1
|
Celsa C, Cabibbo G, Fulgenzi CAM, Scheiner B, D'Alessio A, Manfredi GF, Nishida N, Ang C, Marron TU, Saeed A, Wietharn B, Pinter M, Cheon J, Huang YH, Lee PC, Phen S, Gampa A, Pillai A, Vivaldi C, Salani F, Masi G, Roehlen N, Thimme R, Vogel A, Schönlein M, von Felden J, Schulze K, Wege H, Galle PR, Kudo M, Rimassa L, Singal AG, El Tomb P, Ulahannan S, Parisi A, Chon HJ, Hsu WF, Stefanini B, Verzoni E, Giusti R, Veccia A, Catino A, Aprile G, Guglielmini PF, Di Napoli M, Ermacora P, Antonuzzo L, Rossi E, Verderame F, Zustovich F, Ficorella C, Di Pietro FR, Battelli N, Negrini G, Grossi F, Bordonaro R, Pipitone S, Banzi M, Ricciardi S, Laera L, Russo A, De Giorgi U, Cavanna L, Sorarù M, Montesarchio V, Bordi P, Brunetti L, Pinto C, Bersanelli M, Cammà C, Cortellini A, Pinato DJ. Characteristics and outcomes of immunotherapy-related liver injury in patients with hepatocellular carcinoma versus other advanced solid tumours. J Hepatol 2024; 80:431-442. [PMID: 37972660 DOI: 10.1016/j.jhep.2023.10.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/26/2023] [Accepted: 10/30/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND & AIMS Immune-related liver injury (irLI) is commonly observed in patients with cancer treated with immune checkpoint inhibitors (ICIs). We aimed to compare the incidence, clinical characteristics, and outcomes of irLI between patients receiving ICIs for hepatocellular carcinoma (HCC) vs. other solid tumours. METHODS Two separate cohorts were included: 375 patients with advanced/unresectable HCC, Child-Pugh A class treated with first-line atezolizumab+bevacizumab from the AB-real study, and a non-HCC cohort including 459 patients treated with first-line ICI therapy from the INVIDIa-2 multicentre study. IrLI was defined as a treatment-related increase of aminotransferase levels after exclusion of alternative aetiologies of liver injury. The incidence of irLI was adjusted for the duration of treatment exposure. RESULTS In patients with HCC, the incidence of any grade irLI was 11.4% over a median treatment exposure of 4.4 months (95% CI 3.7-5.2) vs. 2.6% in the INVIDIa-2 cohort over a median treatment exposure of 12.4 months (95% CI 11.1-14.0). Exposure-adjusted-incidence of any grade irLI was 22.1 per 100-patient-years in patients with HCC and 2.1 per 100-patient-years in patients with other solid tumours (p <0.001), with median time-to-irLI of 1.4 and 4.7 months, respectively. Among patients who developed irLI, systemic corticosteroids were administered in 16.3% of patients with HCC and 75.0% of those without HCC (p <0.001), and irLI resolution was observed in 72.1% and 58.3%, respectively (p = 0.362). In patients with HCC, rates of hepatic decompensation and treatment discontinuation due to irLI were 7%. Grade 1-2 irLI was associated with improved overall survival only in patients with HCC (hazard ratio 0.53, 95% CI 0.29-0.96). CONCLUSIONS Despite higher incidence and earlier onset, irLI in patients with HCC is characterised by higher rates of remission and lower requirement for corticosteroid therapy (vs. irLI in other solid tumours), low risk of hepatic decompensation and treatment discontinuation, not negatively affecting oncological outcomes. IMPACT AND IMPLICATIONS Immune-related liver injury (irLI) is common in patients with cancer receiving immune checkpoint inhibitors (ICIs), but whether irLI is more frequent or it is associated with a worse clinical course in patients with hepatocellular carcinoma (HCC), compared to other tumours, is not known. Herein, we compared characteristics and outcomes of irLI in two prospective cohorts including patients treated with ICIs for HCC or for other oncological indications. irLI is significantly more common and it occurs earlier in patients with HCC, also after adjustment for duration of treatment exposure. However, outcomes of patients with HCC who developed irLI are not negatively affected in terms of requirement for corticosteroid therapy, hepatic decompensation, treatment discontinuation and overall survival.
Collapse
Affiliation(s)
- Ciro Celsa
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, W120HS London, UK; Gastroenterology and Hepatology Unit, Department of Health Promotion, Mother & Child Care, Internal Medicine & Medical Specialties, University of Palermo, Italy
| | - Giuseppe Cabibbo
- Gastroenterology and Hepatology Unit, Department of Health Promotion, Mother & Child Care, Internal Medicine & Medical Specialties, University of Palermo, Italy
| | - Claudia A M Fulgenzi
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, W120HS London, UK; Operative Research Unit of Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
| | - Bernhard Scheiner
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, W120HS London, UK; Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Antonio D'Alessio
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, W120HS London, UK; Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Giulia F Manfredi
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, W120HS London, UK; Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Naoshi Nishida
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Celina Ang
- Department of Medicine, Division of Hematology/Oncology, Tisch Cancer Institute, Mount Sinai Hospital, New York, NY, USA
| | - Thomas U Marron
- Department of Medicine, Division of Hematology/Oncology, Tisch Cancer Institute, Mount Sinai Hospital, New York, NY, USA
| | - Anwaar Saeed
- Department of Medicine, Division of Hematology & Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Brooke Wietharn
- Department of Medicine, Division of Medical Oncology, Kansas University Cancer Center, Kansas City, Kansas, USA
| | - Matthias Pinter
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Jaekyung Cheon
- Medical Oncology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Yi-Hsiang Huang
- Healthcare and Services Center, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Gastroenterology and Hepatology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Pei-Chang Lee
- Division of Gastroenterology and Hepatology, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Samuel Phen
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Anuhya Gampa
- Section of Gastroenterology, Hepatology & Nutrition, the University of Chicago Medicine 5841 S. Maryland Ave, 60637 Chicago, IL, USA
| | - Anjana Pillai
- Unit of Medical Oncology 2, Azienda Ospedaliero- Universitaria Pisana, Pisa, Italy
| | - Caterina Vivaldi
- Scuola Superiore Sant'Anna Pisa, interdisciplinary research center "Health Science", Pisa, Italy
| | - Francesca Salani
- Unit of Medical Oncology 2, Azienda Ospedaliero- Universitaria Pisana, Pisa, Italy; Scuola Superiore Sant'Anna Pisa, interdisciplinary research center "Health Science", Pisa, Italy
| | - Gianluca Masi
- Unit of Medical Oncology 2, Azienda Ospedaliero- Universitaria Pisana, Pisa, Italy
| | - Natascha Roehlen
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Robert Thimme
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Arndt Vogel
- Hannover Medical School, Hannover, Germany; Longo Family Chair in Liver Cancer Research, Division of Gastroenterology and Hepatology, Toronto General Hospital, Medical Oncology, Princess Margaret Cancer Centre, Schwartz Reisman Liver Research Centre, Toronto, Canada
| | - Martin Schönlein
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johann von Felden
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kornelius Schulze
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Henning Wege
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter R Galle
- University Medical Center Mainz, Department of Internal Medicine I, Mainz, Germany
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Lorenza Rimassa
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan, Italy; Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Amit G Singal
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Paul El Tomb
- Medical Oncology/TSET Phase 1 Program, Stephenson Cancer Center, University of Oklahoma, Oklahoma City
| | - Susanna Ulahannan
- Medical Oncology/TSET Phase 1 Program, Stephenson Cancer Center, University of Oklahoma, Oklahoma City
| | - Alessandro Parisi
- Department of Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy
| | - Hong Jae Chon
- Medical Oncology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Wei-Fan Hsu
- Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Bernardo Stefanini
- Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Elena Verzoni
- SS. Oncologia Genitourinaria, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | | | - Annamaria Catino
- Medical Thoracic Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Giuseppe Aprile
- Department of Oncology, San Bortolo General Hospital, Vicenza, Italy
| | | | - Marilena Di Napoli
- UC Oncologia Medica Uro-Ginecologica, Istituto Nazionale Tumori "Fondazione G. Pascale", IRCCS, Napoli, Italy
| | - Paola Ermacora
- Dipartimento di Oncologia, Presidio Ospedaliero Universitario Santa Maria della Misericordia, Azienda sanitaria universitaria Integrata Friuli Centrale, Udine, Italy
| | | | - Ernesto Rossi
- Medical Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Fable Zustovich
- UOC Oncologia di Belluno, Dipartimento di Oncologia Clinica, AULSS 1 Dolomiti, Ospedale S.Martino, Belluno, Italy
| | - Corrado Ficorella
- Department of Biotechnological and Applied Clinical Sciences, St Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | | | - Nicola Battelli
- UOC Oncologia, Ospedale Generale Provinciale di Macerata, ASUR Marche Area Vasta 3, Macerata, Italy
| | - Giorgia Negrini
- Medical Oncology Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Francesco Grossi
- Medical Oncology Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Stefania Pipitone
- Medical Oncology Unit, University Hospital of Modena e Reggio Emilia, Italy
| | - Maria Banzi
- Medical Oncology Unit, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | | | - Letizia Laera
- Medical Oncology, Ospedale Generale Regionale F Miulli, Acquaviva delle Fonti, Puglia, Italy
| | - Antonio Russo
- Dipartimento di Discipline Chirurgiche, Oncologiche e Stomatologiche, Università degli Studi di Palermo, Palermo, Italy
| | - Ugo De Giorgi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | | | - Mariella Sorarù
- Medical Oncology, Camposampiero Hospital, AULSS 6 Euganea, Padova, Italy
| | - Vincenzo Montesarchio
- UOC Oncologia, Ospedale Monaldi, Azienda Ospedaliera Specialistica dei Colli, Napoli, Italy
| | - Paola Bordi
- Medical Oncology Unit, Medicine and Surgery Department, University of Parma, Parma, Italy
| | - Leonardo Brunetti
- Operative Research Unit of Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
| | - Carmine Pinto
- Medical Oncology Unit, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Melissa Bersanelli
- Medical Oncology Unit, Medicine and Surgery Department, University of Parma, Parma, Italy
| | - Calogero Cammà
- Gastroenterology and Hepatology Unit, Department of Health Promotion, Mother & Child Care, Internal Medicine & Medical Specialties, University of Palermo, Italy
| | - Alessio Cortellini
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, W120HS London, UK; Operative Research Unit of Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
| | - David J Pinato
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, W120HS London, UK; Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy.
| |
Collapse
|
2
|
Bersanelli M, Verzoni E, Cortellini A, Giusti R, Calvetti L, Ermacora P, Di Napoli M, Catino A, Guadalupi V, Guaitoli G, Scotti V, Mazzoni F, Veccia A, Guglielmini PF, Perrone F, Maruzzo M, Rossi E, Casadei C, Montesarchio V, Grossi F, Rizzo M, Travagliato Liboria MG, Mencoboni M, Zustovich F, Fratino L, Accettura C, Cinieri S, Camerini A, Sorarù M, Zucali PA, Ricciardi S, Russo A, Negrini G, Banzi MC, Lacidogna G, Fornarini G, Laera L, Mucciarini C, Santoni M, Mosillo C, Bonetti A, Longo L, Sartori D, Baldini E, Guida M, Iannopollo M, Bordonaro R, Morelli MF, Tagliaferri P, Spada M, Ceribelli A, Silva RR, Nolè F, Beretta G, Giovanis P, Santini D, Luzi Fedeli S, Nanni O, Maiello E, Labianca R, Pinto C, Clemente A, Tognetto M, De Giorgi U, Pignata S, Di Maio M, Buti S, Giannarelli D. Impact of influenza vaccination on survival of patients with advanced cancer receiving immune checkpoint inhibitors (INVIDIa-2): final results of the multicentre, prospective, observational study. EClinicalMedicine 2023; 61:102044. [PMID: 37434748 PMCID: PMC10331809 DOI: 10.1016/j.eclinm.2023.102044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/24/2023] [Accepted: 05/30/2023] [Indexed: 07/13/2023] Open
Abstract
Background The prospective multicentre observational INVIDIa-2 study investigated the clinical effectiveness of influenza vaccination in patients with advanced cancer receiving immune checkpoint inhibitors (ICI). In this secondary analysis of the original trial, we aimed to assess the outcomes of patients to immunotherapy based on vaccine administration. Methods The original study enrolled patients with advanced solid tumours receiving ICI at 82 Italian Oncology Units from Oct 1, 2019, to Jan 31, 2020. The trial's primary endpoint was the time-adjusted incidence of influenza-like illness (ILI) until April 30, 2020, the results of which were reported previously. Secondary endpoints (data cut-off Jan 31, 2022) included the outcomes of patients to immunotherapy based on vaccine administration, for which the final results are reported herein. A propensity score matching by age, sex, performance status, primary tumour site, comorbidities, and smoking habits was planned for the present analysis. Only patients with available data for these variables were included. The outcomes of interest were overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and disease-control rate (DCR). Findings The original study population consisted of 1188 evaluable patients. After a propensity score matching, 1004 patients were considered (502 vaccinated and 502 unvaccinated), and 986 of them were evaluable for overall survival (OS). At the median follow-up of 20 months, the influenza vaccination demonstrated a favourable impact on the outcome receiving ICI in terms of median OS [27.0 months (CI 19.5-34.6) in vaccinated vs. 20.9 months (16.6-25.2) in unvaccinated, p = 0.003], median progression-free survival [12.5 months (CI 10.4-14.6) vs. 9.6 months (CI 7.9-11.4), p = 0.049], and disease-control rate (74.7% vs. 66.5%, p = 0.005). The multivariable analyses confirmed the favourable impact of influenza vaccination in terms of OS (HR 0.75, 95% C.I. 0.62-0.92; p = 0.005) and DCR (OR 1.47, 95% C.I. 1.11-1.96; p = 0.007). Interpretation The INVIDIa-2 study results suggest a favourable immunological impact of influenza vaccination on the outcome of cancer patients receiving ICI immunotherapy, further encouraging the vaccine recommendation in this population and supporting translational investigations about the possible synergy between antiviral and antitumour immunity. Funding The Federation of Italian Cooperative Oncology Groups (FICOG), Roche S.p.A., and Seqirus.
Collapse
Affiliation(s)
| | - Elena Verzoni
- SS.Oncologia Genitourinaria, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Alessio Cortellini
- Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
- Department of Surgery and Cancer, Hammersmith Hospital Campus, Imperial College London, London, UK
| | - Raffaele Giusti
- Medical Oncology Unit, Azienda Ospedaliero-Universitaria Sant’Andrea, Roma, Italy
| | - Lorenzo Calvetti
- Department of Oncology, San Bortolo General Hospital, Unità Locale Socio-Sanitaria (ULSS)8 Berica, Vicenza, Italy
| | - Paola Ermacora
- Dipartimento di Oncologia, Presidio Ospedaliero Universitario Santa Maria della Misericordia, Azienda Sanitaria Universitaria Integrata Friuli Centrale, Udine, Italy
| | - Marilena Di Napoli
- Department of Uro Gynecological Oncology, Istituto Nazionale dei Tumori IRCCS Fondazione G. Pascale, Napoli, Italy
| | - Annamaria Catino
- Medical Thoracic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari, Italy
| | - Valentina Guadalupi
- SS.Oncologia Genitourinaria, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Giorgia Guaitoli
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Vieri Scotti
- SODc Radioterapia Oncologica, DAI Oncologia, AOU Careggi, Firenze, Italy
| | | | | | | | - Fabiana Perrone
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Marco Maruzzo
- Oncologia Medica 1, Dipartimento di Oncologia, Istituto Oncologico Veneto IOV–IRCCS, Padova, Italy
| | - Ernesto Rossi
- Medical Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Chiara Casadei
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Vincenzo Montesarchio
- U.O.C. Oncologia, Azienda Ospedaliera Specialistica dei Colli, Ospedale Monaldi, Napoli, Italy
| | - Francesco Grossi
- Università degli Studi dell’Insubria, ASST dei Sette Laghi, Varese, Italy
| | - Mimma Rizzo
- Oncologia Traslazionale, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | | | - Manlio Mencoboni
- SSD Oncologia, Villa Scassi Hospital, ASL3 Regione Liguria, Genova, Italy
| | | | | | | | - Saverio Cinieri
- Medical Oncology Division and Breast Unit, Senatore Antonio Perrino Hospital, ASL Brindisi, Brindisi, Italy
| | - Andrea Camerini
- Medical Oncology, Versilia Hospital - Azienda USL Toscana Nord Ovest, Lido di Camaiore, Italy
| | - Mariella Sorarù
- Medical Oncology, Camposampiero Hospital, ULSS 6 Euganea, Padova, Italy
| | - Paolo Andrea Zucali
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Oncology, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | - Serena Ricciardi
- UOSD Pneumologia Oncologica, Az. Ospedal. San Camillo Forlanini, Roma, Italy
| | - Antonio Russo
- Section of Medical Oncology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Giorgia Negrini
- Oncologia Medica, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Maria Chiara Banzi
- Medical Oncology, Comprehensive Cancer Centre, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Gaetano Lacidogna
- Department of Oncology, University of Turin, Turin, Italy
- Medical Oncology, AO Ordine Mauriziano, Turin, Italy
| | - Giuseppe Fornarini
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Letizia Laera
- UOC di Oncologia e Oncoematologia Ente Ecclesiastico Ospedale Generale Regionale “Miulli” Acquaviva delle Fonti (BA), Italy
| | | | - Matteo Santoni
- UOC Oncologia, Ospedale Generale Provinciale di Macerata, ASUR Marche Area Vasta 3, Macerata, Italy
| | - Claudia Mosillo
- Department of Oncology, Medical & Translational Oncology, Azienda Ospedaliera Santa Maria, Terni, Italy
| | - Andrea Bonetti
- Department of Oncology, Mater Salutis Hospital, Verona, Legnago, Italy
| | - Lucia Longo
- UOSD Oncologia Area Sud Azienda AUSL Modena, Sassuolo (MO), Italy
| | | | | | - Michele Guida
- Rare Tumors and Melanoma Unit, IRCCS Istituto dei Tumori “Giovanni Paolo II”, Bari, Italy
| | - Mauro Iannopollo
- SOC Oncologia, Dipartimento di Oncologia, Azienda Usl Toscana Centro, Presidio Ospedaliero SS. Cosma e Damiano - Pescia e San Jacopo, Pistoia, Italy
| | | | | | | | - Massimiliano Spada
- UOC Oncologia, Fondazione Istituto G. Giglio - C.da Pietrapollastra-Pisciotto SNC, Cefalù (PA), Italy
| | - Anna Ceribelli
- Department of Oncology, San Camillo De Lellis Hospital, Rieti, Italy
| | - Rosa Rita Silva
- Medical Oncology, ASUR Marche, Area Vasta 2, Fabriano, Italy
| | - Franco Nolè
- Medical Oncology Division of Urogenital and Head & Neck Tumours IEO, European Institute of Oncology IRCCS, Milano, Italy
| | | | - Petros Giovanis
- UOC Oncologia, Ospedale Santa Maria del Prato, Feltre, AULSS1 Dolomiti, Feltre, Italy
| | - Daniele Santini
- Oncologia Medica A, Policlinico Umberto 1, La Sapienza Università di Roma, Romaa, Italy
| | - Stefano Luzi Fedeli
- Department of Medical Oncology, AOU Ospedali Riuniti, Presidio San Salvatore, Pesaro, Italy
| | - Oriana Nanni
- Biostatistics and Clinical Research Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Evaristo Maiello
- Department of Oncology, Fondazione “Casa Sollievo della Sofferenza” IRCCS Hospital, San Giovanni Rotondo, Italy
- Federation of Italian Cooperative Oncology Groups (FICOG), Milan, Italy
| | - Roberto Labianca
- Federation of Italian Cooperative Oncology Groups (FICOG), Milan, Italy
- Medical Oncology Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Carmine Pinto
- Medical Oncology, Comprehensive Cancer Centre, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Federation of Italian Cooperative Oncology Groups (FICOG), Milan, Italy
| | - Alberto Clemente
- Federation of Italian Cooperative Oncology Groups (FICOG), Milan, Italy
| | - Michele Tognetto
- Federation of Italian Cooperative Oncology Groups (FICOG), Milan, Italy
| | - Ugo De Giorgi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
- Federation of Italian Cooperative Oncology Groups (FICOG), Milan, Italy
| | - Sandro Pignata
- Department of Uro Gynecological Oncology, Istituto Nazionale dei Tumori IRCCS Fondazione G. Pascale, Napoli, Italy
- Federation of Italian Cooperative Oncology Groups (FICOG), Milan, Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin, Turin, Italy
- Medical Oncology, AO Ordine Mauriziano, Turin, Italy
| | - Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
- Medicine and Surgery Department, University of Parma, Parma, Italy
| | - Diana Giannarelli
- Facility of Epidemiology & Biostatistics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | | |
Collapse
|
3
|
Bersanelli M, Giannarelli D, De Giorgi U, Pignata S, Di Maio M, Clemente A, Verzoni E, Giusti R, Di Napoli M, Aprile G, Ermacora P, Catino A, Scotti V, Mazzoni F, Guglielmini PF, Veccia A, Maruzzo M, Rossi E, Grossi F, Casadei C, Ficorella C, Montesarchio V, Verderame F, Rizzo M, Guaitoli G, Fratino L, Accettura C, Mencoboni M, Zustovich F, Baldessari C, Cinieri S, Camerini A, Laera L, Sorarù M, Zucali PA, Guadalupi V, Leonardi F, Tiseo M, Tognetto M, Di Costanzo F, Pinto C, Negrini G, Russo A, Migliorino MR, Filetti M, Buti S. INfluenza Vaccine Indication During therapy with Immune checkpoint inhibitors: a multicenter prospective observational study (INVIDIa-2). J Immunother Cancer 2021; 9:jitc-2021-002619. [PMID: 34016723 PMCID: PMC8141439 DOI: 10.1136/jitc-2021-002619] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2021] [Indexed: 01/03/2023] Open
Abstract
Background Until now, no robust data supported the efficacy, safety and recommendation for influenza vaccination in patients with cancer receiving immune checkpoint inhibitors (ICIs). Methods The prospective multicenter observational INfluenza Vaccine Indication During therapy with Immune checkpoint inhibitors (INVIDIa-2) study investigated the clinical effectiveness of influenza vaccination in patients with advanced cancer receiving ICIs, enrolled in 82 Italian centers from October 2019 to January 2020. The primary endpoint was the time-adjusted incidence of influenza-like illness (ILI) until April 30, 2020. Secondary endpoints regarded ILI severity and vaccine safety. Results The study enrolled 1279 patients; 1188 patients were evaluable for the primary endpoint analysis. Of them, 48.9% (581) received influenza vaccination. The overall ILI incidence was 8.2% (98 patients). Vaccinated patients were significantly more frequently elderly (p<0.0001), males (p=0.004), with poor European Cooperative Oncology Group performance status (p=0.009), affected by lung cancer (p=0.01), and by other non-cancer comorbidities (p<0.0001) when compared with unvaccinated. ILI incidence was not different basing on influenza vaccination: the time-to-ILI was similar in vaccinated and unvaccinated patients (p=0.62). ILI complications were significantly less frequent for patients receiving the vaccination (11.8% vs 38.3% in unvaccinated, p=0.002). ILI-related intravenous therapies were significantly less frequent in vaccinated patients than in unvaccinated (11.8% vs 29.8%, p=0.027). ILI lethality was, respectively, 0% in vaccinated and 4.3% in unvaccinated patients. Vaccine-related adverse events were rare and mild (1.5%, grades 1–2). Conclusion The INVIDIa-2 study results support a positive recommendation for influenza vaccination in patients with advanced cancer receiving immunotherapy.
Collapse
Affiliation(s)
- Melissa Bersanelli
- Medicine and Surgery Department, University of Parma, Parma, Italy .,Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Diana Giannarelli
- Biostatistical Unit, Regina Elena National Cancer Institute, IRCCS, Rome, Italy
| | - Ugo De Giorgi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Sandro Pignata
- UC Oncologia Medica Uro-Ginecologica, Istituto Nazionale Tumori "Fondazione G. Pascale", IRCCS, Napoli, Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin, Torino, Italy.,Medical Oncology, Azienda Ospedaliera Ordine Mauriziano di Torino, Torino, Italy
| | - Alberto Clemente
- Biostatistics and Clinical Research Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Elena Verzoni
- SS.Oncologia Genitourinaria, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | - Marilena Di Napoli
- UC Oncologia Medica Uro-Ginecologica, Istituto Nazionale Tumori "Fondazione G. Pascale", IRCCS, Napoli, Italy
| | - Giuseppe Aprile
- Department of Oncology, San Bortolo General Hospital, Vicenza, Italy
| | - Paola Ermacora
- Dipartimento di Oncologia, Presidio Ospedaliero Universitario Santa Maria della Misericordia, Azienda sanitaria universitaria integrata Friuli Centrale, Udine, Italy
| | - Annamaria Catino
- Medical Thoracic Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Vieri Scotti
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | | | | | | | - Marco Maruzzo
- Oncologia Medica 1, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - Ernesto Rossi
- Medical Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Grossi
- Medical Oncology Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Casadei
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Corrado Ficorella
- Department of Biotechnological and Applied Clinical Sciences, St Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | - Vincenzo Montesarchio
- UOC Oncologia, Azienda Ospedaliera Specialistica dei Colli, Ospedale Monaldi, Napoli, Italy
| | | | - Mimma Rizzo
- Oncologia Traslazionale, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Giorgia Guaitoli
- Medical Oncology Unit, Universita degli Studi di Modena e Reggio Emilia, Modena, Italy
| | - Lucia Fratino
- Medical Oncology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | | | | | - Fable Zustovich
- UOC Oncologia di Belluno, Dipartimento di Oncologia Clinica, AULSS 1 Dolomiti, Ospedale S.Martino, Belluno, Italy
| | - Cinzia Baldessari
- Medical Oncology Unit, Universita degli Studi di Modena e Reggio Emilia, Modena, Italy
| | - Saverio Cinieri
- Medical Oncology Division and Breast Unit, Senatore Antonio Perrino Hospital, Brindisi, Italy
| | - Andrea Camerini
- Oncologia Medica, Ospedale della Versilia, Lido di Camaiore, Italy
| | - Letizia Laera
- Medical Oncology, Ospedale Generale Regionale F Miulli, Acquaviva delle Fonti, Puglia, Italy
| | - Mariella Sorarù
- Medical Oncology, Camposampiero Hospital, ULSS 6 Euganea, Padova, Italy
| | - Paolo Andrea Zucali
- Department of Oncology, Humanitas Clinical and Research Center, IRCCS, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Valentina Guadalupi
- UC Oncologia Medica Uro-Ginecologica, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | - Marcello Tiseo
- Medicine and Surgery Department, University of Parma, Parma, Italy.,Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Michele Tognetto
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | | | - Carmine Pinto
- Medical Oncology Unit, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy.,Presidency of the Federation of Italian Cooperative Oncology Groups (FICOG), Milan, Italy
| | | | - Antonio Russo
- Dipartimento di Discipline Chirurgiche, Oncologiche e Stomatologiche, Università degli Studi di Palermo, Palermo, Italy
| | | | - Marco Filetti
- Department of Clinical and Molecular Medicine, Oncology Unit, Sant'Andrea Hospital, Sapienza University of Rome, Roma, Italy
| | - Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | | |
Collapse
|
4
|
Zambelli A, Chiudinelli L, Fotia V, Negrini G, Bosetti T, Callegaro A, Di Croce A, Caremoli ER, Moro C, Milesi L, Poletti P, Tasca C, Mandalà M, Merelli B, Mosconi S, Arnoldi E, Bettini A, Bonomi L, Messina C, Ghilardi L, Chirco A, Maracino M, Tondini C. Prevalence and Clinical Impact of SARS-CoV-2 Silent Carriers Among Actively Treated Patients with Cancer During the COVID-19 Pandemic. Oncologist 2021; 26:341-347. [PMID: 33355953 PMCID: PMC8018331 DOI: 10.1002/onco.13654] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 07/03/2020] [Accepted: 12/09/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION In Europe, the SARS-CoV-2 pandemic had its first epicenter in Italy. Despite a significant mortality rate, the severity of most cases of COVID-19 infection ranges from asymptomatic to mildly symptomatic, and silent infection affects a still-unknown proportion of the general population. No information is available on the prevalence and clinical impact of SARS-CoV-2 silent infection among patients with cancer receiving anticancer treatment during the pandemic. MATERIALS AND METHODS From April 1, 2020, to the end of the same month, 560 consecutive patients with cancer, asymptomatic for COVID-19 and on anticancer treatment at Papa Giovanni XXIII Hospital in Bergamo, were evaluated and tested for SARS-CoV-2. We implemented a two-step diagnostics, including the rapid serological immunoassay for anti-SARS-CoV-2 immunoglobulin (Ig) G/IgM and the nasopharyngeal swab reverse transcriptase-polymerase chain reaction (RT-PCR) test in case of seropositivity to identify SARS-CoV-2 silent carriers. RESULTS In 560 patients, 172 (31%) resulted positive for anti-SARS-CoV-2 IgM/IgG antibodies, regardless of different type of cancer, stage, and treatment. The Ig-seropositive patients were then tested with RT-PCR nasopharyngeal swabs, and 38% proved to be SARS-CoV-2 silent carriers. At an early follow-up, in the 97 SARS-CoV-2-seropositive/RT-PCR-negative patients who continued their anticancer therapies, only one developed symptomatic COVID-19 illness. CONCLUSION Among patients with cancer, the two-step diagnostics is feasible and effective for SARS-CoV-2 silent carriers detection and might support optimal cancer treatment strategies at both the individual and the population level. The early safety profile of the different anticancer therapies, in patients previously exposed to SARS-CoV-2, supports the recommendation to continue the active treatment, at least in cases of RT-PCR-negative patients. IMPLICATIONS FOR PRACTICE This is the first study evaluating the prevalence and clinical impact of SARS-CoV-2 silent infection in actively treated patients with cancer, during the epidemic peak in one of the worst areas of the COVID-19 pandemic. Lacking national and international recommendations for the detection of asymptomatic SARS-CoV-2 infection, a pragmatic and effective two-step diagnostics was implemented to ascertain SARS-CoV-2 silent carriers. In this series, consisting of consecutive and unselected patients with cancer, the prevalence of both SARS-CoV-2-seropositive patients and silent carriers is substantial (31% and 10%, respectively). The early safety profile of the different anticancer therapies, in patients previously exposed to SARS-CoV-2, supports the recommendation to continue the active treatment, at least in case of RT-PCR-negative patients.
Collapse
Affiliation(s)
- Alberto Zambelli
- Department of Medical Oncology, Ospedale Papa Giovanni XXIIIBergamoItaly
| | - Lorenzo Chiudinelli
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, LombardyItaly
| | - Vittoria Fotia
- Department of Medical Oncology, Ospedale Papa Giovanni XXIIIBergamoItaly
| | - Giorgia Negrini
- Department of Medical Oncology, Ospedale Papa Giovanni XXIIIBergamoItaly
| | - Tommaso Bosetti
- Department of Medical Oncology, Ospedale Papa Giovanni XXIIIBergamoItaly
| | | | - Andrea Di Croce
- Department of Medical Oncology, Ospedale Papa Giovanni XXIIIBergamoItaly
| | | | - Cecilia Moro
- Department of Medical Oncology, Ospedale Papa Giovanni XXIIIBergamoItaly
| | - Laura Milesi
- Department of Medical Oncology, Ospedale Papa Giovanni XXIIIBergamoItaly
| | - Paola Poletti
- Department of Medical Oncology, Ospedale Papa Giovanni XXIIIBergamoItaly
| | - Cristina Tasca
- Department of Medical Oncology, Ospedale Papa Giovanni XXIIIBergamoItaly
| | - Mario Mandalà
- Department of Medical Oncology, Ospedale Papa Giovanni XXIIIBergamoItaly
| | - Barbara Merelli
- Department of Medical Oncology, Ospedale Papa Giovanni XXIIIBergamoItaly
| | - Stefania Mosconi
- Department of Medical Oncology, Ospedale Papa Giovanni XXIIIBergamoItaly
| | | | - Anna Bettini
- Department of Medical Oncology, Ospedale Papa Giovanni XXIIIBergamoItaly
| | - Lucia Bonomi
- Department of Medical Oncology, Ospedale Papa Giovanni XXIIIBergamoItaly
| | - Caterina Messina
- Department of Medical Oncology, Ospedale Papa Giovanni XXIIIBergamoItaly
| | | | | | - Michela Maracino
- Department of Medical Oncology, Ospedale Papa Giovanni XXIIIBergamoItaly
| | - Carlo Tondini
- Department of Medical Oncology, Ospedale Papa Giovanni XXIIIBergamoItaly
| |
Collapse
|
5
|
Mandala M, Lorigan P, De Luca M, Bianchetti A, Merelli B, Bettini AC, Bonomi L, Nahm S, Vitale MG, Negrini G, Di Croce A, Ascierto PA, Rulli E, Tondini CA. SARS-CoV-2 infection and adverse events in patients with cancer receiving immune checkpoint inhibitors: an observational prospective study. J Immunother Cancer 2021; 9:jitc-2020-001694. [PMID: 33593827 PMCID: PMC7887862 DOI: 10.1136/jitc-2020-001694] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In ambulatory patients with cancer with asymptomatic or pauci-symptomatic SARS-CoV-2 infection, the safety of targeted therapies (TTs), chemotherapy (CT) or immune checkpoint inhibitors (ICIs) therapy is still unknown. MATERIAL AND METHODS From the start of the first epidemic wave of SARS-CoV-2 in Bergamo, Italy, we have prospectively screened all consecutive outpatients who presented for treatment to the Oncology Division of the Papa Giovanni XXIII Hospital, Bergamo for SARS-CoV-2 antigen expression. We identified patients treated with ICIs and compared these to patients with the same cancer subtypes treated with TTs or CT. RESULTS Between March 5 and May 18, 293 consecutive patients (49% melanoma, 34% non-small cell lung cancer, 9% renal cell carcinoma, 8% other) were included in this study: 159 (54%), 50 (17%) and 84 (29%) received ICIs, CT or TTs, respectively. Overall 89 patients (30.0%) were SARS-CoV-2 positive. Mortality of SARS-CoV-2-positive patients was statistically significantly higher compared with SARS-CoV-2 negative patients (8/89 vs 3/204, respectively, Fisher's exact test p=0.004). All deaths were due to COVID-19. Serious adverse events (SAEs) were more frequent in SARS-CoV-2-positive patients compared with SARS-CoV-2-negative cases (Cochran-Mantel-Haenszel (CMH) test p=0.0008). The incidence of SAEs in SARS-CoV-2 positive compared with SARS-CoV-2 negative patients was similar in ICI and CT patients (17.3% and 3.7% for positive and negative patients in ICIs and 15.4% and 2.7% in CT, Breslow-Day test p=0.891). No COVID-19-related SAEs were observed in the TTs patients. CONCLUSIONS The incidence of SAEs was higher for SARS-CoV-2-positive patients treated with ICIs and CT, mostly in advanced disease. No SAEs were observed in patients treated with TTs. SAEs were COVID-19 related rather than treatment related. Treatment with ICIs does not appear to significantly increase risk of SAEs compared with CT. This information should be considered when determining treatment options for patients.
Collapse
Affiliation(s)
- Mario Mandala
- Unit of Medical Oncology, University of Perugia, Perugia, Italy
| | - Paul Lorigan
- Medical Oncology-Melanoma, The Christie Hospital NHS Trust, Manchester, UK.,Division of cancer sciences, The University of Manchester, Manchester, UK
| | - Matilde De Luca
- Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Lombardia, Italy
| | - Andrea Bianchetti
- Oncology, Fondazione per la Ricerca Ospedale Maggiore, Bergamo, Italy
| | - Barbara Merelli
- Unit of Medical Oncology, Department of Oncology and Hematology, ASST Papa Giovanni XXIII, Bergamo, Lombardia, Italy
| | - Anna Cecilia Bettini
- Oncology, Department of Oncology and Hematology, ASST Papa Giovanni XXIII, Bergamo, Lombardia, Italy
| | - Lucia Bonomi
- Oncology, Department of Oncology and Hematology, ASST Papa Giovanni XXIII, Bergamo, Lombardia, Italy
| | - Sharon Nahm
- Medical Oncology-Melanoma, The Christie Hospital NHS Trust, Manchester, UK
| | - Maria Grazia Vitale
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Giorgia Negrini
- Oncology, Department of Oncology and Hematology, ASST Papa Giovanni XXIII, Bergamo, Lombardia, Italy
| | - Andrea Di Croce
- Unit of Medical Oncology, Department of Oncology and Hematology, ASST Papa Giovanni XXIII, Bergamo, Lombardia, Italy
| | - Paolo Antonio Ascierto
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Eliana Rulli
- Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Lombardia, Italy
| | - Carlo Alberto Tondini
- Unit of Medical Oncology, Department of Oncology and Hematology, ASST Papa Giovanni XXIII, Bergamo, Lombardia, Italy
| |
Collapse
|
6
|
Bersanelli M, Giannarelli D, De Giorgi U, Pignata S, Di Maio M, Verzoni E, Clemente A, Guadalupi V, Signorelli D, Tiseo M, Giusti R, Filetti M, Di Napoli M, Calvetti L, Cappetta A, Ermacora P, Zara D, Barbieri F, Baldessari C, Scotti V, Mazzoni F, Veccia A, Guglielmini PF, Maruzzo M, Rossi E, Grossi F, Casadei C, Cortellini A, Verderame F, Montesarchio V, Rizzo M, Mencoboni M, Zustovich F, Fratino L, Cinieri S, Negrini G, Banzi M, Sorarù M, Zucali PA, Lacidogna G, Russo A, Battelli N, Fornarini G, Mucciarini C, Bracarda S, Bonetti A, Pezzuolo D, Longo L, Sartori D, Iannopollo M, Cavanna L, Meriggi F, Tassinari D, Corbo C, Gernone A, Prati V, Carnio S, Giordano P, Dicorato AM, Verusio C, Atzori F, Carrozza F, Gori S, Castro A, Pilotto S, Vaccaro V, Garzoli E, Di Costanzo F, Maiello E, Labianca R, Pinto C, Tognetto M, Buti S. Symptomatic COVID-19 in advanced-cancer patients treated with immune-checkpoint inhibitors: prospective analysis from a multicentre observational trial by FICOG. Ther Adv Med Oncol 2020; 12:1758835920968463. [PMID: 33224275 PMCID: PMC7649863 DOI: 10.1177/1758835920968463] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 08/05/2020] [Accepted: 10/02/2020] [Indexed: 12/30/2022] Open
Abstract
Background This prospective, multicentre, observational INVIDIa-2 study is investigating the clinical efficacy of influenza vaccination in advanced-cancer patients receiving immune-checkpoint inhibitors (ICIs), enrolled in 82 Italian centres, from October 2019 to January 2020. The primary endpoint was the incidence of influenza-like illness (ILI) until 30 April 2020. All the ILI episodes, laboratory tests, complications, hospitalizations and pneumonitis were recorded. Therefore, the study prospectively recorded all the COVID-19 ILI events. Patients and methods Patients were included in this non-prespecified COVID-19 analysis, if alive on 31 January 2020, when the Italian government declared the national emergency. The prevalence of confirmed COVID-19 cases was detected as ILI episode with laboratory confirmation of SARS-CoV-2. Cases with clinical-radiological diagnosis of COVID-19 (COVID-like ILIs), were also reported. Results Out of 1257 enrolled patients, 955 matched the inclusion criteria for this unplanned analysis. From 31 January to 30 April 2020, 66 patients had ILI: 9 of 955 cases were confirmed COVID-19 ILIs, with prevalence of 0.9% [95% confidence interval (CI): 0.3-2.4], a hospitalization rate of 100% and a mortality rate of 77.8%. Including 5 COVID-like ILIs, the overall COVID-19 prevalence was 1.5% (95% CI: 0.5-3.1), with 100% hospitalization and 64% mortality. The presence of elderly, males and comorbidities was significantly higher among patients vaccinated against influenza versus unvaccinated (p = 0.009, p < 0.0001, p < 0.0001). Overall COVID-19 prevalence was 1.2% for vaccinated (six of 482 cases, all confirmed) and 1.7% for unvaccinated (8 of 473, 3 confirmed COVID-19 and 5 COVID-like), p = 0.52. The difference remained non-significant, considering confirmed COVID-19 only (p = 0.33). Conclusion COVID-19 has a meaningful clinical impact on the cancer-patient population receiving ICIs, with high prevalence, hospitalization and an alarming mortality rate among symptomatic cases. Influenza vaccination does not protect from SARS-CoV-2 infection.
Collapse
Affiliation(s)
- Melissa Bersanelli
- Medicine and Surgery Department, University of Parma, and Medical Oncology Unit, University Hospital of Parma, Via Gramsci 14, Parma 43126, Italy
| | - Diana Giannarelli
- Biostatistical Unit, Regina Elena National Cancer Institute, IRCCS, Rome, Lazio, Italy
| | - Ugo De Giorgi
- Istituto Scientifico Romagnolo per lo Studio e la Cura de Tumori (IRST) IRCCS, Meldola, Italy
| | - Sandro Pignata
- Dipartimento Corp-S Assistenziale dei Percorsi Oncologici Uro-Genitale, SSD Oncologia Clinica Sperimentale Uro-Andrologica, Istituto Nazionale Tumori 'Fondazione G. Pascale', IRCCS, Napoli, Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin and Medical Oncology, AO Ordine Mauriziano, Turin, Italy
| | - Elena Verzoni
- SS Oncologia Genitourinaria, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Alberto Clemente
- Biostatistics and Clinical Research Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Valentina Guadalupi
- SS Oncologia Genitourinaria, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Diego Signorelli
- Thoracic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori of Milan, Milano, Italy
| | - Marcello Tiseo
- Medicine and Surgery Department, University of Parma, Parma, Italy
| | - Raffaele Giusti
- Medical Oncology Unit, Azienda Ospedaliero-Universitaria Sant'Andrea, Roma, Italy
| | - Marco Filetti
- Medical Oncology Unit, Azienda Ospedaliero-Universitaria Sant'Andrea - Sapienza Facoltà di Medicina e Psicologia, Roma, Italy
| | - Marilena Di Napoli
- Dipartimento Corp-S Assistenziale dei Percorsi Oncologici Uro-Genitale, SSD Oncologia Clinica Sperimentale Uro-Andrologica, Istituto Nazionale Tumori 'Fondazione G. Pascale', IRCCS, Napoli, Italy
| | - Lorenzo Calvetti
- Department of Oncology, San Bortolo General Hospital, Unità Locale Socio-Sanitaria (ULSS) 8 Berica-East District, Vicenza, Italy
| | - Alessandro Cappetta
- Department of Oncology, San Bortolo General Hospital, Unità Locale Socio-Sanitaria (ULSS) 8 Berica-East District, Vicenza, Italy
| | - Paola Ermacora
- Dipartimento di Oncologia, Presidio Ospedaliero Universitario Santa Maria della Misericordia, Azienda sanitaria universitaria integrata Friuli Centrale, Udine, Italy
| | - Diego Zara
- Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Fausto Barbieri
- Medical Oncology Unit, University Hospital of Modena, Modena, Italy
| | | | - Vieri Scotti
- Oncology Department, Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | | | | | | | - Marco Maruzzo
- Oncologia Medica 1, Istituto Oncologico Veneto IOV-IRCCS, Padova
| | - Ernesto Rossi
- Medical Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Francesco Grossi
- Department of Medical Oncology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Chiara Casadei
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Alessio Cortellini
- Department of Biotechnological and Applied Clinical Sciences, St. Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | | | - Vincenzo Montesarchio
- UOC Oncologia, Ospedale Monaldi, Azienda Ospedaliera Specialistica dei Colli, Napoli, Italy
| | - Mimma Rizzo
- Oncologia Traslazionale, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | | | - Fable Zustovich
- UOC Oncologia di Belluno, Dipartimento di Oncologia Clinica, AULSS 1 Dolomiti, Ospedale S. Martino, Belluno, Italy
| | - Lucia Fratino
- Dipartimento di Oncologia Medica, Centro di Riferimento Oncologico di Aviano, Pordenone, Italy
| | - Saverio Cinieri
- Medical Oncology Division and Breast Unit, Senatore Antonio Perrino Hospital, ASL Brindisi, Brindisi, Italy
| | - Giorgia Negrini
- Oncologia Medica, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Maria Banzi
- Medical Oncology Unit, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Mariella Sorarù
- Medical Oncology, Camposampiero Hospital, USSL15 Alta Padovana, Padova, Italy
| | - Paolo Andrea Zucali
- Department of Oncology, Humanitas Clinical and Research Centre, IRCCS, Rozzano, Milan, Italy, and Humanitas University, Department of Biomedical Sciences, Milan, Italy
| | | | - Antonio Russo
- Dipartimento di Discipline Chirurgiche, Oncologiche e Stomatologiche, Università degli Studi di Palermo, Palermo, Italy
| | - Nicola Battelli
- UOC Oncologia, Ospedale Generale Provinciale di Macerata, ASUR Marche Area Vasta 3, Macerata, Italy
| | - Giuseppe Fornarini
- Medical Oncology Unit 1, IRCCS Policlinico San Martino Hospital, Genova, Italy
| | | | - Sergio Bracarda
- Struttura Complessa di Oncologia Medica e Traslazionale, Azienda Ospedaliera Santa Maria di Terni, Italy
| | - Andrea Bonetti
- Department of Oncology, Mater Salutis Hospital, Legnago, Verona
| | - Debora Pezzuolo
- Medicina oncologica, Ospedale di Guastalla e Correggio, Area Nord, Reggio Emilia, Italy
| | - Lucia Longo
- Unità operativa di Oncologia, Ospedale di Sassuolo, Area Sud dell'Azienda USL di Modena, Sassuolo, Modena, Italy
| | - Donata Sartori
- Oncologia Dolo-Mirano, AULSS3 Serenissima, Mestre, Venezia, Italy
| | - Mauro Iannopollo
- Medical Oncology Unit, Dip. Oncology, St Jacopo Hospital, Azienda USL Toscana Centro, Pistoia, Italy
| | | | - Fausto Meriggi
- Oncologia Medica, Fondazione Poliambulanza, Istituto Ospedaliero, Brescia, Italy
| | | | - Claudia Corbo
- UO di Oncologia, Ospedale Sacro Cuore di Gesù, Fatebenefratelli, Benevento, Italy
| | - Angela Gernone
- UO Oncologia Medica Universitaria, Azienda Ospedaliera Policlinico di Bari, Bari, Italy
| | | | - Simona Carnio
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Italy
| | | | | | - Claudio Verusio
- Oncologia Medica, Presidio Ospedaliero di Saronno, Saronno, Italy
| | - Francesco Atzori
- Medical Oncology, Department of Medical Sciences 'M. Aresu', University Hospital and University of Cagliari, Cagliari, Italy
| | - Francesco Carrozza
- Unità Operativa di Oncologia di Faenza, AUSL Romagna, Faenza, Ravenna, Italy
| | - Stefania Gori
- Medical Oncology Unit, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Antonino Castro
- Struttura semplice dipartimentale di Oncologia, ASST Franciacorta, Chiari, Brescia, Italy
| | - Sara Pilotto
- Section of Oncology, Department of Medicine, University of Verona and Verona University Hospital Trust, Verona, Italy
| | - Vanja Vaccaro
- Oncology Unit 1, Regina Elena National Cancer Institute, IRCCS, Rome, Italy
| | | | | | - Evaristo Maiello
- Medical Oncology, Foundation IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | | | - Carmine Pinto
- Medical Oncology Unit, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | | | - Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| |
Collapse
|
7
|
Negrini G, Ghilardi L, Bonomi L, Arnoldi E, Tondini C, Sansi C, Bettini A. Evaluation of the correlation between diverticulosis and the onset of diarrhea in patients with lung cancer treated with immune checkpoint inhibitors. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz449.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
8
|
Tovoli F, Negrini G, Farì R, Guidetti E, Faggiano C, Napoli L, Bolondi L, Granito A. Increased risk of nonalcoholic fatty liver disease in patients with coeliac disease on a gluten-free diet: beyond traditional metabolic factors. Aliment Pharmacol Ther 2018; 48:538-546. [PMID: 29984415 DOI: 10.1111/apt.14910] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 04/27/2018] [Accepted: 06/24/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND A gluten-free diet (GFD) is known to be associated with altered macronutrient intake and metabolic syndrome. Nonalcoholic fatty liver disease (NAFLD) is the hepatic hallmark of metabolic syndrome. The risk of NAFLD in patients with coeliac disease (CD) adhering to a GFD remains to be fully investigated; in particular, data from real-life clinical settings are lacking. AIM To assess the prevalence and relative risk of NAFLD in CD patients treated with a GFD. METHODS Case-control study, with prospective enrolment of CD outpatients following a GFD and controls. Patients were matched for demographic characteristics (age and gender) and metabolic risk factors (overweight, diabetes mellitus, total cholesterol, and triglycerides) using a 1:1 ratio. NAFLD was diagnosed according to the European Association for the Study of the Liver criteria. RESULTS 202 CD patients and 202 controls were compared. The raw prevalence of NAFLD was 34.7% and 21.8% in the CD and control group, respectively (P = 0.006). Binary logistic regression confirmed an increased risk of NAFLD in the CD group (adjusted odds ratio = 2.90, 95% confidence interval: 1.64-5.15, P < 0.001). Additionally, the relative risk for NAFLD was notably higher in non-overweight CD patients (adjusted odds ratio = 5.71, 95% confidence interval: 2.30-14.19, P < 0.001). CONCLUSIONS More than one-third of CD patients adhering to a GFD had concurrent NAFLD, accounting for a three-fold increased risk compared to the general population. Dietary advice provided using a patient-tailored approach should assist CD patients with NAFLD in achieving an appropriate nutritional intake whilst reducing the risk of long-term liver-related events.
Collapse
Affiliation(s)
- F Tovoli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - G Negrini
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - R Farì
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - E Guidetti
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - C Faggiano
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - L Napoli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - L Bolondi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - A Granito
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| |
Collapse
|
9
|
Bergamini C, Negrini G, Finzi GF, Pandiani I, Riolo U. [The use of disinfectants in Northern Italy with special attention to the Emilia-Romagna region]. Arch Sci Med (Torino) 1982; 139:353-356. [PMID: 7186411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
As part of an extensive investigation into the use of disinfectants in hospitals, data from 189 hospitals in the north of Italy, including 38 in the Emilia-Romagna region, were examined. Eleven fields of employment were assessed. It was found that benzalkonium chloride was primarily used for disinfection of the operative field, wounds, excoriations, sores, the skin prior to injection, surgical instruments, catheters, thermometers, and utensils. Chlorhexidine was preferred to disinfection of the hands and medical equipment. Formaldehyde was preferred for ambient surfaces, the air of confined spaces, and (in association with chlorine and its derivatives) for sanitary services and vessels. Glutaric aldehyde was preferred for apparatus fitted with lenses or optical fibres. By comparison with other parts of N. Italy. Emilia-Romagna made greater use of hydrogen peroxide for skin lesions, and alcohol for disinfection prior to transcutaneous injections.
Collapse
|
10
|
Finzi GF, Riolo U, Negrini G, Bergamini C, Pandiani I. [Analysis of the use of disinfectants in Italy particularly in Southern Italy]. Arch Sci Med (Torino) 1982; 139:357-60. [PMID: 7181641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
In an investigation of the use of disinfectants in hospitals, the replies received from 338 institutions were analysed and subsequently compared with those obtained from southern Italy. It was found that benzalkonium chloride was the substance most widely used in Italy for disinfection of the surgical field, wounds, excoriations, sores, the skin prior to injections, surgical instruments, medical apparatus, catheters, thermometers and sanitary appliances, whereas chlorhexidine was preferred for disinfection of the hands, and for ambient surfaces in combination with cetrimide. Formic aldehyde was preferred for ambient surfaces, the air of confined spaces, and, in conjunction with chlorine and its derivatives, for sanitary services and their vessels. Glutaraldehyde was the substance most commonly employed for the disinfection of medical apparatus fitted with optic fibre lenses. In southern Italy, by contrast with the position in Italy as a whole, there was a greater use of chlorine and its derivatives for the disinfection of ambient surfaces, benzalkonium chloride for the disinfection and cleaning of sanitary services, vessels, and equipment with optic fibres, and alcohols for the disinfection of surgical instruments and sanitary appliances.
Collapse
|