelli A, Giommoni E, Aitini E, Spada F, Rosati G, Marchet A, Pucci F, Zaniboni A, Tamberi S, Pressiani T, Sanna G, Cantore M, Mosconi S, Bolzoni P, Pinto C, Landi L, Soto Parra HJ, Cavanna L, Corallo S, Martinetti A, Hembrough TA, Pietrantonio F. Association of high TUBB3 with resistance to adjuvant docetaxel-based chemotherapy in gastric cancer: translational study of ITACA-S. Tumori 2020; 107:150-159. [PMID: 32522106 DOI: 10.1177/0300891620930803] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND No predictive markers for chemotherapy activity have been validated in gastric cancer (GC). The potential value of class III β-tubulin (TUBB3) as biomarker for prognosis and resistance to taxane-based therapy was reported. METHODS We analyzed GC samples of patients enrolled in the Intergroup Trial of Adjuvant Chemotherapy in Adenocarcinoma of the Stomach (ITACA-S), a randomized adjuvant study comparing 5-fluorouracil/leucovorin (5-FU/LV) and docetaxel-based sequential chemotherapy. TUBB3 was quantitated by selected reaction monitoring mass spectrometry and patients were stratified using a threshold of 750 attomoles per microgram (amol/µg). Cox proportional modeling and Kaplan-Meier survival analysis were used to assess the impact of TUBB3 expression on overall survival (OS) and disease-free survival. RESULTS Patients with TUBB3 protein levels >750 and <750 amol/µg were 21.9% and 78.1%, respectively, and were well-balanced between treatment arms. TUBB3 protein levels were not prognostic. Whereas no survival differences according to the 2 arms were observed in the subgroup with low TUBB3 expression (5-year OS 47% vs 40%; p = 0.44), patients with high TUBB3 had a clinically meaningful poorer OS when receiving docetaxel-based versus 5-FU/LV chemotherapy (5-year OS 31% vs 54%; p = 0.09), with a statistically significant interaction between TUBB3 and treatment (p = 0.049). CONCLUSIONS The quantification of TUBB3 might be considered as a negative predictive biomarker of benefit from taxane-based therapy in GC. Studies are needed to evaluate its role in the neoadjuvant setting.
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Affiliation(s)
- Maria Di Bartolomeo
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandra Raimondi
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | | | | | | | | | - Rosalba Miceli
- Department of Medical Statistics, Biometry, and Bioinformatics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Elisa Giommoni
- Medical Oncology, Azienda Ospedaliera-Università Careggi, Firenze, Italy
| | - Enrico Aitini
- Medical Oncology, Ospedale di Suzzara, Mantova, Italy
| | - Francesca Spada
- Gastrointestinal Oncology and Neuroendocrine Tumors, Istituto Oncologico Europeo, Milan, Italy
| | - Gerardo Rosati
- Medical Oncology, Azienda Ospedaliera "San Carlo," Potenza, Italy
| | - Alberto Marchet
- Surgery, Oncology and Gastroenterology Department, Azienda Ospedaliera di Padova, Padova, Italy
| | - Francesca Pucci
- Medical Oncology, Azienda Ospedaliera di Parma, Parma, Italy
| | - Alberto Zaniboni
- Oncology Department, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | | | - Tiziana Pressiani
- Medical Oncology and Hematology, Istituto Clinico Humanitas, Rozzano, Milan, Italy
| | - Gianni Sanna
- Medical Oncology, Istituto Ospedaliero dell'Università di Sassari, Sassari, Italy
| | - Maurizio Cantore
- Medical Oncology, Azienda Ospedaliera "Carlo Poma," Mantova, Italy
| | | | - Paola Bolzoni
- Medical Oncology, Presidio Ospedaliero "Serbelloni" di Gorgonzola, Melegnano, Italy
| | - Carmine Pinto
- Medical Oncology, Arcispedale Santa Maria Nuova Azienda Ospedaliera di Reggio Emilia, Reggio Emilia, Italy
| | - Lorenza Landi
- Medical Oncology, Presidio Ospedaliero di Livorno, Livorno, Italy
| | - Hector Josè Soto Parra
- Medical Oncology, Policlinico Vittorio Emanuele, Presidio Gaspare Rodolico, Catania, Italy
| | - Luigi Cavanna
- Oncology-Hematology Department, Ospedale Civile "Guglielmo da Saliceto," Piacenza, Italy
| | - Salvatore Corallo
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Antonia Martinetti
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Filippo Pietrantonio
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
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22
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Giommoni E, De Vita F, Pecora I, Iachetta F, Strippoli A, Satolli MA, Spallanzani A, Puzzoni M, Nappo F, Sisani M, Formica V, Giovanardi F, Pozzo C, Prisciandaro M, Di Donato S, Pompella L, Salani F, Tirino G, Lavacchi D, Antonuzzo L. Perioperative FLOT in elderly patients with resectable gastric cancer: Subgroup analysis from the observational RealFLOT study. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.4548] [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
4548 Background: The treatment strategy for patients with resectable gastric cancer changed in the last few years with perioperative treatments. FLOT regimen (fluorouracil, oxaliplatin, docetaxel) turned out to be feasible and effective, offering significant improvement in survival outcomes. However, the safety profile of triplet therapies for elderly patients deserves a special attention and, consequently, the best treatment strategy for these patients is still debated. Methods: Focusing on the elderly patient population (age ≥65 years), real-world data from patients with resectable gastric or gastro-oesophageal junction (GEJ) adenocarcinoma (T≥2 and/or N+) enrolled in the observational RealFLOT study were collected. Results: A total of 206 patients with resectable gastric or GEJ adenocarcinoma received perioperative FLOT at 15 Italian centers in routine clinical practice, between September 2016 and September 2019. The median age was 63 years (range 36-77) and 43% of patients enrolled (n = 89) were ≥65 years. Among elderly patients, 46 (52%) received FLOT for at least 4 full-dose cycles in the preoperative phase, 82 (92%) underwent surgery, and 56 (62%) started the postoperative phase. The primary end point of the study, pathological complete response (pCR) rate, was similar among patients aged ≥65 and < 65 (6.7% vs 7.7%, respectively). The distribution of pathological stages did not differ according to age (p = 0.473), and disease-free survival (DFS) is unrelated to the age of patients (log-rank 0.57; p = 0.89). The incidence of grade (G) 3-4 adverse events (AEs) was similar in the two age groups (Table) and the 30-day mortality rates after surgery did not differ according to age. Conclusions: FLOT regimen demonstrated to be feasible and safe in elderly patients since no differences were observed in terms of pCR, DFS and safety profile according to age. [Table: see text]
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Affiliation(s)
- Elisa Giommoni
- Medical Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Ferdinando De Vita
- Division of Medical Oncology, Department of Precision Medicine, University of Study of Campania "L. Vanvitelli", Naples, Italy
| | - Irene Pecora
- Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Francesco Iachetta
- Medical Oncology Unit, Clinical Cancer Center, AUSL-IRCCS, Reggio Emilia, Italy
| | - Antonia Strippoli
- Medical Oncology, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, Rome, Italy
| | | | | | - Marco Puzzoni
- Medical Oncology Department, University Hospital, University of Cagliari, Cagliari, Italy
| | - Floriana Nappo
- Department of Clinical and Experimental Oncology, Medical Oncology 1 Unit, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | | | | | - Filippo Giovanardi
- Medical Oncology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Carmelo Pozzo
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli–IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Michele Prisciandaro
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Samantha Di Donato
- Medical Oncology Department, Nuovo Ospedale-Santo Stefano, Istituto Toscano Tumori, Prato, Italy
| | - Luca Pompella
- Division of Medical Oncology, Department of Precision Medicine, University of Study of Campania "L. Vanvitelli", Naples, Italy
| | - Francesca Salani
- Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Giuseppe Tirino
- Division of Medical Oncology, Department of Precision Medicine, University of Study of Campania "L. Vanvitelli", Naples, Italy
| | - Daniele Lavacchi
- Medical Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Lorenzo Antonuzzo
- Medical Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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23
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Giommoni E, De Vita F, Pecora I, Iachetta F, Strippoli A, Satolli MA, Spallanzani A, Puzzoni M, Stragliotto S, Sisani M, Formica V, Giovanardi F, Pozzo C, Prisciandaro M, Di Donato S, Petrillo A, Catanese S, Tirino G, Lavacchi D, Antonuzzo L. Perioperative FLOT in resectable gastric cancer: Italian real-world data from the RealFLOT study. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.4_suppl.300] [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
300 Background: Perioperative treatments have significantly improved survival in patients with resectable gastric cancer, increasing 5-year overall survival from 23% with surgery alone to 45% with FLOT (fluorouracil, oxaliplatin, docetaxel). Pathological regression is a prognostic marker of better survival. Methods: In this observational, retro- and prospective study we collected data from patients with resectable gastric or gastro-oesophageal junction (GEJ) adenocarcinoma treated, as clinical practice, with perioperative FLOT. All patients had clinical T2 or higher and/or nodal involvement, according to FLOT4-AIO trial. Results: A total of 206 patients received perioperative chemotherapy with FLOT at 15 Italian centres, between September 2016 and September 2019. Overall, 186 (90.3%) patients completed the preoperative phase, 190 (92%) underwent surgery, and 142 (68.9%) started the postoperative phase. Among patients who started the postoperative phase, 105 (51.0%) received FLOT, while 37 (18%) received less intensive regimens (e.g. FOLFOX or De Gramont), depending on performance status after surgery or toxicity in the preoperative phase. Pathological complete response (pCR) was obtained in 7.3% of cases. In the preoperative phase, grade (G) 3-4 hematological and gastrointestinal adverse events (AEs) were reported in 42 (20.4%) and 13 (6.3%) patients, respectively. Conclusions: These real data confirmed the feasibility of perioperative FLOT in a less-selected population, representative of the clinical practice. The pCR rate was lower than in the FLOT4-AIO trial. The survival outcomes, potential predictive or prognostic factors and comprehensive safety data will be included in the final analysis. [Table: see text]
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Affiliation(s)
- Elisa Giommoni
- Medical Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Ferdinando De Vita
- Division of Medical Oncology, Department of Precision Medicine, University of Study of Campania "L. Vanvitelli", Naples, Italy
| | - Irene Pecora
- Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Francesco Iachetta
- Medical Oncology Unit, Clinical Cancer Center, AUSL-IRCCS, Reggio Emilia, Italy
| | - Antonia Strippoli
- Medical Oncology, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, Rome, Italy
| | | | | | - Marco Puzzoni
- Medical Oncology Department, University Hospital, University of Cagliari, Cagliari, Italy
| | - Silvia Stragliotto
- Oncology Unit - Dipartimento di Oncologia Clinica e Sperimentale Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | | | - Vincenzo Formica
- Internal Medicine Department "Tor Vergata" University Hospital, Rome, Italy
| | - Filippo Giovanardi
- Medical Oncology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Carmelo Pozzo
- Medical Oncology, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, Rome, Italy
| | - Michele Prisciandaro
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Samantha Di Donato
- Medical Oncology, Department Nuovo Ospedale-Santo Stefano Instituto Toscano Tumori, Prato, Italy
| | - Angelica Petrillo
- Division of Medical Oncology, Department of Precision Medicine, University of Study of Campania “L. Vanvitelli”, Naples, Italy
| | - Silvia Catanese
- Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Giuseppe Tirino
- Division of Medical Oncology, Department of Precision Medicine, University of Study of Campania “L. Vanvitelli”, Naples, Italy
| | - Daniele Lavacchi
- Medical Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Lorenzo Antonuzzo
- Medical Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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24
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Pellino A, Manai C, Merz V, Scartozzi M, Milella M, De Vita F, Antonuzzo L, Zichi C, Satolli MA, Panebianco M, Noventa S, Giordano G, Nappo F, Zecchetto C, Puzzoni M, Vaccaro V, Pappalardo A, Giommoni E, Melisi D, Lonardi S. Observational retrospective evaluation of treatment with liposomal irinotecan plus fluorouracil/leucovorin for metastatic pancreatic cancer patients: An Italian large real-world analysis. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.4_suppl.660] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
660 Background: In the NAPOLI I phase III trial, Nanoliposomal irinotecan (nal-IRI) plus 5-fluorouracil/leucovorin (5-FU/LV) showed better outcome compared to 5FU/LV in patients with metastatic Pancreatic Cancer (MPC) progressed to 1st- line gemcitabine-based therapy. Aim of this study is to explore the real-world efficacy and safety of 5FU/LV-nal-IRI by a compassionate use programme and to identify potential prognostic factors that could affect survival in this setting. Methods: This is a retrospective multi-center analysis including patients with MPC who received 5FU/LV-nal-IRI after failure of a gemcitabine-based therapy. Survival analyses were carried out by the Kaplan-Meier method. Univariate and multivariate analyses were performed by using the log-rank test and the Cox regression. Results: A total of 296 pts (median age, 69 years, range 30-82; 50% male; ECOG PS 0, 44%) were treated at 11 Italian institutions from June 2016 and November 2018. 34% of the pts have been previously resected on their primary tumor, and 76% received gemcitabine-nabpaclitaxel as 1st - line treatment. 5FU/LV-nal-IRI has been administered as 2nd - line in 72% of the pts, while in 23% of the cases as 3rd - line or more. The median OS was 7.1 months [95% confidence interval (CI) 6.1 - 8.1] and the median PFS was 3.3 months (95% CI 2.9 - 3.6). At six months, OS and PFS rate were 53.4% and 31.4% respectively. ORR was 12% and DCR was 40%. 52% of pts received more than 4 cycle with dose reduction in 148 pts (50%). Most common grade 3 toxicities were neutropenia (14%), diarrhea (11%), anemia (3%), nausea (3%), fatigue (3%), mucositis (2%) and vomiting (1%). Baseline characteristics associated with better OS were ECOG PS 0, normal CEA, neutrophil-to-lymphocyte ratio ≤5 and haemoglobin ≥11 g/dL. Conclusions: These real-world data confirm the efficacy and safety of 5FU/LV-nal-IRI in patients with MPC progressed to a gemcitabine-based therapy, with outcome comparable to NAPOLI-1 even in a less selected population and with more active 1st - line combination therapy. In this cohort, well known prognostic markers has been confirmed, as expected.
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Affiliation(s)
- Antonio Pellino
- Department of Clinical and Experimental Oncology, Medical Oncology 1 Unit, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - Chiara Manai
- Department of Clinical and Experimental Oncology, Medical Oncology 1 Unit, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - Valeria Merz
- Unit of Medical Oncology, University of Verona Hospital Trust, Verona, TN, Italy
| | - Mario Scartozzi
- Medical Oncology Department, University Hospital, University of Cagliari, Cagliari, Italy
| | - Michele Milella
- Medical Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Ferdinando De Vita
- Division of Medical Oncology, Department of Precision Medicine, University of Study of Campania "L. Vanvitelli", Naples, Italy
| | - Lorenzo Antonuzzo
- Medical Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Clizia Zichi
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, Turin, Italy
| | | | - Michele Panebianco
- Medical Oncology Unit, Clinical Cancer Center, IRCCS-AUSL di Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Noventa
- Medical Oncology Unit, Casa di Cura Poliambulanza, Brescia, Italy
| | - Guido Giordano
- Fondazione IRCCS Casa Sollievo della Sofferenza, UO di Oncologia Medica, San Giovanni Rotondo, Italy
| | - Floriana Nappo
- Department of Clinical and Experimental Oncology, Medical Oncology 1 Unit, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - Camilla Zecchetto
- Unit of Medical Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Marco Puzzoni
- Medical Oncology Department, University Hospital, University of Cagliari, Cagliari, Italy
| | - Vanja Vaccaro
- Medical Oncology 1, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Annalisa Pappalardo
- Division of Medical Oncology, Department of Precision Medicine, University of Study of Campania "L. Vanvitelli", Naples, Italy
| | - Elisa Giommoni
- Medical Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Davide Melisi
- Medicine - Digestive Molecular Clinical Oncology Research Unit, University of Verona, Verona, Italy
| | - Sara Lonardi
- Department of Clinical and Experimental Oncology, Medical Oncology 1 Unit, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
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25
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Reni M, Bergamo F, Cavanna L, Spada M, Ghidini M, Giommoni E, Maiello E, Artioli F, Cardellino G, Torri V, Cinquini M, Giugliano V, Pinto C. Real-world guideline application in the management of pancreatic cancer patients: the Italian GARIBALDI study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz155.133] [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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26
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Morano F, Niger M, Corallo S, Lonardi S, Tamberi S, Di Donato S, Giommoni E, Giuliani F, Frassineti GL, Tomasello G, De Vita F, Cardellino GG, Pinotti G, Brizzi MP, Rimassa L, Scartozzi M, Berardi R, De Braud FG, Pietrantonio F, Di Bartolomeo M. Assessment of ramucirumab plus paclitaxel as switch maintenance versus continuation of first-line chemotherapy in patients (pts) with advanced HER2-negative gastric or gastroesophageal junction cancers: The ARMANI phase III trial. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.tps4151] [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
TPS4151 Background: Platinum/fluoropyrimidine regimens are the backbone of first-line therapy for advanced gastric cancer (AGC). The optimal duration of first-line therapy is still unknown and its continuation until disease progression represents the standard. However this strategy is often associated with cumulative toxicity and rapid development of drug resistance. Moreover, only 40% of AGC pts are eligible for second-line treatment. This study aims at assessing whether switch maintenance to ramucirumab plus paclitaxel will extend the progression-free survival (PFS) of subjects with HER-2 negative AGC who have not progressed after a first-line with a platinum/fluoropyrimidine regimen. The hypothesis is that the early administration of an active, non-cross resistant regimen may delay disease progression and, consequently, improve pts’ quality of life. This strategy may also rescue all those subjects that become ineligible for a second-line therapy due to the rapid clinical deterioration. Methods: This is a randomized, open-label, multicenter, phase III trial. Eligibility criteria are: unresectable/metastatic HER-2 negative AGC or gastroesophageal junction (GEJ) cancer; ECOG PS 0-1; measurable and/or evaluable disease by RECIST v1.1; no progression after 3 months of therapy with either FOLFOX4, mFOLFOX6 or XELOX . The primary endpoint is to compare PFS of pts in ARM A (continuation of the same first-line therapy with oxaliplatin/fluoropyrimidine) versus ARM B (switch maintenance to ramucirumab and placlitaxel). Secondary endpoints are: overall survival, time-to-treatment failure, overall response rate, duration of response, percentage of pts receiving a second-line therapy per treatment arm, safety and quality of life. Exploratory analyses to identify primary resistance and prognosis biomarkers are planned, including Next-Generation Sequencing (NGS) on archival tumor tissues. The ARMANI study is sponsored by the Fondazione IRCCS Istituto Nazionale dei Tumori and it is ongoing at 29 Italian centers with a planned population of 280 pts. Clinical trial information: NCT02934464.
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Affiliation(s)
- Federica Morano
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Monica Niger
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Salvatore Corallo
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | | | - Samantha Di Donato
- Medical Oncology Department Nuovo Ospedale-Santo Stefano Instituto Toscano Tumori, Prato, Italy
| | - Elisa Giommoni
- Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | | | - Giovanni Luca Frassineti
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Medical Oncology Unit, Meldola (FO), Italy
| | | | | | | | | | | | - Lorenza Rimassa
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Mario Scartozzi
- Medical Oncology Department, University Hospital, University of Cagliari, Cagliari, Italy
| | - Rossana Berardi
- University Hospital and Polytechnic University Ancona, Marche, Italy
| | | | - Filippo Pietrantonio
- Medical Oncology Department, Fondazione IRCSS - Istituto Nazionale dei Tumori, Milan, Italy
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Raimondi A, Gasparini P, Lonardi S, Corallo S, Fornaro L, Laterza MM, Di Salvatore M, Giommoni E, Lotesoriere C, Murgioni S, Saggio S, Martinetti A, Niger M, Antista M, Pupa S, De Braud FG, Di Bartolomeo M, Sozzi G, Morano F, Pietrantonio F. Vascular endothelial growth factor A (VEGF-A) amplification and long-term response to ramucirumab (ram) in metastatic gastric cancer (mGC): The VERA study. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.3143] [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
3143 Background: The anti-VEGFR-2 monoclonal antibody ram, alone or with paclitaxel, is a cornerstone of second-line treatment of mGC. Even if about half patients do not benefit from ram, no predictive biomarkers have been identified so far. In TCGA, VEGF-A amplification was found in 7% of cases, almost exclusively in chromosomal instability subtype. We hypothesize that VEGF-A amplification in tumor cells could lead to autocrine/paracrine stimulation of tumor growth beside angiogenesis, potentially identifying a patients’ subgroup with exceptional responses to ram. Methods: VERA was a multicentric, prospective study based on a translational hypothesis. mGC patients were included according to the following criteria: 1) complete (CR) or partial response (PR) to single-agent ram; 2) >6 months PFS to single-agent ram; 3) >10 months PFS to paclitaxel+ram. According to a Fleming single-stage design, hypothesizing a prevalence of VEGF-A amplification of 1% and 15% among all-comers and exceptional responders, 20 exceptional responders were required to reject the null hypothesis of low prevalence of VEGF-A amplification, with alpha- and beta- errors of 0.05 and 0.10, respectively. VEGF-A amplification (defined as >10% tumor cells with ≥10 VEGF-A copies, variably sized signal clusters or a ratio of VEGF-A gene to centromere of ≥2) was centrally assessed through fluorescent in situ hybridization on pre-treatment FFPE tumor tissue. Results: At 7 Italian Centers, we included 20 patients satisfying the 1st (n=1), 2nd (n=2), or 3rd (n=17) criterion. Clinical-pathological features were: M/F, 11/9; median age 63 years; gastric/GEJ, 17/3; intestinal/diffuse, 14/6, HER2+/HER2-, 4/16. Median PFS and overall survival to ram-based treatment were 15.6 and 25.7 months, with best response: CR/PR/SD, 0/10/10. VERA met its primary endpoint, revealing 3/20 (15%) tumors with VEGF-A amplification (1 case presenting big clusters, 1 small clusters and 1 with >10% tumor cells with ≥10 VEGF-A copies). Conclusions: Validation analyses of first- and second-line randomized trials could confirm VEGF-A amplification as a biomarker of long-term response to ram-based treatment in mGC patients, advancing treatment personalization.
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Affiliation(s)
- Alessandra Raimondi
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Patrizia Gasparini
- Unit of Tumor Genomics, Department of Experimental Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sara Lonardi
- Department of Clinical and Experimental Oncology, Medical Oncology 1 Unit, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - Salvatore Corallo
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | | | | | - Elisa Giommoni
- Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | | | - Sabina Murgioni
- Medical Oncology Unit 1, Clinical and Experimental Oncology Department, Veneto Institute of Oncology IOV – IRCCS, Padua, Italy
| | - Serena Saggio
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Monica Niger
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Maria Antista
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Serenella Pupa
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | | | - Maria Di Bartolomeo
- Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Gabriella Sozzi
- Fondazione IRCCS-Istituto Nazionale dei Tumori, Milan, Italy
| | - Federica Morano
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Filippo Pietrantonio
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Di Bartolomeo M, Niger M, Tirino G, Petrillo A, Berenato R, Laterza MM, Pietrantonio F, Morano F, Antista M, Lonardi S, Fornaro L, Tamberi S, Giommoni E, Zaniboni A, Rimassa L, Tomasello G, Sava T, Spada M, Latiano T, Bittoni A, Bertolini A, Proserpio I, Bencardino KB, Graziano F, Beretta G, Galdy S, Ventriglia J, Scagnoli S, Spallanzani A, Longarini R, De Vita F. Ramucirumab as Second-Line Therapy in Metastatic Gastric Cancer: Real-World Data from the RAMoss Study. Target Oncol 2018; 13:227-234. [PMID: 29582224 DOI: 10.1007/s11523-018-0562-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Ramucirumab-alone or combined with paclitaxel-represents one of the main options for patients failing first-line treatment for advanced gastric cancer. OBJECTIVE The RAMoss study aimed to evaluate the safety and efficacy profile of ramucirumab in the "real-life setting". PATIENTS AND METHODS Patients from 25 Italian hospitals started therapy consisting of ramucirumab 8 mg/kg i.v. d1,15q28 with or without paclitaxel 80 mg/m2 i.v. d1,8,15q28. The primary endpoint was safety, and secondary endpoints were overall response rate (ORR), progression-free survival (PFS), and overall survival (OS). RESULTS One hundred sixty-seven patients with disease progression on first-line therapy received ramucirumab as monotherapy (10%) or combined with paclitaxel (90%). Median treatment duration was 4 months (1-17 months). Global incidence of grade (G) 3-4 toxicity was 9.6%, and for neutropenia 5.4%; treatment was discontinued due to toxicity in 3% of patients. The most frequent adverse events (AE) were G1-2 fatigue (27.5%), G1-2 neuropathy (26.3%), and G1-2 neutropenia (14.9%). ORR was 20.2%. Stable disease was observed in 39.2% of patients, with a disease control rate of 59.4%. With a median follow-up of 11 months, median PFS was 4.3 months (95% confidence interval [CI] 4.1-4.7), whereas median OS was 8.0 months (95% CI: 7.09-8.9). In a multivariate analysis, ECOG performance status <1 or ≥1 (HR 1.13, 95% CI 1.0-1.27, p = 0.04) and the presence versus absence of peritoneal metastases (HR 1.57, 95% CI 1.63-2.39, p = 0.03) were independent poor prognostic factors. CONCLUSIONS These "real-life" efficacy data on ramucirumab treatment are in line with previous randomized trials. Ramucirumab is well tolerated in daily clinical practice.
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Affiliation(s)
- Maria Di Bartolomeo
- Department of Medical Oncology, Fondazione IRCCS Istituto Tumori, via G. Venezian, 1, 20133, Milan, Italy.
| | - Monica Niger
- Department of Medical Oncology, Fondazione IRCCS Istituto Tumori, via G. Venezian, 1, 20133, Milan, Italy
| | - Giuseppe Tirino
- University of Campania "Luigi Vanvitelli" - School of Medicine, Naples, Italy
| | - Angelica Petrillo
- University of Campania "Luigi Vanvitelli" - School of Medicine, Naples, Italy
| | - Rosa Berenato
- Department of Medical Oncology, Fondazione IRCCS Istituto Tumori, via G. Venezian, 1, 20133, Milan, Italy
| | | | - Filippo Pietrantonio
- Department of Medical Oncology, Fondazione IRCCS Istituto Tumori, via G. Venezian, 1, 20133, Milan, Italy
| | - Federica Morano
- Department of Medical Oncology, Fondazione IRCCS Istituto Tumori, via G. Venezian, 1, 20133, Milan, Italy
| | - Maria Antista
- Department of Medical Oncology, Fondazione IRCCS Istituto Tumori, via G. Venezian, 1, 20133, Milan, Italy
| | - Sara Lonardi
- Department of Medical Oncology, Istituto Oncologico Veneto-IRCCS, Padova, Italy
| | - Lorenzo Fornaro
- Oncology Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Stefano Tamberi
- Department of Oncology and Haematology, Oncology Unit, Faenza Hospital AUSL Romagna, Ravenna, Italy
| | - Elisa Giommoni
- Medical Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | | | - Lorenza Rimassa
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center, Milan, Italy
| | - Gianluca Tomasello
- Division of Medicine and Medical Oncology, Azienda Istituti Ospitalieri, Cremona, Italy
| | - Teodoro Sava
- Department of Medical Oncology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | | | - Tiziana Latiano
- Medical Oncology Hospital Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Alessandro Bittoni
- Department of Oncology, Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | | | - Ilaria Proserpio
- Medical Oncology, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | | | - Francesco Graziano
- Medical Oncology Unit, Azienda Ospedaliera-Ospedali Riuniti Marche Nord, Pesaro, Italy
| | | | - Salvatore Galdy
- Unit of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, Milan, Italy
| | - Jole Ventriglia
- University of Campania "Luigi Vanvitelli" - School of Medicine, Naples, Italy
| | - Simone Scagnoli
- Medical Oncology Department, University of Rome Sapienza, Rome, Italy
| | - Andrea Spallanzani
- Medical Oncology and Hematology Department, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | | | - Ferdinando De Vita
- University of Campania "Luigi Vanvitelli" - School of Medicine, Naples, Italy
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Giommoni E, Maiello E, Vaccaro V, Rondini E, Vivaldi C, Tortora G, Toppo L, Giordano G, Latiano TP, Antonuzzo L, Lamperini C, Boni L, Di Costanzo F. Activity and safety of Nab-FOLFIRI and Nab-FOLFOX as first-line treatment for metastatic pancreatic cancer (phase II NabucCO study). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.4_suppl.351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
351 Background: FOLFIRINOX is an approved regimen for metastatic pancreatic cancer (mPC). We performed a modification in FOLFIRINOX schedule, using nab-paclitaxel (nab-p) to obtain two regimens that could be as effective and less toxic than the original triplet. NabucCO study was a randomized phase II trial to assess activity and toxicity of nab-p instead of either oxaliplatin (Nab-FOLFIRI) or irinotecan (Nab-FOLFOX) in first line setting. Previous dose–finding NabucCO study defined that maximum tolerated dose of nab-p with FOLFIRI is 120 mg/m2, and with FOLFOX is 160 mg/m2. Methods: The study was a 1:1 parallel arm, open label, not comparative one to assess overall response rate (ORR) of Nab-FOLFIRI and Nab-FOLFOX as primary end-point. Patients (pts) with PS 0-1, untreated for mPC were randomized to receive leucovorin 400 mg/m2, 5FU bolus 400 mg/m2, 5FU 48h ci 2400 mg/m2, irinotecan 180 mg/m2 plus nab-p 120 mg/m2 (arm A) or leucovorin 400 mg/m2, 5FU bolus 400 mg/m2, 5FU 48h ci 2400 mg/m2 and oxaliplatin 85 mg/m2 iv plus nab-p 160 mg/m2 (arm B) every 2 weeks for up to 12 cycles. Secondary end points were clinical benefit rate (CBR), progression free survival (PFS), overall survival (OS), and safety. Results: From November 2015 to January 2017, 84 pts were treated (42 for each arm). Median age was 60 years (29-65) in arm A and 64 years (47-64) in arm B. The ORR was 31 % for both schedules, with a CBR of 69% and 71%, respectively. At a median follow-up of 11.4 months for arm A and 14.5 months for arm B (censored on august, 31th 2017), 1-year survival is 41% and 50%, respectively. For Nab-FOLFIRI PFS and mOS were 6 months (90% CI: 4.9-8.0) and 13.2 months (90% CI: 8.3-14.8), while in Nab-FOLFOX were 5.6 months (90% CI:4.9-7.2) and 10.8 months (90% CI: 8.4-12.8). Grade ≥3 toxicities in arm A were neutropenia (19%) and febrile neutropenia (12%). In arm B, main grade ≥3 toxicities were neutropenia (29%), fatigue (14%), peripheral neuropathy (7%). No toxic death were registered. Conclusions: Nab-FOLFIRI and Nab–FOLFOX demonstrated a similar activity to FOLFIRINOX, with better safety profile in terms of neutropenia, fatigue and neuropathy. These results could justify a future phase III evaluation. Clinical trial information: NCT02109341.
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Affiliation(s)
- Elisa Giommoni
- Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Evaristo Maiello
- IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | | | | | | | - Giampaolo Tortora
- Azienda Ospedaliera Universitaria Integrata/ University of Verona, Verona, Italy
| | | | - Guido Giordano
- Ospedale Sacro Cuore di Gesù Fatebenefratelli, Benevento, Italy
| | | | | | | | - Luca Boni
- Clinical Trial Coordinating Center, AOU Careggi, Istituto Toscano Tumori, Firenze, Italy
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30
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Pietrantonio F, Fucà G, Morano F, Gloghini A, Corso S, Aprile G, Perrone F, De Vita F, Tamborini E, Tomasello G, Gualeni AV, Ongaro E, Busico A, Giommoni E, Volpi CC, Laterza MM, Corallo S, Prisciandaro M, Antista M, Pellegrinelli A, Castagnoli L, Pupa SM, Pruneri G, de Braud F, Giordano S, Cremolini C, Di Bartolomeo M. Biomarkers of Primary Resistance to Trastuzumab in HER2-Positive Metastatic Gastric Cancer Patients: the AMNESIA Case-Control Study. Clin Cancer Res 2017; 24:1082-1089. [PMID: 29208673 DOI: 10.1158/1078-0432.ccr-17-2781] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 10/27/2017] [Accepted: 11/30/2017] [Indexed: 01/12/2023]
Abstract
Purpose: Refining the selection of HER2-positive metastatic gastric cancer patient candidates for trastuzumab is a challenge of precision oncology. Preclinical studies have suggested several genomic mechanisms of primary resistance, leading to activation of tyrosine kinase receptors other than HER2 or downstream signaling pathways.Experimental Design: We carried out this multicenter, prospective, case-control study to demonstrate the negative predictive impact of a panel of candidate genomic alterations (AMNESIA panel), including EGFR/MET/KRAS/PI3K/PTEN mutations and EGFR/MET/KRAS amplifications. Hypothesizing a prevalence of candidate alterations of 30% and 0% in resistant and sensitive HER2-positive patients, respectively, 20 patients per group were needed.Results: AMNESIA panel alterations were significantly more frequent in resistant (11 of 20, 55%) as compared with sensitive (0% of 17) patients (P < 0.001), and in HER2 IHC 2+ (7 of 13, 53.8%) than 3+ (4 of 24, 16.7%) tumors (P = 0.028). Patients with tumors bearing no candidate alterations had a significantly longer median progression-free [5.2 vs. 2.6 months; HR, 0.34; 95% confidence interval (CI), 0.07-0.48; P = 0.001] and overall survival (16.1 vs. 7.6 months; HR, 0.38; 95% CI, 0.09-0.75; P = 0.015). The predictive accuracy of the AMNESIA panel and HER2 IHC was 76% and 65%, respectively. The predictive accuracy of the combined evaluation of the AMNESIA panel and HER2 IHC was 84%.Conclusions: Our panel of candidate genomic alterations may be clinically useful to predict primary resistance to trastuzumab in patients with HER2-positive metastatic gastric cancer and should be further validated with the aim of molecularly stratifying HER2-addicted cancers for the development of novel treatment strategies. Clin Cancer Res; 24(5); 1082-9. ©2017 AACR.
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Affiliation(s)
- Filippo Pietrantonio
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Giovanni Fucà
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Federica Morano
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Annunziata Gloghini
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Simona Corso
- University of Torino, Department of Oncology and Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | - Giuseppe Aprile
- Department of Oncology, ULSS8 Berica, San Bortolo General Hospital, Vicenza, Italy
| | - Federica Perrone
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Ferdinando De Vita
- Division of Medical Oncology, Department of Clinical and Experimental Medicine and Surgery, University of Campania 'Luigi Vanvitelli', School of Medicine, Naples, Italy
| | - Elena Tamborini
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Ambra Vittoria Gualeni
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elena Ongaro
- Department of Oncology, University and General Hospital, Udine, Italy
| | - Adele Busico
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elisa Giommoni
- Medical Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Chiara Costanza Volpi
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Maria Maddalena Laterza
- Division of Medical Oncology, Department of Clinical and Experimental Medicine and Surgery, University of Campania 'Luigi Vanvitelli', School of Medicine, Naples, Italy
| | - Salvatore Corallo
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Michele Prisciandaro
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Maria Antista
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandro Pellegrinelli
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Lorenzo Castagnoli
- Molecular Targeting Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Serenella M Pupa
- Molecular Targeting Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giancarlo Pruneri
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Filippo de Braud
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,Oncology and Haemato-Oncology Department, University of Milan, Università degli Studi di Milano, Milan, Italy
| | - Silvia Giordano
- University of Torino, Department of Oncology and Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | - Chiara Cremolini
- Unit of Medical Oncology 2, Azienda Ospedaliera-Universitaria Pisana, Pisa, Italy
| | - Maria Di Bartolomeo
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Antonuzzo L, Lunghi A, Petreni P, Brugia M, Laffi A, Giommoni E, Mela MM, Mazzoni F, Balestri V, Costanzo FD. Osteonecrosis of the Jaw and Angiogenesis inhibitors: A Revival of a Rare but Serous Side Effect. Curr Med Chem 2017; 24:3068-3076. [PMID: 28494743 DOI: 10.2174/0929867324666170511113811] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 04/18/2017] [Accepted: 05/05/2017] [Indexed: 11/22/2022]
Abstract
Osteonecrosis of the jaw (ONJ) is a rare treatment related side effect that was firstly described in 2002 through a case report in metastatic bone cancer patient treated with bisphosphonates (BPs) therapy. ONJ is defined as an eight weeks or longer clinical finding of exposed bone in the oral cavity without response to appropriate therapy. The diagnosis is mainly clinical but often requires a radiological confirmation with an orthopantomography. So it must be made by a dental specialist with sufficient experience on ONJ and requires a detailed anamnestic exploration of comorbidities and treatments history. In particular, ONJ affects a wide number of oncologic patients treated with BPs for bone metastatic cancers and, more recently, with anti-angiogenic drugs. The aim of this this paper is to describe diagnosis and classification of this rare but serious side effect and its pathophysiology. In particular, we provide a detailed description of clinical evidences upon the relationship between anti-angiogenic drugs and ONJ. Considering the evolving of cancer epidemiology with a greater number of cancer surviving patients, this side effect always deserves more attention. We conclude that ONJ must be always carefully investigated and prevented with a multidisciplinary approach involving oncologist, radiation oncologist and skilled dental practitioner when a cancer patient must begin a BP or an antiangiogenic treatment.
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Affiliation(s)
- Lorenzo Antonuzzo
- Medical Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50139 Firenze. Italy
| | - Alice Lunghi
- Azienda Ospedaliero-Universitaria Careggi, Medical Oncology Unit, Largo Brambilla 3, 50139 Firenze. Italy
| | - Paolo Petreni
- Azienda Ospedaliero-Universitaria Careggi, Medical Oncology Unit, Largo Brambilla 3, 50139 Firenze. Italy
| | - Marco Brugia
- Azienda Ospedaliero-Universitaria Careggi, Medical Oncology Unit, Largo Brambilla 3, 50139 Firenze. Italy
| | - Alice Laffi
- Azienda Ospedaliero-Universitaria Careggi, Medical Oncology Unit, Largo Brambilla 3, 50139 Firenze. Italy
| | - Elisa Giommoni
- Azienda Ospedaliero-Universitaria Careggi, Medical Oncology Unit, Largo Brambilla 3, 50139 Firenze. Italy
| | - Marinella M Mela
- Azienda Ospedaliero-Universitaria Careggi, Medical Oncology Unit, Largo Brambilla 3, 50139 Firenze. Italy
| | - Francesca Mazzoni
- Azienda Ospedaliero-Universitaria Careggi, Medical Oncology Unit, Largo Brambilla 3, 50139 Firenze. Italy
| | - Vanni Balestri
- Azienda Ospedaliero-Universitaria Careggi, Unit of Special Care Dentistry, Largo Brambilla 3, 50139 Firenze. Italy
| | - Francesco Di Costanzo
- Azienda Ospedaliero-Universitaria Careggi, Medical Oncology Unit, Largo Brambilla 3, 50139 Firenze. Italy
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32
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Giordano G, Milella M, Lo Re G, Di Marco M, Melisi D, Passardi A, Febbraro A, Iop A, Vaccaro V, Foltran L, Bertocchi P, Bergamo F, Vecchiarelli S, Giommoni E, Ricci V, Aloi MB, Vasile E, Zaniboni A, Zagonel V, De Vita F. Nab-paclitaxel (Nab-P) and gemcitabine (G) first-line chemotherapy (CT) in patients (pts) with metastatic pancreatic cancer (mPC) who relapsed after adjuvant treatment (ADJ T): A “REAL LIFE” study. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.4_suppl.396] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
396 Background: Nab-P and G represents a standard of care in first line mPC treatment. Only 5% of pts in Nab-P + G arm received ADJ T in the MPACT phase III trial. Accordingly, there is a lack of information about Nab-P + G benefit in this population. Aim of this analysis was to evaluate outcomes in mPC “real life” pts receiving first-line Nab-P + G after relapsing from ADJ T. Methods: Clinical records of 330 mPC pts receiving Nab-P + G with standard schedule as first line CT were retrospectively reviewed, investigating, efficacy (Progression Free Survival, PFS and Overall Survival, OS defined as time elapsed from the start of Nab-P + G to progression or death respectively) in pts treated with prior ADJ T. Analysis was then performed in ADJ T subgroup according disease free survival (DFS) cut-off ( ≤ 6 vs 6-12 vs ≥ 12 months). OS and PFS were estimated with Kaplan-Meyer method with 95% CI. Cox-regression model was applied to the data with univariate and multivariate approach. Results: At time of data analysis in the entire cohort median (m) OS was 11.3 months (95% CI 9.157-13.443); mPFS 7 months (95% CI 5.827-8.173). 90 out of 330 pts (27.3%) had received G-based ADJ T with mDFS of 29.2 months (95% CI 25.62-32.78). In the overall population at multivariate analysis, ADJ treatment was an independent prognostic factor related to better OS (HR 0.53, 95% CI 0.40-0.66; p < 0.001) and PFS (HR 0.69, 95% CI 0.49-0.89; p = 0.024). Median OS in ADJ T pts was significantly higher than pts who had not received ADJ T (15.0 vs 10.8 months respectively; p = 0.012). A similar trend in mPFS was observed in ADJ T versus non ADJ T pts (8.6 vs 6.9 months; p = 0.06). Pts with longer DFS after ADJ T showed major benefit in mOS (16.3 vs 13.1 vs 8.7 months in ≥ 12 vs 6-12 vs ≤ 6 months DFS respectively; p < 0.001). No significant differences in mPFS were observed in the three subgroups (p = 0.271). Conclusions: Nab-P + G is a standard of care also in pts treated with ADJ T. ADJ treatment is an independent prognostic factor related to better survival, maybe reflecting the effect of prior radical surgery. Pts who received G-based ADJ T may benefit of Nab-P+G combination with an increased survival in pts with longer DFS.
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Affiliation(s)
- Guido Giordano
- Medical Oncology, San Filippo Neri Hospital, Rome, Rome, Italy
| | | | | | - Mariacristina Di Marco
- Department of Specialized, Experimental, and Diagnostic Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy, Bologna, Italy
| | - Davide Melisi
- Digestive Molecular Clinical Oncology, University of Verona, Verona, Italy
| | - Alessandro Passardi
- Medical Oncology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Antonio Febbraro
- Oncologia Medica, Ospedale Sacro Cuore di Gesu Fatebenefratelli, Benevento, Italy
| | - Aldo Iop
- Div of Medcl Oncology, Udine, UD, Italy
| | - Vanja Vaccaro
- Oncologia Medica, Istituto Nazionale Tumori Regina Elena, Roma, Italy
| | | | - Paola Bertocchi
- Department of Medical Oncology, Fondazione Poliambulanza, Brescia, Italy
| | - Francesca Bergamo
- Oncologia Medica I, Istituto Oncologico Veneto, IRCCS, Padova, Italy
| | - Silvia Vecchiarelli
- Oncology Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy, Bologna, Italy
| | - Elisa Giommoni
- SC Oncologia Medica, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Vincenzo Ricci
- Medical Oncology, S.Croce & Carle Teaching Hospital, Cuneo, Italy
| | | | - Enrico Vasile
- U.O. Oncologia Medica II, Azienda Ospedaliero-Universitaria Pisana Istituto Toscano Tumori, Pisa, Italy
| | | | - Vittorina Zagonel
- Clinical and Experimental Oncology Department, Medical Oncology Unit 1, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
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Giommoni E, Maiello E, Tortora G, Vaccaro V, Rondini E, Toppo L, Giordano G, Latiano T, Calvetti L, Antonuzzo L, Lamperini C, Boni L, Di Costanzo F. Nab-paclitaxel in substitution of oxaliplatin and irinotecan in folfirinox schedule as first-line therapy in patients with metastatic pancreatic cancer: results of phase I dose finding of NabucCO study by GOIRC. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw371.74] [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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Di Bartolomeo M, Niger M, Laterza M, Vivaldi C, Giommoni E, Zaniboni A, Bozzarelli S, Tomasello G, Sava T, Spada M, Bittoni A, Galdy S, Spallanzani A, Bassan F, Scagnoli S, Morano F, Berenato R, Caporale M, Filippo P, De Vita F. Safety and efficacy profile of ramucirumab alone or combined with paclitaxel in metastatic gastric cancer (MGC): A real-life overview of compassionate-use named patients (pts) (RAMoss study). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw371.28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Pietrantonio F, Caporale M, Morano F, Scartozzi M, Gloghini A, De Vita F, Giommoni E, Fornaro L, Aprile G, Melisi D, Berenato R, Mennitto A, Volpi CC, Laterza MM, Pusceddu V, Antonuzzo L, Vasile E, Ongaro E, Simionato F, de Braud F, Torri V, Di Bartolomeo M. HER2 loss in HER2-positive gastric or gastroesophageal cancer after trastuzumab therapy: Implication for further clinical research. Int J Cancer 2016; 139:2859-2864. [PMID: 27578417 DOI: 10.1002/ijc.30408] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [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: 05/30/2016] [Revised: 07/18/2016] [Accepted: 08/17/2016] [Indexed: 12/21/2022]
Abstract
Mechanisms of acquired resistance to trastuzumab-based treatment in gastric cancer are largely unknown. In this study, we analyzed 22 pairs of tumor samples taken at baseline and post-progression in patients receiving chemotherapy and trastuzumab for advanced HER2-positive [immunohistochemistry (IHC) 3+ or 2+ with in-situ hybridization (ISH) amplification] gastric or gastroesophageal cancers. Strict clinical criteria for defining acquired trastuzumab resistance were adopted. Loss of HER2 positivity and loss of HER2 over-expression were defined as post-trastuzumab IHC score <3+ and absence of ISH amplification, and IHC "downscoring" from 2+/3+ to 0/1+, respectively. HER2 IHC was always performed, while ISH was missing in 3 post-progression samples. Patients with initial HER2 IHC score 3+ and 2+ were 14 (64%) and 8 (36%), respectively. Loss of HER2 positivity and HER2 over-expression was observed in 32 and 32% samples, respectively. The chance of HER2 loss was not associated with any of the baseline clinicopathological variables. The only exception was in patients with initial IHC score 2+ versus 3+, for both endpoints of HER2 positivity (80 vs. 14%; p = 0.008) and HER2 over-expression (63 vs. 14%; p = 0.025). As already shown in breast cancer, loss of HER2 may be observed also in gastric cancers patients treated with trastuzumab-based chemotherapy in the clinical practice. This phenomenon may be one of the biological reasons explaining the failure of anti-HER2 second-line strategies in initially HER2-positive disease.
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Affiliation(s)
- F Pietrantonio
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - M Caporale
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - F Morano
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - M Scartozzi
- Medical Oncology Department, Azienda Ospedaliera Universitaria Cagliari, Presidio Policlinico Universitario "Duilio Casula", Cagliari, Italy
| | - A Gloghini
- Diagnostic pathology and laboratory medicine Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - F De Vita
- Medical Oncology Department, Seconda Università degli studi di Napoli, Naples, Italy
| | - E Giommoni
- Medical Oncology 1, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - L Fornaro
- U.O. Oncologia Medica 2 Universitaria, Ospedale S. Chiara - Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano, Tumori, Italy
| | - G Aprile
- Medical Oncology Department, University and General Hospital, Udine, Italy
| | - D Melisi
- Medical Oncology, Università degli studi di Verona, Italy
| | - R Berenato
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - A Mennitto
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - C C Volpi
- Diagnostic pathology and laboratory medicine Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - M M Laterza
- Medical Oncology Department, Seconda Università degli studi di Napoli, Naples, Italy
| | - V Pusceddu
- Medical Oncology Department, Azienda Ospedaliera Universitaria Cagliari, Presidio Policlinico Universitario "Duilio Casula", Cagliari, Italy
| | - L Antonuzzo
- Medical Oncology 1, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - E Vasile
- U.O. Oncologia Medica 2 Universitaria, Ospedale S. Chiara - Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano, Tumori, Italy
| | - E Ongaro
- Medical Oncology Department, University and General Hospital, Udine, Italy
| | - F Simionato
- Medical Oncology, Università degli studi di Verona, Italy
| | - F de Braud
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,Oncology Department, University of Milan, Italy
| | - V Torri
- Oncology Department, IRCCS-Mario Negri Institute for Pharmacological Rresearch, Milan, Italy
| | - M Di Bartolomeo
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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De Vita F, Niger M, Vivaldi C, Giommoni E, Zaniboni A, Bozzarelli S, Tomasello G, Sava T, Spada M, Menatti E, Proserpio I, Galdy S, Bittoni A, Bencardino K, Squadroni M, Latiano T, Spallanzani A, Tirino G, Petrillo A, Di Bartolomeo M. Ramucirumab as second line therapy in metastatic gastric cancer (MGC): results of the Italian compassionate-use named patients. The RAMoss study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw333.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lunghi A, Antonuzzo L, Laffi A, Giommoni E, Di Costanzo F. Response. J Natl Cancer Inst 2016; 108:djw156. [DOI: 10.1093/jnci/djw156] [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] [Received: 05/14/2016] [Accepted: 05/20/2016] [Indexed: 11/14/2022] Open
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Pietrantonio F, Caporale M, Berenato R, Lonardi S, Murialdo R, Paterno E, Tampellini M, Bertolini AS, Rimassa L, Cremolini C, Giommoni E, Tomasello G, Longarini R, Petrelli F, Zaniboni A, Cortesi E, Sartore Bianchi A, Bossi I, Di Bartolomeo M, De Braud FG. First-line FOLFOX-4 plus panitumumab followed by 5-FU/LV plus panitumumab or single-agent panitumumab as maintenance therapy in patients (pts) with RAS wild-type, metastatic colorectal cancer (mCRC): The VALENTINO study. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.tps3634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Rosa Berenato
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | | | | | | | | | | | - Lorenza Rimassa
- Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Chiara Cremolini
- Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | - Elisa Giommoni
- SC Oncologia Medica, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | | | | | - Fausto Petrelli
- Department of Medical Oncology, Treviglio and Caravaggio Hospital, Treviglio, Italy
| | | | - Enrico Cortesi
- Dipartimento di Oncologia Medica, Università di Roma La Sapienza, Rome, Italy
| | | | - Ilaria Bossi
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
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Giordano G, Febbraro A, Milella M, Vaccaro V, Melisi D, Foltran L, Zagonel V, Zaniboni A, Bertocchi P, Bergamo F, Passardi A, Musettini G, Giommoni E, Iop A, Aloi MB, Vecchiarelli S, Vasile E, Lo Re G, Di Marco M, De Vita F. Impact of second-line treatment (2L T) in advanced pancreatic cancer (APDAC) patients (pts) receiving first line Nab-Paclitaxel (nab-P) + Gemcitabine (G): An Italian multicentre real life experience. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.4124] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Guido Giordano
- Oncologia Medica, Ospedale Sacro Cuore di Gesu' Fatebenefratelli, Benevento, Italy
| | - Antonio Febbraro
- Oncologia Medica, Ospedale Sacro Cuore di Gesù Fatebenefratelli, Benevento, Italy
| | | | - Vanja Vaccaro
- Oncologia Medica, Istituto Nazionale Tumori Regina Elena, Roma, Italy
| | - Davide Melisi
- Digestive Molecular Clinical Oncology, University of Verona, Verona, Italy
| | | | - Vittorina Zagonel
- Medical Oncology 1, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
| | | | - Paola Bertocchi
- Department of Medical Oncology, Fondazione Poliambulanza, Brescia, Italy
| | - Francesca Bergamo
- Oncologia Medica I, Istituto Oncologico Veneto, IRCCS, Padova, Italy
| | - Alessandro Passardi
- IRCCS Istitituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Italy
| | - Gianna Musettini
- U.O. Oncologia Medica II, Universitaria Ospedale S. Chiara, Azienda Ospedaliero-Universitaria Pisana Istituto Toscano Tumori, Pisa, Italy
| | - Elisa Giommoni
- SC Oncologia Medica, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Aldo Iop
- Div of Medcl Oncology, Udine, UD, Italy
| | | | - Silvia Vecchiarelli
- Oncology Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy, Bologna, Italy
| | - Enrico Vasile
- U.O. Oncologia Medica II, Azienda Ospedaliero-Universitaria Pisana Istituto Toscano Tumori, Pisa, Italy
| | | | - Mariacristina Di Marco
- Department of Specialized, Experimental, and Diagnostic Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy, Bologna, Italy
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Antonuzzo L, Lunghi A, Giommoni E, Brugia M, Di Costanzo F. Regorafenib Also Can Cause Osteonecrosis of the Jaw. J Natl Cancer Inst 2016; 108:djw002. [DOI: 10.1093/jnci/djw002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Pietrantonio F, Cremolini C, Aprile G, Lonardi S, Orlandi A, Mennitto A, Berenato R, Antoniotti C, Casagrande M, Marsico V, Marmorino F, Cardellino GG, Bergamo F, Tomasello G, Formica V, Longarini R, Giommoni E, Caporale M, Di Bartolomeo M, Loupakis F, de Braud F. Single-Agent Panitumumab in Frail Elderly Patients With Advanced RAS and BRAF Wild-Type Colorectal Cancer: Challenging Drug Label to Light Up New Hope. Oncologist 2015; 20:1261-5. [PMID: 26446234 DOI: 10.1634/theoncologist.2015-0171] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [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: 03/26/2015] [Accepted: 08/21/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND No prospective trials have specifically addressed the efficacy and safety of panitumumab in elderly patients with metastatic colorectal cancer (CRC). We aimed at assessing the efficacy and safety of single agent panitumumab in "frail" elderly patients diagnosed with metastatic RAS and BRAF wild-type CRC. MATERIALS AND METHODS Forty elderly patients (aged ≥ 75 years) with metastatic RAS-BRAF wild-type CRC received off-label prescriptions of single-agent panitumumab at seven Italian institutions. Treatment was administered as first line in patients with absolute contraindication to any chemotherapy or as second-line treatment after failure of a fluoropyrimidine-based treatment, in the presence of contraindication to irinotecan. The outcome measures included objective response rate (ORR), as well as progression-free survival (PFS), disease control rate (DCR), overall survival (OS), and safety. RESULTS The median PFS and OS were 6.4 months (95% confidence interval [CI]: 4.9-8 months) and 14.3 months (95% CI: 10.9-17.7 months), respectively. ORR was 32.5%, and DCR was 72.5%. Dose reductions related to adverse events (AEs) were reported in 9 (23%) patients, but no permanent treatment discontinuation caused by was reported. The most frequent grade 3 AE was skin rash, with an incidence of 20%. CONCLUSION Panitumumab is effective and well-tolerated in frail elderly patients with RAS-BRAF wild-type metastatic CRC and deemed unfit for chemotherapy. A randomized study is needed to confirm these data. IMPLICATIONS FOR PRACTICE Treatment of elderly patients with metastatic colorectal cancer represents a difficult challenge in clinical practice. A significant proportion of frail elderly patients do not receive treatment, reflecting ongoing uncertainty of clinical benefit and toxicity of chemotherapy. Unfit condition in this cohort of patients further limits antineoplastic prescription and consequently patient survival. RAS and BRAF wild-type status could help select an elderly and unfit population that could benefit from anti-epidermal growth factor receptor single agent therapy. In the present study, single-agent off-label panitumumab was effective and well-tolerated as first-line treatment in frail elderly patients deemed unfit for chemotherapy for metastatic RAS and BRAF wild-type colorectal cancer.
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Affiliation(s)
- Filippo Pietrantonio
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Chiara Cremolini
- Polo Oncologico, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Giuseppe Aprile
- Dipartimento di Oncologia, Azienda Ospedaliero-Universitaria di Udine, Udine, Italy
| | - Sara Lonardi
- Unità Operativa Complessa Oncologia Medica 1, Istituto Oncologico Veneto, IRCCS, Padova, Italy
| | - Armando Orlandi
- Medical Oncology Unit, Policlinico Universitario "A. Gemelli," Rome, Italy
| | - Alessia Mennitto
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Rosa Berenato
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | | | - Valentina Marsico
- Unità Operativa Complessa Oncologia Medica 1, Istituto Oncologico Veneto, IRCCS, Padova, Italy
| | | | | | - Francesca Bergamo
- Unità Operativa Complessa Oncologia Medica 1, Istituto Oncologico Veneto, IRCCS, Padova, Italy
| | | | - Vincenzo Formica
- Unità di Oncologia Medica, Policlinico Universitario Tor Vergata, Roma, Italy
| | | | - Elisa Giommoni
- Struttura Complessa Oncologia Medica I, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | - Marta Caporale
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Maria Di Bartolomeo
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Fotios Loupakis
- Polo Oncologico, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Filippo de Braud
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Antonuzzo L, Giommoni E, Pastorelli D, Latiano T, Pavese I, Azzarello D, Aieta M, Pastina I, Di Fabio F, Bertolini A, Corsi DC, Mogavero S, Angelini V, Pazzagli M, Di Costanzo F. Bevacizumab plus XELOX as first-line treatment of metastatic colorectal cancer: The OBELIX study. World J Gastroenterol 2015; 21:7281-7288. [PMID: 26109816 PMCID: PMC4476891 DOI: 10.3748/wjg.v21.i23.7281] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 03/13/2015] [Accepted: 04/17/2015] [Indexed: 02/07/2023] Open
Abstract
AIM: To confirm the efficacy and safety of bevacizumab/XELOX combination for the treatment of locally advanced or metastatic colorectal cancer (CRC) in Italy.
METHODS: This multicentric, prospective, open-label study included patients with CRC previously untreated with chemotherapy. Patients were administered bevacizumab in combination with XELOX. The primary efficacy end-point was progression-free survival (PFS). Secondary end-points included time to overall response (TOR), duration of response (DOR), time to treatment failure (TTF) and overall survival (OS). The incidence and type of adverse events AEs and severe AEs were evaluated. Also, the mutational status of BRAF and KRAS was assessed by high resolution melting and direct sequencing, and quality of life (QoL) was measured by the EuroQoL EQ-5D questionnaire at baseline and at the last visit.
RESULTS: The intention-to-treat population included 197 patients (mean age: 62.3 ± 9.9 years, 56.4% males). At baseline, 16/34 evaluable subjects (47.1%) harbored a KRAS and/or a BRAF mutation; the mean QoL index was 80.2 ± 14.3. First-line therapy was given for 223.7 ± 175.9 d, and after a mean follow-up of 387.7 ± 238.8 d all patients discontinued from the study mainly for disease progression (PD, 45.4%) and AEs (25.4%). Median PFS was 9.7 mo (95%CI: 8.4-10.5) and the median values for secondary end-points were: TOR = 3.9 mo (95%CI: 2.6-4.7), DOR = 8.5 mo (95%CI: 7.3-10.3), TTF = 6.7 mo (95%CI: 6.0-7.7) and OS = 23.2 mo (95%CI: 20.1-27.2). Patients carrying at least one lesion had a lower overall response rate (66.7% vs 88.9%) and a lower probability of achieving complete or partial response than those without mutations, but the difference in relative risk was not statistically significant (P = 0.2). Mean EQ-5D-3L raw index score significantly decreased to 74.9 ± 19.1 at the last visit (signed-rank test, P = 0.0076), but in general the evaluation on QoL perceived by patients was good.
CONCLUSION: The efficacy of bevacizumab in combination with XELOX in terms of PFS in patients with aCRC or mCRC in Italy was confirmed, with acceptable toxicity.
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Giommoni E, Maiello E, Toppo L, Cognetti F, Tortora G, Febbraro A, Banzi M, Molinara E, Nanni L, Lamperini C, Liguigli W, Laface R, Vaccaro V, Antonuzzo L, Melisi D, Fanello S, Giordano G, Boni L, Di Costanzo F. Nab-paclitaxel (nab-p) in association with FOLFIRI (Nab-FOLFIRI) or FOLFOX (Nab-FOLFOX) for metastatic pancreatic cancer: A phase I/II trial by Italian Oncology Group for Clinical Research (GOIRC)—NabucCO Trial. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e15242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Elisa Giommoni
- SC Oncologia Medica, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Evaristo Maiello
- UO Oncologia, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Laura Toppo
- SC Oncologia Medica, Istituti Ospitalieri di Cremona, Cremona, Italy
| | | | | | - Antonio Febbraro
- Oncologia Medica, Ospedale Sacro Cuore di Gesù Fatebenefratelli, Benevento, Italy
| | - Maria Banzi
- Oncologia, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Elena Molinara
- SC Oncologia Medica, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Luciano Nanni
- UO Oncologia, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Cinzia Lamperini
- SC Oncologia Medica, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Wanda Liguigli
- SC Oncologia Medica, Istituti Ospitalieri di Cremona, Cremona, Italy
| | - Rosa Laface
- SC Oncologia Medica, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Vanja Vaccaro
- Oncologia Medica, Istituto Nazionale Tumori Regina Elena, Roma, Italy
| | | | - Davide Melisi
- UO Oncologia, Azienda Ospedaliero Universitaria Integrata di Verona, Verona, Italy
| | - Silvia Fanello
- Oncologia, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Guido Giordano
- Oncologia Medica, Ospedale Sacro Cuore di Gesu' Fatebenefratelli, Benevento, Italy
| | - Luca Boni
- Clinical Trial Coordinating Center, AOU Careggi, Istituto Toscano Tumori, Firenze, Italy
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Giordano G, Vaccaro V, Lucchini E, Musettini G, Bertocchi P, Bergamo F, Giommoni E, Santoni M, Russano M, Campidoglio S, Santini D, Zaniboni A, Zagonel V, Cascinu S, Vasile E, Melisi D, Milella M, Febbraro A. Nab-paclitaxel (Nab-P) and gemcitabine (G) as first-line chemotherapy (CT) in advanced pancreatic cancer (APDAC) elderly patients (pts): A “real-life” study. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.3_suppl.424] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
424 Background: Nab-P and G represents a standard of care in first line APDAC treatment. Neverthless, activity, efficacy and safety of Nab-P + G have not been established in elderly pts and clinical trials on APDAC treatment contain fewer elderly pts compared with everyday clinical practice. Aim of this analysis is to evaluate outcomes and toxicities of elderly pts treated with first line Nab-P + G in a “real world” population. Methods: Clinical records of APDAC pts receiving Nab-P 125 mg/m2 and G 1000 mg/m2on days 1,8 and 15 of a 28 day cycle as first line CT were retrospectively reviewed, investigating activity (Disease Control Rate, DCR: Stable Disease + Partial Response + Complete Response, SD+PR+CR), efficacy (Progression Free Survival, PFS and Overall Survival, OS) and safety. Analysis was then performed in ≥ 70 years group of pts. OS and PFS were estimated with Kaplan-Meyer method with 95% CI. Cox-regression model was applied to the data with univariate and multivariate approach. Results: 105 pts (M/F:58/47), median age 64 (range 37-77) ECOG Performance Status of 0/1/2: 46/41/17 respectively were included in our analysis. 37 pts (35%) were ≥ 70 years old. In overall population Nab-P+G was administered for a median number of 6 cycles (range 1-12). 4 CR, 24 PR and 28 SD were observed (DCR: 53%), median PFS was 7 months (95% C.I. 5.93 - 8.08) and median OS was 11 months (95% C.I. 9.58 – 12.41). Pts aged ≥ 70 received a median number of 5 cycles (range 1 - 10). DCR was 48% (9 PR + 9 SD) with no differences in PFS (6.5 months, 95%C.I. 5.36 – 7.64, p=0.49) and OS (10 months, 95% C.I. 8.53 – 11.47 p=0.67) with < 70 years old pts. Treatment was mildly tolerated and toxicity profile appeared to be different in elderly pts than younger ones with more G3-4 non-haematological (27% vs 15% p=0.03) and fewer haematological (12% vs 29% p=0.004) events respectively. Conclusions: These data, evaluated under daily practice conditions, in absence of clinical trials on APDAC elderly pts, show that pts aged ≥ 70 may benefit of first-line Nab-P and G combination, as well as younger ones, both in terms of response and survival experiencing a tolerable, but significantly different toxicity profile.
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Affiliation(s)
- Guido Giordano
- Medical Oncology Unit, Ospedale Sacro Cuore di Gesù, Fatebenefratelli,, Benevento, Italy
| | | | | | - Gianna Musettini
- U.O. Oncologia Medica II Universitaria Ospedale S. Chiara, Azienda Ospedaliero-Universitaria Pisana Istituto Toscano Tumori, Pisa, Italy
| | - Paola Bertocchi
- Department of Medical Oncology, Fondazione Poliambulanza, Brescia, Italy
| | - Francesca Bergamo
- Oncologia Medica I, Istituto Oncologico Veneto, IRCCS, Padova, Italy
| | - Elisa Giommoni
- Medical Oncology I, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Matteo Santoni
- Medical Oncology, Polytechnic University of the Marche Region, Azienda Ospedaliero-Universitaria, Ospedali Riuniti Umberto I-GM Lancisi and G Salesi, Ancona, Italy
| | - Marco Russano
- Department of Medical Oncology Campus Bio-Medico University, Rome, Italy
| | - Serena Campidoglio
- Medical Oncology Unit, Ospedale Sacro Cuore di Gesù, Fatebenefratelli, Benevento, Italy
| | - Daniele Santini
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Alberto Zaniboni
- Department of Medical Oncology, Casa di Cura Poliambulanza, Brescia, Italy
| | - Vittorina Zagonel
- Oncologia Medica I, Istituto Oncologico Veneto, IRCCS, Padova, Italy
| | - Stefano Cascinu
- Clinica di Oncologia Medica, A.O. Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Enrico Vasile
- U.O. Oncologia Medica II, Azienda Ospedaliero-Universitaria Pisana Istituto Toscano Tumori, Pisa, Italy
| | - Davide Melisi
- Medical Oncology, University of Verona, Verona, Italy
| | | | - Antonio Febbraro
- Medical Oncology Unit, Ospedale Sacro Cuore di Gesù, Fatebenefratelli, Benevento, Italy
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Giordano G, Vaccaro V, Lucchini E, Bertocchi P, Bergamo F, Musettini G, Santoni M, Lo Re G, Giommoni E, Russano M, Campidoglio S, Santini D, Vasile E, Cascinu S, Zagonel V, Zaniboni A, Melisi D, Milella M, Febbraro A. Analysis of prognostic factors in advanced pancreatic cancer (APDAC) patients (pts) undergoing to first-line nab-paclitaxel (Nab-P) and gemcitabine (G) treatment. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.3_suppl.412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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
412 Background: Nab-P + G combination represents an optimal first line therapeutic option in APDAC. Actually we have no parameters to predict prognosis in pts receiving this regimen. Here we present data of a multicentre retrospective analysis evaluating prognostic impact of clinical or biological factors in a cohort of APDAC pts treated with Nab-P + G first line CT. Methods: Clinical records of 118 APDAC pts receiving first line Nab-P + G were retrospectively reviewed. Overall survival (OS) and progression free survival (PFS) were evaluated with Kaplan Meier method with 95% CI and curves were compared with log-rank test. Cox-regression model was applied to the data with univariate and multivariate approach. Variables included in analysis were age, gender, ECOG PS, primary tumor site, liver metastases, multiple metastatic sites, baseline CA19-9, bilirubin levels, neutrophil/lymphocyte ratio (NLR), CA19-9 decrease > 50%, biliary stent and symptomatic disease. Results: Median age was 66 (37 - 83), M/F:65/53, ECOG PS 0/1/2: 51/46/21 respectively. 4 complete and 27 partial responses were observed with 26% response rate (RR). Median OS and PFS were 11 months (95% CI 9.58 – 12.41) and 7 months ( 95% CI 5.96 – 8.03) respectively. When considered at univariate analysis primary tumor location to the head, ECOG PS of 2, bilirubin levels higher than median and NLR ≥ 5 had a bad prognostic impact both on PFS and OS. Differently, CA19-9 decrease > 50% was considered a positive prognostic factor for PFS and OS. Multivariate analysis confirmed the negative role of NLR ≥ 5 respect of PFS (HR 3.21; 95%CI 1.61 – 5.68, p = 0.002) and OS (HR 3.38; 95%CI 1.88 – 5.79, p = 0.001) and positive impact of CA19-9 decrease > 50% on PFS (HR 0.37; 95% CI 0.11 – 0.68, p=0.006) and OS (HR 0.53; 95% CI 0.15 – 0.97, p=0.005), as independent prognostic factors. Conclusions: This analysis suggest that in APDAC pts receiving first line Nab-P + G, high NLR value (≥5) could be considered an easy detectable, independent parameter to predict poor outcomes in terms of PFS and OS. Furthermore CA19-9 reduction > 50% from baseline may be, in absence of other clinical and molecular parameters, an early marker of good prognosis.
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Affiliation(s)
- Guido Giordano
- Medical Oncology Unit, Ospedale Sacro Cuore di Gesù, Fatebenefratelli,, Benevento, Italy
| | | | | | - Paola Bertocchi
- Department of Medical Oncology, Fondazione Poliambulanza, Brescia, Italy
| | - Francesca Bergamo
- Oncologia Medica I, Istituto Oncologico Veneto, IRCCS, Padova, Italy
| | - Gianna Musettini
- U.O. Oncologia Medica II Universitaria Ospedale S. Chiara, Azienda Ospedaliero-Universitaria Pisana Istituto Toscano Tumori, Pisa, Italy
| | - Matteo Santoni
- Medical Oncology, Polytechnic University of the Marche Region, Azienda Ospedaliero-Universitaria, Ospedali Riuniti Umberto I-GM Lancisi and G Salesi, Ancona, Italy
| | - Giovanni Lo Re
- Santa Maria Degli Angeli General Hospital, Pordenone, Italy
| | - Elisa Giommoni
- Medical Oncology I, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Marco Russano
- Department of Medical Oncology Campus Bio-Medico University, Rome, Italy
| | - Serena Campidoglio
- Medical Oncology Unit, Ospedale Sacro Cuore di Gesù, Fatebenefratelli, Benevento, Italy
| | - Daniele Santini
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Enrico Vasile
- U.O. Oncologia Medica II, Azienda Ospedaliero-Universitaria Pisana Istituto Toscano Tumori, Pisa, Italy
| | - Stefano Cascinu
- Clinica di Oncologia Medica, A.O. Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Vittorina Zagonel
- Oncologia Medica I, Istituto Oncologico Veneto, IRCCS, Padova, Italy
| | - Alberto Zaniboni
- Department of Medical Oncology, Casa di Cura Poliambulanza, Brescia, Italy
| | - Davide Melisi
- Medical Oncology, University of Verona, Verona, Italy
| | | | - Antonio Febbraro
- Medical Oncology Unit, Ospedale Sacro Cuore di Gesù, Fatebenefratelli, Benevento, Italy
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46
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Giordano G, Melisi D, Milella M, Zaniboni A, Vasile E, Zagonel V, Giommoni E, Maiorino L, Santoni M, Vaccaro V, Bertocchi P, Bergamo F, Musettini G, Lucchini E, Cascinu S, Febbraro A. Activity, Efficacy and Safety of Nab-Paclitaxel (Nab-P) and Gemcitabine (G) in Advanced Pancreatic Cancer (Apdac) Elderly Patients. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu334.98] [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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47
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Giordano G, Milella M, Melisi D, Zaniboni A, Caponi S, Zagonel V, Giommoni E, Santoni M, Vaccaro V, Bertocchi P, Bergamo F, Molinara E, Musettini G, Lucchini E, Febbraro A. Nab-Paclitaxel (Nab-P) and Gemcitabine (G) in Pretreated Advanced Pancreatic Cancer (Apdac) Patients (Pts): a Multicentre Retrospective Analysis. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu334.103] [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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48
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Febbraro A, Zaniboni A, Zagonel V, Di Costanzo F, Maiorino L, Bertocchi P, Bergamo F, Giommoni E, Giordano G. Activity, efficacy, and safety of nab-paclitaxel (Nab-P) and gemcitabine (G) in heaviliy pretreated advanced pancreatic cancer (APDAC) patients (pts): A multicenter retrospective analysis. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e15255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Antonio Febbraro
- Medical Oncology Unit, Ospedale Sacro cuore di Gesù, Fatebenefratelli, Benevento, Italy, Benevento, Italy
| | - Alberto Zaniboni
- Department of Medical Oncology, Casa di Cura Poliambulanza, Brescia, Italy
| | - Vittorina Zagonel
- Medical Oncology 1, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
| | | | - Luigi Maiorino
- Medical Oncology, Ospedale San Gennaro, Naples, Naples, Italy
| | - Paola Bertocchi
- Department of Medical Oncology, Fondazione Poliambulanza, Brescia, Italy
| | - Francesca Bergamo
- Oncologia Medica 1, Istituto Oncologico Veneto - IRCCS, Padova, Italy
| | - Elisa Giommoni
- Medical Oncology 1 - Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Guido Giordano
- Medical Oncology Unit, Ospedale Sacro Cuore di Gesù, Fatebenefratelli,, Benevento, Italy
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49
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Lastraioli E, Boni L, Romoli MR, Crescioli S, Taddei A, Beghelli S, Tomezzoli A, Vindigni C, Saragoni L, Messerini L, Bernini M, Bencini L, Giommoni E, Freschi G, Di Costanzo F, Scarpa A, Morgagni P, Farsi M, Roviello F, De Manzoni G, Bechi P, Arcangeli A. VEGF-A clinical significance in gastric cancers: immunohistochemical analysis of a wide Italian cohort. Eur J Surg Oncol 2014; 40:1291-8. [PMID: 24784776 DOI: 10.1016/j.ejso.2014.03.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 03/29/2014] [Accepted: 03/31/2014] [Indexed: 12/20/2022] Open
Abstract
PURPOSE The clinical significance of VEGF-A expression in gastric cancer (GC) has been reported with contradicting results. We analyzed the expression and clinical significance of VEGF-A in a wide Italian cohort of GC specimens. METHODS VEGF-A expression was tested by immunohistochemistry in 507 patients with GC of all clinical stages. The impact of VEGF-A on overall survival (OS) was evaluated in conjunction with clinical and pathological parameters. RESULTS In the Italian cohort we studied VEGF-A was not an independent prognostic factor neither at the univariate nor at multivariate analysis. CONCLUSIONS Although frequently expressed, in our study VEGF-A was not able to discriminate between groups of patients with different risk.
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Affiliation(s)
- E Lastraioli
- Department of Clinical and Experimental Medicine, University of Florence, Largo GA Brambilla 3, 50134 Florence, Italy
| | - L Boni
- Clinical Trials Coordinating Center, Azienda Ospedaliero-Universitaria Careggi/Istituto Toscano Tumori, Largo GA Brambilla 3, 50134 Florence, Italy
| | - M R Romoli
- Department of Clinical and Experimental Medicine, University of Florence, Largo GA Brambilla 3, 50134 Florence, Italy
| | - S Crescioli
- Department of Clinical and Experimental Medicine, University of Florence, Largo GA Brambilla 3, 50134 Florence, Italy
| | - A Taddei
- Surgery and Translational Medicine, University of Florence, Largo GA Brambilla 3, 50134 Florence, Italy
| | - S Beghelli
- Department of Pathology and Diagnostics, University of Verona, Piazzale LA Scuro 10, 37134 Verona, Italy
| | - A Tomezzoli
- Pathology Division, Borgo Trento Hospital, Piazzale A Stefani 1, 37134 Verona, Italy
| | - C Vindigni
- Pathology Division, Azienda Ospedaliero-Universitaria Senese, Viale M Bracci 16, 53100 Siena, Italy
| | - L Saragoni
- Pathology Division, Morgagni-Pierantoni Hospital, Via C Forlanini 34, 47121 Forlì, Italy
| | - L Messerini
- Department of Clinical and Experimental Medicine, University of Florence, Largo GA Brambilla 3, 50134 Florence, Italy
| | - M Bernini
- General Surgery and Surgical Oncology, Azienda Ospedaliero-Universitaria Careggi, Largo GA Brambilla 3, 50134 Florence, Florence, Italy
| | - L Bencini
- General Surgery and Surgical Oncology, Azienda Ospedaliero-Universitaria Careggi, Largo GA Brambilla 3, 50134 Florence, Florence, Italy
| | - E Giommoni
- Medical Oncology, Azienda Ospedaliero-Universitaria Careggi, Largo GA Brambilla 3, 50134 Florence, Florence, Italy
| | - G Freschi
- Surgery and Translational Medicine, University of Florence, Largo GA Brambilla 3, 50134 Florence, Italy
| | - F Di Costanzo
- Medical Oncology, Azienda Ospedaliero-Universitaria Careggi, Largo GA Brambilla 3, 50134 Florence, Florence, Italy
| | - A Scarpa
- Department of Pathology and Diagnostics, University of Verona, Piazzale LA Scuro 10, 37134 Verona, Italy
| | - P Morgagni
- General Surgery, Morgagni-Pierantoni Hospital, Via C Forlanini 34, 47121 Forlì, Italy
| | - M Farsi
- General Surgery and Surgical Oncology, Azienda Ospedaliero-Universitaria Careggi, Largo GA Brambilla 3, 50134 Florence, Florence, Italy
| | - F Roviello
- Department of General Surgery and Oncology, University of Siena, Viale M Bracci 16, 53100 Siena, Italy
| | - G De Manzoni
- Division of Surgery, University of Verona, Piazzale LA Scuro 10, 37134 Verona, Italy
| | - P Bechi
- Surgery and Translational Medicine, University of Florence, Largo GA Brambilla 3, 50134 Florence, Italy
| | - A Arcangeli
- Department of Clinical and Experimental Medicine, University of Florence, Largo GA Brambilla 3, 50134 Florence, Italy.
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50
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Crociani O, Lastraioli E, Boni L, Pillozzi S, Romoli MR, D'Amico M, Stefanini M, Crescioli S, Masi A, Taddei A, Bencini L, Bernini M, Farsi M, Beghelli S, Scarpa A, Messerini L, Tomezzoli A, Vindigni C, Morgagni P, Saragoni L, Giommoni E, Gasperoni S, Di Costanzo F, Roviello F, De Manzoni G, Bechi P, Arcangeli A. hERG1 channels regulate VEGF-A secretion in human gastric cancer: clinicopathological correlations and therapeutical implications. Clin Cancer Res 2014; 20:1502-12. [PMID: 24449824 DOI: 10.1158/1078-0432.ccr-13-2633] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE hERG1 channels are aberrantly expressed in several types of human cancers, where they affect different aspects of cancer cell behavior. A thorough analysis of the functional role and clinical significance of hERG1 channels in gastric cancer is still lacking. EXPERIMENTAL DESIGN hERG1 expression was tested in a wide (508 samples) Italian cohort of surgically resected patients with gastric cancer, by immunohistochemistry and real-time quantitative PCR. The functional link between hERG1 and the VEGF-A was studied in different gastric cancer cell lines. The effects of hERG1 and VEGF-A inhibition were evaluated in vivo in xenograft mouse models. RESULTS hERG1 was positive in 69% of the patients and positivity correlated with Lauren's intestinal type, fundus localization of the tumor, G1-G2 grading, I and II tumor-node-metastasis stage, and VEGF-A expression. hERG1 activity modulated VEGF-A secretion, through an AKT-dependent regulation of the transcriptional activity of the hypoxia inducible factor. Treatment of immunodeficient mice xenografted with human gastric cancer cells, with a combination of hERG1 blockers and anti-VEGF-A antibodies, impaired tumor growth more than single-drug treatments. CONCLUSION Our results show that hERG1 (i) is aberrantly expressed in human gastric cancer since its early stages; (ii) drives an intracellular pathway leading to VEGF-A secretion; (iii) can be exploited to identify a gastric cancer patients' group where a combined treatment with antiangiogenic drugs and noncardiotoxic hERG1 inhibitors could be proposed.
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Affiliation(s)
- Olivia Crociani
- Authors' Affiliations: Department of Clinical and Experimental Medicine; Surgery and Translational Medicine, University of Florence; Clinical Trials Coordinating Center; General Surgery and Surgical Oncology; Medical Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence; Department of Pathology and Diagnostics, Division of Surgery, University of Verona; Pathology Division, Borgo Trento Hospital, Verona; Pathology Division, Azienda Ospedaliero-Universitaria Senese, Department of General Surgery and Oncology, University of Siena, Siena; and General Surgery and Division of Pathology, Morgagni-Pierantoni Hospital, Forlì, Italy
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