1
|
Attili I, Corvaja C, Spitaleri G, Del Signore E, Trillo Aliaga P, Passaro A, de Marinis F. New Generations of Tyrosine Kinase Inhibitors in Treating NSCLC with Oncogene Addiction: Strengths and Limitations. Cancers (Basel) 2023; 15:5079. [PMID: 37894445 PMCID: PMC10605462 DOI: 10.3390/cancers15205079] [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: 09/29/2023] [Revised: 10/17/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
Tyrosine kinase inhibitors (TKIs) revolutionized the treatment of patients with advanced or metastatic non-small cell lung cancer (NSCLC) harboring most driver gene alterations. Starting from the first generation, research rapidly moved to the development of newer, more selective generations of TKIs, obtaining improved results in terms of disease control and survival. However, the use of novel generations of TKIs is not without limitations. We reviewed the main results obtained, as well as the ongoing clinical trials with TKIs in oncogene-addicted NSCLC, together with the biology underlying their potential strengths and limitations. Across driver gene alterations, novel generations of TKIs allowed delayed resistance, prolonged survival, and improved brain penetration compared to previous generations, although with different toxicity profiles, that generally moved their use from further lines to the front-line treatment. However, the anticipated positioning of novel generation TKIs leads to abolishing the possibility of TKI treatment sequencing and any role of previous generations. In addition, under the selective pressure of such more potent drugs, resistant clones emerge harboring more complex and hard-to-target resistance mechanisms. Deeper knowledge of tumor biology and drug properties will help identify new strategies, including combinatorial treatments, to continue improving results in patients with oncogene-addicted NSCLC.
Collapse
Affiliation(s)
- Ilaria Attili
- Division of Thoracic Oncology, European Institute of Oncology IRCCS, Via G. Ripamonti 435, 20141 Milan, Italy
| | | | | | | | | | | | | |
Collapse
|
2
|
Spitaleri G, Trillo Aliaga P, Attili I, Del Signore E, Corvaja C, Corti C, Uliano J, Passaro A, de Marinis F. MET in Non-Small-Cell Lung Cancer (NSCLC): Cross 'a Long and Winding Road' Looking for a Target. Cancers (Basel) 2023; 15:4779. [PMID: 37835473 PMCID: PMC10571577 DOI: 10.3390/cancers15194779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
Non-Small-Cell Lung Cancer (NSCLC) can harbour different MET alterations, such as MET overexpression (MET OE), MET gene amplification (MET AMP), or MET gene mutations. Retrospective studies of surgical series of patients with MET-dysregulated NSCLC have shown worse clinical outcomes irrespective of the type of specific MET gene alteration. On the other hand, earlier attempts failed to identify the 'druggable' molecular gene driver until the discovery of MET exon 14 skipping mutations (METex14). METex14 are rare and amount to around 3% of all NSCLCs. Patients with METex14 NSCLC attain modest results when they are treated with immune checkpoint inhibitors (ICIs). New selective MET inhibitors (MET-Is) showed a long-lasting clinical benefit in patients with METex14 NSCLC and modest activity in patients with MET AMP NSCLC. Ongoing clinical trials are investigating new small molecule tyrosine kinase inhibitors, bispecific antibodies, or antibodies drug conjugate (ADCs). This review focuses on the prognostic role of MET, the summary of pivotal clinical trials of selective MET-Is with a focus on resistance mechanisms. The last section is addressed to future developments and challenges.
Collapse
Affiliation(s)
- Gianluca Spitaleri
- Division of Thoracic Oncology, IEO, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (P.T.A.); (I.A.); (E.D.S.); (C.C.); (F.d.M.)
| | - Pamela Trillo Aliaga
- Division of Thoracic Oncology, IEO, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (P.T.A.); (I.A.); (E.D.S.); (C.C.); (F.d.M.)
| | - Ilaria Attili
- Division of Thoracic Oncology, IEO, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (P.T.A.); (I.A.); (E.D.S.); (C.C.); (F.d.M.)
| | - Ester Del Signore
- Division of Thoracic Oncology, IEO, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (P.T.A.); (I.A.); (E.D.S.); (C.C.); (F.d.M.)
| | - Carla Corvaja
- Division of Thoracic Oncology, IEO, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (P.T.A.); (I.A.); (E.D.S.); (C.C.); (F.d.M.)
| | - Chiara Corti
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, 20141 Milan, Italy; (C.C.); (J.U.)
- Department of Oncology and Haematology (DIPO), University of Milan, 20122 Milan, Italy
| | - Jacopo Uliano
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, 20141 Milan, Italy; (C.C.); (J.U.)
- Department of Oncology and Haematology (DIPO), University of Milan, 20122 Milan, Italy
| | - Antonio Passaro
- Division of Thoracic Oncology, IEO, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (P.T.A.); (I.A.); (E.D.S.); (C.C.); (F.d.M.)
| | - Filippo de Marinis
- Division of Thoracic Oncology, IEO, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (P.T.A.); (I.A.); (E.D.S.); (C.C.); (F.d.M.)
| |
Collapse
|
3
|
Rinaldi L, Guerini Rocco E, Spitaleri G, Raimondi S, Attili I, Ranghiero A, Cammarata G, Minotti M, Lo Presti G, De Piano F, Bellerba F, Funicelli G, Volpe S, Mora S, Fodor C, Rampinelli C, Barberis M, De Marinis F, Jereczek-Fossa BA, Orecchia R, Rizzo S, Botta F. Association between Contrast-Enhanced Computed Tomography Radiomic Features, Genomic Alterations and Prognosis in Advanced Lung Adenocarcinoma Patients. Cancers (Basel) 2023; 15:4553. [PMID: 37760521 PMCID: PMC10527057 DOI: 10.3390/cancers15184553] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
Non-invasive methods to assess mutational status, as well as novel prognostic biomarkers, are warranted to foster therapy personalization of patients with advanced non-small cell lung cancer (NSCLC). This study investigated the association of contrast-enhanced Computed Tomography (CT) radiomic features of lung adenocarcinoma lesions, alone or integrated with clinical parameters, with tumor mutational status (EGFR, KRAS, ALK alterations) and Overall Survival (OS). In total, 261 retrospective and 48 prospective patients were enrolled. A Radiomic Score (RS) was created with LASSO-Logistic regression models to predict mutational status. Radiomic, clinical and clinical-radiomic models were trained on retrospective data and tested (Area Under the Curve, AUC) on prospective data. OS prediction models were trained and tested on retrospective data with internal cross-validation (C-index). RS significantly predicted each alteration at training (radiomic and clinical-radiomic AUC 0.95-0.98); validation performance was good for EGFR (AUC 0.86), moderate for KRAS and ALK (AUC 0.61-0.65). RS was also associated with OS at univariate and multivariable analysis, in the latter with stage and type of treatment. The validation C-index was 0.63, 0.79, and 0.80 for clinical, radiomic, and clinical-radiomic models. The study supports the potential role of CT radiomics for non-invasive identification of gene alterations and prognosis prediction in patients with advanced lung adenocarcinoma, to be confirmed with independent studies.
Collapse
Affiliation(s)
- Lisa Rinaldi
- Radiation Research Unit, IEO European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy;
| | - Elena Guerini Rocco
- Division of Pathology, European Institute of Oncology IRCCS, 20141 Milan, Italy; (E.G.R.); (A.R.); (M.B.)
- Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy; (S.V.)
| | - Gianluca Spitaleri
- Division of Thoracic Oncology, IEO European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (G.S.); (I.A.); (F.D.M.)
| | - Sara Raimondi
- Department of Experimental Oncology, IEO European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy (F.B.)
| | - Ilaria Attili
- Division of Thoracic Oncology, IEO European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (G.S.); (I.A.); (F.D.M.)
| | - Alberto Ranghiero
- Division of Pathology, European Institute of Oncology IRCCS, 20141 Milan, Italy; (E.G.R.); (A.R.); (M.B.)
| | - Giulio Cammarata
- Department of Experimental Oncology, IEO European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy (F.B.)
| | - Marta Minotti
- Division of Radiology, IEO European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (M.M.); (C.R.); (R.O.)
| | - Giuliana Lo Presti
- Department of Experimental Oncology, IEO European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy (F.B.)
| | - Francesca De Piano
- Division of Radiology, IEO European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (M.M.); (C.R.); (R.O.)
| | - Federica Bellerba
- Department of Experimental Oncology, IEO European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy (F.B.)
| | - Gianluigi Funicelli
- Division of Radiology, IEO European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (M.M.); (C.R.); (R.O.)
| | - Stefania Volpe
- Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy; (S.V.)
- Department of Radiation Oncology, IEO European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Serena Mora
- Data Management Unit, IEO European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (S.M.); (C.F.)
| | - Cristiana Fodor
- Data Management Unit, IEO European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (S.M.); (C.F.)
| | - Cristiano Rampinelli
- Division of Radiology, IEO European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (M.M.); (C.R.); (R.O.)
| | - Massimo Barberis
- Division of Pathology, European Institute of Oncology IRCCS, 20141 Milan, Italy; (E.G.R.); (A.R.); (M.B.)
| | - Filippo De Marinis
- Division of Thoracic Oncology, IEO European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (G.S.); (I.A.); (F.D.M.)
| | - Barbara Alicja Jereczek-Fossa
- Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy; (S.V.)
- Department of Radiation Oncology, IEO European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Roberto Orecchia
- Division of Radiology, IEO European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (M.M.); (C.R.); (R.O.)
- Scientific Direction, IEO European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Stefania Rizzo
- Clinica di Radiologia EOC, Istituto Imaging della Svizzera Italiana (IIMSI), Via Tesserete 46, 6900 Lugano, Switzerland;
- Faculty of Biomedical Sciences, Università della Svizzera italiana, Via G. Buffi 13, 6900 Lugano, Switzerland
| | - Francesca Botta
- Medical Physics Unit, IEO European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy;
| |
Collapse
|
4
|
Attili I, Passaro A, Corvaja C, Trillo Aliaga P, Del Signore E, Spitaleri G, de Marinis F. Immune checkpoint inhibitors in EGFR-mutant non-small cell lung cancer: A systematic review. Cancer Treat Rev 2023; 119:102602. [PMID: 37481836 DOI: 10.1016/j.ctrv.2023.102602] [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: 06/13/2023] [Revised: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Since their first introduction in clinical practice, immune checkpoint inhibitors showed limited benefit in patients with NSCLC harboring EGFR mutations. With the rationale of increasing immune activation, combinatorial ICI strategies have been evaluated also in this subgroup of patients. METHODS We performed a systematic review on efficacy of ICI-based strategies in EGFR-mutant NSCLC according to most updated evidence. RESULTS Overall, ICI monotherapy and ICI plus chemotherapy confirm to be ineffective in EGFR-mutant NSCLC, whereas the combination of ICI with antiangiogenic and chemotherapy showed promising results. Limited data are available with alternative ICI combination strategies, driven by strong biological rationale of modulating the tumor immune microenvironment. CONCLUSIONS To date, the available evidence do not support the use of ICI in patients with NSCLC harboring EGFR mutations. Clinical trials are ongoing to define which is the best timing and exploring novel combinations with ICI in this specific disease.
Collapse
Affiliation(s)
- Ilaria Attili
- Division of Thoracic Oncology, European Institute of Oncology IRCCS, Via G. Ripamonti 435, 20141 Milan, Italy
| | - Antonio Passaro
- Division of Thoracic Oncology, European Institute of Oncology IRCCS, Via G. Ripamonti 435, 20141 Milan, Italy.
| | - Carla Corvaja
- Division of Thoracic Oncology, European Institute of Oncology IRCCS, Via G. Ripamonti 435, 20141 Milan, Italy
| | - Pamela Trillo Aliaga
- Division of Thoracic Oncology, European Institute of Oncology IRCCS, Via G. Ripamonti 435, 20141 Milan, Italy
| | - Ester Del Signore
- Division of Thoracic Oncology, European Institute of Oncology IRCCS, Via G. Ripamonti 435, 20141 Milan, Italy
| | - Gianluca Spitaleri
- Division of Thoracic Oncology, European Institute of Oncology IRCCS, Via G. Ripamonti 435, 20141 Milan, Italy
| | - Filippo de Marinis
- Division of Thoracic Oncology, European Institute of Oncology IRCCS, Via G. Ripamonti 435, 20141 Milan, Italy
| |
Collapse
|
5
|
Spitaleri G, Trillo Aliaga P, Attili I, Del Signore E, Corvaja C, Corti C, Crimini E, Passaro A, de Marinis F. Sustained Improvement in the Management of Patients with Non-Small-Cell Lung Cancer (NSCLC) Harboring ALK Translocation: Where Are We Running? Curr Oncol 2023; 30:5072-5092. [PMID: 37232842 DOI: 10.3390/curroncol30050384] [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: 03/21/2023] [Revised: 05/06/2023] [Accepted: 05/08/2023] [Indexed: 05/27/2023] Open
Abstract
ALK translocation amounts to around 3-7% of all NSCLCs. The clinical features of ALK+ NSCLC are an adenocarcinoma histology, younger age, limited smoking history, and brain metastases. The activity of chemotherapy and immunotherapy is modest in ALK+ disease. Several randomized trials have proven that ALK inhibitors (ALK-Is) have greater efficacy with respect to platinum-based chemotherapy and that second/third generation ALK-Is are better than crizotinib in terms of improvements in median progression-free survival and brain metastases management. Unfortunately, most patients develop acquired resistance to ALK-Is that is mediated by on- and off-target mechanisms. Translational and clinical research are continuing to develop new drugs and/or combinations in order to raise the bar and further improve the results attained up to now. This review summarizes first-line randomized clinical trials of several ALK-Is and the management of brain metastases with a focus on ALK-I resistance mechanisms. The last section addresses future developments and challenges.
Collapse
Affiliation(s)
- Gianluca Spitaleri
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Pamela Trillo Aliaga
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Ilaria Attili
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Ester Del Signore
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Carla Corvaja
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Chiara Corti
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy
- Department of Oncology and Haematology (DIPO), University of Milan, 20122 Milan, Italy
| | - Edoardo Crimini
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy
- Department of Oncology and Haematology (DIPO), University of Milan, 20122 Milan, Italy
| | - Antonio Passaro
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Filippo de Marinis
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| |
Collapse
|
6
|
Potena L, Spitaleri G, Masetti M, Borgese L, Giovannini L, Orsini A, De Nicolò B, Scuppa M, Manno S, Baldovini C, Leone O, Bonora E. Initial Experience with Local Laboratory Run Assay to Detect Donor-Derived Cell Free Dna for Non-Invasive Diagnosis of Acute Myocardial Rejection. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.515] [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: 04/05/2023] Open
|
7
|
Masetti M, Scuppa M, Giovannini L, Borgese L, Aloisio A, Spitaleri G, Giannella M, Potena L. Trying to Protect HT Patients Poor Vaccine Responders: Reducing MMF or Trust Tixagevimab/Cilgavimab? Insights from CONTRAST Study. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.601] [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: 04/05/2023] Open
|
8
|
Spitaleri G, Trillo Aliaga P, Catania C, Signore ED, Attili I, Santoro C, Giugliano F, Berton Giachetti PPM, Curigliano G, Passaro A, de Marinis F. Safety of mRNA-COVID-19 Vaccines in Patients With Thoracic Cancers. Clin Lung Cancer 2023; 24:e19-e26. [PMID: 36372676 PMCID: PMC9584758 DOI: 10.1016/j.cllc.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/13/2022] [Accepted: 10/14/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Pivotal trials of COVID-19 vaccines did not include cancer patients with questions remaining in this population. Particularly in patients with thoracic malignancies receiving anticancer treatments, the safety of these vaccines has so far been little investigated. METHODS This is a prospective trial of patients with thoracic cancer receiving anticancer treatments and COVID-19 vaccines at the Division of Thoracic Oncology of European Institute of Oncology between February and September 2021. RESULTS A total 207 patients affected by thoracic cancers (199 lung cancers and 8 mesotheliomas) had received Covid-19 vaccines (206 mRNA vaccines and 1 virus-vectored vaccine). The majority of patients had at least one comorbidity (76.3%). They were concomitantly treating with targeted therapy (TT) (45.9%), immunotherapy (IO) (22.7%), and chemotherapy (CT) (14%). A total of 64 AEs (15.6%) were observed after administration of Sars-Cov-2 vaccine. The majority of AEs were grade 1 [G1] (6.3%) and G2 (8.8%), only two events were G3 (0.5%). The median follow-up was 9 months (range 1-22 months), during this follow-up 21 patients (10.1%) had a positive nasal swab, most of the patients were asymptomatic (67%) and the symptomatic ones (33%) had mild symptoms and fewer complications and hospitalizations. CONCLUSIONS COVID-19 m-RNA vaccines appear to be safe in the cohort of patients with thoracic malignances in active treatment, including those receiving immunotherapy. Considering the high morbidity and mortality associated with COVID-19 in patients with lung cancer receiving active treatments, our study supports the current vaccine prioritization, third and/or fourth dose, of all cancer patients with active treatment.
Collapse
Affiliation(s)
- G Spitaleri
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy.
| | - P Trillo Aliaga
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - C Catania
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - E Del Signore
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - I Attili
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - C Santoro
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hematology (DIPO), University of Milan, Milan, Italy
| | - F Giugliano
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hematology (DIPO), University of Milan, Milan, Italy
| | - P P M Berton Giachetti
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hematology (DIPO), University of Milan, Milan, Italy
| | - G Curigliano
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hematology (DIPO), University of Milan, Milan, Italy
| | - A Passaro
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - F de Marinis
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| |
Collapse
|
9
|
Aimo A, Lupon J, Spitaleri G, Domingo M, Codina P, Santiago-Vacas E, Cediel G, Zamora E, Troya MI, Santesmases J, Romero-Gonzalez GA, Nunez J, Martini N, Emdin M, Bayes-Genis A. Global warming, renal function and heart failure: a 20-year follow-up study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
There is a growing concern about the possible effects of global warming on human health. In HF outpatients, renal function significantly worsens during summer. More specific analyses on the impact of increasing temperatures on body homeostasis are lacking.
Purpose
We investigated the relationship between the trend of temperatures from 2002 to 2021 and renal function in heart failure (HF) outpatients.
Methods
All creatinine and estimated glomerular filtration rate (eGFR) values of HF outpatients followed at one tertiary hospital in a Mediterranean area of Spain were retrieved from electronic health records. eGFR was calculated through the CKD-EPI formula. Temperature data from the local municipality were derived from the Meteocat service; as temperatures from the years 2004–2005 were not available, these years were not analysed. Summer was defined as the timespan from June to September included. We calculated average values of creatinine and eGFR during summer and the rest of the same year, considering each patient and each year. Similarly, we averaged temperature values during summer and the rest of the same year.
Results
We derived 6,307 couples of average creatinine/eGFR values in summer and in the rest of the year from 2,194 patients. Across all the years (2002–2003 and 2006–2021), creatinine was slightly higher in summer than in the rest of the year (1.26 vs. 1.21 mg/dL, p<0.001), and eGFR was lower (65 vs. 67 mL/min/1.73 m2, p<0.001). Temperatures in summer and the rest of the year increased gradually, albeit not linearly, from 2002 to 2021 (Figure 1). The absolute (Δ) and percent changes (Δ%) in median temperatures between summer and the rest of the year increased across years (r=0.149, p=0.001 and r=0.144, p=0.002, respectively), as well as Δ and Δ% of the monthly median of maximal temperatures (r=0.119, p<0.001 and r=0.052, p<0.001, respectively) (Figure 1). The Δ and Δ% temperatures between summer and the rest of the year displayed several significant correlations with Δ and Δ% creatinine and eGFR after adjusting for several variables including age, sex, HF therapies, and creatinine outside of summer (Figure 2).
Conclusions
Over a 20-year timespan there has been an increase in 1) temperatures in summer and in the rest of the year, and 2) the temperature excursion between summer and the rest of the year. Changes in temperatures between summer and the rest of the year correlated with the magnitude of the decrease in renal function during summer, likely because of worse dehydration with higher temperatures. Therefore, the progressive rise in temperature may have detrimental effects on renal function during summer in HF outpatients.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- A Aimo
- Sant'Anna School of Advanced Studies , Pisa , Italy
| | - J Lupon
- Germans Trias i Pujol Hospital , Badalona , Spain
| | - G Spitaleri
- Germans Trias i Pujol Hospital , Badalona , Spain
| | - M Domingo
- Germans Trias i Pujol Hospital , Badalona , Spain
| | - P Codina
- Germans Trias i Pujol Hospital , Badalona , Spain
| | | | - G Cediel
- Germans Trias i Pujol Hospital , Badalona , Spain
| | - E Zamora
- Germans Trias i Pujol Hospital , Badalona , Spain
| | - M I Troya
- Germans Trias i Pujol Hospital , Badalona , Spain
| | | | | | - J Nunez
- INCLIVA Foundation , Valencia , Spain
| | - N Martini
- Fondazione Toscana Gabriele Monasterio , Pisa , Italy
| | - M Emdin
- Fondazione Toscana Gabriele Monasterio , Pisa , Italy
| | | |
Collapse
|
10
|
Attili I, Valenza C, Santoro C, Antonarelli G, Trillo Aliaga P, Del Signore E, Catania C, Spitaleri G, Passaro A, de Marinis F. Comparison of real-world data (RWD) analysis on efficacy and post-progression outcomes with pembrolizumab plus chemo vs chemo alone in metastatic non-squamous non-small cell lung cancer with PD-L1 < 50%. Front Oncol 2022; 12:980765. [PMID: 36033444 PMCID: PMC9399686 DOI: 10.3389/fonc.2022.980765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 07/22/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundFollowing the introduction of immunotherapy (IO) in the first-line (1L) treatment in patients with non-small cell lung cancer (NSCLC) without sensitizing EGFR/ALK mutations, increasing real-world data depict how difficult it is to replicate data from clinical trials to clinical practice, with high rates of early treatment failure. In the context of chemo-IO, our study aims to compare platinum-pemetrexed-pembrolizumab combination to platinum-doublet alone in patients with low PD-L1 (<50%).MethodsWe retrospectively collected medical records from patients with stage IV non-squamous NSCLC with PD-L1<50%, consecutively treated at our Centre from 2016 to 2021. Patients were grouped according to 1L treatment received: chemo-IO (group A) or platinum-doublet (group B). Survival outcomes were analyzed and compared among the two groups.ResultsOverall, 105 patients were included: 49 in group A and 56 in group B. At data cut-off, median follow-up was 12.4 and 34.8 months, with 32/49 and 52/56 events for progression-free survival (PFS) and 21/49 and 29/56 events for overall survival (OS), respectively. No difference in PFS was observed between group B and group A (6.6 versus 8 months, HR 1.12, 95%CI 0.57-1.40). Patients receiving 1L platinum-doublet had significantly longer OS compared to those receiving chemo-IO (median OS 23.8 vs 14.9 months, HR 0.47, 95% CI 1.15- 3.98, p=0.01). 12 month-OS was 58% (95% CI 44-76%) in group A and 78% (95% CI 68-91%) in group B (p=0.040). Subgroup analysis identified KRAS G12C mutation as potentially affecting PFS in patients receiving chemo-IO (HR 0.29, 95% CI 0-10-0.91). The OS benefit of platinum-doublet was consistent across subgroups, with particular benefit in female sex, liver or pleural metastases, PD-L1 negative. Overall, only 46.9% of patients with progression received subsequent treatment in group A (15/32), compared to 86.5% in group B (45/52, all receiving 2L IO), with no difference in PFS to 2L (group A 3.7months, group B 4.1months, p=0.3).ConclusionsDespite small study population and differential follow-up, our study demonstrates that sequential use of 1L platinum-doublet and 2L IO is not inferior to 1L chemo-IO in non-squamous NSCLC with PD-L1<50%. In addition, we identified subgroups who might benefit differentially from the two approaches.
Collapse
Affiliation(s)
- Ilaria Attili
- Division of Thoracic Oncology, European Institute of Oncology IRCCS, Milan, Italy
- *Correspondence: Ilaria Attili,
| | - Carmine Valenza
- Division of New Drug Development, European Institute of Oncology IRCCS, Milan, Italy
- Università degli Studi di Milano, Department of Oncology and Hemato-Oncology, Milan, Italy
| | - Celeste Santoro
- Division of New Drug Development, European Institute of Oncology IRCCS, Milan, Italy
- Università degli Studi di Milano, Department of Oncology and Hemato-Oncology, Milan, Italy
| | - Gabriele Antonarelli
- Division of New Drug Development, European Institute of Oncology IRCCS, Milan, Italy
- Università degli Studi di Milano, Department of Oncology and Hemato-Oncology, Milan, Italy
| | - Pamela Trillo Aliaga
- Division of Thoracic Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - Ester Del Signore
- Division of Thoracic Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - Chiara Catania
- Division of Thoracic Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - Gianluca Spitaleri
- Division of Thoracic Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - Antonio Passaro
- Division of Thoracic Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - Filippo de Marinis
- Division of Thoracic Oncology, European Institute of Oncology IRCCS, Milan, Italy
| |
Collapse
|
11
|
Wen S, Du X, Chen Y, Xia J, Wang R, Zhu M, Peng W, Spitaleri G, Hofman P, Bironzo P, Wang X, Shen B. Association between changes in thioredoxin reductase and other peripheral blood biomarkers with response to PD-1 inhibitor-based combination immunotherapy in non-small cell lung cancer: a retrospective study. Transl Lung Cancer Res 2022; 11:757-775. [PMID: 35693285 PMCID: PMC9186172 DOI: 10.21037/tlcr-22-300] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 05/18/2022] [Indexed: 11/06/2022]
Abstract
Background Immunotherapy deeply changed the treatment paradigm of advanced non-small cell lung cancer (NSCLC) in the past years. However, the objective response rate (ORR) after immunotherapy is about 20–30% of NSCLC patients. Therefore, identification of predictive biomarkers is crucial for selecting patients with NSCLC who would most benefit from programmed cell death receptor protein 1 (PD-1) inhibitor-based immunotherapy. Methods We retrospectively collected medical records and thioredoxin reductase (TrxR) data from 90 patients with a NSCLC who received PD-1 inhibitor-based combination therapy. Serum biomarkers were also measured at 6- and 12-week post-treatment and compared with their baseline values. Associations between changes in serum biomarkers, clinical characteristics and treatment efficacy were evaluated using univariate tests. The patients who were still alive were followed up remotely by phone or email to assess survival. The association between serum biomarkers and TrxR with overall survival (OS) and progression-free survival (PFS) were assessed by univariate and multivariate Cox proportional hazard regression. Nomogram prediction models were constructed using factors associated with PFS and OS, respectively. Results The median follow-up time among the 90 patients was 19.7 (range, 13.6 to 25.8) months. Median PFS and OS were 13.6 [95% confidence interval (CI): 13.5 to 13.7] and 19.7 (95% CI: 13.6 to 25.8) months, respectively. Patients with decreased carcinoembryonic antigen (CEA), albumin (Alb), and TrxR values at 6- and 12-week post-treatment compared to baseline had statistically significantly improved disease remission rates (P<0.05). Patients with decreased white blood cell (WBC), neutrophil-to-lymphocyte ratio (NLR), derived NLR (dNLR) at week 6, and decreased Alb, CEA, and lymphocyte-to-monocyte ratio (LMR) at week 12 had statistically significantly increased ORRs (P<0.05). According to the univariate and multivariate Cox regression analyses, we included adenocarcinoma, Eastern Cooperative Oncology Group performance status (ECOG PS), and CEA change at week 6 post-treatment as predictors for PFS, and adenocarcinoma, change in absolute lymphocyte count (ALC), and TrxR at week 6 as predictors for OS in the nomogram models. Each nomogram was also validated internally using a bootstrap method with 1,000 resamples. Conclusions Change in TrxR at 6 weeks post-treatment in combination with other clinical and hematological biomarkers could be used as a predictor for treatment outcome and prognosis in NSCLC patients after PD-1 inhibitor-based combination immunotherapy.
Collapse
Affiliation(s)
- Shaodi Wen
- Department of Oncology, The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing, China
| | - Xiaoyue Du
- Department of Oncology, The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing, China
| | - Yuzhong Chen
- Department of Oncology, The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing, China
| | - Jingwei Xia
- Department of Oncology, The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing, China
| | - Ruotong Wang
- Department of Oncology, The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing, China
| | - Miaolin Zhu
- Department of Oncology, The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing, China
| | - Weiwei Peng
- Department of Oncology, The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing, China
| | - Gianluca Spitaleri
- Division of Thoracic Oncology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Paul Hofman
- Laboratory of Clinical and Experimental Pathology, FHU OncoAge, Pasteur Hospital, BB-0033-00025, CHU Nice, Université Côte d’Azur, Nice, France
| | - Paolo Bironzo
- Thoracic Oncology Unit, Department of Oncology, University of Torino at San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Xin Wang
- Department of Oncology, The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing, China
| | - Bo Shen
- Department of Oncology, The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing, China
| |
Collapse
|
12
|
Attili I, Valenza C, Santoro C, Antonarelli G, Trillo Aliaga P, Del Signore E, Catania C, Spitaleri G, Passaro A, de Marinis F. 42P Comparative real-world analysis of pembrolizumab plus chemo vs platinum-doublet alone in metastatic non-squamous NSCLC with PD-L1 low. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.02.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
13
|
Catania C, Muthusamy B, Spitaleri G, Del Signore E, Pennell NA. The new era of immune checkpoint inhibition and target therapy in early-stage non-small cell lung cancer. A review of the literature. Clin Lung Cancer 2021; 23:108-115. [PMID: 34952792 DOI: 10.1016/j.cllc.2021.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 07/29/2021] [Revised: 09/22/2021] [Accepted: 11/04/2021] [Indexed: 12/25/2022]
Abstract
Surgery is the best option for patients with early stage non-small cell lung cancer (NSCLC). However, the rate of local and metastatic recurrences following surgery alone is high, especially in NSCLC patients with N2 lymph node involvement. A recent American study showed that 60% of lung cancers are diagnosed in an advanced stage, and less than 20% are diagnosed in an early, resectable stage. The same study reported the 5 year survival of patients with stage IV NSCLC was 6% compared to 50% in patients with resectable NSCLC depending by stage. The addition of adjuvant or neoadjuvant chemotherapy only improves 5 year survival by 5%-10%. Recently, immunotherapy with or without chemotherapy and novel targeted therapies have yielded excellent results, in terms of both progression-free survival and overall survival, in advanced NSCLC. Published studies have shown a benefit in using immunotherapy and targeted therapy in both the adjuvant and neoadjuvant settings with many further studies still ongoing. Here we review the published data on immunotherapy and targeted therapy in the adjuvant and neoadjuvant settings in patients with operable NSCLC.
Collapse
Affiliation(s)
- Chiara Catania
- Division of Thoracic Oncology, IEO, European Institute of Oncology, IRCCS, Milan Italy.
| | | | - Gianluca Spitaleri
- Division of Thoracic Oncology, IEO, European Institute of Oncology, IRCCS, Milan Italy
| | - Ester Del Signore
- Division of Thoracic Oncology, IEO, European Institute of Oncology, IRCCS, Milan Italy
| | | |
Collapse
|
14
|
Escabia C, Codina Verdaguer P, Buchaca D, Spitaleri G, Domingo M, Santiago-Vacas E, Cediel G, Zamora E, Alonso N, Troya M, Santesmases J, Crespo E, Nunez J, Lupon J, Bayes-Genis A. Long-term evolution of estimated glomerular filtration rate in patients with type 2 diabetes and heart failure. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Limited data are available on the very long-term trajectory of glomerular filtration rate (GFR) in patients with chronic heart failure (HF) and type 2 diabetes mellitus (T2D).
Purpose
To prospectively assess dynamic trajectories of GFR estimated by CKD-EPI in a real-life cohort of HF patients based on the presence or absence of T2D over a 14-year follow-up.
Methods
In a prospective observational registry of real-life HF outpatients, estimated GFR (eGFR) was calculated by CKD-EPI at baseline and on a structured schedule every 3 months up to 14 years. We included in the analysis only eGFR values that were assessed at scheduled visits, discarding urgent renal function assessments. Loess (locally weighted error sum of squares) curves were plotted for the subgroups according to baseline T2D up to 14 years of follow-up. Loess curves are useful to observe a trend or relationship on nonlinear data observed over time.
Results
2386 patients were consecutively included from August 2001 to December 2018. 43.2% of the patients had a history of T2D. Mean age was 67.0±12.6 years, 28.9% were women and 71.0% had HF with reduced ejection fraction (EF<40%). 25080 eGFR values were included in the analysis with a median of 8 values per patient [IQR 4–15] and a range between 1 and 47.
Diabetic patients had a worse baseline eGFR and presented a persistent decline over time. On the contrary non-diabetic patients presented an early decrease, mid-term improvement and a late progressive decline (Figure 1).
Conclusions
eGFR long-term trajectories in diabetic and non-diabetic patients with chronic HF were significantly different.
Funding Acknowledgement
Type of funding sources: None. eGFR evolution according to baseline T2D
Collapse
Affiliation(s)
- C Escabia
- Germans Trias i Pujol Hospital, Badalona, Spain
| | | | - D Buchaca
- Barcelona Supercomputing Center, Barcelona, Spain
| | - G Spitaleri
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - M Domingo
- Germans Trias i Pujol Hospital, Badalona, Spain
| | | | - G Cediel
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - E Zamora
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - N Alonso
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - M.I Troya
- Germans Trias i Pujol Hospital, Badalona, Spain
| | | | - E Crespo
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - J Nunez
- INCLIVA Foundation, Valencia, Spain
| | - J Lupon
- Germans Trias i Pujol Hospital, Badalona, Spain
| | | |
Collapse
|
15
|
Spitaleri G, Cediel G, Santiago-Vacas E, Codina P, Domingo M, Zamora E, Santesmases J, Diez-Quevedo C, Troya M, Boldo M, Altimir S, Alonso N, Rivas C, Lupon J, Bayes-Genis A. Differences in long-term all-cause and cardiovascular mortality according to heart failure aetiology in ambulatory patients. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Heart failure (HF) is the final stage of many cardiac disorders. Mortality in heart HF remains challenging despite improvement in outcomes proved in clinical trials in HF with reduced ejection fraction and it can be influenced by the aetiology of HF.
Purpose
To assess differences in long-term mortality (up to 18 years) in a real-life cohort of HF outpatients according to the aetiology of HF.
Methods
Consecutive patients with HF admitted at the HF Clinic from August 2001 to September 2019 were included. Follow-up was closed at 30.9.2020. HF aetiology was divided into ischemic heart disease (IHD), dilated cardiomyopathy (CM) –including non-compaction CM–, hypertensive CM, alcohol-derived CM, drug-derived CM, valvular disease, hypertrophic CM and others. For the present analysis, this latter group was excluded due to the big heterogeneity and limited number of patients in each subtype of aetiology. All-cause death and cardiovascular death were the primary end-points. Fine & Gray method for competing risk was used for cardiovascular mortality analysis.
Results
Out of 2387 patients included (age 66.5±12.5 years, 71.3% men, LVEF 35.4%±14.2, mainly in NYHA class II [65.5%] and III [26.5%]), 1317 deaths were recorded (731 from cardiovascular cause) during a maximum follow-up of 18 years (median 4.1 years [IQR 2–7.8] for the total cohort, 5.3 years [IQR 2.6–9.7] for survivors). Figure 1 shows Cox regression multivariable analysis for all-cause death and cardiovascular mortality. Considering IHD aetiology as reference, only dilated CM showed significantly lower risk of all-cause death, and only drug-induced CM showed higher risk of all-cause death. However, when cardiovascular mortality was considered almost all aetiologies showed significant lower risk of cardiovascular death than IHD. Figure 2 shows adjusted survival curves (A) and adjusted incidence curves of cardiovascular death (B) based on HF aetiology.
Conclusions
After adjusting for multiple prognostic factors among the studied HF aetiologies, dilated CM and drug-related CM showed the lowest and the highest risk of all-cause death, respectively. Patients with IHD showed the highest adjusted risk of cardiovascular death.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- G Spitaleri
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - G Cediel
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - E Santiago-Vacas
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - P Codina
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - M Domingo
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - E Zamora
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - J Santesmases
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - C Diez-Quevedo
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - M Troya
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - M Boldo
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - S Altimir
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - N Alonso
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - C Rivas
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - J Lupon
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - A Bayes-Genis
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| |
Collapse
|
16
|
Cediel Calderon G, Teis A, Codina P, Domingo M, Santiago-Vacas E, Spitaleri G, Zamora E, Santasmases J, Alonso N, Lupon J, Bayes-Genis A. Clinical and prognostic significance of the inflammatory markers GlycA and GlycB in chronic heart failure of both ischemic and non-ischemic etiologies. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
N-acetylglucosamine/galactosamine (GlycA) and sialic acid (GlycB) constitute evolving nuclear magnetic resonance (NMR) biomarkers of systemic inflammation. They have been increasingly studied and associated with cardiovascular (CV) disease and incident heart failure (HF), but little is known about its value in chronic HF population.
Purpose
We aimed to examine the association on long-term CV outcomes of GlycA and GlycB in chronic HF relative to aetiology.
Methods
We prospectively included a cohort of 429 HF patients admitted to an ambulatory HF Unit. Plasma GlycA and GlycB concentrations were determined using NMR spectroscopy. The primary endpoint was a composite of CV death and readmission due to HF. Competing risk regression models were performed with non-CV death as the competing event. Because an interaction existed between GlycA and GlycB with ischemic etiology (p<0.01), we examined this further.
Results
The mean (SD) follow-up was 4.5±2.9 years. Median concentrations (IQR) for GlycA and GlycB were 5.4 (4.9–6.2) mmol/L and 1.9 (1.7–2.2) mmol/L, respectively. A total of 92 (41.1%) and 123 (60.0%) patients from non-ischemic and ischemic etiology, respectively, the clinical endpoint. In ischaemic HF patients (47.8%; n=205) both markers were not associated with the primary endpoint. Conversely, in non-ischemic HF patients (52.2%; n=224), GlycA and GlycB exhibited association with the primary endpoint in univariable and after multivariable adjustment (HR 1.14; 95% confidence interval [CI]: 1.02–1.28, p=0.018 and HR 1.91; 95% CI: 1.27–2.88, p=0.002; respectively. Figure 1 and 2). In this subgroup, a correlation analysis with well-known biomarkers (NT-proBNP, hs-TnT and ST2) only evidenced a positively and significantly correlation of GlycB with ST2 (r=0.26, p<0.001). No association was found with NYHA functional class.
Conclusions
GlycA and GlycB represent an evolving approach of inflammation status with prognostic value of long-term CV related events in non-ischemic HF patients.
Funding Acknowledgement
Type of funding sources: None. Figure 1. Probability of MACE by GlycA tertilesFigure 2. Probability of MACE by GlycB tertiles
Collapse
Affiliation(s)
- G Cediel Calderon
- University Hospital Germans Trias i Pujol de Badalona, Badalona, Spain
| | - A Teis
- University Hospital Germans Trias i Pujol de Badalona, Badalona, Spain
| | - P Codina
- University Hospital Germans Trias i Pujol de Badalona, Badalona, Spain
| | - M Domingo
- University Hospital Germans Trias i Pujol de Badalona, Badalona, Spain
| | - E Santiago-Vacas
- University Hospital Germans Trias i Pujol de Badalona, Badalona, Spain
| | - G Spitaleri
- University Hospital Germans Trias i Pujol de Badalona, Badalona, Spain
| | - E Zamora
- University Hospital Germans Trias i Pujol de Badalona, Badalona, Spain
| | - J Santasmases
- University Hospital Germans Trias i Pujol de Badalona, Badalona, Spain
| | - N Alonso
- University Hospital Germans Trias i Pujol de Badalona, Badalona, Spain
| | - J Lupon
- University Hospital Germans Trias i Pujol de Badalona, Badalona, Spain
| | - A Bayes-Genis
- University Hospital Germans Trias i Pujol de Badalona, Badalona, Spain
| |
Collapse
|
17
|
Spitaleri G, Cediel G, Santiago-Vacas E, Codina P, Domingo M, Zamora E, Santesmases J, Diez-Quevedo C, Troya M, Boldo M, Alonso N, Gonzalez B, Nunez J, Lupon J, Bayes-Genis A. Kidney function derangements during summer in ambulatory heart failure patients. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Heart failure (HF) is characterized by alterations in kidney function that are associated with poor prognosis and can be related to the evolution of the disease or induced by medical treatment. High temperatures during summer may result in some degree of dehydration, especially in patients treated with diuretics, and may contribute to transient glomerular filtration rate (eGFR) reduction.
Objective
To assess creatinine and eGFR changes during summer in ambulatory heart failure patients.
Methods
Consecutive patients with HF admitted at our HF Clinic (Spain) from August 2001 to December 2020 were included. eGFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula. We included in the analysis creatinine and eGFR values that were assessed at planned visits only, discarding urgent renal function assessments. Creatinine and eGFR values were grouped according to the period of the year (summer [from June to September, both included] vs. the rest of the year). Changes in creatinine and eGFR between the rest of the year and summer for each patient were evaluated using paired samples t-test.
Results
Out of 37360 creatinine and eGFR values, 25458 were included in the analysis for a total of 2423 patients (median number of observations for each patient: 8, IQR 4–15). Mean creatinine and eGFR were 1.4±1.0 mg/dl and 63.0±27.7 ml/min, respectively. Table 1 shows baseline patient characteristics. Creatinine increased significantly during summer (1.44±0.9 mg/dl vs. 1.48±1.1 mg/dl, p<0.001). Similarly, eGFR was lower in summer as compared to the rest of the year 60.6±25.4 ml/min vs. 59.4±26.0 ml/min, p<0.001.
Conclusions
In ambulatory HF patients in a Mediterranean area, we found significant worsening of renal function during summer, likely related to an imbalance between water intake and fluid loss. To prevent summer-driven kidney stress, diuretic treatment should be carefully adjusted during the hottest months of the year.
Funding Acknowledgement
Type of funding sources: None. Table 1
Collapse
Affiliation(s)
- G Spitaleri
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - G Cediel
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - E Santiago-Vacas
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - P Codina
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - M Domingo
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - E Zamora
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - J Santesmases
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - C Diez-Quevedo
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - M Troya
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - M Boldo
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - N Alonso
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - B Gonzalez
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - J Nunez
- Instituto de Investigacion Sanitaria INCLIVA, Valencia, Spain
| | - J Lupon
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| | - A Bayes-Genis
- Germans Trias i Pujol Hospital, Heart Failure Clinic and Cardiology Service, Badalona, Spain
| |
Collapse
|
18
|
Santiago-Vacas E, Domingo M, Codina P, Cediel G, Spitaleri G, Zamora E, Gual F, Teis A, Santesmases J, Velayos P, Pulido A, Crespo E, Nunez J, Lupon J, Bayes-Genis A. How predict right ventricular-pulmonary circulation coupling improvement in chronic heart failure. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Right ventricular-pulmonary circulation coupling (RVPAC), which can be measured by the relation between tricuspid annular plane systolic excursion (TAPSE) and systolic pulmonary artery pressure (SPAP) by echocardiography, has been postulated as an independent prognostic factor of hospitalizations and mortality in heart failure (HF) patients.
Purpose
Our aim was to know the predictors of RVPAC improvement in a chronic HF cohort.
Methods
Retrospective analysis of a prospectively studied cohort of HF outpatients of different aetiologies attended in a multidisciplinary HF Unit. Prospectively scheduled echo-Doppler studies were performed at first visit and 1 year. A TAPSE/SPAP ratio <0.36 mm/mmHg was identified as the most deleterious. Significant RVPAC improvement at 1 year was defined as TAPSE/SPAP ratio ≥0.36 mm/mmHg together with a ≥10% improvement from baseline RVPAC. Multivariable logistic regression analysis (conditional backward stepwise) was performed to select variables independently associated with significant RVPAC improvement. A predictive model including age and the previously selected variables was created.
Results
From August 2001 to July 2017, 554 patients with TAPSE and SPAP data in the initial visit were included. Mean follow-up time was 4.6±3.7 years. At first visit 252 (45.5%) patients had RVPAC <0.36 mm/mmHg. Out of them, RVPAC at 1 year improved in 55 (21.8%). In multivariable analysis, the presence of baseline atrial fibrillation/flutter (OR 0.12 [95% CI 0.05–0.28], p<0.001), SPAP (OR 0.96 [95% CI 0.92–0.99], p=0.014) and female gender (OR 0.34 [95% CI 0.12–0.91], p=0.03) were related to lesser probability of RVPAC improvement at 1 year. A model with such variables, together with age, showed an AUC of 0.824 to predict significant RVPAC improvement.
Conclusions
Atrial fibrillation/flutter, increasing SPAP and female gender hamper RVPAC improvement at 1 year in HF patients with baseline TAPSE/SPAP ratio <0.36.
Funding Acknowledgement
Type of funding sources: None. Multivariate regression analysis
Collapse
Affiliation(s)
| | - M Domingo
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - P Codina
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - G Cediel
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - G Spitaleri
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - E Zamora
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - F Gual
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - A Teis
- Germans Trias i Pujol Hospital, Badalona, Spain
| | | | - P Velayos
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - A Pulido
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - E Crespo
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - J Nunez
- Research Foundation Hospital of Valencia (INCLIVA), Valencia, Spain
| | - J Lupon
- Germans Trias i Pujol Hospital, Badalona, Spain
| | | |
Collapse
|
19
|
Cediel Calderon G, Resta H, Codina P, Santiago-Vacas E, Domingo M, Spitaleri G, Lupon J, Bayes-Genis A. Head-to-head comparison of NT-proBNP and soluble ST2 for long-term prognosis of patients with hypertrophic cardiomyopathy. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
N-terminal pro-brain natriuretic peptide (NT-proBNP) predicts mortality and the development of heart failure (HF) in hypertrophic cardiomyopathy (HCM), however, evidence regarding soluble interleukin-1 receptor-like 1 (ST2) in this population is lacking.
Purpose
To assess the ST2 and NT-proBNP significance for risk stratification of patients with HCM during long-term follow-up.
Methods
We prospectively enrolled a cohort of consecutive patients with HCM admitted to an ambulatory HF Unit in a Tertiary University Hospital. All patients had clinical and echocardiographic evaluation and measurement of NT-proBNP and ST2 at inclusion. The primary endpoint was the composite of all-cause death or HF-related hospitalization.
Results
103 patients were enrolled, 68% (n=70) males with a median (IQR) age of 60 (50–71) years. The median (IQR) of ST2 was 31.5 (IQR: 24.5 – 40.7) pg/mL. During a median follow-up of 2.5 years, 17 patients had the primary endpoint. Both, NT-proBNP and ST2 (both log-transformed) were associated with the primary endpoint in the univariable analyses (p<0.01). However, after adjustment by age, sex, NYHA functional class and left ventricular ejection fraction (LVEF), this association remained statistically significant only for ST2 (HR: 4.62, 95% CI 1.80–11.87, p=0.001 vs HR: 1.57, 95% CI 0.97–2.54, p=0.068 for NT-proBNP). The addition of ST2 to a clinical model (age, sex, NYHA functional class and LVEF) increased the Harrel's C statistic from 0.70 to 0.76, while the addition of NT-proBNP increase this C-statistic only to 0.73.
Conclusions
ST2 appears to be a valuable biomarker for the prediction of death and heart failure related hospitalization in patients with HCM, outperforming the prognostic value of NT-proBNP. Future research should delve into this association.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- G Cediel Calderon
- University Hospital Germans Trias i Pujol de Badalona, Badalona, Spain
| | - H Resta
- University Hospital Germans Trias i Pujol de Badalona, Badalona, Spain
| | - P Codina
- University Hospital Germans Trias i Pujol de Badalona, Badalona, Spain
| | - E Santiago-Vacas
- University Hospital Germans Trias i Pujol de Badalona, Badalona, Spain
| | - M Domingo
- University Hospital Germans Trias i Pujol de Badalona, Badalona, Spain
| | - G Spitaleri
- University Hospital Germans Trias i Pujol de Badalona, Badalona, Spain
| | - J Lupon
- University Hospital Germans Trias i Pujol de Badalona, Badalona, Spain
| | - A Bayes-Genis
- University Hospital Germans Trias i Pujol de Badalona, Badalona, Spain
| |
Collapse
|
20
|
Casquete D, Codina P, Domingo M, Santiago E, Cediel G, Spitaleri G, Zamora E, Santesmases J, Boldo M, Rivas C, Gonzalez B, Velayos P, Pulido A, Lupon J, Bayes-Genis A. Natriuretic peptide dynamics with remote pulmonary artery pressure monitoring. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Real-life clinical practice has confirmed the value of pulmonary artery (PA) pressure-guided therapy in patients with heart failure (HF) and history of repeated HF hospitalizations (HFH), to greater extent to that reported in the pivotal clinical trial CHAMPION-HF. The value of hemodynamic monitoring in a population of patients with HF and elevated natriuretic peptides, but without recent HFH, is unknown.
Objective
To assess N-terminal-pro-brain natriuretic peptide (NTproBNP) dynamics before and 6 months after PA pressure sensor implantation.
Methods
Ten patients managed in a multidisciplinary HF clinic implanted with the CardioMEMS PA pressure sensor were consecutively included from June 2019 to July 2020. Mean age was 63.1±23.5 years, 30% were women, 40% had HF with reduced EF (EF <40%). NTproBNP was measured at baseline and six months after sensor implantation. Wilcoxon matched-pairs signed-rank test was used to compare NTproBNP values at baseline and at 6 months. Fractional polynomial fit plot was used to represent changes in mean PA pressure over time. Linear regression was used to predict the change in NTproBNP based on the change in PA pressures.
Results
Mean daily pressure transmission rate was 92.4±5.1%. During the six-month study period 90% of patients had a change in medication related to PA pressure, with an average of 0.21 [0.17–0.66] changes per patient per month. Mean PA pressure at baseline was 28.5±9.5 mmHg, and decreased by 5.5 mmHg at 6 months (p=0.01) (Figure 1). NTproBNP was also significantly lower six months post CardioMEMS implantation; decreasing from 1696 pg/ml [976–2930] at baseline to 1046 pg/ml [616–2076] after six months (p=0.04) (Figure 2). There was a weak correlation between the change in NTproBNP and the change in mean PA pressure (R2=0.22, p=0.17).
Conclusions
NTproBNP values were significantly lower 6-months following implantation of a PA pressure sensor to guide HF management. Mean PA pressures were also significantly reduced.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Hospital Universitari Germans Trias i Pujol Figure 1. Change in mean PA pressure over time.Figure 2. Change in NTproBNP after PAP monitoring.
Collapse
Affiliation(s)
- D Casquete
- Germans Trias i Pujol Hospital, Cardiology, Badalona, Spain
| | - P Codina
- Germans Trias i Pujol Hospital, Cardiology, Badalona, Spain
| | - M Domingo
- Germans Trias i Pujol Hospital, Cardiology, Badalona, Spain
| | - E Santiago
- Germans Trias i Pujol Hospital, Cardiology, Badalona, Spain
| | - G Cediel
- Germans Trias i Pujol Hospital, Cardiology, Badalona, Spain
| | - G Spitaleri
- Germans Trias i Pujol Hospital, Cardiology, Badalona, Spain
| | - E Zamora
- Germans Trias i Pujol Hospital, Cardiology, Badalona, Spain
| | - J Santesmases
- Germans Trias i Pujol Hospital, Cardiology, Badalona, Spain
| | - M Boldo
- Germans Trias i Pujol Hospital, Cardiology, Badalona, Spain
| | - C Rivas
- Germans Trias i Pujol Hospital, Cardiology, Badalona, Spain
| | - B Gonzalez
- Germans Trias i Pujol Hospital, Cardiology, Badalona, Spain
| | - P Velayos
- Germans Trias i Pujol Hospital, Cardiology, Badalona, Spain
| | - A Pulido
- Germans Trias i Pujol Hospital, Cardiology, Badalona, Spain
| | - J Lupon
- Germans Trias i Pujol Hospital, Cardiology, Badalona, Spain
| | - A Bayes-Genis
- Germans Trias i Pujol Hospital, Cardiology, Badalona, Spain
| |
Collapse
|
21
|
Iborra Egea O, Spitaleri G, Domingo M, Revuelta Lopez E, Codina P, Cediel G, Santiago Vacas E, Cserkoova A, Pascual Figal D, Nunez J, Lupon J, Bayes Genis A. Empagliflozin in heart failure with preserved ejection fraction: decoding its molecular mechanism of action using artificial intelligence. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Rationale The use of sodium-glucose co-transporter 2 inhibitors (SGLT2i) to treat heart failure with preserved ejection fraction (HFpEF) is under investigation in ongoing clinical trials, but the exact mechanism of action is unclear. Here we aimed to use artificial intelligence (AI) to characterize the mechanism of action of empagliflozin in HFpEF at the molecular level.
Methods
We retrieved information regarding HFpEF pathophysiological motifs and differentially expressed genes/proteins, together with empagliflozin target information and bioflags, from specialized publicly available databases. Artificial neural networks and deep learning AI were used to model the molecular effects of empagliflozin in HFpEF.
Results
The model predicted that empagliflozin could reverse 59% of the protein alterations found in HFpEF. The effects of empagliflozin in HFpEF appeared to be predominantly mediated by inhibition of NHE1 (Na+/H+ exchanger 1), with SGLT2 playing a less prominent role. The elucidated molecular mechanism of action had an accuracy of 94%. Empagliflozin's pharmacological action mainly affected cardiomyocyte oxidative stress modulation, and greatly influenced cardiomyocyte stiffness, myocardial extracellular matrix remodelling, heart concentric hypertrophy, and systemic inflammation. Validation of these in silico data was performed in vivo in patients with HFpEF by measuring the declining plasma concentrations of NOS2, the NLPR3 inflammasome, and TGF-β1 during 12 months of empagliflozin treatment.
Conclusion
Using AI modelling, we identified that the main effect of empagliflozin in HFpEF treatment is exerted via NHE1 and is focused on cardiomyocyte oxidative stress modulation. These results support the potential use of empagliflozin in HFpEF.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Instituto de Salud Carlos IIICentro de investigaciόn biomédica en red cardiovascular (CIBERCV) Summary figureTable 1
Collapse
Affiliation(s)
- O Iborra Egea
- Health Science Research Institute Germans Trias i Pujol (IGTP), Badalona, Spain
| | - G Spitaleri
- Germans Trias i Pujol Hospital, Cardiology, Badalona, Spain
| | - M Domingo
- Germans Trias i Pujol Hospital, Cardiology, Badalona, Spain
| | - E Revuelta Lopez
- Health Sciences Research Institute Germans Trias i Pujol (IGTP), ICREC (Heart Failure and Cardiac Regeneration) Research Programme, Badalona, Spain
| | - P Codina
- Germans Trias i Pujol Hospital, Cardiology, Badalona, Spain
| | - G Cediel
- Germans Trias i Pujol Hospital, Cardiology, Badalona, Spain
| | | | - A Cserkoova
- Health Sciences Research Institute Germans Trias i Pujol (IGTP), ICREC (Heart Failure and Cardiac Regeneration) Research Programme, Badalona, Spain
| | - D Pascual Figal
- Hospital Universitario Virgen Arrixaca, Cardiology, Murcia, Spain
| | - J Nunez
- University of Valencia, Cardiology, Valencia, Spain
| | - J Lupon
- University of Valencia, Cardiology, Valencia, Spain
| | - A Bayes Genis
- Germans Trias i Pujol Hospital, Cardiology, Badalona, Spain
| |
Collapse
|
22
|
Codina Verdaguer P, Buchaca D, Spitaleri G, Domingo M, Santiago-Vacas E, Cediel G, Zamora E, Santesmases J, Troya M, Escabia C, Gonzalez B, Rivas C, Nunez J, Lupon J, Bayes-Genis A. Long-term evolution of estimated glomerular filtration rate in heart failure. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Limited data are available on the very long-term trajectory of glomerular filtration rate (GFR) in patients with chronic heart failure (HF).
Purpose
To assess the GFR dynamics estimated by CKD-EPI in a real-life cohort of HF patients over a 14-year follow-up.
Methods
In a prospective observational registry of real-life HF outpatients, estimated GFR (eGFR) was calculated by CKD-EPI at baseline and on a structured schedule every 3 months up to 14 years. We included in the analysis only eGFR values that were assessed at scheduled visits, discarding urgent renal function assessments. Loess (locally weighted error sum of squares) curves were plotted for the whole cohort and subgroups according to vital status up to 14 years of follow-up. Loess curves are useful to observe a trend or relationship on nonlinear data observed over time.
Results
2423 patients were consecutively included from August 2001 to December 2018. Mean age was 67.0±12.7 years, 28,8% were women and 71.1% had HF with reduced ejection fraction (EF<40%). Out of 37360 eGFR values, 25458 were included in the analysis with a median of 8 values per patient [IQR 4–15] and a range between 1 and 47.
Significant changes occurred along the whole trajectory. An initial decline in eGFR was observed during the first three years of follow-up. Subsequently, there was an upward trend during the following five years and after that period a progressive decline was seen until the end of follow-up (Figure 1). In the sub-group of patients who died during follow-up the eGFR slope showed a persistent decline over time of ∼1ml/min/1.73m2 per year. On the contrary, patients who survived to follow-up maintained a stable eGFR (Figure 2).
Conclusions
The eGFR long-term trajectory in patients with chronic HF showed a snaky pattern with an early decrease, mid-term improvement and late progressive decline. Patients who died during follow-up presented a progressive decline from the beginning.
Funding Acknowledgement
Type of funding sources: None. Figure 1. Long-term evolution of eGFRFigure 2. eGFR evolution according to vital status
Collapse
Affiliation(s)
| | - D Buchaca
- Barcelona Supercomputing Center, Barcelona, Spain
| | - G Spitaleri
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - M Domingo
- Germans Trias i Pujol Hospital, Badalona, Spain
| | | | - G Cediel
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - E Zamora
- Germans Trias i Pujol Hospital, Badalona, Spain
| | | | - M.I Troya
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - C Escabia
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - B Gonzalez
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - C Rivas
- Germans Trias i Pujol Hospital, Badalona, Spain
| | - J Nunez
- INCLIVA Foundation, Valencia, Spain
| | - J Lupon
- Germans Trias i Pujol Hospital, Badalona, Spain
| | | |
Collapse
|
23
|
Attili I, Passaro A, Spaggiari L, Spitaleri G, de Marinis F. Adjuvant EGFR TKIs in NSCLC harboring EGFR mutations: looking for a consensus way. Ann Transl Med 2020; 8:1111. [PMID: 33145330 PMCID: PMC7575955 DOI: 10.21037/atm.2020.04.35] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Ilaria Attili
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Surgery, Oncology and Gastroenterology, Faculty of Medicine, University of Padua, Padua, Italy
| | - Antonio Passaro
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Lorenzo Spaggiari
- Division of Thoracic Surgery, IEO, European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Gianluca Spitaleri
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Filippo de Marinis
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| |
Collapse
|
24
|
Catania C, Spitaleri G, Del Signore E, Attili I, Radice D, Stati V, Gianoncelli L, Morganti S, de Marinis F. Fears and Perception of the Impact of COVID-19 on Patients With Lung Cancer: A Mono-Institutional Survey. Front Oncol 2020; 10:584612. [PMID: 33163413 PMCID: PMC7591454 DOI: 10.3389/fonc.2020.584612] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 09/22/2020] [Indexed: 12/21/2022] Open
Abstract
In February 2020, Italy became one of the first countries to be plagued by the SARS-CoV-2 pandemic, COVID-19. In March 2020, the Italian government decreed a lockdown for the whole country, which overturned communication systems, hospital organization, and access to patients and their relatives and carers. This issue had a particular regard for cancer patients. Our Thoracic Oncology Division therefore reorganized patient access in order to reduce the risk of contagion and, at the same time, encourage the continuation of treatment. Our staff contacted all patients to inform them of any changes in treatment planning, check that they were taking safety measures, and ascertain their feelings and whether they had any COVID-19 symptoms. To better understand patients’ fears and expectations of during the pandemic period, we created a nine-question interview, administered from April to May 2020 to 156 patients with lung cancer. Patients were classified by age, sex, comorbidity, disease stage, prior treatment, and treatment type. The survey showed that during the pandemic period some patients experienced fear of COVID-19, in particular: women (55% vs. 33%), patients with comorbidities (24% vs. 9%), and patients who had already received prior insult (radiotherapy or surgery) on the lung (30% vs. 11%). In addition, the patients who received oral treatment at home or for whom intravenous treatment was delayed, experienced a sense of relief (90% and 72% respectively). However, only 21% of the patients were more afraid of COVID-19 than of their cancer, in particular patients with long-term (> 12 months) vs. short-term cancer diagnosis (28% vs. 12.5%, respectively). Furthermore, the quarantine period or even just the lockdown period alone, worsened the quality of life of some patients (40%), especially those in oral treatment (47%). Our data demonstrate how lung cancer patients are more afraid of their disease than of a world pandemic. Also this interview indirectly highlights the clinician’s major guiding principle in correctly and appropriately managing not just the patient’s expectations of their illness and its treatment, but also and especially of the patient’s fears.
Collapse
Affiliation(s)
- Chiara Catania
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Gianluca Spitaleri
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Ester Del Signore
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Ilaria Attili
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Davide Radice
- Division of Epidemiology and Biostatistics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Valeria Stati
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Letizia Gianoncelli
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Stefania Morganti
- Division of Early Drug Development for Innovative Therapies, IEO European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Filippo de Marinis
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| |
Collapse
|
25
|
Passaro A, Spitaleri G, de Marinis F. Reply. Clin Lung Cancer 2020; 21:e415-e416. [DOI: 10.1016/j.cllc.2020.02.009] [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: 01/20/2020] [Revised: 02/04/2020] [Accepted: 02/13/2020] [Indexed: 11/15/2022]
|
26
|
Catania C, Stati V, Spitaleri G. Interstitial pneumonitis in the COVID-19 era: a difficult differential diagnosis in patients with lung cancer. Tumori 2020; 107:267-269. [DOI: 10.1177/0300891620951863] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
In this coronavirus 2019 (COVID-19) era, when pneumonitis occurs in patients with lung cancer receiving immune checkpoint inhibitors (ICIs), a major challenge is to make a rapid and correct differential diagnosis among drug-induced pulmonary toxicity, tumour progression, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)–induced pneumonitis. While waiting for polymerase chain reaction (PCR) testing results, an accurate evaluation of the symptoms and serologic features can help us make a first diagnostic hypothesis and quickly start correct treatment. Physicians need a collaborative effort to develop and share a common database reporting clinical (anosmia, dysgeusia), serologic, and radiologic data in ICI-treated patients with lung cancer developing interstitial disease to create an evidence-based clinical diagnostic algorithm. This tool will continue to be helpful when we emerge from the pandemic crisis into a world in which COVID-19 may not have been eradicated to better select the target population requiring the most resource-consuming PCR tests.
Collapse
Affiliation(s)
- Chiara Catania
- Division of Thoracic Oncology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Valeria Stati
- Division of Thoracic Oncology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Gianluca Spitaleri
- Division of Thoracic Oncology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| |
Collapse
|
27
|
Passaro A, Attili I, Morganti S, Del Signore E, Gianoncelli L, Spitaleri G, Stati V, Catania C, Curigliano G, de Marinis F. Clinical features affecting survival in metastatic NSCLC treated with immunotherapy: A critical review of published data. Cancer Treat Rev 2020; 89:102085. [PMID: 32771858 DOI: 10.1016/j.ctrv.2020.102085] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 06/26/2020] [Accepted: 07/16/2020] [Indexed: 12/18/2022]
Abstract
Immune checkpoint inhibitors (ICIs) represent one of the main steps forward for the treatment of advanced or metastatic non-small-cell lung cancer (NSCLC), without oncogenic driver alterations. Despite this recent progress, only a minority of patients achieve a broad and durable benefit and another proportion report poor survival and sometimes fast disease progression, confirming the need to optimise the patient's selection. To date, several issues are unsolved about how to personalise the immunotherapy treatment for individual patients. In this review, analysing data from pivotal randomised clinical trials (RCTs), we discuss patient baseline clinical and demographic features, including sex, age, ECOG performance status, smoking habit and specific site of metastases (liver, bone and brain) that may influence the efficacy outcomes in patients treated with ICIs. The high performance of the ICIs blurred the vision on different efficacy-limiting factors, which require extensive evaluation to improve the understanding ofthe tumour-specificimmune response, in which clinical drivers could be useful for better patient stratification.
Collapse
Affiliation(s)
- Antonio Passaro
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy.
| | - Ilaria Attili
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Stefania Morganti
- Division of Early Drug Development for Innovative Therapies, IEO European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Ester Del Signore
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Letizia Gianoncelli
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Gianluca Spitaleri
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Valeria Stati
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Chiara Catania
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Giuseppe Curigliano
- Division of Early Drug Development for Innovative Therapies, IEO European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Filippo de Marinis
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| |
Collapse
|
28
|
de Marinis F, Attili I, Morganti S, Stati V, Spitaleri G, Gianoncelli L, Del Signore E, Catania C, Rampinelli C, Omodeo Salè E, Spaggiari L, Mastrilli F, Passaro A. Results of Multilevel Containment Measures to Better Protect Lung Cancer Patients From COVID-19: The IEO Model. Front Oncol 2020; 10:665. [PMID: 32391282 PMCID: PMC7188943 DOI: 10.3389/fonc.2020.00665] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/09/2020] [Indexed: 01/22/2023] Open
Abstract
A novel coronavirus causing severe acute respiratory syndrome (SARS), named SARS-CoV-2, was identified at the end of 2019. The spread of coronavirus disease 2019 (COVID-19) has progressively expanded from China, involving several countries throughout the world, leading to the classification of the disease as a pandemic by the World Health Organization (WHO). According to published reports, COVID-19 severity and mortality are higher in elderly patients and those with active comorbidities. In particular, lung cancer patients were reported to be at high risk of pulmonary complications related to SARS-CoV2 infection. Therefore, the management of cancer care during the COVID-19 pandemic is a crucial issue, to which national and international oncology organizations have replied with recommendations concerning patients receiving anticancer treatments, delaying follow-up visits and limiting caregiver admission to the hospitals. In this historical moment, medical oncologists are required to consider the possibility to delay active treatment administration based on a case-by-case risk/benefit evaluation. Potential risks associated with COVID-19 infection should be considered, considering tumor histology and natural course, disease setting, clinical conditions, and disease burden, together with the expected benefit, toxicities (e.g., myelosuppression or interstitial lung disease), and response obtained from the planned or ongoing treatment. In this study, we report the results of proactive measures including social media, telemedicine, and telephone triage for screening patients with lung cancer during the COVID-19 outbreak in the European Institute of Oncology (Milan, Italy). Proactive management and containment measures, applied in a structured and daily way, has significantly aided the identification of advance patients with suspected symptoms related to COVID-19, limiting their admission to our cancer center; we have thus been more able to protect other patients from possible contamination and at the same time guarantee to the suspected patients the immediate treatment and evaluation in referral hospitals for COVID-19.
Collapse
Affiliation(s)
- Filippo de Marinis
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Ilaria Attili
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Stefania Morganti
- Division of Early Drug Development for Innovative Therapies, IEO European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Valeria Stati
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Gianluca Spitaleri
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Letizia Gianoncelli
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Ester Del Signore
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Chiara Catania
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | | | - Lorenzo Spaggiari
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Division of Thoracic Surgery, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Fabrizio Mastrilli
- Medical Administration, CMO, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Antonio Passaro
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| |
Collapse
|
29
|
Gianoncelli L, Spitaleri G, Passaro A, Radice D, Fumagalli C, Del Signore E, Stati V, Catania CM, Guerini-Rocco E, Barberis M, DE Marinis F. Efficacy of Anti-PD1/PD-L1 Therapy (IO) in KRAS Mutant Non-small Cell Lung Cancer Patients: A Retrospective Analysis. Anticancer Res 2020; 40:427-433. [PMID: 31892597 DOI: 10.21873/anticanres.13970] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 11/14/2019] [Accepted: 11/18/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM The role of anti-PD1/PD-L1 therapy (IO) in NSCLC harboring driver mutations is questionable. This study aimed to examine the efficacy of IO in patients with non-small cell lung cancer (NSCLC) with a KRAS mutation (KRAS+). PATIENTS AND METHODS We retrospectively identified NSCLC patients harboring KRAS mutation treated with IO in our Institution. We analyzed the results in comparison to non-KRAS patients. RESULTS Among 328 consecutive KRAS+ NSCLC patients, 43 (13.1%) received IO in our Institution. In parallel 117 non-KRAS NSCLC patients treated with IO were selected for comparison. The baseline characteristics were similar between the two groups. No significant difference was observed between KRAS+ and non-KRAS patients in terms of mPFS (4.6 vs. 3.3 months, p=0.58) or OS (8.1 vs. 13.0 months, p=0.38). CONCLUSION KRAS mutations seem to be irrelevant for selecting patients for IO that could be therefore considered an effective therapy for NSCLC patients, independently of KRAS status.
Collapse
Affiliation(s)
- Letizia Gianoncelli
- Division of Thoracic Oncology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Gianluca Spitaleri
- Division of Thoracic Oncology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Antonio Passaro
- Division of Thoracic Oncology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Davide Radice
- Division of Epidemiology and Biostatistics European Institute of Oncology, IRCCS, Milan, Italy
| | - Caterina Fumagalli
- Division of Pathology & Laboratory Medicine, European Institute of Oncology, IRCCS, Milan, Italy
| | - Ester Del Signore
- Division of Thoracic Oncology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Valeria Stati
- Division of Thoracic Oncology, European Institute of Oncology, IRCCS, Milan, Italy
| | | | - Elena Guerini-Rocco
- Division of Pathology & Laboratory Medicine, European Institute of Oncology, IRCCS, Milan, Italy
| | - Massimo Barberis
- Division of Pathology & Laboratory Medicine, European Institute of Oncology, IRCCS, Milan, Italy
| | - Filippo DE Marinis
- Division of Thoracic Oncology, European Institute of Oncology, IRCCS, Milan, Italy
| |
Collapse
|
30
|
Domínguez JM, Keller B, Moisés J, Spitaleri G, Farrero M, Casal J, Pérez-Villa F, Castel MA. Changes in Pulmonary Function in Patients With Advanced Heart Failure Listed for Heart Transplantation. Transplant Proc 2019; 51:3424-3427. [PMID: 31810509 DOI: 10.1016/j.transproceed.2019.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 09/09/2019] [Accepted: 09/21/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Pulmonary function tests (PFTs) are often impaired in patients with advanced heart failure. There is limited data about their impact on survival after heart transplantation (HT). We sought to assess the prevalence and type of PFT abnormalities in patients on HT waiting list and their impact on outcomes. METHODS We performed a retrospective analysis of a prospective registry of consecutive patients undergoing HT between 2012 and 2018. Patients were classified into 4 groups according to pre-HT PFT results: 1. normal pattern: forced vital capacity (FVC) ≥ 80% and forced expiratory volume in 1 second (FEV1) to FVC ratio (FEV1/FVC) ≥ 0.7; 2. obstructive: FEV1/FVC < 0.7; 3. nonobstructive: FEV1/FVC ≥ 0.7 and FVC < 80% when total lung capacity value was not available; and 4. restrictive: FEV1/FVC ≥ 0.7 and total lung capacity < 80%. The prevalence of impaired carbon monoxide diffusing capacity corrected for hemoglobin < 80% and FEV1 < 70% was also analyzed. High-urgency HT patients and those referred from other centers without quantitative pulmonary evaluation were excluded. RESULTS Among 123 patients who underwent HT, 83 patients with complete PFT were included. Median follow-up was 2.7 ± 1.9 years. Of these, 29 (34.9%) had an obstructive pattern, 20 (24.1%) a nonobstructive, 18 (21.7%) a restrictive, and 16 (19.3%) a normal pattern. Fifty-one (61.4%) patients had FEV1 < 70% and 58 (69.9%) a carbon monoxide diffusing capacity corrected for hemoglobin < 80%. There was a tendency to lower survival in all altered PFT groups compared with normal (P = .054) but not within the other groups. Patients with an impaired FEV1 had significantly higher mortality than patients with normal values (P = .008). Area under receiver operating characteristic curve for FEV1 was 0.73 (95% confidence interval [0.60-0.86]). A cutoff value of FEV1 (60.5) predicts mortality with 66% sensitivity and 64% specificity. CONCLUSIONS PFT alterations have a very high prevalence on HT waiting list patients. Patients with impaired FEV1 had worse outcomes after heart transplantation.
Collapse
Affiliation(s)
- J M Domínguez
- Cardiovascular Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - B Keller
- Cardiovascular Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - J Moisés
- Pneumology department, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - G Spitaleri
- Cardiovascular Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - M Farrero
- Cardiovascular Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - J Casal
- Cardiovascular Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - F Pérez-Villa
- Cardiovascular Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - M A Castel
- Cardiovascular Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain.
| |
Collapse
|
31
|
Affiliation(s)
- Chiara Catania
- Division of Thoracic Oncology, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Ester Del Signore
- Division of Thoracic Oncology, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Gianluca Spitaleri
- Division of Thoracic Oncology, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| |
Collapse
|
32
|
Landi L, Tiseo M, Heukamp L, Menon R, Spitaleri G, Cortinovis D, Delmonte A, Galetta D, D’Arcangelo M, D’Incà F, Bertrand M, Jóri B, Zacher A, Gridelli C, Novello S, Chiari R, Verusio C, Crinò L, Cappuzzo F. Secondary ROS1 mutations and lorlatinib sensitivity in crizotinib-refractory ROS1 positive NSCLC: Results of the prospective PFROST trial. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz260.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
33
|
Passaro A, Mancuso P, Gandini S, Spitaleri G, Labanca V, Guerini-Rocco E, Barberis M, Catania C, Del Signore E, de Marinis F, Bertolini F. Correction to: Gr-MDSC-linked asset as a potential immune biomarker in pretreated NSCLC receiving nivolumab as second-line therapy. Clin Transl Oncol 2019; 22:621. [PMID: 31432394 DOI: 10.1007/s12094-019-02198-5] [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: 11/29/2022]
Abstract
Acknowledgements section was missing.
Collapse
Affiliation(s)
- A Passaro
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Via G. Ripamonti, 435, 20141, Milan, Italy.
| | - P Mancuso
- Laboratory of Hematology-Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - S Gandini
- Division of Epidemiology and Biostatistics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - G Spitaleri
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Via G. Ripamonti, 435, 20141, Milan, Italy
| | - V Labanca
- Laboratory of Hematology-Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - E Guerini-Rocco
- Division of Pathology and Laboratory Medicine, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - M Barberis
- Division of Pathology and Laboratory Medicine, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - C Catania
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Via G. Ripamonti, 435, 20141, Milan, Italy
| | - E Del Signore
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Via G. Ripamonti, 435, 20141, Milan, Italy
| | - F de Marinis
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Via G. Ripamonti, 435, 20141, Milan, Italy
| | - F Bertolini
- Laboratory of Hematology-Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| |
Collapse
|
34
|
Passaro A, Mancuso P, Gandini S, Spitaleri G, Labanca V, Guerini-Rocco E, Barberis M, Catania C, Del Signore E, de Marinis F, Bertolini F. Gr-MDSC-linked asset as a potential immune biomarker in pretreated NSCLC receiving nivolumab as second-line therapy. Clin Transl Oncol 2019; 22:603-611. [PMID: 31254252 DOI: 10.1007/s12094-019-02166-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 02/26/2019] [Accepted: 06/16/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE Immunotherapy is a new standard first-line treatment for non-small cell lung cancers (NSCLC) with high programmed cell death-ligand 1 (PD-L1) expression (≥ 50%) and second-line treatment regardless of PD-L1 status, though not all patients benefit from this approach. Much effort is ongoing to identify robust prognostic and predictive biomarkers of response to immune checkpoint inhibitors, overcoming PD-L1 that appears limited in its ability to discriminate patient candidates to this new class of anticancer agents. The purpose of this research study is to identify potential new biomarkers for immunotherapy in lung cancer. METHODS Fifty-three consecutive patients with advanced NSCLC treated with nivolumab were enrolled in the study. All the patients received a blood analysis looking for the relationship between different populations of baseline white blood cells and granulocytic myeloid-derived suppressor cells (Gr-MDSC) detected by flow cytometry, to identify and characterize patients with poor likelihood of benefit from nivolumab in NSCLC second-line setting, regardless of clinical feature and PDL1 expression. RESULTS Univariate analysis showed that high baseline levels of Gr-MDSC and low baseline CD8/Gr-MDSC ratio are associated with significantly better (P = 0.02) response to immunotherapy treatment. Log-rank tests suggested a significant improvement in OS and PFS with high baseline levels of Gr-MDSC levels (≥ 6 cell/μl), low absolute neutrophil count (< 5840/μl), high eosinophil count (> 90 /μl), and NLR < 3. The multivariate analysis showed a statistically significant improvement for PFS (P = 0.003) and OS (P = 0.05) in favour of the identified good prognostic Gr-MDSC-linked asset group, compared with the poor prognosis group. CONCLUSION The role of Gr-MDSC appears interesting as a potential biomarker in NSCLC patients receiving immune-checkpoint inhibitors. Further analyses are needed to confirmed and study in deep the role of these particular cells and their role in cancer response and progression during ICI therapy.
Collapse
Affiliation(s)
- A Passaro
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Via G. Ripamonti, 435, 20141, Milan, Italy.
| | - P Mancuso
- Laboratory of Hematology-Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - S Gandini
- Division of Epidemiology and Biostatistics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - G Spitaleri
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Via G. Ripamonti, 435, 20141, Milan, Italy
| | - V Labanca
- Laboratory of Hematology-Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - E Guerini-Rocco
- Division of Pathology and Laboratory Medicine, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - M Barberis
- Division of Pathology and Laboratory Medicine, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - C Catania
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Via G. Ripamonti, 435, 20141, Milan, Italy
| | - E Del Signore
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Via G. Ripamonti, 435, 20141, Milan, Italy
| | - F de Marinis
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Via G. Ripamonti, 435, 20141, Milan, Italy
| | - F Bertolini
- Laboratory of Hematology-Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| |
Collapse
|
35
|
Passaro A, Spitaleri G, Gyawali B, de Marinis F. Immunotherapy in Non-Small-Cell Lung Cancer Patients With Performance Status 2: Clinical Decision Making With Scant Evidence. J Clin Oncol 2019; 37:1863-1867. [PMID: 30995172 DOI: 10.1200/jco.18.02118] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
| | | | - Bishal Gyawali
- 2Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,3Queen's Cancer Research Institute, Kingston, Ontario, Canada
| | | |
Collapse
|
36
|
Gianoncelli L, Spitaleri G, Passaro A, Fumagalli C, Trillo Aliaga P, Del Signore E, Stati V, Ferraro E, Guerini-Rocco E, Catania C, Barberis M, de Marinis F. Correlation among different KRAS alterations, genetic co-mutations and PD-L1 expression in patients treated with immunotherapy in metastatic NSCLC. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz063.050] [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
|
37
|
Passaro A, Prelaj A, Spitaleri G, Del Signore E, Rossi G, Guerini-Rocco E, Barberis M, Catania C, de Marinis F. Clinical and treatment features associated with improved 5-year survival rate in ALK-positive lung cancer treated with ALK-TKIs. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz063.042] [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
|
38
|
Passaro A, Prelaj A, Bonanno L, Tiseo M, Tuzi A, Proto C, Chiari R, Rocco D, Genova C, Sini C, Cortinovis D, Pilotto S, Landi L, Bennati C, Camerini A, Toschi L, Putzu C, Cerea G, Spitaleri G, Cappuzzo F, de Marinis F. Activity of EGFR TKIs in Caucasian Patients With NSCLC Harboring Potentially Sensitive Uncommon EGFR Mutations. Clin Lung Cancer 2018; 20:e186-e194. [PMID: 30563752 DOI: 10.1016/j.cllc.2018.11.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 10/30/2018] [Accepted: 11/11/2018] [Indexed: 12/09/2022]
Abstract
BACKGROUND Molecular characterization of non-small-cell lung cancer (NSCLC), defined predictive and druggable mutations that greatly modified patient prognoses. The most frequent driver mutations detected in NSCLC are epidermal growth factor receptor (EGFR) mutations, accounting for approximately 90% of exon 19 deletions and exon 21 point mutations. The other EGFR mutations are classified as uncommon or nonclassical and include exon 18 point mutations, exon 20 insertions, and combined mutations, which present different sensitivity to tyrosine kinase inhibitor (TKI) targeting. PATIENTS AND METHODS We collected data from EGFR TKI-naive patients with metastatic NSCLC, harboring EGFR exon 18 mutations and EGFR combined mutations treated with first- or second-generation EGFR TKIs. Efficacy end points were evaluated considering the activity of EGFR TKIs in exon 18 versus double-mutation EGFR groups. RESULTS Eighty-eight patients harboring uncommon EGFR mutations were evaluated in our analysis, and subdivided into 2 group: complex mutations (cohort A = 46 patients) and double mutations in exon 18 (cohort B = 42 patients). The results showed a median progression-free survival of 8.3 versus 12.3 months (hazard ratio [HR], 0.65; P = .06) and a median overall survival of 17.0 versus 31.0 months (HR, 0.62, P = .04) favoring the EGFR combination group. Within the combination group, no detrimental effect was associated with exon 20 mutations. CONCLUSION Our study confirmed that EGFR exon 18 and combination mutations might be considered potentially sensitive uncommon mutations, with a similar survival compared with the well known common EGFR mutations. Comparative analysis showed that patients with complex mutations achieved longer survival compared with the exon 18 group, without correlation with the presence of exon 20 mutations.
Collapse
Affiliation(s)
- Antonio Passaro
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy.
| | - Arsela Prelaj
- Division of Thoracic Oncology, IRCCS, Istituto Nazionale Tumori, Milan, Italy
| | - Laura Bonanno
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Marcello Tiseo
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | | | - Claudia Proto
- Division of Thoracic Oncology, IRCCS, Istituto Nazionale Tumori, Milan, Italy
| | - Rita Chiari
- Medical Oncology, Santa Maria della Misericordia Hospital, AOU di Perugia, Perugia, Italy
| | - Danilo Rocco
- Department of Oncology, AORN Vincenzo Monaldi, Naples, Italy
| | - Carlo Genova
- Lung Cancer Unit, IRCCS AOU San Martino-IST, Genova, Italy
| | | | | | - Sara Pilotto
- Medical Oncology, University of Verona, AOUI Verona, Verona, Italy
| | - Lorenza Landi
- Onco-Hematology Department, AUSL Romagna, Ravenna, Italy
| | - Chiara Bennati
- Onco-Hematology Department, AUSL Romagna, Ravenna, Italy
| | - Andrea Camerini
- Medical Oncology, Versilia Hospital and Istituto Toscano Tumori, Lido di Camaiore, Italy
| | - Luca Toschi
- Medical Oncology, Humanitas Research Hospital, Rozzano, Italy
| | - Carlo Putzu
- Oncology Unit, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Giulio Cerea
- Department of Oncology and Hemato-Oncology, Niguarda Cancer Center, Milan, Italy
| | - Gianluca Spitaleri
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Filippo de Marinis
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| |
Collapse
|
39
|
Spitaleri G, Passaro A, de Marinis F. Ensartinib (X-396) a novel drug for anaplastic lymphoma kinase-positive non-small cell lung cancer patients: we need smart trials to avoid wasting good bullets. Chin Clin Oncol 2018; 8:S1. [PMID: 30525749 DOI: 10.21037/cco.2018.09.03] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 09/03/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Gianluca Spitaleri
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy.
| | - Antonio Passaro
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Filippo de Marinis
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| |
Collapse
|
40
|
de Jong EEC, van Elmpt W, Rizzo S, Colarieti A, Spitaleri G, Leijenaar RTH, Jochems A, Hendriks LEL, Troost EGC, Reymen B, Dingemans AMC, Lambin P. Applicability of a prognostic CT-based radiomic signature model trained on stage I-III non-small cell lung cancer in stage IV non-small cell lung cancer. Lung Cancer 2018; 124:6-11. [PMID: 30268481 DOI: 10.1016/j.lungcan.2018.07.023] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 05/19/2018] [Accepted: 07/17/2018] [Indexed: 01/30/2023]
Abstract
OBJECTIVES Recently it has been shown that radiomic features of computed tomography (CT) have prognostic information in stage I-III non-small cell lung cancer (NSCLC) patients. We aim to validate this prognostic radiomic signature in stage IV adenocarcinoma patients undergoing chemotherapy. MATERIALS AND METHODS Two datasets of chemo-naive stage IV adenocarcinoma patients were investigated, dataset 1: 285 patients with CTs performed in a single center; dataset 2: 223 patients included in a multicenter clinical trial. The main exclusion criteria were EGFR mutation or unknown mutation status and non-delineated primary tumor. Radiomic features were calculated for the primary tumor. The c-index of cox regression was calculated and compared to the signature performance for overall survival (OS). RESULTS In total CT scans from 195 patients were eligible for analysis. Patients having a prognostic index (PI) lower than the signature median (n = 92) had a significantly better OS than patients with a PI higher than the median (n = 103, HR 1.445, 95% CI 1.07-1.95, p = 0.02, c-index 0.576, 95% CI 0.527-0.624). CONCLUSION The radiomic signature, derived from daily practice CT scans, has prognostic value for stage IV NSCLC, however the signature performs less than previously described for stage I-III NSCLC stages. In the future, machine learning techniques can potentially lead to a better prognostic imaging based model for stage IV NSCLC.
Collapse
Affiliation(s)
- Evelyn E C de Jong
- The D-Lab: Decision Support for Precision Medicine, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center+, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands.
| | - Wouter van Elmpt
- Department of Radiation Oncology (MAASTRO), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center+, Doctor Tanslaan 12, 6229 ET, Maastricht, The Netherlands.
| | - Stefania Rizzo
- Department of Radiology, European Institute of Oncology, Via Ripamonti 435, 20141 Milano, Italy.
| | - Anna Colarieti
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy.
| | - Gianluca Spitaleri
- Department of Thoracic Oncology, European Institute of Oncology, Via Ripamonti 435, 20141 Milano, Italy.
| | - Ralph T H Leijenaar
- The D-Lab: Decision Support for Precision Medicine, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center+, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands.
| | - Arthur Jochems
- The D-Lab: Decision Support for Precision Medicine, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center+, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands.
| | - Lizza E L Hendriks
- Department of Pulmonary Diseases, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center+, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
| | - Esther G C Troost
- Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology - OncoRay, Händelallee 26/Bldg. 130, 01309 Dresden, Germany; Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Händelallee 26/Bldg. 130, 01309 Dresden, Germany; OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Händelallee 26/Bldg. 130, 01309 Dresden, Germany; German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany.
| | - Bart Reymen
- Department of Radiation Oncology (MAASTRO), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center+, Doctor Tanslaan 12, 6229 ET, Maastricht, The Netherlands.
| | - Anne-Marie C Dingemans
- Department of Pulmonary Diseases, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center+, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
| | - Philippe Lambin
- The D-Lab: Decision Support for Precision Medicine, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center+, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands.
| |
Collapse
|
41
|
Toffalorio F, Santarpia M, Radice D, Jaramillo CA, Spitaleri G, Manzotti M, Catania C, Jordheim LP, Pelosi G, Peters GJ, Tibaldi C, Funel N, Spaggiari L, de Braud F, De Pas T, Giovannetti E. 5'-nucleotidase cN-II emerges as a new predictive biomarker of response to gemcitabine/platinum combination chemotherapy in non-small cell lung cancer. Oncotarget 2018; 9:16437-16450. [PMID: 29662657 PMCID: PMC5893252 DOI: 10.18632/oncotarget.24505] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 02/02/2018] [Indexed: 02/04/2023] Open
Abstract
A number of pharmacogenetic studies have been carried out in non-small-cell lung cancer (NSCLC) to identify and characterize genes involved in chemotherapy activity. However, the results obtained so far are controversial and no reliable biomarker is currently used to predict clinical benefit from platinum-based chemotherapy, which represents the cornerstone of treatment of advanced NSCLC. This study investigated the expression levels of ERCC1 and of six genes (RRM1, RRM2, hENT1, dCK, cN-II and CDA) involved in gemcitabine metabolism in locally/advanced NSCLC patients treated with gemcitabine/platinum combination. Gene expression was assessed by quantitative-PCR in laser-microdissected specimens and correlated with tumor response. Frequency distribution of responses above and below the median expression level of biomarkers was compared using a two-sided Fisher’s test. 5′-nucleotidase (cN-II) was the only gene differently expressed (p = 0.016) in the responders (complete/partial-response) compared to non-responders (stable/progressive disease). In the multivariate analysis, overexpression of this catabolic enzyme of gemcitabine remained a significant negative predictive factor. Patients with low cN-II had a modest trend toward increased survival, while both survival and progression-free survival were significantly longer in a more homogenous validation cohort of 40 advanced NSCLC (8.0 vs. 5.1 months, p = 0.026). Moreover, in vitro studies showed that silencing or pharmacological inhibition of cN-II increased the cytotoxicity of gemcitabine. This is the first study demonstrating the role of cN-II as a predictor of response to gemcitabine/platinum combinations in NSCLC. Its validation in prospective studies may improve clinical outcome of selected patients.
Collapse
Affiliation(s)
- Francesca Toffalorio
- Medical Oncology Unit of Respiratory Tract and Sarcomas, New Drugs Development Division, European Institute of Oncology, Milan, Italy.,Medical Affairs, Roche Spa, Monza, Italy
| | - Mariacarmela Santarpia
- Medical Oncology Unit of Respiratory Tract and Sarcomas, New Drugs Development Division, European Institute of Oncology, Milan, Italy.,Medical Oncology Unit, Department of Human Pathology, University of Messina, Messina, Italy
| | - Davide Radice
- Epidemiology and Biostatistics Division, European Institute of Oncology, Milan, Italy
| | | | - Gianluca Spitaleri
- Medical Oncology Unit of Respiratory Tract and Sarcomas, New Drugs Development Division, European Institute of Oncology, Milan, Italy.,Thoracic Oncology Division, European Institute of Oncology, Milan, Italy
| | - Michela Manzotti
- Division of Pathology and Laboratory Medicine, European Institute of Oncology, Milan, Italy
| | - Chiara Catania
- Medical Oncology Unit of Respiratory Tract and Sarcomas, New Drugs Development Division, European Institute of Oncology, Milan, Italy.,Thoracic Oncology Division, European Institute of Oncology, Milan, Italy
| | - Lars Petter Jordheim
- Centre de Recherche en Cancérologie de Lyon, INSERM 1052/CNRS UMR 5286, Lyon, France
| | - Giuseppe Pelosi
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Inter-Hospital Pathology Division, Science and Technology Park, IRCCS MultiMedica, Milan, Italy
| | - Godefridus J Peters
- Department of Medical Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Carmelo Tibaldi
- Division of Oncology, Department of Oncology, S. Luca Hospital, Lucca, Italy
| | - Niccola Funel
- CNR-Nano, Institute of Nanoscience and Nanotechnology, Pisa, Italy.,Cancer Pharmacology Laboratory, AIRC Start-Up Unit, University of Pisa, Pisa, Italy
| | - Lorenzo Spaggiari
- Thoracic Surgery Division, European Institute of Oncology, Milan, Italy
| | - Filippo de Braud
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Inter-Hospital Pathology Division, Science and Technology Park, IRCCS MultiMedica, Milan, Italy
| | - Tommaso De Pas
- Medical Oncology Unit of Respiratory Tract and Sarcomas, New Drugs Development Division, European Institute of Oncology, Milan, Italy
| | - Elisa Giovannetti
- Department of Medical Oncology, VU University Medical Center, Amsterdam, The Netherlands.,CNR-Nano, Institute of Nanoscience and Nanotechnology, Pisa, Italy.,Cancer Pharmacology Laboratory, AIRC Start-Up Unit, University of Pisa, Pisa, Italy
| |
Collapse
|
42
|
Pilotto S, Rossi A, Vavalà T, Follador A, Tiseo M, Galetta D, Morabito A, Di Maio M, Martelli O, Caffo O, Piovano PL, Cortinovis D, Zilembo N, Casartelli C, Banna GL, Ardizzoia A, Barzelloni ML, Bearz A, Genestreti G, Mucciarini C, Filipazzi V, Menis J, Rizzo E, Barbieri F, Rijavec E, Cecere F, Spitaleri G, Bria E, Novello S. Outcomes of First-Generation EGFR-TKIs Against Non-Small-Cell Lung Cancer Harboring Uncommon EGFR Mutations: A Post Hoc Analysis of the BE-POSITIVE Study. Clin Lung Cancer 2018. [DOI: 10.1016/j.cllc.2017.05.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
|
43
|
Rampinelli C, Spitaleri G, Passaro A, Pochesci A, Ancona E, De Marinis F. Lung Tissue Injury as an Atypical Response to Nivolumab in Non-Small Cell Lung Cancer. Am J Respir Crit Care Med 2017; 196:1349-1350. [PMID: 28910131 DOI: 10.1164/rccm.201705-0875im] [Citation(s) in RCA: 4] [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: 11/16/2022] Open
Affiliation(s)
| | - Gianluca Spitaleri
- 2 Division of Thoracic Oncology, European Institute of Oncology, Milan, Italy; and
| | - Antonio Passaro
- 2 Division of Thoracic Oncology, European Institute of Oncology, Milan, Italy; and
| | - Alessia Pochesci
- 2 Division of Thoracic Oncology, European Institute of Oncology, Milan, Italy; and
| | | | - Filippo De Marinis
- 2 Division of Thoracic Oncology, European Institute of Oncology, Milan, Italy; and
| |
Collapse
|
44
|
Angevin E, Spitaleri G, Rodon J, Dotti K, Isambert N, Salvagni S, Moreno V, Assadourian S, Gomez C, Harnois M, Hollebecque A, Azaro A, Hervieu A, Rihawi K, De Marinis F. A first-in-human phase I study of SAR125844, a selective MET tyrosine kinase inhibitor, in patients with advanced solid tumours with MET amplification. Eur J Cancer 2017; 87:131-139. [PMID: 29145039 DOI: 10.1016/j.ejca.2017.10.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 10/17/2017] [Indexed: 12/16/2022]
Abstract
PURPOSE Dysregulated MET signalling is implicated in oncogenesis. The safety and preliminary efficacy of a highly selective MET kinase inhibitor (SAR125844) was investigated in patients with advanced solid tumours and MET dysregulation. METHODS This was a phase I dose-escalation (3 + 3 design [50-740 mg/m2]) and dose-expansion study. In the dose escalation, patients had high total MET (t-MET) expression by immunohistochemistry (IHC) or MET amplification by fluorescence in situ hybridisation. In the dose expansion, patients had MET amplification (including a subset of patients with non-small cell lung cancer [NSCLC]) or phosphorylated-MET (p-MET) expression (IHC). Objectives were determination of maximum tolerated dose (MTD) of once-weekly intravenous SAR125844 based on dose-limiting toxicities; safety and pharmacokinetic profile; preliminary efficacy of SAR125844 MTD in the expansion cohort. RESULTS In total, 72 patients were enrolled: dose escalation, N = 33; dose expansion, N = 39; 570 mg/m2 was established as the MTD. Most frequent treatment-emergent adverse events (AEs) were asthenia/fatigue (58.3%), nausea (31.9%), and abdominal pain, constipation, and dyspnea (27.8% for each); 58.3% of patients reported grade 3 AEs (19.4% were treatment related). Of the 29 evaluable patients with MET amplification treated at 570 mg/m2, five achieved a partial response, including four of 22 with NSCLC; 17 patients had stable disease. No response was observed in patients with high p-MET solid tumours. There was no correlation between tumour response and t-MET status or MET gene copy number. CONCLUSION The MTD of once-weekly SAR125844 was 570 mg/m2; SAR125844 was well tolerated, with significant antitumour activity in patients with MET-amplified NSCLC. CLINICAL TRIAL REGISTRATION NUMBER NCT01391533.
Collapse
Affiliation(s)
- Eric Angevin
- Drug Development Department, Département d'Innovation Thérapeutique et des Essais Précoces (DITEP), Université Paris-Saclay, Gustave Roussy, Villejuif, F-94805, France.
| | - Gianluca Spitaleri
- Thoracic Oncology Division, Istituto Europeo di Oncologia, Via Ripamonti 435, 20141, Milan, Italy.
| | - Jordi Rodon
- Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, P. Vall d'Hebron 119-129, Barcelona, 08035, Spain.
| | - Katia Dotti
- Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milan, Italy.
| | - Nicolas Isambert
- Centre Georges-François Leclerc, 1 Rue du Professeur Marion, 21000, Dijon, France.
| | - Stefania Salvagni
- Oncologia Medica, S. Orsola-Malpighi University Hospital Bologna, Via Pietro Albertoni, 15, 40138, Bologna, Italy.
| | - Victor Moreno
- START MADRID - FJD., Hospital Universitario Fundación Jiménez Díaz, vda. Reyes Católicos, 2, 28040, Madrid, Spain.
| | | | | | | | - Antoine Hollebecque
- Drug Development Department, Département d'Innovation Thérapeutique et des Essais Précoces (DITEP), Université Paris-Saclay, Gustave Roussy, Villejuif, F-94805, France.
| | - Analia Azaro
- Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, P. Vall d'Hebron 119-129, Barcelona, 08035, Spain.
| | - Alice Hervieu
- Centre Georges-François Leclerc, 1 Rue du Professeur Marion, 21000, Dijon, France.
| | - Karim Rihawi
- Oncologia Medica, S. Orsola-Malpighi University Hospital Bologna, Via Pietro Albertoni, 15, 40138, Bologna, Italy.
| | - Filippo De Marinis
- Thoracic Oncology Division, Istituto Europeo di Oncologia, Via Ripamonti 435, 20141, Milan, Italy.
| |
Collapse
|
45
|
Landi L, Chiari R, Dazzi C, Tiseo M, Chella A, Delmonte A, Bonanno L, Cortinovis D, De Marinis F, Minuti G, Buosi R, Morabito A, Spitaleri G, Gridelli C, Maione P, Galetta D, Barbieri F, Grossi F, Novello S, Bruno R, Alì G, Proietti A, Fontanini G, Joseph A, Crinò L, Cappuzzo F. P1.01-015 Crizotinib in ROS1 Rearranged or MET Deregulated Non-Small-Cell Lung Cancer (NSCLC): Final Results of the METROS Trial. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.669] [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: 11/28/2022]
|
46
|
Moscarella E, Spitaleri G, Brugaletta S, Pernigotti A, Ortega Paz L, Cequier A, Iniguez A, Serra A, Jimenez-Quevedo P, Mainar V, Campo G, Tespili M, Valgimigli M, Serruys P, Sabate M. P5604Impact of body mass index on outcomes after everolimus-eluting stents versus bare metal stents implantation in patients with ST-segment elevation myocardial infarction: insights the EXAMINATION trial. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5604] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
47
|
Mancuso P, Passaro A, Labanca V, Gandini S, Spitaleri G, Guerini E, Barberis M, Noberasco C, Signore ED, Pochesci A, Catania C, Marinis FD, Bertolini F. Abstract 2635: Baseline myeloid-derived suppressor cell and eosinophil cell counts predict clinical efficacy in patients with non-small cell lung cancer (NSCLC) treated with nivolumab in second line. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-2635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
The anti-PD-1 monoclonal antibody nivolumab is clinically active in a variety of tumor types including squamous (sq) and non-squamous (non-sq) NSCLC in second-line, where randomized phase III trials have shown a survival benefit. However, no predictive/prognostic or dynamic biomarkers have been found so far to correlate with clinical benefit in patients treated with anti-PD-1 antibodies. The aim of the present study is to investigate the potential role of baseline peripheral blood cell counts in relation to survival and response rate in NSCLC patients treated with nivolumab in a second-line setting. From July to May 2016 we evaluated 45 patients with Sq (n = 10) and non-Sq (n = 35) NSCLC, previously treated with first-line platinum-based chemotherapy, who received nivolumab 3 mg/kg IV on day 1 of each 2 week treatment cycle. Clinical characteristics (T-Stage, lymph nodes involvement, M-Stage) were assessed. Total numbers of white blood cells, myeloid-derived suppressor cells (MDSCs, including both monocytic [Mo-MDSC]) and polymorphonuclear [PMN-MDSC] types), regulatory T cells (T-regs), and serum lactate dehydrogenase (LDH) were assessed. Endpoints were correlations with objective response rate (RR), progression-free survival (PFS, categorized as ≤ 3 or > 3 months) and overall survival (OS). Tumor response was assessed using RECIST criteria, version 1.1, at week 9 and every 6 weeks thereafter until disease progression. Statistical investigations were based on univariate analyses by the Wilcoxon rank test. The median PFS of the overall study population was 3 months. Data about PMN-MDSCs (identified by flow cytometry as Lin-CD15+CD14-CD11b+HLA-DRlow/-), Mo-MDSCs (Lin-CD14-CD11b+HLA-DRlow/-) and absolute eosinophil count (AEC) were available in 37/45 patients (82% of treated patients). Baseline absolute numbers of PMN-MDSCs, Mo-MDSCs and AEC were greater in patients with a good prognosis (PFS > 3 months) and a better RR. In particular, among patients with shorter PFS and lower RR, the median numbers of PMN-MDSCs, Mo-MDSCs and AEC were significantly lower than those detected in patients with longer PFS (4 vs 13 cell/µl, p=0.01; 4 vs 21 cell/µl, p=0.06; 55 vs 155 cell/µl; p=0.02, respectively). Our data suggest that a baseline blood signature characterized by low levels of PMN-MDSCs, Mo-MDSCs and AEC is associated with a poor clinical outcome (median PFS ≤ of 3 months and low RR) in 67.6% of patients treated with nivolumab. In contrast, patients with high levels of these three biomarkers showed a median PFS significantly longer than 3 months and a higher RR. The OS analysis is ongoing, and further studies have been planned to understand whether this signature has a biomarker potential also in chemotherapy-naïve, first line NSCLC patients.
Citation Format: Patrizia Mancuso, Antonio Passaro, Valentina Labanca, Sara Gandini, Gianluca Spitaleri, Elena Guerini, Massimo Barberis, Cristina Noberasco, Ester del Signore, Alessia Pochesci, Chiara Catania, Filippo De Marinis, Francesco Bertolini. Baseline myeloid-derived suppressor cell and eosinophil cell counts predict clinical efficacy in patients with non-small cell lung cancer (NSCLC) treated with nivolumab in second line [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 2635. doi:10.1158/1538-7445.AM2017-2635
Collapse
|
48
|
Passaro A, Guerini-Rocco E, Pochesci A, Vacirca D, Spitaleri G, Catania CM, Rappa A, Barberis M, de Marinis F. Targeting EGFR T790M mutation in NSCLC: From biology to evaluation and treatment. Pharmacol Res 2017; 117:406-415. [DOI: 10.1016/j.phrs.2017.01.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 01/03/2017] [Accepted: 01/04/2017] [Indexed: 02/06/2023]
|
49
|
Passaro A, Prelaj A, Pochesci A, Spitaleri G, Rossi G, Del Signore E, Catania C, de Marinis F. Brigatinib for the treatment of ALK-positive advanced non-small cell lung cancer patients. Drugs Today (Barc) 2017; 53:435-446. [DOI: 10.1358/dot.2017.53.8.2676119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
50
|
Passaro A, Mancuso P, Labanca V, Spitaleri G, Guerini-Rocco E, Barberis M, Gandini S, Noberasco C, Del Signore E, Catania C, Pochesci A, Bertolini F, De Marinis F. P2.01-044 Baseline Peripheral Blood Cell Subsets Associated with Survival Outcomes in Advanced NSCLC Treated with Nivolumab in Second-Line Setting. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.1096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|