1
|
Pozzi P, Boffi R, Veronese C, Trussardo S, Valsecchi C, Sabia F, Pastorino U, Apolone G, Cardani E, Tarantini F, Munarini E. Cytisine as a smoking cessation aid: Preliminary observations with a modified therapeutic scheme in real life. Tumori 2024; 110:124-131. [PMID: 38149659 PMCID: PMC11005299 DOI: 10.1177/03008916231216906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 11/06/2023] [Accepted: 11/09/2023] [Indexed: 12/28/2023]
Abstract
INTRODUCTION Cigarette smoke accounts for over 90,000 deaths each year in Italy. Tobacco dependence treatment guidelines suggest adopting an integrated pharmacological-behavioral model of intervention. Cytisine is a partial agonist of nicotinic receptors. Trials conducted to date have demonstrated its good efficacy in promoting smoking cessation. The cytisine scheme of treatment consists of 25 days of treatment. A 40-day regimen, with an escalating dose and an extended duration of the treatment, has been in use in many anti-smoking centers in Italy for several years, but to date there are no reports on the use of cytisine with this scheme. METHODS A retrospective, real-life, observational study was conducted between January 2016 and September 2022. The 300 patients who had received at least one dose of study medication were selected. Continuous variables were compared by the Wilcoxon-Mann-Whitney test. Univariate and multivariate logistic regression models were implemented for self-reported seven-day point prevalence for abstinence at three, six and 12 months. RESULTS The median age of the patients was 59 years, 57% were women. The median smoking exposure was 33.8 pack-years. Self-reported smoking abstinence at three, six and 12 months was 68.7%, 56.3% and 47.3% respectively. 84% completed the cytisine treatment, 31.3% reported adverse events and in 8.3% these led to dropping out of the treatment. CONCLUSION Cytisine, administered with a novel therapeutic scheme in the real-life setting of a specialized anti-smoking center, significantly promotes smoking abstinence. However, more studies are needed to assess the tolerability and efficacy of this new regimen.
Collapse
Affiliation(s)
- Paolo Pozzi
- Pulmonology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Roberto Boffi
- Pulmonology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Chiara Veronese
- Pulmonology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Sara Trussardo
- Department of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Camilla Valsecchi
- Department of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Federica Sabia
- Department of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Ugo Pastorino
- Department of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Giovanni Apolone
- Scientific Directorate, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Elisa Cardani
- Pulmonology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Francesco Tarantini
- Pulmonology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Elena Munarini
- Pulmonology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| |
Collapse
|
2
|
Nader-Marta G, Monteforte M, Agostinetto E, Cinquini M, Martins-Branco D, Langouo M, Llombart-Cusac A, Cortés J, Ignatiadis M, Torri V, Apolone G, Cappelletti V, Pruneri G, de Azambuja E, Di Cosimo S. Circulating tumor DNA for predicting recurrence in patients with operable breast cancer: a systematic review and meta-analysis. ESMO Open 2024; 9:102390. [PMID: 38460249 PMCID: PMC10940943 DOI: 10.1016/j.esmoop.2024.102390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 03/11/2024] Open
Abstract
BACKGROUND The incorporation of circulating tumor DNA (ctDNA) into the management of operable breast cancer (BC) has been hampered by the heterogeneous results from different studies. We aimed to assess the prognostic value of ctDNA in patients with operable (non metastatic) BC. MATERIALS AND METHODS A systematic search of databases (PubMed/Medline, Embase, and CENTRAL) and conference proceedings was conducted to identify studies reporting the association of ctDNA detection with disease-free survival (DFS) and overall survival (OS) in patients with stage I-III BC. Log-hazard ratios (HRs) were pooled at each timepoint of ctDNA assessment (baseline, after neoadjuvant therapy, and follow-up). ctDNA assays were classified as primary tumor-informed and non tumor-informed. RESULTS Of the 3174 records identified, 57 studies including 5779 patients were eligible. In univariate analyses, ctDNA detection was associated with worse DFS at baseline [HR 2.98, 95% confidence interval (CI) 1.92-4.63], after neoadjuvant therapy (HR 7.69, 95% CI 4.83-12.24), and during follow-up (HR 14.04, 95% CI 7.55-26.11). Similarly, ctDNA detection at all timepoints was associated with worse OS (at baseline: HR 2.76, 95% CI 1.60-4.77; after neoadjuvant therapy: HR 2.72, 95% CI 1.44-5.14; and during follow-up: HR 9.19, 95% CI 3.26-25.90). Similar DFS and OS results were observed in multivariate analyses. Pooled HRs were numerically higher when ctDNA was detected at the end of neoadjuvant therapy or during follow-up and for primary tumor-informed assays. ctDNA detection sensitivity and specificity for BC recurrence ranged from 0.31 to 1.0 and 0.7 to 1.0, respectively. The mean lead time from ctDNA detection to overt recurrence was 10.81 months (range 0-58.9 months). CONCLUSIONS ctDNA detection was associated with worse DFS and OS in patients with operable BC, particularly when detected after treatment and using primary tumor-informed assays. ctDNA detection has a high specificity for anticipating BC relapse.
Collapse
Affiliation(s)
- G Nader-Marta
- Academic Trials Promoting Team (ATPT), Institut Jules Bordet, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (U.L.B), Brussels, Belgium.
| | - M Monteforte
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - E Agostinetto
- Academic Trials Promoting Team (ATPT), Institut Jules Bordet, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (U.L.B), Brussels, Belgium. https://twitter.com/ElisaAgostinett
| | - M Cinquini
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - D Martins-Branco
- Academic Trials Promoting Team (ATPT), Institut Jules Bordet, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (U.L.B), Brussels, Belgium. https://twitter.com/DMBranco
| | - M Langouo
- Medical Oncology Department, Institut Jules Bordet, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (U.L.B), Brussels, Belgium
| | - A Llombart-Cusac
- Medica Scientia Innovation Research (MEDSIR), Barcelona, Spain; Medica Scientia Innovation Research (MEDSIR), Ridgewood, New Jersey, USA; Arnau de Vilanova Hospital; Universidad Católica de Valencia, Valencia, Spain
| | - J Cortés
- Medica Scientia Innovation Research (MEDSIR), Barcelona, Spain; Medica Scientia Innovation Research (MEDSIR), Ridgewood, New Jersey, USA; International Breast Cancer Center (IBCC), Pangaea Oncology, Quiron Group, Barcelona, Spain; Department of Medicine, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Madrid, Spain. https://twitter.com/JavierCortesMD
| | - M Ignatiadis
- Academic Trials Promoting Team (ATPT), Institut Jules Bordet, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (U.L.B), Brussels, Belgium; Medical Oncology Department, Institut Jules Bordet, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (U.L.B), Brussels, Belgium. https://twitter.com/MIgnatiadis
| | - V Torri
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy. https://twitter.com/ValterTorri
| | - G Apolone
- Scientific Directorate, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - V Cappelletti
- Department of Advanced Diagnostics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - G Pruneri
- Department of Advanced Diagnostics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; University of Milan, School of Medicine, Milan, Italy. https://twitter.com/PruneriG
| | - E de Azambuja
- Academic Trials Promoting Team (ATPT), Institut Jules Bordet, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (U.L.B), Brussels, Belgium; Medical Oncology Department, Institut Jules Bordet, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (U.L.B), Brussels, Belgium. https://twitter.com/E_de_Azambuja
| | - S Di Cosimo
- Department of Advanced Diagnostics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. https://twitter.com/serenadicosimo
| |
Collapse
|
3
|
Sala L, Ciniselli CM, Bozzi F, Summo V, Bonini C, Brich S, Bertolotti A, Trupia DV, Volpi CC, Pizzamiglio S, Paolini B, Aiello A, Apolone G, Verderio P, Cortinovis U. Periprosthetic effusions surrounding breast expander: a flow cytometric, immunohistochemical and molecular characterization. Tumori 2024; 110:49-59. [PMID: 37574933 DOI: 10.1177/03008916231189532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
INTRODUCTION The synthesis of the periprosthetic capsule during implant-based breast reconstruction is the result of a coordinate cascade of inflammatory events ending in a fibrous tissue deposition around the expander or implant. Although the development of small volumes of fluid is one of the complications of prosthetic-based breast reconstruction, the characterization of the periprosthetic effusions coupled with the micro-textured devices, that have been recently introduced after the recall of macro-textured ones, is still lacking. The investigation of these periprosthetic effusions and paired capsules in terms of immunological content were the primary and secondary aims of the present study, respectively. METHODS For this, 68 women, 41 of whom had periprosthetic effusions at the time of expander replacement with implant, were recruited. For each case, capsule and healthy dermal tissues were taken and for women with periprosthetic effusion, peripheral blood was also collected. Periprosthetic effusions and peripheral blood were characterized by cytometry while capsules and dermal tissues by immunohistochemistry and Nanostring analysis. RESULTS The results showed an increase of Th1, Th2 lymphocytes and a HLA-DR+bright CD16+ cells (likely representing monocytes-derived macrophages) in periprosthetic effusions in respect to peripheral blood. These pro-inflammatory cells were counterbalanced by the gain of suppressive CD4 Treg cells. In the corresponding capsules, immunohistochemistry revealed the absence of Th1 cells and the presence of tissutal FOXP3 Treg. No significant difference in expression of inflammatory-related genes between capsules and dermal tissues was present. CONCLUSIONS These results suggest the presence of a Treg-controlled inflammation in both periprosthetic effusions and capsules.
Collapse
Affiliation(s)
- Laura Sala
- Department of Plastic Reconstructive Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Lombardia, Italy
| | - Chiara Maura Ciniselli
- Unit of Bioinformatics and Biostatistics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Lombardia, Italy
| | - Fabio Bozzi
- Department of Diagnostics Innovation, Pathology Unit 2, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Lombardia, Italy
| | - Valeria Summo
- Department of Plastic Reconstructive Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Lombardia, Italy
| | - Chiara Bonini
- Unit of laboratory Medicine, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Lombardia, Italy
| | - Silvia Brich
- Department of Diagnostics Innovation, Pathology Unit 2, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Lombardia, Italy
| | - Alessia Bertolotti
- Department of Diagnostics Innovation, Pathology Unit 2, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Lombardia, Italy
| | - Desiré Viola Trupia
- Department of Diagnostics Innovation, Pathology Unit 2, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Lombardia, Italy
| | - Chiara Costanza Volpi
- Department of Diagnostics Innovation, Pathology Unit 2, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Lombardia, Italy
| | - Sara Pizzamiglio
- Unit of Bioinformatics and Biostatistics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Lombardia, Italy
| | - Biagio Paolini
- Department of Diagnostics Innovation, Pathology Unit 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Lombardia, Italy
| | - Antonella Aiello
- Department of Diagnostics Innovation, Pathology Unit 2, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Lombardia, Italy
| | - Giovanni Apolone
- Scientific Directorate, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Lombardia, Italy
| | - Paolo Verderio
- Unit of Bioinformatics and Biostatistics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Lombardia, Italy
| | - Umberto Cortinovis
- Department of Plastic Reconstructive Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Lombardia, Italy
| |
Collapse
|
4
|
Avancini A, Baldassari I, Gargano G, Lu M, Jing H, Zhao H, Zhang J, Sieri S, Mussa FR, Krogh V, Apolone G, Pala V. Protocol for the CHINT study: a cross-sectional observational study of risk factors for cancer and other non-communicable diseases in the Chinese community of Milan. BMJ Open 2024; 14:e073512. [PMID: 38233062 PMCID: PMC10806820 DOI: 10.1136/bmjopen-2023-073512] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 01/07/2024] [Indexed: 01/19/2024] Open
Abstract
INTRODUCTION The Chinese community in Italy is the largest in Europe. The area of Milan hosts the largest Chinese Italian community-about 41 000 people. Since little is known of the health practices of Chinese persons in Italy, we designed the CHINT study (survey of risk factors for cancer and other non-communicable diseases (NCDs) in the Chinese community of Milan) to investigate lifestyle-related risk factors for these diseases in this community. We expect the study to reveal potentially unhealthy lifestyle behaviours that may be addressed in future prevention programmes. METHODS AND ANALYSIS The CHINT study is a cross-sectional study on a sample of around 600 adults recruited from the Chinese community of Milan and surrounding areas. The non-random sample is clustered by age, sex, occupation and socioeconomic characteristics and is being recruited with the active cooperation of stakeholders within the Chinese community. The study employs face-to-face meetings, text messaging and WeChat. At the first recruitment meeting, participants' physical measurements are taken and a lifestyle questionnaire is administered which enquires about physical activity, the consumption of salt, fruit and vegetables, tobacco and alcohol, and the presence of other risk factors for NCDs. A food frequency questionnaire is in preparation. By analysis of physical data and the results of the two questionnaires, the prevalence and distribution of NCD risk factors, and characteristics associated with these factors, will be identified. Factors associated with recruitment and compliance/retention will be investigated to identify predictors of willingness to participate future intervention studies. ETHICS AND DISSEMINATION The study has been approved by the ethics committee of the Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy. All participants are required to provide written informed consent. Findings will be disseminated through peer-reviewed scientific publications, conferences and public meetings involving the Chinese community and the lay public.
Collapse
Affiliation(s)
- Alice Avancini
- Department of Oncology, University of Verona, Verona, Veneto, Italy
| | - Ivan Baldassari
- Department of Epidemiology and Data Science, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Giuliana Gargano
- Department of Epidemiology and Data Science, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Ming Lu
- Clinical Epidemiology Unit, Shandong University Qilu Hospital, Jinan, China
| | - Hao Jing
- China Agricultural University, Beijing, China
| | - Hongwei Zhao
- Texas A&M University, College Station, Texas, USA
| | - Ji Zhang
- Karolinska Institute, Stockholm, Sweden
| | - Sabina Sieri
- Department of Epidemiology and Data Science, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Francesca Romana Mussa
- Department of Epidemiology and Data Science, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milano, Lombardia, Italy
| | - Vittorio Krogh
- Department of Epidemiology and Data Science, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Giovanni Apolone
- General Directorate for Scientific Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Lombardia, Italy
| | - Valeria Pala
- Department of Epidemiology and Data Science, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| |
Collapse
|
5
|
Rausa E, Ciniselli CM, Signoroni S, Boer LS, Oldhoff L, Dijk L, Van Luijk F, Ricci MT, Ghidoli C, Duroni V, Brignola C, Borreani C, Alfieri S, Apolone G, Verderio P, Vitellaro M. Quality of life after prophylactic surgery for colorectal adenomatous polyposis. Int J Colorectal Dis 2023; 38:249. [PMID: 37804449 DOI: 10.1007/s00384-023-04531-5] [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] [Accepted: 09/10/2023] [Indexed: 10/09/2023]
Abstract
PURPOSE Colorectal adenomatous polyposis is characterized by the onset of tens to thousands of adenomas in the colorectal epithelium and, if not treated, leads to a lifetime increased risk of developing colorectal cancer compared to the general population. Thus, prophylactic surgery is recommended. This study aims to investigate the quality of life of colorectal adenomatous polyposis patients following prophylactic surgery and indirectly compares these findings with those of healthy adults of the normative sample. METHODS All patients who underwent prophylactic surgery for polyposis and were in follow-up at the hereditary digestive tract tumors outpatient department of our institute were eligible for the study. The Short Form-36 questionnaire and 21 ad hoc items were used at the time of clinical evaluation. RESULTS A total of 102 patients were enrolled. For the SF-36 domains, mean values ranged from 64.18 for vitality to 88.49 for physical functioning, with the highest variability for role-physical limitations; the minimum value of functioning was reached for role-physical limitations, role-emotional limitations, and social functioning. The maximum value of functioning was reached for role-emotional limitations (73.96%) and role-physical limitations (60.42%). In total, 48.96% and 90.63% of patients reported no fecal or urinary incontinence episodes, respectively; 69.79% of patients did not have problems in work/school resumption or the personal sexual sphere. CONCLUSION Quality of life following prophylactic surgery for these patients seems to be good when indirectly compared to HP-normative samples'. Young adult patients appear to quickly manage and adapt to changes in bowel functioning. A minority of patients may experience social and sexual issues.
Collapse
Affiliation(s)
- Emanuele Rausa
- Unit of Hereditary Digestive Tract Tumours, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Chiara Maura Ciniselli
- Unit of Bioinformatics and Biostatistics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stefano Signoroni
- Unit of Hereditary Digestive Tract Tumours, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Laura Sophie Boer
- Department of Medical Sciences, University of Groningen, Groningen, Netherlands
| | - Loïs Oldhoff
- Department of Medical Sciences, University of Groningen, Groningen, Netherlands
| | - Laura Dijk
- Department of Medical Sciences, University of Groningen, Groningen, Netherlands
| | - Franka Van Luijk
- Department of Medical Sciences, University of Groningen, Groningen, Netherlands
| | - Maria Teresa Ricci
- Unit of Hereditary Digestive Tract Tumours, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Chiara Ghidoli
- Unit of Hereditary Digestive Tract Tumours, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Valeria Duroni
- Unit of Bioinformatics and Biostatistics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Clorinda Brignola
- Unit of Hereditary Digestive Tract Tumours, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Claudia Borreani
- Clinical Psychology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sara Alfieri
- Clinical Psychology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanni Apolone
- Scientific Directorate, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paolo Verderio
- Unit of Bioinformatics and Biostatistics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marco Vitellaro
- Unit of Hereditary Digestive Tract Tumours, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Colorectal Surgery Division, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| |
Collapse
|
6
|
Di Cosimo S, Ljevar S, Trama A, Bernasconi A, Lasalvia P, De Santis MC, Cappelletti V, Miceli R, Apolone G. Direct and indirect effects of COVID-19 on short-term mortality of breast cancer patients. Breast 2023; 71:60-62. [PMID: 37499377 PMCID: PMC10413129 DOI: 10.1016/j.breast.2023.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 07/29/2023] Open
Abstract
We studied the COVID-19 impact in newly-diagnosed breast cancer (7,349 patients in 2019, and 5,563 in 2020). In 2020 there were two diagnostic drops: -37.2% (March-May), -15.8% (October-December). Early-stage at presentation (76.4% vs. 74.4%, p = 0.0013), conserving surgery (71.0% vs. 67.0%, p < 0.0001), chemotherapy (86.2% vs. 53.4%, p < 0.0001), and radiotherapy (65.7% vs. 42.1%, p < 0.0001) decreased in 2020 compared to 2019. COVID-19 occurred in 250 patients (4.49%). The time-dependent COVID-19 effect was associated with mortality (multivariable Cox analysis HR [95% CI] 2.26 [1.35-3.74]; p = 0.0018). Survival within the year of diagnosis was 97.6% in 2020 and 98.3% in 2019; 30-day mortality was 1.13% in 2020 (1.07 in uninfected patients), and 0.61% in 2019. The year of diagnosis lost its prognostic relevance after adjusting for stage and treatment. These findings emphasize the critical role of continuity of care, which was disrupted during the pandemic, and underscore the need for policies minimizing treatment initiation delay in newly diagnosed breast cancer patients.
Collapse
Affiliation(s)
- Serena Di Cosimo
- Department of Advanced Diagnostics, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy.
| | - Silva Ljevar
- Biostatistics for Clinical Research Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Annalisa Trama
- Evaluative Epidemiology Unit, Department of Epidemiology and Data Science, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Alice Bernasconi
- Evaluative Epidemiology Unit, Department of Epidemiology and Data Science, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Paolo Lasalvia
- Evaluative Epidemiology Unit, Department of Epidemiology and Data Science, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | - Vera Cappelletti
- Department of Advanced Diagnostics, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Rosalba Miceli
- Biostatistics for Clinical Research Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Giovanni Apolone
- Scientific Directorate, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| |
Collapse
|
7
|
Vingiani A, Agnelli L, Duca M, Lorenzini D, Damian S, Proto C, Niger M, Nichetti F, Tamborini E, Perrone F, Piccolo A, Manoukian S, Azzollini J, Brambilla M, Colombo E, Lopez S, Vernieri C, Marra F, Conca E, Busico A, Capone I, Bozzi F, Angelini M, Devecchi A, Salvatori R, De Micheli V, Baggi A, Pasini S, Jommi C, Ladisa V, Apolone G, De Braud F, Pruneri G. Molecular Tumor Board as a Clinical Tool for Converting Molecular Data Into Real-World Patient Care. JCO Precis Oncol 2023; 7:e2300067. [PMID: 37487147 PMCID: PMC10581623 DOI: 10.1200/po.23.00067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/28/2023] [Accepted: 06/12/2023] [Indexed: 07/26/2023] Open
Abstract
PURPOSE The investigation of multiple molecular targets with next-generation sequencing (NGS) has entered clinical practice in oncology, yielding to a paradigm shift from the histology-centric approach to the mutational model for personalized treatment. Accordingly, most of the drugs recently approved in oncology are coupled to specific biomarkers. One potential tool for implementing the mutational model of precision oncology in daily practice is represented by the Molecular Tumor Board (MTB), a multidisciplinary team whereby molecular pathologists, biologists, bioinformaticians, geneticists, medical oncologists, and pharmacists cooperate to generate, interpret, and match molecular data with personalized treatments. PATIENTS AND METHODS Since May 2020, the institutional MTB set at Fondazione IRCCS Istituto Nazionale Tumori of Milan met weekly via teleconference to discuss molecular data and potential therapeutic options for patients with advanced/metastatic solid tumors. RESULTS Up to October 2021, among 1,996 patients evaluated, we identified >10,000 variants, 43.2% of which were functionally relevant (pathogenic or likely pathogenic). On the basis of functionally relevant variants, 711 patients (35.6%) were potentially eligible to targeted therapy according to European Society of Medical Oncology Scale for Clinical Actionability of Molecular Targets tiers, and 9.4% received a personalized treatment. Overall, larger NGS panels (containing >50 genes) significantly outperformed small panels (up to 50 genes) in detecting actionable gene targets across different tumor types. CONCLUSION Our real-world data provide evidence that MTB is a valuable tool for matching NGS data with targeted treatments, eventually implementing precision oncology in clinical practice.
Collapse
Affiliation(s)
- Andrea Vingiani
- Department of Diagnostic Innovation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Luca Agnelli
- Department of Diagnostic Innovation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Matteo Duca
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Daniele Lorenzini
- Department of Diagnostic Innovation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Silvia Damian
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Claudia Proto
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Monica Niger
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Federico Nichetti
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
- Computational Oncology Group, Molecular Precision Oncology Program, National Center for Tumor Diseases (NCT) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Elena Tamborini
- Department of Diagnostic Innovation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Federica Perrone
- Department of Diagnostic Innovation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alberta Piccolo
- Department of Diagnostic Innovation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Siranoush Manoukian
- Unit of Medical Genetics, Department of Medical Oncology and Hematology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Jacopo Azzollini
- Unit of Medical Genetics, Department of Medical Oncology and Hematology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Marta Brambilla
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Elena Colombo
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Salvatore Lopez
- Gynecologic Oncology, Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Claudio Vernieri
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
- IFOM ETS, The AIRC Institute of Molecular Oncology, Milan, Italy
| | - Francesca Marra
- Department of Diagnostic Innovation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elena Conca
- Department of Diagnostic Innovation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Adele Busico
- Department of Diagnostic Innovation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Iolanda Capone
- Department of Diagnostic Innovation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Fabio Bozzi
- Department of Diagnostic Innovation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marta Angelini
- Department of Diagnostic Innovation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andrea Devecchi
- Department of Diagnostic Innovation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Rebecca Salvatori
- Department of Diagnostic Innovation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Precision Cancer Therapeutics Program, Center for Individualized Medicine, Mayo Clinic, Rochester, MN
| | | | - Anna Baggi
- Business Integration Partners S.p.A., Milan, Italy
| | | | - Claudio Jommi
- Department of Pharmaceutical Sciences, Università del Piemonte Orientale, Novara, Italy
| | - Vito Ladisa
- Hospital Pharmacy, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Giovanni Apolone
- Scientific Directorate, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Filippo De Braud
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Giancarlo Pruneri
- Department of Diagnostic Innovation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| |
Collapse
|
8
|
Di Cosimo S, Apolone G, Cappelletti V, Torri V. DESTINY-Breast03 trial: some questions remain. Lancet 2023; 401:1653. [PMID: 37210116 DOI: 10.1016/s0140-6736(23)00685-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/28/2023] [Indexed: 05/22/2023]
Affiliation(s)
- Serena Di Cosimo
- Department of Advanced Diagnostics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan 20133, Italy.
| | - Giovanni Apolone
- Scientific Directorate, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan 20133, Italy
| | - Vera Cappelletti
- Department of Advanced Diagnostics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan 20133, Italy
| | - Valter Torri
- Laboratory of Methodology for Biomedical Research, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| |
Collapse
|
9
|
Verderio P, Lecchi M, Ciniselli CM, Shishmani B, Apolone G, Manenti G. 3Rs Principle and Legislative Decrees to Achieve High Standard of Animal Research. Animals (Basel) 2023; 13:ani13020277. [PMID: 36670818 PMCID: PMC9854901 DOI: 10.3390/ani13020277] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 01/15/2023] Open
Abstract
Animal experimentation is a vast ecosystem that tries to make different issues such as legislative, ethical and scientific coexist. Research in animal experimentation has made many strides thanks to the 3Rs principle and the attached legislative decrees, but for this very reason, it needs to be evenly implemented both among the countries that have adhered to the decrees and among the team members who design and execute the experimental practice. In this article, we emphasize the importance of the 3Rs principle's application, with a particular focus on the concept of Reduction and related key aspects that can best be handled with the contribution of experts from different fields.
Collapse
Affiliation(s)
- Paolo Verderio
- Unit of Bioinformatics and Biostatistics, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
- Correspondence: ; Tel.: +39-02-2390-3201
| | - Mara Lecchi
- Unit of Bioinformatics and Biostatistics, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Chiara Maura Ciniselli
- Unit of Bioinformatics and Biostatistics, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Bjorn Shishmani
- Unit of Bioinformatics and Biostatistics, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Giovanni Apolone
- Scientific Directorate, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Giacomo Manenti
- Unit of Animal Health and Welfare, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| |
Collapse
|
10
|
Rescigno M, Agrati C, Salvarani C, Giannarelli D, Costantini M, Mantovani A, Massafra R, Zinzani PL, Morrone A, Notari S, Matusali G, Pinter GL, Uccelli A, Ciliberto G, Baldanti F, Locatelli F, Silvestris N, Sinno V, Turola E, Lupo-Stanghellini MT, Apolone G. Neutralizing antibodies to Omicron after the fourth SARS-CoV-2 mRNA vaccine dose in immunocompromised patients highlight the need of additional boosters. Front Immunol 2023; 14:1104124. [PMID: 36776853 PMCID: PMC9911671 DOI: 10.3389/fimmu.2023.1104124] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 01/09/2023] [Indexed: 01/28/2023] Open
Abstract
Introduction Immunocompromised patients have been shown to have an impaired immune response to COVID-19 vaccines. Methods Here we compared the B-cell, T-cell and neutralizing antibody response to WT and Omicron BA.2 SARS-CoV-2 virus after the fourth dose of mRNA COVID-19 vaccines in patients with hematological malignancies (HM, n=71), solid tumors (ST, n=39) and immune-rheumatological (IR, n=25) diseases. The humoral and T-cell responses to SARS-CoV-2 vaccination were analyzed by quantifying the anti-RBD antibodies, their neutralization activity and the IFN-γ released after spike specific stimulation. Results We show that the T-cell response is similarly boosted by the fourth dose across the different subgroups, while the antibody response is improved only in patients not receiving B-cell targeted therapies, independent on the pathology. However, 9% of patients with anti-RBD antibodies did not have neutralizing antibodies to either virus variants, while an additional 5.7% did not have neutralizing antibodies to Omicron BA.2, making these patients particularly vulnerable to SARS-CoV-2 infection. The increment of neutralizing antibodies was very similar towards Omicron BA.2 and WT virus after the third or fourth dose of vaccine, suggesting that there is no preferential skewing towards either virus variant with the booster dose. The only limited step is the amount of antibodies that are elicited after vaccination, thus increasing the probability of developing neutralizing antibodies to both variants of virus. Discussion These data support the recommendation of additional booster doses in frail patients to enhance the development of a B-cell response directed against Omicron and/or to enhance the T-cell response in patients treated with anti-CD20.
Collapse
Affiliation(s)
- Maria Rescigno
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Mucosal Immunology and Microbiota Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Rozzano, Milano, Italy
| | - Chiara Agrati
- Cellular Immunology Laboratory, National Institute for Infectious Diseases (INMI) L Spallanzani - Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy.,Department of Hematology and Oncology and Cell and Gene Therapy, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Bambino Gesù Children Hospital , Roma, Italy
| | - Carlo Salvarani
- Unità di Reumatologia, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) di Reggio Emilia, Reggio Emilia, Italy.,Unità di Reumatologia, Università degli Studi di Modena e Reggio Emilia, Reggio Emilia, Italy
| | - Diana Giannarelli
- Facility di Epidemiologia e Biostatistica, Fondazione Policlinico Universitario A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy
| | - Massimo Costantini
- Scientific Directorate, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Alberto Mantovani
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Humanitas Scientific Directorate, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Rozzano, Milan, Italy.,William Harvey Research Institute, Queen Mary University, London, United Kingdom
| | - Raffaella Massafra
- Vice Scientific Directorate, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Pier Luigi Zinzani
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy.,Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Aldo Morrone
- Scientific Directorate, San Gallicano Dermatological Institute Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy
| | - Stefania Notari
- Cellular Immunology Laboratory, National Institute for Infectious Diseases (INMI) L Spallanzani - Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Giulia Matusali
- Virology Laboratory, INMI L Spallanzani - Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy
| | - Giuseppe Lauria Pinter
- Scientific Directorate, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milano, Italy.,Department of Medical Biotechnology and Translational Medicine, University of Milan, Milano, Italy
| | - Antonio Uccelli
- Scientific Directorate, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Gennaro Ciliberto
- Scientific Directorate, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena, National Cancer Institute, Istituti Fisioterapici Ospitalieri (IFO), Roma, Italy
| | - Fausto Baldanti
- Microbiology and Virology Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy.,Department of Clinical, Surgical, Diagnostics and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Franco Locatelli
- Department of Hematology and Oncology and Cell and Gene Therapy, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Bambino Gesù Children Hospital , Roma, Italy.,Department of Pediatrics, Catholic University of the Sacred Heart, Roma, Italy
| | - Nicola Silvestris
- Medical Oncology Unit, Department of Human Pathology "G. Barresi", University of Messina, Messina, Italy
| | - Valentina Sinno
- Department of Oncology and Hematology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Elena Turola
- Infrastruttura Ricerca e Statistica, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) di Reggio Emilia, Reggio Emilia, Italy
| | - Maria Teresa Lupo-Stanghellini
- Hematology and BMT Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale San Raffaele, Milano, Italy
| | - Giovanni Apolone
- Scientific Directorate, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | | |
Collapse
|
11
|
Pastorino U, Ladisa V, Trussardo S, Sabia F, Rolli L, Valsecchi C, Ledda RE, Milanese G, Suatoni P, Boeri M, Sozzi G, Marchianò A, Munarini E, Boffi R, Gallus S, Apolone G. Cytisine Therapy Improved Smoking Cessation in the Randomized Screening and Multiple Intervention on Lung Epidemics Lung Cancer Screening Trial. J Thorac Oncol 2022; 17:1276-1286. [PMID: 35908731 DOI: 10.1016/j.jtho.2022.07.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/24/2022] [Accepted: 07/11/2022] [Indexed: 10/31/2022]
Abstract
INTRODUCTION Cytisine, a partial agonist-binding nicotine acetylcholine receptor, is a promising cessation intervention. We conducted a single-center, randomized, controlled trial (RCT) in Italy to assess the efficacy and tolerability of cytisine as a smoking cessation therapy among lung cancer screening participants. METHODS From July 2019 to March 2020, the Screening and Multiple Intervention on Lung Epidemics RCT enrolled 869 current heavy tobacco users in a low-dose computed tomography screening program, with a randomized comparison of pharmacologic intervention with cytisine plus counseling (N = 470) versus counseling alone (N = 399). The primary outcome was continuous smoking abstinence at 12 months, biochemically verified through carbon monoxide measurement. RESULTS At the 12-month follow-up, the quit rate was 32.1% (151 participants) in the intervention arm and 7.3% (29 participants) in the control arm. The adjusted OR of continuous abstinence was 7.2 (95% confidence interval: 4.6-11.2). Self-reported adverse events occurred more frequently in the intervention arm (399 events among 196 participants) than in the control arm (230 events among 133 participants, p < 0.01). The most common adverse events were gastrointestinal symptoms, comprising abdominal swelling, gastritis, and constipation. CONCLUSIONS The efficacy and safety observed in the Screening and Multiple Intervention on Lung Epidemics RCT indicate that cytisine, a very low-cost medication, is a useful treatment option for smoking cessation and a feasible strategy to improve low-dose computed tomography screening outcomes with a potential benefit for all-cause mortality.
Collapse
Affiliation(s)
- Ugo Pastorino
- Division of Thoracic Surgery, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy.
| | - Vito Ladisa
- Division of Pharmacy, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
| | - Sara Trussardo
- Division of Thoracic Surgery, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
| | - Federica Sabia
- Division of Thoracic Surgery, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
| | - Luigi Rolli
- Division of Thoracic Surgery, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
| | - Camilla Valsecchi
- Division of Thoracic Surgery, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberta E Ledda
- Division of Thoracic Surgery, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy; Section of Radiology, Unit of Surgical Sciences, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - Gianluca Milanese
- Section of Radiology, Unit of Surgical Sciences, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - Paola Suatoni
- Division of Thoracic Surgery, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
| | - Mattia Boeri
- Division of Tumour Genomics, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
| | - Gabriella Sozzi
- Division of Tumour Genomics, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
| | - Alfonso Marchianò
- Division of Radiology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
| | - Elena Munarini
- Division of Pneumology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberto Boffi
- Division of Pneumology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
| | - Silvano Gallus
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Giovanni Apolone
- Scientific Directorate, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
| |
Collapse
|
12
|
Di Cosimo S, Susca N, Apolone G, Silvestris N, Racanelli V. The worldwide impact of COVID-19 on cancer care: A meta-analysis of surveys published after the first wave of the pandemic. Front Oncol 2022; 12:961380. [PMID: 36249038 PMCID: PMC9556993 DOI: 10.3389/fonc.2022.961380] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 06/04/2022] [Accepted: 09/12/2022] [Indexed: 01/19/2023] Open
Abstract
Background The rapid and global spread of COVID-19 posed a massive challenge to healthcare systems, which came across the need to provide high-intensity assistance to thousands of patients suffering from SARS-CoV-2 infection while assuring continuous care for all other diseases. This has been of particular importance in the oncology field. This study explores how oncology centers responded to the pandemic at a single center level by assessing surveys addressing different aspects of cancer care after the pandemic outbreak. Methods We performed a systematic review and meta-analysis of the cancer care surveys published until December 11th, 2020. Data were analyzed according to three main areas of interest, namely health care organization, including cancellation/delay and/or modification of scheduled treatments, cancellation/delay of outpatient visits, and reduction of overall cancer care activities; routine use of preventive measures, such as personal protective equipment (PPE) by both patients and health care workers, and systematic SARS-CoV-2 screening by nasopharyngeal swabs; and implementation of telemedicine through remote consultations. Findings Fifty surveys reporting data on 9150 providers from 121 countries on 5 continents were included. Cancellation/delay of treatment occurred in 58% of centers; delay of outpatient visits in 75%; changes in treatment plans in 65%; and a general reduction in clinical activity in 58%. Routine use of PPE by patients and healthcare personnel was reported by 81% and 80% of centers, respectively; systematic SARS-CoV-2 screening by nasopharyngeal swabs was reported by only 41% of centers. Virtual visits were implemented by the majority (72%) of centers. Interpretation These results describe the negative impact of COVID-19 on cancer care, the rapid response of cancer centers in terms of preventive measures and alternative treatment approaches such as telemedicine, and confirm that surveys can provide the valuable, low-cost and immediate information that critical situations require.
Collapse
Affiliation(s)
- Serena Di Cosimo
- Platform of Integrated Biology Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Nicola Susca
- School of Medicine: Interdisciplinary of Medicine, Aldo Moro University of Bari, Bari, Italy
| | - Giovanni Apolone
- Scientific Directorate, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Nicola Silvestris
- Medical Oncology Unit, Department of Human Pathology “G. Barresi”, University of Messina, Messina, Italy
| | - Vito Racanelli
- School of Medicine: Interdisciplinary of Medicine, Aldo Moro University of Bari, Bari, Italy
- *Correspondence: Vito Racanelli,
| |
Collapse
|
13
|
Corradini P, Agrati C, Apolone G, Mantovani A, Giannarelli D, Marasco V, Bordoni V, Sacchi A, Matusali G, Salvarani C, Zinzani PL, Mantegazza R, Tagliavini F, Lupo-Stanghellini MT, Ciceri F, Damian S, Uccelli A, Fenoglio D, Silvestris N, Baldanti F, Piaggio G, Ciliberto G, Morrone A, Locatelli F, Sinno V, Rescigno M, Costantini M. Humoral and T-Cell Immune Response After 3 Doses of Messenger RNA Severe Acute Respiratory Syndrome Coronavirus 2 Vaccines in Fragile Patients: The Italian VAX4FRAIL Study. Clin Infect Dis 2022; 76:e426-e438. [PMID: 35607769 PMCID: PMC9213871 DOI: 10.1093/cid/ciac404] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [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: 12/31/2021] [Revised: 05/09/2022] [Accepted: 05/18/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Patients with solid or hematological tumors or neurological and immune-inflammatory disorders are potentially fragile subjects at increased risk of experiencing severe coronavirus disease 2019 and an inadequate response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. METHODS We designed a prospective Italian multicenter study to assess humoral and T-cell responses to SARS-CoV-2 vaccination in patients (n = 378) with solid tumors (ST), hematological malignancies (HM), neurological disorders (ND), and immunorheumatological diseases (ID). A group of healthy controls was also included. We analyzed the immunogenicity of the primary vaccination schedule and booster dose. RESULTS The overall seroconversion rate in patients after 2 doses was 62.1%. Significantly lower rates were observed in HM (52.4%) and ID (51.9%) than in ST (95.6%) and ND (70.7%); a lower median antibody level was detected in HM and ID versus ST and ND (P < .0001). Similar rates of patients with a positive SARS-CoV-2 T-cell response were found in all disease groups, with a higher level observed in ND. The booster dose improved the humoral response in all disease groups, although to a lesser extent in HM patients, whereas the T-cell response increased similarly in all groups. In the multivariable logistic model, independent predictors of seroconversion were disease subgroup, treatment type, and age. Ongoing treatment known to affect the immune system was associated with the worst humoral response to vaccination (P < .0001) but had no effect on T-cell responses. CONCLUSIONS Immunosuppressive treatment more than disease type per se is a risk factor for a low humoral response after vaccination. The booster dose can improve both humoral and T-cell responses.
Collapse
Affiliation(s)
| | - Chiara Agrati
- Correspondence: C. Agrati, Cellular Immunology Laboratory, INMI L Spallanzani, Via Portuense 292, 00149, Rome, Italy ()
| | - Giovanni Apolone
- Fondazione IRCCS Istituto Nazionale dei Tumori di, Milano, Italy
| | - Alberto Mantovani
- Humanitas Scientific Directorate, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy,William Harvey Research Institute, Queen Mary University, London, United Kingdom
| | - Diana Giannarelli
- Biostatistical Unit, Istituto Nazionale Tumori Regina Elena IRCCS - IFO, Rome, Italy
| | - Vincenzo Marasco
- Department of Oncology and Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori di, Milano, Italy
| | - Veronica Bordoni
- Cellular Immunology Laboratory, National Institute for Infectious Diseases L Spallanzani – IRCCS, Rome, Italy
| | - Alessandra Sacchi
- Cellular Immunology Laboratory, National Institute for Infectious Diseases L Spallanzani – IRCCS, Rome, Italy
| | - Giulia Matusali
- Virology Laboratory, National Institute for Infectious Diseases L Spallanzani – IRCCS, Rome, Italy
| | - Carlo Salvarani
- Unità di Reumatologia, Azienda USL-IRCCS, Reggio Emilia, Italy,Unità di Reumatologia, Università degli Studi di Modena e Reggio Emilia, Modena
| | - Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli”, Bologna, Italy,Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Renato Mantegazza
- Neuromuscular Diseases and Neuroimmunology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | | | | | - Fabio Ciceri
- IRCSS San Raffaele Scientific Institute, Milano, Italy
| | - Silvia Damian
- Department of Oncology and Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori di, Milano, Italy
| | - Antonio Uccelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) University of Genoa, Genoa, Italy,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Daniela Fenoglio
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy,Centre of Excellence for Biomedical Research and Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Nicola Silvestris
- Medical Oncology Department, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari, Italy,Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, Bari, Italy
| | - Fausto Baldanti
- Molecular Virology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy,Department of Clinical, Surgical, Diagnostics and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Giulia Piaggio
- SAFU Unit IRCCS Regina Elena, National Cancer Institute, Istituti Fisioterapici Ospitalieri (IFO), Rome, Italy
| | - Gennaro Ciliberto
- National Cancer Institute, Istituti Fisioterapici Ospitalieri (IFO), Rome, Italy
| | - Aldo Morrone
- San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Franco Locatelli
- Department of Pediatric Hematology and Oncology and Cell and Gene Therapy, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy,Department of Gynecology-Obstetrics and Pediatrics, University ‘La Sapienza’, Roma, Italy
| | - Valentina Sinno
- Department of Oncology and Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori di, Milano, Italy
| | | | | | | |
Collapse
|
14
|
De Rose F, Meduri B, Carmen De Santis M, Ferro A, Marino L, Ray Colciago R, Gregucci F, Vanoni V, Apolone G, Di Cosimo S, Delaloge S, Cortes J, Curigliano G. Rethinking breast cancer follow-up based on individual risk and recurrence management. Cancer Treat Rev 2022; 109:102434. [DOI: 10.1016/j.ctrv.2022.102434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 12/01/2022]
|
15
|
Ciniselli CM, Lecchi M, Figini M, Melani CC, Daidone MG, Morelli D, Zito E, Apolone G, Verderio P. COVID-19 Vaccination in Health Care Workers in Italy: A Literature Review and a Report from a Comprehensive Cancer Center. Vaccines (Basel) 2022; 10:vaccines10050734. [PMID: 35632490 PMCID: PMC9146113 DOI: 10.3390/vaccines10050734] [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: 03/29/2022] [Revised: 04/28/2022] [Accepted: 05/05/2022] [Indexed: 02/04/2023] Open
Abstract
The coronavirus disease 2019 pandemic still represents a global public health emergency, despite the availability of different types of vaccines that reduced the number of severe cases, the hospitalization rate and mortality. The Italian Vaccine Distribution Plan identified healthcare workers (HCWs) as the top-priority category to receive access to a vaccine and different studies on HCWs have been implemented to clarify the duration and kinetics of antibody response. The aim of this paper is to perform a literature review across a total of 44 studies of the serologic response to COVID-19 vaccines in HCWs in Italy and to report the results obtained in a prospective longitudinal study implemented at the Fondazione IRCCS Istituto Nazionale Tumori (INT) of Milan on 1565 HCWs. At INT we found that 99.81% of the HCWs developed an antibody response one month after the second dose. About six months after the first serology evaluation, 100% of the HCWs were still positive to the antibody, although we observed a significant decrease in its levels. Overall, our literature review results highlight a robust antibody response in most of the HCWs after the second vaccination dose. These figures are also confirmed in our institutional setting seven months after the completion of the cycle of second doses of vaccination.
Collapse
Affiliation(s)
- Chiara Maura Ciniselli
- Bioinformatics and Biostatistics Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (C.M.C.); (M.L.)
| | - Mara Lecchi
- Bioinformatics and Biostatistics Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (C.M.C.); (M.L.)
| | - Mariangela Figini
- Biomarker Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy;
| | - Cecilia C. Melani
- Scientific Directorate, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (C.C.M.); (M.G.D.); (G.A.)
| | - Maria Grazia Daidone
- Scientific Directorate, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (C.C.M.); (M.G.D.); (G.A.)
| | - Daniele Morelli
- Laboratory Medicine, Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy;
| | - Emanuela Zito
- ICT, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy;
| | - Giovanni Apolone
- Scientific Directorate, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (C.C.M.); (M.G.D.); (G.A.)
| | - Paolo Verderio
- Bioinformatics and Biostatistics Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (C.M.C.); (M.L.)
- Correspondence:
| |
Collapse
|
16
|
Tamborero D, Dienstmann R, Rachid MH, Boekel J, Lopez-Fernandez A, Jonsson M, Razzak A, Braña I, De Petris L, Yachnin J, Baird RD, Loriot Y, Massard C, Martin-Romano P, Opdam F, Schlenk RF, Vernieri C, Masucci M, Villalobos X, Chavarria E, Balmaña J, Apolone G, Caldas C, Bergh J, Ernberg I, Fröhling S, Garralda E, Karlsson C, Tabernero J, Voest E, Rodon J, Lehtiö J. Author Correction: The Molecular Tumor Board Portal supports clinical decisions and automated reporting for precision oncology. Nat Cancer 2022; 3:649. [PMID: 35449310 PMCID: PMC9135626 DOI: 10.1038/s43018-022-00378-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- David Tamborero
- Department of Oncology and Pathology, Karolinska Institutet, Science for Life Laboratory, Stockholm, Sweden.
| | - Rodrigo Dienstmann
- Medical Oncology, Oncology Data Science, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Maan Haj Rachid
- Department of Oncology and Pathology, Karolinska Institutet, Science for Life Laboratory, Stockholm, Sweden
| | - Jorrit Boekel
- Department of Oncology and Pathology, Karolinska Institutet, Science for Life Laboratory, Stockholm, Sweden
| | - Adria Lopez-Fernandez
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Markus Jonsson
- Department of Oncology and Pathology, Karolinska Institutet, Science for Life Laboratory, Stockholm, Sweden
| | - Ali Razzak
- Department of Oncology and Pathology, Karolinska Institutet, Science for Life Laboratory, Stockholm, Sweden
| | - Irene Braña
- Medical Oncology Department, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Luigi De Petris
- Department of Oncology and Pathology, Karolinska Institutet, Theme Cancer, Karolinska Comprehensive Cancer Center, Karolinska University Hospital, Stockholm, Sweden
| | - Jeffrey Yachnin
- Department of Oncology and Pathology, Karolinska Institutet, Theme Cancer, Karolinska Comprehensive Cancer Center, Karolinska University Hospital, Stockholm, Sweden
| | | | - Yohann Loriot
- Département d'Innovation Thérapeutique et d'Essais Précoces, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Christophe Massard
- Département d'Innovation Thérapeutique et d'Essais Précoces, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Patricia Martin-Romano
- Département d'Innovation Thérapeutique et d'Essais Précoces, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Frans Opdam
- The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Richard F Schlenk
- NCT Trial Center, German Cancer Research Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Claudio Vernieri
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- IFOM, FIRC Institute of Molecular Oncology, Milan, Italy
| | - Michele Masucci
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | | | - Elena Chavarria
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Judith Balmaña
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Giovanni Apolone
- Scientific Directorate, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Jonas Bergh
- Department of Oncology and Pathology, Karolinska Institutet, Theme Cancer, Karolinska Comprehensive Cancer Center, Karolinska University Hospital, Stockholm, Sweden
| | - Ingemar Ernberg
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Stefan Fröhling
- National Center for Tumor Diseases Heidelberg, German Cancer Research Center, Heidelberg, Germany
| | - Elena Garralda
- Medical Oncology Department, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Claes Karlsson
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Josep Tabernero
- Medical Oncology Department, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Emile Voest
- The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Oncode Institute, Utrecht, the Netherlands
| | - Jordi Rodon
- Medical Oncology Department, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
- Department of Investigational Cancer Therapeutics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Janne Lehtiö
- Clinical Proteomics Unit, Department of Oncology and Pathology, Karolinska Institutet, Science for Life Laboratory, Karolinska University Hospital, Stockholm, Sweden.
| |
Collapse
|
17
|
La Rocca E, De Santis MC, Silvestri M, Ortolan E, Valenti M, Folli S, de Braud FG, Bianchi GV, Scaperrotta GP, Apolone G, Daidone MG, Cappelletti V, Pruneri G, Di Cosimo S. Early stage breast cancer follow-up in real-world clinical practice: the added value of cell free circulating tumor DNA. J Cancer Res Clin Oncol 2022; 148:1543-1550. [PMID: 35396978 PMCID: PMC9114063 DOI: 10.1007/s00432-022-03990-7] [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] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 03/20/2022] [Indexed: 11/28/2022]
Abstract
Purpose Physical examinations and annual mammography (minimal follow-up) are as effective as laboratory/imaging tests (intensive follow-up) in detecting breast cancer (BC) recurrence. This statement is now challenged by the availability of new diagnostic tools for asymptomatic cases. Herein, we analyzed current practices and circulating tumor DNA (ctDNA) in monitoring high-risk BC patients treated with curative intent in a comprehensive cancer center. Patients and methods Forty-two consecutive triple negative BC patients undergoing neoadjuvant therapy and surgery were prospectively enrolled. Data from plasma samples and surveillance procedures were analyzed to report the diagnostic pattern of relapsed cases, i.e., by symptoms, follow-up procedures and ctDNA. Results Besides minimal follow-up, 97% and 79% of patients had at least 1 non-recommended imaging and laboratory tests for surveillance purposes. During a median follow-up of 5.1(IQR, 4.1–5.9) years, 13 events occurred (1 contralateral BC, 1 loco-regional recurrence, 10 metastases, and 1 death). Five recurrent cases were diagnosed by intensive follow-up, 5 by symptoms, and 2 incidentally. ctDNA antedated disseminated disease in all evaluable cases excepted two with bone-only and single liver metastases. The mean time from ctDNA detection to suspicious findings at follow-up imaging was 3.81(SD, 2.68), and to definitive recurrence diagnosis 8(SD, 2.98) months. ctDNA was undetectable in the absence of disease and in two suspected cases not subsequently confirmed. Conclusions Some relapses are still symptomatic despite the extensive use of intensive follow-up. ctDNA is a specific test, sensitive enough to detect recurrence before other methods, suitable for clarifying equivocal imaging, and exploitable for salvage therapy in asymptomatic BC survivors. Supplementary Information The online version contains supplementary material available at 10.1007/s00432-022-03990-7.
Collapse
Affiliation(s)
- E La Rocca
- Breast Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.,Radiation Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - M C De Santis
- Breast Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.,Radiation Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - M Silvestri
- Biomarkers Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - E Ortolan
- Biomarkers Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - M Valenti
- Biomarkers Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - S Folli
- Breast Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.,Breast Cancer Surgery, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - F G de Braud
- Breast Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.,Division of Medical Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.,School of Medicine, University of Milan, Milan, Italy
| | - G V Bianchi
- Breast Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.,Division of Medical Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - G P Scaperrotta
- Breast Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.,Radiology Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - G Apolone
- Scientific Directorate, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - M G Daidone
- Scientific Directorate, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - V Cappelletti
- Biomarkers Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - G Pruneri
- Breast Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.,School of Medicine, University of Milan, Milan, Italy.,Department of Pathology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - S Di Cosimo
- Biomarkers Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.
| |
Collapse
|
18
|
Silvestris N, Brunetti O, Galvano A, Russo A, Apolone G. Editorial: The Effect of the COVID-19 Pandemic on Cancer Patients and Healthcare. Front Oncol 2022; 12:859903. [PMID: 35359379 PMCID: PMC8961276 DOI: 10.3389/fonc.2022.859903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 02/14/2022] [Indexed: 11/20/2022] Open
Affiliation(s)
- Nicola Silvestris
- Medical Oncology Unit, Department of Human Pathology "G. Barresi", University of Messina, Messina, Italy
| | - Oronzo Brunetti
- Medical Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Antonio Galvano
- Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, Italy
| | - Antonio Russo
- Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, Italy
| | - Giovanni Apolone
- Scientific Direction - Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| |
Collapse
|
19
|
Lobefaro R, Rota S, Porcu L, Brunelli C, Alfieri S, Zito E, Taglialatela I, Ambrosini M, Spagnoletti A, Zimatore M, Fatuzzo G, Lavecchia F, Borreani C, Apolone G, De Braud F, Platania M. Cancer-related fatigue and depression: a monocentric, prospective, cross-sectional study in advanced solid tumors. ESMO Open 2022; 7:100457. [PMID: 35366489 PMCID: PMC9058920 DOI: 10.1016/j.esmoop.2022.100457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/14/2022] [Accepted: 02/28/2022] [Indexed: 12/28/2022] Open
Abstract
Background Cancer-related fatigue (CRF) is common in patients with advanced solid tumors and several risk factors are described. The possible role of depression is reported by clinicians despite the association with CRF being unclear. Material and methods In this monocentric, cross-sectional, prospective study we recruited patients with advanced solid tumors who were hospitalized at Fondazione IRCCS Istituto Nazionale dei Tumori of Milan. The primary objective was to assess the correlation between CRF and depression. Secondary objectives were the estimation of CRF and depression prevalence and the identification of associated clinical risk factors. CRF and depression were evaluated through the Functional Assessment of Cancer Therapy-Fatigue subscale and the Zung Self Depression Scale (ZSDS) questionnaires. The Cochran-Armitage trend test was used to demonstrate the primary hypothesis. Univariate and multivariate logistic regression models were used to investigate the impact of clinical variables. Results A total of 136 patients were enrolled. The primary analysis found a linear correlation (P < 0.0001) between CRF and depression. The prevalence of CRF and of moderate to severe depressive symptoms was 43.5% and 29.2%, respectively. In univariate analysis, patients with poor Eastern Cooperative Oncology Group performance status (ECOG PS), anemia, distress, pain, and receiving oncological treatment were at a significantly higher risk for CRF, whereas poor ECOG PS, pain, and distress were risk factors for depression. In multivariate analysis, high levels of ZSDS were confirmed to be correlated to CRF: odds ratio of 3.86 [95% confidence interval (CI) 0.98-15.20) and 11.20 (95% CI 2.35-53.36) for ZSDS of 50-59 and 60-100, respectively (P value for trend 0.002). Moreover, the ECOG PS score was confirmed to be significantly associated with CRF (OR 7.20; 95% CI 1.73-29.96; P = 0.007). Conclusions Our data suggest a strong correlation between CRF and depression in patients with advanced solid tumors. Further investigations are needed to better understand this relationship and if depressive disorder therapeutic strategies could also impact on CRF. Validated patient-reported outcome measures were used for screening CRF and depression in advanced cancer patients. A direct strong correlation between CRF and depression was found in these patients, often unconsidered by clinicians. Other different clinical risk factors for the onset and worsening of CRF were identified. A comprehensive evaluation of cancer patients, that should also consider mood disorders, could improve CRF management.
Collapse
Affiliation(s)
- R Lobefaro
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - S Rota
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - L Porcu
- Methodology for Clinical Research Laboratory, Oncology Department, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - C Brunelli
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - S Alfieri
- Clinical Psychology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - E Zito
- Information and Communication Technology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - I Taglialatela
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - M Ambrosini
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - A Spagnoletti
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - M Zimatore
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - G Fatuzzo
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - F Lavecchia
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - C Borreani
- Clinical Psychology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - G Apolone
- Scientific Directorate, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - F De Braud
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Department of Oncology and Hematology, University of Milan, Milan, Italy
| | - M Platania
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| |
Collapse
|
20
|
Lupo-Stanghellini MT, Di Cosimo S, Costantini M, Monti S, Mantegazza R, Mantovani A, Salvarani C, Zinzani PL, Inglese M, Ciceri F, Apolone G, Ciliberto G, Baldanti F, Morrone A, Sinno V, Locatelli F, Notari S, Turola E, Giannarelli D, Silvestris N. mRNA-COVID19 Vaccination Can Be Considered Safe and Tolerable for Frail Patients. Front Oncol 2022; 12:855723. [PMID: 35371993 PMCID: PMC8969577 DOI: 10.3389/fonc.2022.855723] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 01/15/2022] [Accepted: 02/21/2022] [Indexed: 01/04/2023] Open
Abstract
Background Frail patients are considered at relevant risk of complications due to coronavirus disease 2019 (COVID-19) infection and, for this reason, are prioritized candidates for vaccination. As these patients were originally not included in the registration trials, fear related to vaccine adverse events and disease worsening was one of the reasons for vaccine hesitancy. Herein, we report the safety profile of the prospective, multicenter, national VAX4FRAIL study (NCT04848493) to evaluate vaccines in a large trans-disease cohort of patients with solid or hematological malignancies and neurological and rheumatological diseases. Methods Between March 3 and September 2, 2021, 566 patients were evaluable for safety endpoint: 105 received the mRNA-1273 vaccine and 461 the BNT162b2 vaccine. Frail patients were defined per protocol as patients under treatment with hematological malignancies (n = 131), solid tumors (n = 191), immune-rheumatological diseases (n = 86), and neurological diseases (n = 158), including multiple sclerosis and generalized myasthenia. The impact of the vaccination on the health status of patients was assessed through a questionnaire focused on the first week after each vaccine dose. Results The most frequently reported moderate–severe adverse events were pain at the injection site (60.3% after the first dose, 55.4% after the second), fatigue (30.1%–41.7%), bone pain (27.4%–27.2%), and headache (11.8%–18.9%). Risk factors associated with the occurrence of severe symptoms after vaccine administration were identified through a multivariate logistic regression analysis: age was associated with severe fever presentation (younger patients vs. middle-aged vs. older ones), female individuals presented a higher probability of severe pain at the injection site, fatigue, headache, and bone pain; and the mRNA-1237 vaccine was associated with a higher probability of severe pain at the injection site and fever. After the first dose, patients presenting a severe symptom were at a relevant risk of recurrence of the same severe symptom after the second one. Overall, 11 patients (1.9%) after the first dose and 7 (1.2%) after the second one required postponement or suspension of the disease-specific treatment. Finally, two fatal events occurred among our 566 patients. These two events were considered unrelated to the vaccine. Conclusions Our study reports that mRNA-COVID-19 vaccination is safe also in frail patients; as expected, side effects were manageable and had a minimum impact on patient care path.
Collapse
Affiliation(s)
| | - Serena Di Cosimo
- Biomarkers Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | - Sara Monti
- Department of Rheumatology, Policlinico San Matteo IRCCS Fondazione, University of Pavia, Pavia, Italy
| | - Renato Mantegazza
- Neuromuscular Diseases and Neuroimmunology Unit, Fondazione IRCCS Isitituto Neurologico Carlo Besta, Milano, Italy
| | - Alberto Mantovani
- Humanitas Scientific Directorate, IRCCS Humanitas, Clinical and Research Center, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Milano, Italy
- William Harvey Research Institute, Queen Mary University, London, United Kingdom
| | - Carlo Salvarani
- Unità di Reumatologia, Azienda unità sanitaria locale-IRCCS, Reggio Emilia, Italy
- Unità di Reumatologia, Università degli Studi di Modena e Reggio Emilia, Reggio Emilia, Italy
| | - Pier Luigi Zinzani
- Istituto di Ematologia “Seràgnoli” Azienda Ospedaliero-Universitaria di Bologna, IRCCS, Bologna, Italy
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna, Bologna, Italy
| | - Matilde Inglese
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health and Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Fabio Ciceri
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Giovanni Apolone
- Scientific Directorate, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Gennaro Ciliberto
- Scientific Directorate, IRCCS Regina Elena, National Cancer Institute, Istituti Fisioterapici Ospitalieri (IFO), Rome, Italy
| | - Fausto Baldanti
- Molecular Virology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical, Surgical, Diagnostics and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Aldo Morrone
- Scientific Directorate, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Valentina Sinno
- Department of Oncology and Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Franco Locatelli
- Department of Pediatric Hematology and Oncology and Cell and Gene Therapy, IRCCS Ospedale Pediatrico Bambino Gesù, Roma, Italy
- Department of Gynecology-Obstetrics and Pediatrics, University “La Sapienza”, Roma, Italy
| | - Stefania Notari
- Cellular Immunology Laboratory, National Institute for Infectious Diseases L Spallanzani–IRCCS, Rome, Italy
| | - Elena Turola
- Infrastruttura Ricerca e Statistica, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - Diana Giannarelli
- Biostatistical Unit, Istituto Nazionale Tumori Regina Elena IRCCS-IFO, Rome, Italy
| | - Nicola Silvestris
- Medical Oncology Department, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari, Italy
- Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, Bari, Italy
- *Correspondence: Nicola Silvestris,
| |
Collapse
|
21
|
Di Cosimo S, Depretto C, Miceli R, Baili P, Ljevar S, Sant M, Ferranti C, Folli S, Gennaro M, de Braud FG, Vernieri C, De Santis MC, Lozza L, Vingiani A, Pruneri G, Apolone G, Marchianò A, Scaperrotta GP. Abstract P3-01-12: The impact of COVID-19 on diagnosis of recurrent breast cancer. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p3-01-12] [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
Background - Physical distancing for COVID-19 led to decreased in-person patient follow up assessments and delayed imaging appointments. Herein we describe for the first time the impact of delays in diagnostic investigations of patients with an history of early-stage breast cancer (BC) in the largest public cancer center of Lombardy, the Italian region most affected by the pandemic. Methods - This single-institution retrospective study included three observational periods. The first pandemic peak period (March-April 2020) corresponding to the interruption of follow up imaging; the post-peak period (May-December 2020); the pre-pandemic period represented by the five previous years (January 2015- December 2019) as control. The flow of diagnostic activities was compared among the different years. Moreover, the number and characteristics of recurrent BC cases (rBC) diagnosed in the post-peak period were compared to the figures observed in pre-pandemic years, when imaging was regularly carried out, using descriptive statistics. A further comparison was performed between the characteristics of scheduled and delayed rBC diagnosed after the first peak. Results - During the first pandemic peak, diagnostic investigations declined by 81.2% (from 1032 in January-February to 194 in March-April), a drop which was not identified in the same period of the pre-pandemic years, before rebounding to 1065 in May-June, 832 July-August (reflecting the summer physiological drop), 1334 September-October, and 879 November-December. The average number of rBC cases of 16 (range 12-25) in March-April of the pre-pandemic period declined to a value as low as 4 during the first pandemic peak. Thereafter, the number of rBC cases began a steady increase, until reaching a total of 27 in September-October 2020, almost doubling the mean of 14.8 (range 11-21) achieved in the corresponding months of 2015-2019. As a result, the absolute number of rBC cases was 76 in 2020 and on average 78.4 (range 70 - 95) in pre-pandemic years, and the rBC proportion of 1.42% (76/5336; 95% exact confidence interval, CI: 1.12-1.78%) in 2020 was slightly higher than the average proportion of 1.26% of the five previous years, though the latter being well included in the CI of the 2020 proportion. No difference in primary tumor presentation and age at initial diagnosis was found among recurrent patients before and after the pandemic. Of the rBC cases reported during 2020, 10 were from 513 patients with postponed follow up who were finally diagnosed between September-December. As compared to patients on schedule, delayed rBC cases did not present with ductal carcinoma in situ, and reported a median tumor size of 18 mm (range 4.3-90 mm), which was 20% higher than the median of 15 mm (3.1-34) observed for scheduled patients. Distribution of luminal-like, triple negative and HER2-overexpressing BC subtypes among evaluable rBC cases was 75%, 12.5%, 12.5% in scheduled and 66%, 11% and 22% in delayed cases, respectively. Conclusions - Our data showed a slight decrease in the absolute number of rBC during 2020 despite a rebound of examinations, and an increased size of invasive recurrence following the 2-month stop of the first pandemic peak. The full impact of the COVID-19 pandemic on recurrent cancer diagnosis will be known when national population-based data become available in the coming years.
Citation Format: Serena Di Cosimo, Catherine Depretto, Rosalba Miceli, Paolo Baili, Silva Ljevar, Milena Sant, Claudio Ferranti, Secondo Folli, Massimiliano Gennaro, Filippo G de Braud, Claudio Vernieri, Maria Carmen De Santis, Laura Lozza, Andrea Vingiani, Giancarlo Pruneri, Giovanni Apolone, Alfonso Marchianò, Gianfranco P Scaperrotta. The impact of COVID-19 on diagnosis of recurrent breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-01-12.
Collapse
Affiliation(s)
| | | | - Rosalba Miceli
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Paolo Baili
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Silva Ljevar
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Milena Sant
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | - Secondo Folli
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | | | | | | | - Laura Lozza
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Andrea Vingiani
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | | | | | | |
Collapse
|
22
|
Brunelli C, Zito E, Alfieri S, Borreani C, Roli A, Caraceni A, Apolone G. Knowledge, use and attitudes of healthcare professionals towards patient-reported outcome measures (PROMs) at a comprehensive cancer center. BMC Cancer 2022; 22:161. [PMID: 35144569 PMCID: PMC8832637 DOI: 10.1186/s12885-022-09269-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 01/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Despite evidence of the positive impact of routine assessment of patient-reported outcome measures (PROMs), their systematic collection is not widely implemented in cancer care. AIM To assess the knowledge, use and attitudes of healthcare professionals (HCPs) towards PROMs and electronically collected PROMs (ePROMs) in clinical practice and research and to explore respondent-related factors associated with the above dimensions. METHOD An ad hoc developed online survey was administered to all HCPs employed in clinical activity in an Italian comprehensive cancer center. The survey investigated which PROMs were known and used, as well as HCPs' opinions on the advantages and drawbacks of routine PROM assessment, including electronic assessment (ePROM). Linear and logistic regression models were used for association analyses. RESULTS Five Hundred Eleven of nine hundred ninety-two invited HCPs (52%) provided analyzable responses. 68% were women, 46% were nurses and 42% physicians, and 52.5% had > 20 years seniority. The average number of PROMs known was six among 17 proposed. All proved to be under-used (< 28%) except unidimensional and multidimensional pain scales (77 and 36%). Respondents expressed an overall positive attitude towards PROMs, with strengths outweighing weaknesses (mean overall scores 3.6 and 2.9, respectively, on a 1-5 scale). 67% of respondents preferred electronic collection over paper and pencil. Profession was associated with knowledge and use (physicians reported knowing more PROMs than other professionals) and with a preference for electronic collection (nurses were less likely to prefer the electronic format than physicians). Senior HCPs were slightly more critical about both PROMs and electronic administration. CONCLUSIONS This survey indicates an acceptable level of knowledge of common PROM tools but low usage in practice. Based on the generally positive attitude of HCPs, routine implementation of ePROMs can be promoted as long as adequate resources and training are provided. TRIAL REGISTRATION Not registered.
Collapse
Affiliation(s)
- Cinzia Brunelli
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Emanuela Zito
- Information and Communication Technology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sara Alfieri
- Clinical Psychology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milan, Italy.
| | - Claudia Borreani
- Clinical Psychology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milan, Italy
| | - Anna Roli
- Quality, Education and Data Protection Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Augusto Caraceni
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanni Apolone
- Scientific Directorate, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| |
Collapse
|
23
|
Tamborero D, Dienstmann R, Rachid MH, Boekel J, Lopez-Fernandez A, Jonsson M, Razzak A, Braña I, De Petris L, Yachnin J, Baird RD, Loriot Y, Massard C, Martin-Romano P, Opdam F, Schlenk RF, Vernieri C, Masucci M, Villalobos X, Chavarria E, Balmaña J, Apolone G, Caldas C, Bergh J, Ernberg I, Fröhling S, Garralda E, Karlsson C, Tabernero J, Voest E, Rodon J, Lehtiö J. The Molecular Tumor Board Portal supports clinical decisions and automated reporting for precision oncology. Nat Cancer 2022; 3:251-261. [PMID: 35221333 PMCID: PMC8882467 DOI: 10.1038/s43018-022-00332-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 01/10/2022] [Indexed: 12/17/2022]
Abstract
There is a growing need for systems that efficiently support the work of medical teams at the precision-oncology point of care. Here, we present the implementation of the Molecular Tumor Board Portal (MTBP), an academic clinical decision support system developed under the umbrella of Cancer Core Europe that creates a unified legal, scientific and technological platform to share and harness next-generation sequencing data. Automating the interpretation and reporting of sequencing results decrease the need for time-consuming manual procedures that are prone to errors. The adoption of an expert-agreed process to systematically link tumor molecular profiles with clinical actions promotes consistent decision-making and structured data capture across the connected centers. The use of information-rich patient reports with interactive content facilitates collaborative discussion of complex cases during virtual molecular tumor board meetings. Overall, streamlined digital systems like the MTBP are crucial to better address the challenges brought by precision oncology and accelerate the use of emerging biomarkers.
Collapse
Affiliation(s)
- David Tamborero
- Department of Oncology and Pathology, Karolinska Institutet, Science for Life Laboratory, Stockholm, Sweden.
| | - Rodrigo Dienstmann
- Medical Oncology, Oncology Data Science, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Maan Haj Rachid
- Department of Oncology and Pathology, Karolinska Institutet, Science for Life Laboratory, Stockholm, Sweden
| | - Jorrit Boekel
- Department of Oncology and Pathology, Karolinska Institutet, Science for Life Laboratory, Stockholm, Sweden
| | - Adria Lopez-Fernandez
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Markus Jonsson
- Department of Oncology and Pathology, Karolinska Institutet, Science for Life Laboratory, Stockholm, Sweden
| | - Ali Razzak
- Department of Oncology and Pathology, Karolinska Institutet, Science for Life Laboratory, Stockholm, Sweden
| | - Irene Braña
- Medical Oncology Department, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Luigi De Petris
- Department of Oncology and Pathology, Karolinska Institutet, Theme Cancer, Karolinska Comprehensive Cancer Center, Karolinska University Hospital, Stockholm, Sweden
| | - Jeffrey Yachnin
- Department of Oncology and Pathology, Karolinska Institutet, Theme Cancer, Karolinska Comprehensive Cancer Center, Karolinska University Hospital, Stockholm, Sweden
| | | | - Yohann Loriot
- Département d'Innovation Thérapeutique et d'Essais Précoces, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Christophe Massard
- Département d'Innovation Thérapeutique et d'Essais Précoces, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Patricia Martin-Romano
- Département d'Innovation Thérapeutique et d'Essais Précoces, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Frans Opdam
- The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Richard F Schlenk
- NCT Trial Center, German Cancer Research Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Claudio Vernieri
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- IFOM, FIRC Institute of Molecular Oncology, Milan, Italy
| | - Michele Masucci
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | | | - Elena Chavarria
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Judith Balmaña
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Giovanni Apolone
- Scientific Directorate, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Jonas Bergh
- Department of Oncology and Pathology, Karolinska Institutet, Theme Cancer, Karolinska Comprehensive Cancer Center, Karolinska University Hospital, Stockholm, Sweden
| | - Ingemar Ernberg
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Stefan Fröhling
- National Center for Tumor Diseases Heidelberg, German Cancer Research Center, Heidelberg, Germany
| | - Elena Garralda
- Medical Oncology Department, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Claes Karlsson
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Josep Tabernero
- Medical Oncology Department, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Emile Voest
- The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Oncode Institute, Utrecht, the Netherlands
| | - Jordi Rodon
- Medical Oncology Department, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
- Department of Investigational Cancer Therapeutics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Janne Lehtiö
- Clinical Proteomics Unit, Department of Oncology and Pathology, Karolinska Institutet, Science for Life Laboratory, Karolinska University Hospital, Stockholm, Sweden.
| |
Collapse
|
24
|
Roberto A, Greco MT, Uggeri S, Cavuto S, Deandrea S, Corli O, Apolone G. A living systematic review to assess the analgesic undertreatment in cancer patients. Pain Pract 2022; 22:487-496. [PMID: 35014151 DOI: 10.1111/papr.13098] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [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: 10/04/2021] [Revised: 11/15/2021] [Accepted: 01/03/2022] [Indexed: 11/28/2022]
Abstract
This living, systematic review aims to provide an updated summary of the available evidence on pain undertreatment prevalence in patients with cancer; correlations with some potential determinants and confounders were also carried out. We updated a systematic review published in 2014, including observational and experimental studies reporting the use of the pain management index (PMI) in adults with cancer and pain, from 2014 to 2020. We conducted searches in PubMed/MEDLINE, Embase, and Google Scholar. We performed univariate and multivariable regression analyses to describe the relationship between PMI and a list of potential explanatory variables. Twenty new papers were identified, yielding a total sample size of 66 studies. The proportion of patients classified as undertreated according to the year of study publication shows a higher decrease from 1994 to 2013 (-13% as relative change) than the most recent years 2014-2020 (-11%). The quality of the included studies has increased over the years (from 80% to 93%). At the multivariable analysis, a statistically significant relationship was confirmed between undertreatment and the year of the publication of the study and with a low-medium economic level of the countries where the studies were conducted. Despite the improvement when compared to the period 1994-2000,-still about 40% of the cases identified received an analgesic treatment inadequate to the intensity of pain, according to the PMI. Despite its intrinsic limitations, PMI continues to be widely used and it could allow a continuous monitoring of pain management across a different mix of studies and patients.
Collapse
Affiliation(s)
- Anna Roberto
- Traslational Research in Gynecology Oncology Unit, Laboratory of Methodology for Clinical Research, Oncology Departement, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Maria T Greco
- Pain and Palliative Care Research Unit, Laboratory of Methodology for Clinical Research, Oncology Departement, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Sara Uggeri
- Pain and Palliative Care Research Unit, Laboratory of Methodology for Clinical Research, Oncology Departement, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Silvio Cavuto
- Clinical Trials and Statistics Unit, Azienda USL di Reggio Emilia - IRCCS, Reggio Emilia, Italy
| | - Silvia Deandrea
- Prevention Department, Agency for Health Protection, Pavia, Italy
| | - Oscar Corli
- Pain and Palliative Care Research Unit, Laboratory of Methodology for Clinical Research, Oncology Departement, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Giovanni Apolone
- Scientific Directorate, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| |
Collapse
|
25
|
Vernieri C, Fucà G, Ligorio F, Huber V, Vingiani A, Iannelli F, Raimondi A, Rinchai D, Frigè G, Belfiore A, Lalli L, Chiodoni C, Cancila V, Zanardi F, Ajazi A, Cortellino S, Vallacchi V, Squarcina P, Cova A, Pesce S, Frati P, Mall R, Corsetto PA, Rizzo AM, Ferraris C, Folli S, Garassino MC, Capri G, Bianchi G, Colombo MP, Minucci S, Foiani M, Longo VD, Apolone G, Torri V, Pruneri G, Bedognetti D, Rivoltini L, de Braud F. Fasting-Mimicking Diet Is Safe and Reshapes Metabolism and Antitumor Immunity in Patients with Cancer. Cancer Discov 2022; 12:90-107. [PMID: 34789537 PMCID: PMC9762338 DOI: 10.1158/2159-8290.cd-21-0030] [Citation(s) in RCA: 104] [Impact Index Per Article: 52.0] [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: 01/11/2021] [Revised: 08/04/2021] [Accepted: 10/22/2021] [Indexed: 01/07/2023]
Abstract
In tumor-bearing mice, cyclic fasting or fasting-mimicking diets (FMD) enhance the activity of antineoplastic treatments by modulating systemic metabolism and boosting antitumor immunity. Here we conducted a clinical trial to investigate the safety and biological effects of cyclic, five-day FMD in combination with standard antitumor therapies. In 101 patients, the FMD was safe, feasible, and resulted in a consistent decrease of blood glucose and growth factor concentration, thus recapitulating metabolic changes that mediate fasting/FMD anticancer effects in preclinical experiments. Integrated transcriptomic and deep-phenotyping analyses revealed that FMD profoundly reshapes anticancer immunity by inducing the contraction of peripheral blood immunosuppressive myeloid and regulatory T-cell compartments, paralleled by enhanced intratumor Th1/cytotoxic responses and an enrichment of IFNγ and other immune signatures associated with better clinical outcomes in patients with cancer. Our findings lay the foundations for phase II/III clinical trials aimed at investigating FMD antitumor efficacy in combination with standard antineoplastic treatments. SIGNIFICANCE: Cyclic FMD is well tolerated and causes remarkable systemic metabolic changes in patients with different tumor types and treated with concomitant antitumor therapies. In addition, the FMD reshapes systemic and intratumor immunity, finally activating several antitumor immune programs. Phase II/III clinical trials are needed to investigate FMD antitumor activity/efficacy.This article is highlighted in the In This Issue feature, p. 1.
Collapse
Affiliation(s)
- Claudio Vernieri
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,IFOM, The FIRC Institute of Molecular Oncology, Milan, Italy.,Corresponding Authors: Claudio Vernieri, IFOM, The FIRC Institute of Molecular Oncology and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. Phone: 390223903066; E-mail: or ; and Licia Rivoltini,
| | - Giovanni Fucà
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Francesca Ligorio
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Veronica Huber
- Unit of Immunotherapy of Human Tumors, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andrea Vingiani
- Oncology and Haemato-Oncology Department, University of Milan, Milan, Italy.,Deparment of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Fabio Iannelli
- IFOM, The FIRC Institute of Molecular Oncology, Milan, Italy
| | - Alessandra Raimondi
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Darawan Rinchai
- Immunology Department, Cancer Program, Sidra Medicine, Doha, Qatar
| | - Gianmaria Frigè
- Department of Experimental Oncology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Antonino Belfiore
- Deparment of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Luca Lalli
- Unit of Immunotherapy of Human Tumors, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Claudia Chiodoni
- Molecular Immunology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Valeria Cancila
- Tumor Immunology Unit, Department of Health Sciences, University of Palermo, Palermo, Italy
| | | | - Arta Ajazi
- IFOM, The FIRC Institute of Molecular Oncology, Milan, Italy
| | | | - Viviana Vallacchi
- Unit of Immunotherapy of Human Tumors, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paola Squarcina
- Unit of Immunotherapy of Human Tumors, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Agata Cova
- Unit of Immunotherapy of Human Tumors, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Samantha Pesce
- Unit of Immunotherapy of Human Tumors, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paola Frati
- Unit of Immunotherapy of Human Tumors, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Raghvendra Mall
- Qatar Computing Research Institute, Hamad Bin Khalifa University, Doha, Qatar
| | - Paola Antonia Corsetto
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Angela Maria Rizzo
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Cristina Ferraris
- Breast Unit, Fondazione IRCCS Istituto Nazionale dei Tumori. Milan 20133, Italy
| | - Secondo Folli
- Breast Unit, Fondazione IRCCS Istituto Nazionale dei Tumori. Milan 20133, Italy
| | | | - Giuseppe Capri
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giulia Bianchi
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Mario Paolo Colombo
- Molecular Immunology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Saverio Minucci
- Department of Experimental Oncology, European Institute of Oncology (IEO), IRCCS, Milan, Italy.,Department of Biosciences, University of Milan, Milan, Italy
| | - Marco Foiani
- IFOM, The FIRC Institute of Molecular Oncology, Milan, Italy.,Oncology and Haemato-Oncology Department, University of Milan, Milan, Italy
| | - Valter Daniel Longo
- IFOM, The FIRC Institute of Molecular Oncology, Milan, Italy.,Longevity Institute, School of Gerontology, Department of Biological Sciences, University of Southern California, Los Angeles, California
| | - Giovanni Apolone
- Scientific Directorate, Fondazione IRCCS Istituto Nazionale dei Tumori. Milan, Italy
| | - Valter Torri
- Laboratory of Methodology for Biomedical Research, Istituto di Ricerche Farmacologiche “Mario Negri” IRCCS, Milan, Italy
| | - Giancarlo Pruneri
- Oncology and Haemato-Oncology Department, University of Milan, Milan, Italy.,Deparment of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Davide Bedognetti
- Immunology Department, Cancer Program, Sidra Medicine, Doha, Qatar.,Dipartimento di Medicina Interna e Specialità Mediche, Università degli Studi di Genova, Genova, Italy.,College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Qatar
| | - Licia Rivoltini
- Unit of Immunotherapy of Human Tumors, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,Corresponding Authors: Claudio Vernieri, IFOM, The FIRC Institute of Molecular Oncology and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. Phone: 390223903066; E-mail: or ; and Licia Rivoltini,
| | - Filippo de Braud
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,Oncology and Haemato-Oncology Department, University of Milan, Milan, Italy
| |
Collapse
|
26
|
Fucà G, Lecchi M, Ciniselli CM, Ottini A, Spagnoletti A, Mazzeo L, Morelli D, Frati P, Stroscia M, Ebrahem E, Sottotetti E, Galli G, D’Elia MG, Lobefaro R, Ducceschi M, Di Guardo L, Bhoori S, Provenzano S, Platania M, Niger M, Colombo E, Nichetti F, Duca M, Rivoltini L, Mortarini R, Baili P, Apolone G, de Braud F, Verderio P, Damian S. Efficacy of mRNA anti-SARS-CoV-2 vaccination and dynamics of humoral immune response in patients with solid tumors: results from the institutional registry of an Italian tertiary cancer center. Ther Adv Med Oncol 2022; 14:17588359221108687. [PMID: 35923922 PMCID: PMC9340426 DOI: 10.1177/17588359221108687] [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: 02/07/2022] [Accepted: 06/06/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Systemic immunosuppression characterizing cancer patients represents a concern regarding the efficacy of anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination, and real-world evidence is needed to define the efficacy and the dynamics of humoral immune response to mRNA-based anti-SARS-CoV-2 vaccines. Methods: We conducted an observational study that included patients with solid tumors who were candidates for mRNA anti-SARS-CoV-2 vaccination at the Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. The primary objective was to monitor the immunologic response to the mRNA anti-SARS-CoV-2 vaccination in terms of anti-spike antibody levels. All the patients received two doses of the mRNA-1273 vaccine or the BNT162b2 vaccine. Healthcare workers served as a control group of healthy subjects. Results: Among the 243 patients included in the present analysis, 208 (85.60%) and 238 (97.94%) resulted seroconverted after the first and the second dose of vaccine, respectively. Only five patients (2.06%) had a negative titer after the second dose. No significant differences in the rate of seroconversion after two vaccine doses were observed in patients as compared with the control group of healthy subjects. Age and anticancer treatment class had an independent impact on the antibody titer after the second dose of vaccination. In a subgroup of 171 patients with available data about the third timepoint, patients receiving immunotherapy with immune checkpoint inhibitors seem to have a higher peak of antibodies soon after the second dose (3 weeks after), but a more pronounced decrease at a late timepoint (3 months after). Conclusions: The systemic immunosuppression characterizing cancer patients did not seem to dramatically affect the humoral response to anti-SARS-CoV-2 mRNA vaccines in our population of patients with solid tumors. Further investigation is needed to dissect the interplay between immunotherapy and longitudinal dynamics of humoral response to mRNA vaccines, as well as to analyze the cellular response to mRNA vaccines in cancer patients.
Collapse
Affiliation(s)
- Giovanni Fucà
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Mara Lecchi
- Unit of Bioinformatics and Biostatistics, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Chiara Maura Ciniselli
- Unit of Bioinformatics and Biostatistics, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Arianna Ottini
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andrea Spagnoletti
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Laura Mazzeo
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Daniele Morelli
- Unit of Bioinformatics and Biostatistics, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paola Frati
- Unit of Immunotherapy of Human Tumors, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Martina Stroscia
- Unit of Immunotherapy of Human Tumors, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elisabella Ebrahem
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elisa Sottotetti
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giulia Galli
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Maria Grazia D’Elia
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Riccardo Lobefaro
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Monika Ducceschi
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Lorenza Di Guardo
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sherrie Bhoori
- Hepato-Pancreatic-Biliary Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Salvatore Provenzano
- Medical Oncology Unit 2, Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marco Platania
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Monica Niger
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elena Colombo
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Federico Nichetti
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Computational Oncology, Molecular Diagnostics Program, National Center for Tumor Diseases and German Cancer Research Center, Heidelberg, Germany
| | - Matteo Duca
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Licia Rivoltini
- Unit of Immunotherapy of Human Tumors, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberta Mortarini
- Human Tumors Immunobiology Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paolo Baili
- Unit of Bioinformatics and Biostatistics, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Scientific Directorate, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanni Apolone
- Scientific Directorate, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Filippo de Braud
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy Oncology and Hemato-Oncology Department, University of Milan, Milan, Italy
| | | | - Silvia Damian
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, Milan 20133, Italy
| |
Collapse
|
27
|
Di Cosimo S, Lupo-Stanghellini MT, Costantini M, Mantegazza R, Ciceri F, Salvarani C, Zinzani PL, Mantovani A, Ciliberto G, Uccelli A, Baldanti F, Apolone G, Delcuratolo S, Morrone A, Locatelli F, Agrati C, Silvestris N. Safety of third dose of COVID-19 vaccination in frail patients: Results from the prospective Italian VAX4FRAIL study. Front Oncol 2022; 12:1002168. [PMID: 36338743 PMCID: PMC9631315 DOI: 10.3389/fonc.2022.1002168] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 09/29/2022] [Indexed: 02/05/2023] Open
Abstract
IMPORTANCE Despite people with impaired immune competence due to an underlying disease or ongoing therapy, hereinafter frail patients, are (likely to be) the first to be vaccinated, they were usually excluded from clinical trials. OBJECTIVE To report adverse reactions of frail patients after receipt of the third dose (booster) administered after completion of a two-dose mRNA vaccination and to compare with those reported after the receipt of the first two doses. DESIGN A multicenter, observational, prospective study aimed at evaluating both the safety profile and the immune response of Pfizer-BioNTech or Moderna vaccines in frail patients. SETTING National Project on Vaccines, COVID-19 and Frail Patients (VAX4FRAIL). PARTICIPANTS People consenting and included in the VAX4FRAIL trial. EXPOSURE A series of three doses of COVID-19 mRNA vaccination from the same manufacturer. MAIN OUTCOMES AND MEASURES Evaluation of a self-assessment questionnaire addressing a predefined list of eight symptoms on a five-item Likert scale. Symptoms were classified as severe if the patient rated them as severe or overwhelming. RESULTS Among 320 VAX4FRAIL participants diagnosed/treated for hematological malignancies (N=105; 32.8%), solid tumors (N=48; 15.0%), immune-rheumatological diseases (N=60; 18.8%), neurological diseases (N=107; 33.4%), and receiving the booster dose, 70.3% reported at least one loco-regional or systemic reactions. Adverse events were mostly mild or moderate, none being life-threatening. Only six of the 320 (1.9%) patients had their treatment postponed due to the vaccine. The safety profile of the booster compared to previously administered two doses showed a stable prevalence of patients with one or more adverse events (73.5%, 79.7% and 73.9% respectively), and a slightly increment of patients with one or more severe adverse events (13.4%, 13.9% and 19.2% respectively). CONCLUSIONS AND RELEVANCE The booster of the mRNA COVID-19 vaccine was safely administered in the largest prospective cohort of frail patients reported so far. VAX4FRAIL will continue to monitor the safety of additional vaccine doses, especially systemic adverse events that can be easily prevented to avoid interruption of continuity of care. CLINICAL TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT04848493, identifier NCT04848493.
Collapse
Affiliation(s)
- Serena Di Cosimo
- Department of Applied Research and Technological Development, Fondazione Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milano, Italy
| | - Maria Teresa Lupo-Stanghellini
- Hematology and Bone Marrow Transplantation Unit, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milano, Italy
| | - Massimo Costantini
- Scientific Directorate, Fondazione Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Renato Mantegazza
- Neuromuscular Diseases and Neuroimmunology Unit, Fondazione Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milano, Italy
| | - Fabio Ciceri
- Hematology and Bone Marrow Transplantation Unit, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milano, Italy
- University Vita-Salute San Raffaele, Milano, Italy
| | - Carlo Salvarani
- Unità di Reumatologia, Azienda Unità Sanitaria Locale (USL)-Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Reggio Emilia, Italy
- Unità di Reumatologia, Università degli Studi di Modena e Reggio Emilia, Modena, Italy
| | - Pier Luigi Zinzani
- Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli”, Bologna, Italy
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Alberto Mantovani
- Humanitas Scientific Directorate, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- William Harvey Research Institute, Queen Mary University, London, United Kingdom
| | - Gennaro Ciliberto
- Scientific Directorate Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena, National Cancer Institute, Istituti Fisioterapici Ospitalieri (IFO), Rome, Italy
| | - Antonio Uccelli
- Biotherapy Unit, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Fausto Baldanti
- Molecular Virology Unit, Fondazione Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
- Department of Clinical, Surgical, Diagnostics and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Giovanni Apolone
- Scientific Directorate, Fondazione Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Sabina Delcuratolo
- Scientific Directorate, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Tumori “Giovanni Paolo II”, Bari, Italy
| | - Aldo Morrone
- Scientific Directorate, San Gallicano Dermatological Institute Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Franco Locatelli
- Department of Pediatric Hematology and Oncology and Cell and Gene Therapy, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Pediatrico Bambino Gesù, Roma, Italy
- Department of Gynecology-Obstetrics and Pediatrics, University “La Sapienza”, Roma, Italy
| | - Chiara Agrati
- Cellular Immunology Laboratory, National Institute for Infectious Diseases L Spallanzani – Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Nicola Silvestris
- Medical Oncology Unit, Department of Human Pathology “G. Barresi”, University of Messina, Messina, Italy
- *Correspondence: Nicola Silvestris,
| |
Collapse
|
28
|
Montomoli E, Apolone G, Manenti A, Boeri M, Suatoni P, Sabia F, Marchianò A, Bollati V, Pastorino U, Sozzi G. Timeline of SARS-CoV-2 Spread in Italy: Results from an Independent Serological Retesting. Viruses 2021; 14:61. [PMID: 35062265 PMCID: PMC8778320 DOI: 10.3390/v14010061] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 12/24/2021] [Accepted: 12/27/2021] [Indexed: 12/25/2022] Open
Abstract
The massive emergence of COVID-19 cases in the first phase of pandemic within an extremely short period of time suggest that an undetected earlier circulation of SARS-CoV-2 might have occurred. Given the importance of this evidence, an independent evaluation was recommended by the World Health Organization (WHO) to test a subset of samples selected on the level of positivity in ELISA assays (positive, low positive, negative) detected in our previous study of prepandemic samples collected in Italy. SARS-CoV-2 antibodies were blindly retested by two independent centers in 29 blood samples collected in the prepandemic period in Italy, 29 samples collected one year before and 11 COVID-19 control samples. The methodologies used included IgG-RBD/IgM-RBD ELISA assays, a qualitative micro-neutralization CPE-based assay, a multiplex IgG protein array, an ELISA IgM kit (Wantai), and a plaque-reduction neutralization test. The results suggest the presence of SARS-CoV-2 antibodies in some samples collected in the prepandemic period, with the oldest samples found to be positive for IgM by both laboratories collected on 10 October 2019 (Lombardy), 11 November 2019 (Lombardy) and 5 February 2020 (Lazio), the latter with neutralizing antibodies. The detection of IgM and/or IgG binding and neutralizing antibodies was strongly dependent on the different serological assays and thresholds employed, and they were not detected in control samples collected one year before. These findings, although gathered in a small and selected set of samples, highlight the importance of harmonizing serological assays for testing the spread of the SARS-CoV-2 virus and may contribute to a better understanding of future virus dynamics.
Collapse
Affiliation(s)
- Emanuele Montomoli
- Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, Italy;
- VisMederi S.r.l., 53200 Siena, Italy;
| | - Giovanni Apolone
- Scientific Direction, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy;
| | - Alessandro Manenti
- VisMederi S.r.l., 53200 Siena, Italy;
- VisMederi Research S.r.l., 53100 Siena, Italy
| | - Mattia Boeri
- Department of Research, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy;
| | - Paola Suatoni
- Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy; (P.S.); (F.S.)
| | - Federica Sabia
- Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy; (P.S.); (F.S.)
| | - Alfonso Marchianò
- Department of Radiology, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy;
| | - Valentina Bollati
- EPIGET-Epidemiology, Epigenetics and Toxicology Lab., University of Milan, 20100 Milan, Italy;
| | - Ugo Pastorino
- Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy; (P.S.); (F.S.)
| | - Gabriella Sozzi
- Department of Research, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy;
| |
Collapse
|
29
|
Marasco V, Carniti C, Guidetti A, Farina L, Magni M, Miceli R, Calabretta L, Verderio P, Ljevar S, Serpenti F, Morelli D, Apolone G, Ippolito G, Agrati C, Corradini P. T-cell immune response after mRNA SARS-CoV-2 vaccines is frequently detected also in the absence of seroconversion in patients with lymphoid malignancies. Br J Haematol 2021; 196:548-558. [PMID: 34649298 PMCID: PMC8653177 DOI: 10.1111/bjh.17877] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/08/2021] [Accepted: 09/22/2021] [Indexed: 12/27/2022]
Abstract
Patients affected by lymphoid malignancies (LM) are frequently immune‐compromised, suffering increased mortality from COVID‐19. This prospective study evaluated serological and T‐cell responses after complete mRNA vaccination in 263 patients affected by chronic lymphocytic leukaemia, B‐ and T‐cell lymphomas and multiple myeloma. Results were compared with those of 167 healthy subjects matched for age and sex. Overall, patient seroconversion rate was 64·6%: serological response was lower in those receiving anti‐cancer treatments in the 12 months before vaccination: 55% vs 81·9% (P < 0·001). Anti‐CD20 antibody plus chemotherapy treatment was associated with the lowest seroconversion rate: 17·6% vs. 71·2% (P < 0·001). In the multivariate analysis conducted in the subgroup of patients on active treatment, independent predictors for seroconversion were: anti‐CD20 treatment (P < 0·001), aggressive B‐cell lymphoma diagnosis (P = 0·002), and immunoglobulin M levels <40 mg/dl (P = 0·030). The T‐cell response was evaluated in 99 patients and detected in 85 of them (86%). Of note, 74% of seronegative patients had a T‐cell response, but both cellular and humoral responses were absent in 13·1% of cases. Our findings raise some concerns about the protection that patients with LM, particularly those receiving anti‐CD20 antibodies, may gain from vaccination. These patients should strictly maintain all the protective measures.
Collapse
Affiliation(s)
| | - Cristiana Carniti
- Division of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Italy
| | - Anna Guidetti
- School of Medicine, University of Milano, Italy.,Division of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Italy
| | - Lucia Farina
- Division of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Italy
| | - Martina Magni
- Division of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Italy
| | - Rosalba Miceli
- Department of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori, Italy
| | | | - Paolo Verderio
- Unit of Bioinformatics and Biostatistics, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Italy
| | - Silva Ljevar
- Department of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori, Italy
| | | | - Daniele Morelli
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Italy
| | - Giovanni Apolone
- Scientific Directorate, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Giuseppe Ippolito
- National Institute for Infectious Diseases "Lazzaro Spallanzani" I.R.C.C.S, Italy
| | - Chiara Agrati
- Cellular Immunology Laboratory, INMI L Spallanzani, Rome, Italy
| | - Paolo Corradini
- School of Medicine, University of Milano, Italy.,Division of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Italy
| |
Collapse
|
30
|
Apolone G, Montomoli E, Manenti A, Boeri M, Sabia F, Hyseni I, Mazzini L, Martinuzzi D, Cantone L, Milanese G, Sestini S, Suatoni P, Marchianò A, Bollati V, Sozzi G, Pastorino U. Unexpected detection of SARS-CoV-2 antibodies in the prepandemic period in Italy. Tumori 2021; 107:446-451. [PMID: 33176598 PMCID: PMC8529295 DOI: 10.1177/0300891620974755] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 12/15/2022]
Abstract
There are no robust data on the real onset of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and spread in the prepandemic period worldwide. We investigated the presence of SARS-CoV-2 receptor-binding domain (RBD)-specific antibodies in blood samples of 959 asymptomatic individuals enrolled in a prospective lung cancer screening trial between September 2019 and March 2020 to track the date of onset, frequency, and temporal and geographic variations across the Italian regions. SARS-CoV-2 RBD-specific antibodies were detected in 111 of 959 (11.6%) individuals, starting from September 2019 (14%), with a cluster of positive cases (>30%) in the second week of February 2020 and the highest number (53.2%) in Lombardy. This study shows an unexpected very early circulation of SARS-CoV-2 among asymptomatic individuals in Italy several months before the first patient was identified, and clarifies the onset and spread of the coronavirus disease 2019 (COVID-19) pandemic. Finding SARS-CoV-2 antibodies in asymptomatic people before the COVID-19 outbreak in Italy may reshape the history of pandemic.
Collapse
Affiliation(s)
| | - Emanuele Montomoli
- Faculty of Medicine and Surgery, University of
Siena, Siena, Italy
- VisMederi Srl, Siena, Italy
| | | | - Mattia Boeri
- Fondazione IRCCS Istituto Nazionale Tumori,
Milan, Italy
| | - Federica Sabia
- Fondazione IRCCS Istituto Nazionale Tumori,
Milan, Italy
| | | | - Livia Mazzini
- Faculty of Medicine and Surgery, University of
Siena, Siena, Italy
- VisMederi Research Srl, Siena, Italy
| | | | - Laura Cantone
- EPIGET–Epidemiology, Epigenetics and
Toxicology Lab, University of Milan, Milan, Italy
| | - Gianluca Milanese
- Radiology, Department of Medicine and Surgery,
University of Parma, Parma, Italy
| | | | - Paola Suatoni
- Fondazione IRCCS Istituto Nazionale Tumori,
Milan, Italy
| | | | - Valentina Bollati
- EPIGET–Epidemiology, Epigenetics and
Toxicology Lab, University of Milan, Milan, Italy
| | | | - Ugo Pastorino
- Fondazione IRCCS Istituto Nazionale Tumori,
Milan, Italy
| |
Collapse
|
31
|
Rundo L, Ledda RE, di Noia C, Sala E, Mauri G, Milanese G, Sverzellati N, Apolone G, Gilardi MC, Messa MC, Castiglioni I, Pastorino U. A Low-Dose CT-Based Radiomic Model to Improve Characterization and Screening Recall Intervals of Indeterminate Prevalent Pulmonary Nodules. Diagnostics (Basel) 2021; 11:1610. [PMID: 34573951 PMCID: PMC8471292 DOI: 10.3390/diagnostics11091610] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 08/25/2021] [Accepted: 08/30/2021] [Indexed: 12/25/2022] Open
Abstract
Lung cancer (LC) is currently one of the main causes of cancer-related deaths worldwide. Low-dose computed tomography (LDCT) of the chest has been proven effective in secondary prevention (i.e., early detection) of LC by several trials. In this work, we investigated the potential impact of radiomics on indeterminate prevalent pulmonary nodule (PN) characterization and risk stratification in subjects undergoing LDCT-based LC screening. As a proof-of-concept for radiomic analyses, the first aim of our study was to assess whether indeterminate PNs could be automatically classified by an LDCT radiomic classifier as solid or sub-solid (first-level classification), and in particular for sub-solid lesions, as non-solid versus part-solid (second-level classification). The second aim of the study was to assess whether an LCDT radiomic classifier could automatically predict PN risk of malignancy, and thus optimize LDCT recall timing in screening programs. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), accuracy, positive predictive value, negative predictive value, sensitivity, and specificity. The experimental results showed that an LDCT radiomic machine learning classifier can achieve excellent performance for characterization of screen-detected PNs (mean AUC of 0.89 ± 0.02 and 0.80 ± 0.18 on the blinded test dataset for the first-level and second-level classifiers, respectively), providing quantitative information to support clinical management. Our study showed that a radiomic classifier could be used to optimize LDCT recall for indeterminate PNs. According to the performance of such a classifier on the blinded test dataset, within the first 6 months, 46% of the malignant PNs and 38% of the benign ones were identified, improving early detection of LC by doubling the current detection rate of malignant nodules from 23% to 46% at a low cost of false positives. In conclusion, we showed the high potential of LDCT-based radiomics for improving the characterization and optimizing screening recall intervals of indeterminate PNs.
Collapse
Affiliation(s)
- Leonardo Rundo
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK;
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0RE, UK
| | - Roberta Eufrasia Ledda
- Unit of Radiological Sciences, Department of Medicine and Surgery (DiMeC), University of Parma, 43126 Parma, Italy; (R.E.L.); (G.M.); (N.S.)
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milan, Italy; (G.A.); (U.P.)
| | - Christian di Noia
- Department of Physics “Giuseppe Occhialini”, University of Milano-Bicocca, 20126 Milan, Italy;
| | - Evis Sala
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK;
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge CB2 0RE, UK
| | - Giancarlo Mauri
- Department of Informatics, Systems and Communication, University of Milano-Bicocca, 20126 Milan, Italy;
| | - Gianluca Milanese
- Unit of Radiological Sciences, Department of Medicine and Surgery (DiMeC), University of Parma, 43126 Parma, Italy; (R.E.L.); (G.M.); (N.S.)
| | - Nicola Sverzellati
- Unit of Radiological Sciences, Department of Medicine and Surgery (DiMeC), University of Parma, 43126 Parma, Italy; (R.E.L.); (G.M.); (N.S.)
| | - Giovanni Apolone
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milan, Italy; (G.A.); (U.P.)
| | - Maria Carla Gilardi
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy; (M.C.G.); (M.C.M.)
| | - Maria Cristina Messa
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy; (M.C.G.); (M.C.M.)
- Institute of Biomedical Imaging and Physiology, Italian National Research Council (IBFM-CNR), Segrate, 20090 Milan, Italy
- Fondazione Tecnomed, University of Milano-Bicocca, 20900 Monza, Italy
| | - Isabella Castiglioni
- Department of Physics “Giuseppe Occhialini”, University of Milano-Bicocca, 20126 Milan, Italy;
- Institute of Biomedical Imaging and Physiology, Italian National Research Council (IBFM-CNR), Segrate, 20090 Milan, Italy
| | - Ugo Pastorino
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milan, Italy; (G.A.); (U.P.)
| |
Collapse
|
32
|
Agrati C, Di Cosimo S, Fenoglio D, Apolone G, Ciceri F, Ciliberto G, Baldanti F, Costantini M, Giannarelli D, Ippolito G, Locatelli F, Mantovani A, Morrone A, Tagliavini F, Uccelli A, Zinzani PL, Silvestris N, Rescigno M. COVID-19 Vaccination in Fragile Patients: Current Evidence and an Harmonized Transdisease Trial. Front Immunol 2021; 12:704110. [PMID: 34447374 PMCID: PMC8383886 DOI: 10.3389/fimmu.2021.704110] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 05/01/2021] [Accepted: 07/12/2021] [Indexed: 01/14/2023] Open
Abstract
Patients diagnosed with malignancy, neurological and immunological disorders, i.e., fragile patients, have been excluded from COVID-19 vaccine trials. However, this population may present immune response abnormalities, and relative reduced vaccine responsiveness. Here we review the limited current evidence on the immune responses to vaccination of patients with different underlying diseases. To address open questions we present the VAX4FRAIL study aimed at assessing immune responses to vaccination in a large transdisease cohort of patients with cancer, neurological and rheumatological diseases.
Collapse
Affiliation(s)
- Chiara Agrati
- Cellular Immunology Laboratory, Department of Epidemiology, Preclinical Research and Advanced Diagnostic, National Institute for Infectious Diseases (INMI) Lazzaro Spallanzani - IRCCS, Roma, Italy
| | - Serena Di Cosimo
- Biomarkers Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Daniela Fenoglio
- Department of Internal Medicine and Centre of Excellence for Biomedical Research, University of Genoa, Genoa, Italy
- Biotherapies Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giovanni Apolone
- Scientific Directorate, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Fabio Ciceri
- Scientific Directorate, IRCSS San Raffaele Scientific Institute, Milano, Italy
| | - Gennaro Ciliberto
- IRCCS Regina Elena National Cancer Institute, Istituti Fisioterapici Ospitalieri (IFO), Rome, Italy
| | - Fausto Baldanti
- Molecular Virology Unit, Fondazione IRCCS Policlinico San Matteo; Dpt. of Clinical, Surgical, Diagnostics and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Massimo Costantini
- Scientific Directorate, Azienda Unita Sanitaria Locale (USL)-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Diana Giannarelli
- Biostatistical Unit, Istituto Nazionale Tumori Regina Elena IRCCS - IFO, Rome, Italy
| | - Giuseppe Ippolito
- Scientific Directorate, INMI Lazzaro Spallanzani - IRCCS, Roma, Italy
| | - Franco Locatelli
- Department of Pediatric Hematology and Oncology, IRCCS Ospedale Pediatrico Bambino Gesù, Department of Gynecology-Obstetrics and Pediatrics, University “La Sapienza”, Roma, Italy
| | - Alberto Mantovani
- Scientific Directorate, IRCCS Humanitas Clinical and Research Center, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- William Harvey Research Institute, Queen Mary University, London, United Kingdom
| | - Aldo Morrone
- Scientific Directorate, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Fabrizio Tagliavini
- Scientific Directorate, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Antonio Uccelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health and Center of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia “Seràgnoli”, Bologna, Italy
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna, Bologna, Italy
| | - Nicola Silvestris
- Medical Oncology Department, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari, Italy
- Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, Bari, Italy
| | - Maria Rescigno
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Mucosal Immunology and Microbiota Unit, IRCCS Humanitas Clinical and Research Center, Milano, Italy
| |
Collapse
|
33
|
Apolone G, Ardizzoni A, Biondi A, Bortolami A, Cardone C, Ciniselli CM, Conte P, Crippa C, de Braud F, Duca M, Gori S, Gritti G, Inno A, Luksch R, Lussana F, Maio M, Pasello G, Perrone F, Rambaldi A, Rossi G, Signorelli D, Soverini G, Valente M, Verderio P, Buzzetti G. Skip pattern approach toward the early access of innovative anticancer drugs. ESMO Open 2021; 6:100227. [PMID: 34352703 PMCID: PMC8350180 DOI: 10.1016/j.esmoop.2021.100227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/29/2021] [Accepted: 07/06/2021] [Indexed: 10/29/2022] Open
Abstract
BACKGROUND With the rapid development of innovative anticancer treatments, the optimization of tools able to accelerate the access of new drugs to the market by the regulatory authority is a major issue. The aim of the project was to propose a reliable methodological pathway for the assessment of clinical value of new therapeutic innovative options, to objectively identify drugs which deserve early access (EA) priority for solid and possibly in other cancer scenarios, such as the hematological ones. MATERIALS AND METHODS After a comprehensive review of the European Public Assessment Report of 21 drugs, to which innovation had previously been attributed by the Italian Medicines Agency (Agenzia Italiana del Farmaco, AIFA), an expert panel formulated an algorithm for the balanced use of three parameters: Unmet Medical Need (UMN) according to AIFA criteria, Added Benefit (AB) according to the European Society for Medical Oncology's Magnitude of Clinical Benefit Scale (ESMO-MCBS) criteria and Quality of Evidence (QE) assessed by the Grades of Recommendation Assessment, Development and Evaluation (GRADE) method. By sequentially combining the above indicators, a final priority status (i.e. EA or not) was obtained using the skip pattern approach (SPA). RESULTS By applying the SPA to the non-curative setting in solid cancers, the EA status was obtained by 5 out of 14 investigated drugs (36%); by enhancing the role of some categories of the UMN, additional 4 drugs, for a total of 9 (64%), reached the EA status: 2 and 3 drugs were excluded for not achieving an adequate score according to AB and QE criteria, respectively. For hematology cancer, only the UMN criteria were found to be adequate. CONCLUSIONS The use of this model may represent a reliable tool for assessment available to the various stakeholders involved in the EA process and may help regulatory agencies in a more comprehensive and objective definition of new treatments' value in these contexts. Its generalizability in other national contexts needs further evaluation.
Collapse
Affiliation(s)
- G Apolone
- Scientific Directorate, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - A Ardizzoni
- Department of Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - A Biondi
- Department of Pediatrics, University of Milano Bicocca-Fondazione MBBM/Ospedale San Gerardo, Monza, Italy
| | - A Bortolami
- Rete Oncologica Veneta, Istituto Oncologico Veneto, Padova, Italy
| | - C Cardone
- Experimental Clinical Abdominal Oncology, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Napoli, Italy
| | - C M Ciniselli
- Unit of Bioinformatics and Biostatistics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - P Conte
- Istituto Oncologico Veneto, Padova, Italy
| | - C Crippa
- Department of Hemathology, Spedali Civili di Brescia, Brescia, Italy
| | - F de Braud
- Department of Medical Oncology & Haematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - M Duca
- Department of Medical Oncology & Haematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - S Gori
- Department of Oncology, IRCCS Sacro Cuore Don Calabria Hospital of Negrar, Verona, Italy
| | - G Gritti
- Hematology and Bone Marrow Transplantation Unit, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - A Inno
- Department of Oncology, IRCCS Sacro Cuore Don Calabria Hospital of Negrar, Verona, Italy
| | - R Luksch
- Department of Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - F Lussana
- Hematology and Bone Marrow Transplantation Unit, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - M Maio
- Center for Immuno-Oncology, Medical Oncology and Immunotherapy, University Hospital of Siena, Siena, Italy
| | - G Pasello
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy; Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - F Perrone
- Clinical Trials Unit, National Cancer Institute of Naples, Napoli, Italy
| | - A Rambaldi
- Department of Oncology-Hematology, University of Milan, Milano, Italy; Department of Oncology and Hematology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - G Rossi
- Deparment of Hematology ASST Spedali Civili di Brescia, Brescia, Italy
| | - D Signorelli
- Department of Medical Oncology & Haematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Niguarda Cancer Center-Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - G Soverini
- Deparment of Hematology ASST Spedali Civili di Brescia, Brescia, Italy
| | - M Valente
- Center for Immuno-Oncology, Medical Oncology and Immunotherapy, University Hospital of Siena, Siena, Italy
| | - P Verderio
- Unit of Bioinformatics and Biostatistics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
| | | |
Collapse
|
34
|
Belfiore A, Ciniselli CM, Signoroni S, Gariboldi M, Mancini A, Rivoltini L, Morelli D, Masci E, Bruno E, Macciotta A, Ricci MT, Daveri E, Cattaneo L, Gargano G, Apolone G, Milione M, Verderio P, Pasanisi P, Vitellaro M. Preventive Anti-inflammatory Diet to Reduce Gastrointestinal Inflammation in Familial Adenomatous Polyposis Patients: A Prospective Pilot Study. Cancer Prev Res (Phila) 2021; 14:963-972. [PMID: 34253565 DOI: 10.1158/1940-6207.capr-21-0076] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/24/2021] [Accepted: 07/06/2021] [Indexed: 11/16/2022]
Abstract
Familial adenomatous polyposis (FAP) is an autosomal-dominant hereditary condition associated with germline mutations in the adenomatous polyposis coli gene. Patient management involves prophylactic surgery and intensive life-long endoscopic surveillance. Diet is a major concern for patients with FAP, who are generally free of symptoms before surgery but tend to have issues related to bowel function postoperatively. We hypothesized that a low-inflammatory diet based on the principles and recipes of the Mediterranean diet would reduce markers of local and systemic inflammation. Twenty-eight patients with FAP over 18 years of age who underwent rectum-sparing prophylactic colectomy and were included in our surveillance program participated in a pilot dietary intervention study. Blood and stool samples at baseline (T0), at the end of the dietary intervention (T1, three months), and at the end of the study (T2, six months after T0) were collected. Gastrointestinal inflammation markers including fecal calprotectin, cyclooxygenase-2, and 15-hydroxyprostaglandin dehydrogenase were evaluated. Serum calprotectin, insulin, insulin-like growth factor-1, C-reactive protein, and glycated hemoglobin were also assessed. Significant changes in serum calprotectin, insulin, and insulin-like growth factor-1 levels occurred over time. Borderline significant changes were observed in the neutrophil-lymphocyte ratio. These changes were noticeable immediately at the end of the 3-month active dietary intervention (T1). A significant increase in 15-hydroxyprostaglandin dehydrogenase expression in the normal crypts of matched samples was also observed between T0 and T2. This pilot study supports the hypothesis that a low-inflammatory diet can modulate gastrointestinal markers of inflammation in individuals with FAP. PREVENTION RELEVANCE: Cancer is known to be related to inflammatory conditions. This study suggests that anti-inflammatory dietary intervention may potentially prevent adenomas and cancer in FAP patients by reducing systemic and tissue inflammatory indices.
Collapse
Affiliation(s)
- Antonino Belfiore
- First Pathology Division, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Chiara Maura Ciniselli
- Unit of Bioinformatics and Biostatistics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stefano Signoroni
- Unit of Hereditary Digestive Tract Tumors, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Manuela Gariboldi
- Unit of Genetic Epidemiology and Pharmacogenomics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andrea Mancini
- Unit of Diagnostic and Therapeutic Endoscopy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Licia Rivoltini
- Unit of Immunotherapy of Human Tumors, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Daniele Morelli
- Laboratory Medicine Division, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Enzo Masci
- Unit of Diagnostic and Therapeutic Endoscopy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Eleonora Bruno
- Unit of Epidemiology and Prevention, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandra Macciotta
- Unit of Bioinformatics and Biostatistics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Maria Teresa Ricci
- Unit of Hereditary Digestive Tract Tumors, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elena Daveri
- Unit of Immunotherapy of Human Tumors, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Laura Cattaneo
- First Pathology Division, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giuliana Gargano
- Unit of Epidemiology and Prevention, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanni Apolone
- Scientific Directorate, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Massimo Milione
- First Pathology Division, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paolo Verderio
- Unit of Bioinformatics and Biostatistics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Patrizia Pasanisi
- Unit of Epidemiology and Prevention, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marco Vitellaro
- Unit of Hereditary Digestive Tract Tumors, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,Colorectal Surgery Division, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| |
Collapse
|
35
|
Mazzini E, Soncini F, Cerullo L, Genovese L, Apolone G, Ghirotto L, Mazzi G, Costantini M. A focused ethnography in the context of a European cancer research hospital accreditation program. BMC Health Serv Res 2021; 21:446. [PMID: 33975580 PMCID: PMC8111912 DOI: 10.1186/s12913-021-06466-5] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 04/28/2021] [Indexed: 05/31/2023] Open
Abstract
Background A quality accreditation program (AP) is designed to guarantee predefined quality standards of healthcare organizations. Evidence of the impact of quality standards remains scarce and somewhat challenging to document. This study aimed to investigate the accreditation of a cancer research hospital (Italy), promoted by the Organization of European Cancer Institutes (OECI), by focusing on the individual, group, and organizational experiences resulting from the OECI AP. Methods A focused ethnography study was carried out to analyze the relevance of participation in the accreditation process. Twenty-nine key informants were involved in four focus group meetings, and twelve semistructured interviews were conducted with professionals and managers. Inductive qualitative content analysis was applied to examine all transcripts. Results Four main categories emerged: a) OECI AP as an opportunity to foster diversity within professional roles; b) OECI AP as a possibility for change; c) perceived barriers; and d) OECI AP-solicited expectations. Conclusions The accreditation process is an opportunity for improving the quality and variety of care services for cancer patients through promoting an interdisciplinary approach to care provision. Perceiving accreditation as an opportunity is a prerequisite for overcoming the barriers that professionals involved in the process may report. Critical to a positive change is sharing the values and the framework, which are at the basis of accreditation programs. Improving the information-sharing process among managers and professionals may limit the risk of unmet expectations and prevent demotivation by future accreditation programs. Finally, we found that positive changes are more likely to happen when an accreditation process is considered an activity whose results depend on managers’ and professionals’ joint work.
Collapse
Affiliation(s)
- Elisa Mazzini
- Azienda USL - IRCCS di Reggio Emilia, viale Umberto I, 50, 42123, Reggio Emilia, Italy
| | - Francesco Soncini
- Istituto Ortopedico Rizzoli - IRCCS, Via Giulio Cesare Pupilli, 1, 40136, Bologna, Italy
| | - Loredana Cerullo
- Azienda USL - IRCCS di Reggio Emilia, viale Umberto I, 50, 42123, Reggio Emilia, Italy
| | - Lucia Genovese
- Azienda USL - IRCCS di Reggio Emilia, viale Umberto I, 50, 42123, Reggio Emilia, Italy
| | - Giovanni Apolone
- Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133, Milan, Italy
| | - Luca Ghirotto
- Azienda USL - IRCCS di Reggio Emilia, viale Umberto I, 50, 42123, Reggio Emilia, Italy
| | - Giorgio Mazzi
- Azienda USL - IRCCS di Reggio Emilia, viale Umberto I, 50, 42123, Reggio Emilia, Italy
| | - Massimo Costantini
- Azienda USL - IRCCS di Reggio Emilia, viale Umberto I, 50, 42123, Reggio Emilia, Italy.
| |
Collapse
|
36
|
Caraceni A, Apolone G. Conquer cancer for everyone. Lancet Oncol 2021; 22:583-584. [PMID: 33932370 DOI: 10.1016/s1470-2045(21)00059-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Augusto Caraceni
- European Association for Palliative Care Research Network, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan 20133, Italy.
| | - Giovanni Apolone
- European Association for Palliative Care Research Network, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan 20133, Italy; Organisation of European Cancer Institutes, Fondation Universitaire, Brussels, Belgium
| |
Collapse
|
37
|
Sozzi G, Manenti A, Boeri M, Sabia F, Montomoli E, Pastorino U, Apolone G. Reply to comments on: Unexpected detection of SARS-CoV-2 antibodies in the prepandemic period in Italy. Tumori 2021; 107:472-473. [PMID: 33877026 DOI: 10.1177/03008916211009688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Gabriella Sozzi
- Department of Research, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Alesandro Manenti
- VisMederi Research S.r.l., Siena, Italy.,VisMederi S.r.l., Siena, Italy
| | - Mattia Boeri
- Department of Research, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Federica Sabia
- Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Emanuele Montomoli
- VisMederi S.r.l., Siena, Italy.,Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Ugo Pastorino
- Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Giovanni Apolone
- Scientific Direction, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| |
Collapse
|
38
|
Milanese G, Sabia F, Sestini S, Ledda RE, Rolli L, Suatoni P, Sverzellati N, Sozzi G, Apolone G, Marchianò AV, Pastorino U. Feasibility and Safety of Lung Cancer Screening and Prevention Program During the COVID-19 Pandemic. Chest 2021; 160:e5-e7. [PMID: 33745992 PMCID: PMC7970789 DOI: 10.1016/j.chest.2021.02.072] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 02/26/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Gianluca Milanese
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Radiology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Federica Sabia
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | | | - Roberta Eufrasia Ledda
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Radiology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Luigi Rolli
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Paola Suatoni
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Nicola Sverzellati
- Radiology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | | | | | - Ugo Pastorino
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
| |
Collapse
|
39
|
Bogani G, Apolone G, Ditto A, Scambia G, Panici PB, Angioli R, Pignata S, Greggi S, Scollo P, Delia M, Franchi M, Martinelli F, Signorelli M, Lopez S, Di Donato V, Valabrega G, Ferrandina G, Palaia I, Bergamini A, Bocciolone L, Savarese A, Ghezzi F, Casarin J, Pinelli C, Trojano V, Chiantera V, Giorda G, Sopracordevole F, Malzoni M, Salerno G, Sartori E, Testa A, Zannoni G, Zullo F, Vizza E, Trojano G, Chiantera A, Raspagliesi F. Impact of COVID-19 in gynecologic oncology: a Nationwide Italian Survey of the SIGO and MITO groups. J Gynecol Oncol 2020; 31:e92. [PMID: 33078597 PMCID: PMC7593217 DOI: 10.3802/jgo.2020.31.e92] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 06/17/2020] [Revised: 07/29/2020] [Accepted: 08/09/2020] [Indexed: 12/22/2022] Open
Abstract
Objective Coronavirus disease 2019 (COVID-19) has caused rapid and drastic changes in cancer management. The Italian Society of Gynecology and Obstetrics (SIGO), and the Multicenter Italian Trials in Ovarian cancer and gynecologic malignancies (MITO) promoted a national survey aiming to evaluate the impact of COVID-19 on clinical activity of gynecologist oncologists and to assess the implementation of containment measures against COVID-19 diffusion. Methods The survey consisted of a self-administered, anonymous, online questionnaire. The survey was sent via email to all the members of the SIGO, and MITO groups on April 7, 2020, and was closed on April 20, 2020. Results Overall, 604 participants completed the questionnaire with a response-rate of 70%. The results of this survey suggest that gynecologic oncology units had set a proactive approach to COVID-19 outbreak. Triage methods were adopted in order to minimize in-hospital diffusion of COVID-19. Only 38% of gynecologic surgeons were concerned about COVID-19 outbreak. Although 73% of the participants stated that COVID-19 has not significantly modified their everyday practice, 21% declared a decrease of the use of laparoscopy in favor of open surgery (19%). However, less than 50% of surgeons adopted specific protection against COVID-19. Additionally, responders suggested to delay cancer treatment (10%–15%), and to perform less radical surgical procedures (20%–25%) during COVID-19 pandemic. Conclusions National guidelines should be implemented to further promote the safety of patients and health care providers. International cooperation is of paramount importance, as heavily affected nations can serve as an example to find out ways to safely preserve clinical activity during the COVID-19 outbreak.
Collapse
Affiliation(s)
- Giorgio Bogani
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy.
| | - Giovanni Apolone
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Antonino Ditto
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Giovanni Scambia
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Roma, Italy
| | - Pierluigi Benedetti Panici
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Roberto Angioli
- Department of Gynecology, Università Campus Bio-Medico, Rome, Italy
| | - Sandro Pignata
- Urogynaecological Medical Oncology Unit Istituto Nazionale Tumori, IRCCS, Naples, Italy
| | - Stefano Greggi
- Urogynaecological Medical Oncology Unit Istituto Nazionale Tumori, IRCCS, Naples, Italy
| | - Paolo Scollo
- Department of Gynecology, Cannizzaro Hospital, Catania, Italy
| | | | - Massimo Franchi
- Department of Obstetrics and Gynaecology, AOUI Verona, University of Verona, Verona, Italy
| | - Fabio Martinelli
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Mauro Signorelli
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Salvatore Lopez
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Violante Di Donato
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Giorgio Valabrega
- Candiolo Cancer Institute, FPO, IRCCS, Candiolo, Italy.,Department of Oncology, University of Torino, Torino, Italy
| | - Gabriella Ferrandina
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Roma, Italy
| | - Innocenza Palaia
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Alice Bergamini
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca Bocciolone
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonella Savarese
- Oncologia Medica 1, IRCCS Istituto Nazionale Tumori Regina Elena, Roma, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
| | - Jvan Casarin
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
| | - Ciro Pinelli
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
| | - Vito Trojano
- Department of Obstetrics and Gynaecology, Mater Dei Hospital, Bari, Italy
| | - Vito Chiantera
- Department of Gynecologic Oncology, University of Palermo, Palermo, Italy
| | - Giorgio Giorda
- Gynaecological Oncology Unit, Centro di Riferimento Oncologico (CRO) di Aviano, IRCCS, Aviano, Italy
| | - Francesco Sopracordevole
- Gynaecological Oncology Unit, Centro di Riferimento Oncologico (CRO) di Aviano, IRCCS, Aviano, Italy
| | - Mario Malzoni
- Endoscopica Malzoni, Center for Advanced Endoscopic Gynecological Surgery, Avellino, Italy
| | - Giovanna Salerno
- Department of Gynecology, San Camillo-Forlanini Hospital, Rome, Italy
| | - Enrico Sartori
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Antonia Testa
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Roma, Italy
| | - Gianfranco Zannoni
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Roma, Italy
| | - Fulvio Zullo
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Enrico Vizza
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppe Trojano
- Department of Obstetrics and Gynecology, University Medical School "A. Moro", Bari, Italy
| | - Antonio Chiantera
- President of the Scientific Society, Italian Society of Gynecology and Obstetrics (SIGO), Bologna, Italy
| | | |
Collapse
|
40
|
Franchi M, Trama A, Merlo I, Minicozzi P, Tarantini L, Garau D, Kirchmayer U, Di Martino M, Romero M, De Carlo I, Scondotto S, Apolone G, Corrao G. Cardiovascular Risk After Adjuvant Trastuzumab in Early Breast Cancer: An Italian Population-Based Cohort Study. Oncologist 2020; 25:e1492-e1499. [PMID: 32770690 PMCID: PMC7543336 DOI: 10.1634/theoncologist.2020-0216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 07/20/2020] [Indexed: 11/17/2022] Open
Abstract
Background Although trastuzumab (T) represents the standard of care for the adjuvant treatment of HER2‐positive early‐stage breast cancer, contrasting results are available about the cardiac toxicity associated to its use. We conducted a multiregional population‐based cohort investigation aimed to assess both the short‐ and long‐term cardiovascular (CV) outcomes in women with early breast cancer treated with T‐based or standard adjuvant chemotherapy (CT). Materials and Methods We used health care use databases of six Italian regions, overall accounting for 42% of the Italian population. The study cohort was made by all women surgically treated for breast cancer who started a first‐line adjuvant T‐based or CT treatment. Patients treated with T were 1:2 matched to those treated with CT based on date of treatment start, age, and presence of CV risk factors. Short‐ and long‐term CV outcomes (heart failure and cardiomyopathy) were measured, respectively, after 1 year and at the end of follow‐up. Results Among 28,599 women who met the inclusion criteria, 6,208 T users were matched to 12,416 CT users. After a mean follow‐up of 5.88 years, short‐ and long‐term cumulative CV risk were 0.8% and 2.6% in patients treated with T and 0.2% and 2.8% in those treated with CT, respectively. Adjusted hazard ratios were 4.6 (95% confidence interval [CI], 2.6–8.0) for short‐term and 1.2 (95% CI, 0.9–1.6) for long‐term CV risk. Discussion In our large real‐world investigation, T‐associated cardiotoxicity was limited to the treatment period. The addition of T to adjuvant CT did not result in long‐term worsening of CV events. Implications for Practice Adjuvant trastuzumab‐based chemotherapy represents the backbone therapy in patients with HER2‐positive early breast cancer. Although well tolerated, cardiovascular events can manifest during or after therapy because of treatment‐related toxicities. In this wide multicenter and unselected cohort, long‐term symptomatic cardiotoxicity was low and limited to the treatment period. The findings suggest that developing tools that would be adequately able to predict cardiac toxicity at an early stage remains an important area in which additional research efforts are needed. With breast cancer patients experiencing longer survival, emphasizing their overall health through management of late and long‐term treatment effects is becoming increasingly important. This article reports a multiregional real‐world population‐based cohort investigation carried out to compare short‐term and long‐term cardiovascular risk of symptomatic cardiovascular events in women with localized breast cancer treated with trastuzumab‐based or standard adjuvant therapy in clinical practice.
Collapse
Affiliation(s)
- Matteo Franchi
- National Centre for Healthcare Research and PharmacoepidemiologyMilanItaly
- Laboratory of Healthcare Research & Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano‐BicoccaMilanItaly
| | - Annalisa Trama
- Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
| | - Ivan Merlo
- National Centre for Healthcare Research and PharmacoepidemiologyMilanItaly
- Laboratory of Healthcare Research & Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano‐BicoccaMilanItaly
| | - Pamela Minicozzi
- Analytical Epidemiology and Health Impact Unit, Fondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
- Cancer Survival Group, Department of Non‐Communicable Disease Epidemiology, London School of Hygiene and Tropical MedicineLondon
| | - Luigi Tarantini
- Department of Cardiology, Azienda Ospedale San Martino, ASL n. 1BellunoItaly
| | | | - Ursula Kirchmayer
- Department of Epidemiology ASL Roma 1, Lazio Regional Health ServiceRomeItaly
| | - Mirko Di Martino
- Department of Epidemiology ASL Roma 1, Lazio Regional Health ServiceRomeItaly
| | - Marilena Romero
- Department of Medical, Oral and Biotechnological Sciences, Section of Pharmacology and Toxicology, University of ChietiItaly
| | - Ilenia De Carlo
- Regional Centre of Pharmacovigilance, Regional Health Authority, Marche RegionItaly
| | - Salvatore Scondotto
- Department of Health Services and Epidemiological Observatory, Regional Health Authority, Sicily RegionPalermoItaly
| | - Giovanni Apolone
- Scientific Director, Fondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
| | - Giovanni Corrao
- National Centre for Healthcare Research and PharmacoepidemiologyMilanItaly
- Laboratory of Healthcare Research & Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano‐BicoccaMilanItaly
| | | |
Collapse
|
41
|
Brunelli C, Borreani C, Caraceni A, Roli A, Bellazzi M, Lombi L, Zito E, Pellegrini C, Spada P, Kaasa S, Foschi AM, Apolone G. PATIENT VOICES, a project for the integration of the systematic assessment of patient reported outcomes and experiences within a comprehensive cancer center: a protocol for a mixed method feasibility study. Health Qual Life Outcomes 2020; 18:252. [PMID: 32723341 PMCID: PMC7388528 DOI: 10.1186/s12955-020-01501-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 07/20/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Listening to "patient voices" in terms of symptoms, emotional status and experiences with care, is crucial for patient empowerment in clinical practice. Despite convincing evidence that routine patient reported outcomes and experience measurements (PRMs) with rapid feed-back to oncologists can improve symptom control, patient well-being and cost effectiveness, PRMs are not commonly used in cancer care, due to barriers at various level. Part of these barriers may be overcome through electronic PRMs collection (ePRMs) integrated with the electronic medical record (EMR). The PATIENT VOICES initiative is aimed at achieving a stepwise integration of ePRMs assessment into routine cancer care. The feasibility project presented here is aimed at assessing the knowledge, use and attitudes toward PRMs in a comprehensive cancer centre; developing and assessing feasibility of a flexible system for ePRM assessment; identifying barriers to and developing strategies for implementation and integration of ePRMs clinical practice. METHODS The project has been organized into four phases: a) pre-development; b) software development and piloting; c) feasibility assessment; d) post-development. A convergent mixed method design, based on concurrent quantitative and qualitative data collection will be applied. A web-survey on health care providers (HCPs), qualitative studies on patients and HCPs (semi-structured interviews and focus groups) as well as longitudinal and cross-sectional quantitative studies will be carried out. The quantitative studies will enroll 600 patients: 200 attending out-patient clinics (physical symptom assessement), 200 attending inpatient wards (psychological distress assessment) and 200 patients followed by multidisciplinary teams (patient experience with care assessment). The Edmonton symptom assessment scale, the Distress Thermometer, and a tool adapted from existing patient reported experience with cancer care questionnaires, will be used in quantitative studies. A multi-disciplinary stakeholder team including researchers, clinicians, health informatics professionals, health system administrators and patients will be involved in the development of potentially effective implementation strategies in the post development phase. DISCUSSION The documentation of potential advantages and implementation barriers achieved within this feasibility project, will serve as a starting point for future and more focused interventions aimed at achieving effective ePRMs routine assessment in cancer care. TRIAL REGISTRATION ClinicalTrials.gov ( NCT03968718 ) May 30th, 2019.
Collapse
Affiliation(s)
- Cinzia Brunelli
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Claudia Borreani
- Clinical psychology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Augusto Caraceni
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Anna Roli
- Quality, education and data protection Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marco Bellazzi
- Information and communication technology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milan, Italy
| | - Linda Lombi
- Department of Sociology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Emanuela Zito
- Information and communication technology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milan, Italy.
| | - Chiara Pellegrini
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Pierangelo Spada
- Nursing, technical and rehabilitation services Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stein Kaasa
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anna Maria Foschi
- Patient representative, Scientific Directorate, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanni Apolone
- Scientific Directorate, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | |
Collapse
|
42
|
Tamborero D, Dienstmann R, Rachid MH, Boekel J, Baird R, Braña I, De Petris L, Yachnin J, Massard C, Opdam FL, Schlenk R, Vernieri C, Garralda E, Masucci M, Villalobos X, Chavarria E, Calvo F, Fröhling S, Eggermont A, Apolone G, Voest EE, Caldas C, Tabernero J, Ernberg I, Rodon J, Lehtiö J. Support systems to guide clinical decision-making in precision oncology: The Cancer Core Europe Molecular Tumor Board Portal. Nat Med 2020; 26:992-994. [PMID: 32632195 DOI: 10.1038/s41591-020-0969-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- David Tamborero
- Department of Oncology and Pathology, Science for Life Laboratory, Karolinska Institutet, Stockholm, Sweden.
| | - Rodrigo Dienstmann
- Medical Oncology-Oncology Data Science (ODysSey) Group, Vall d'Hebron Institute of Oncology, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Maan Haj Rachid
- Department of Oncology and Pathology, Science for Life Laboratory, Karolinska Institutet, Stockholm, Sweden
| | - Jorrit Boekel
- Department of Oncology and Pathology, Science for Life Laboratory, Karolinska Institutet, Stockholm, Sweden
| | | | - Irene Braña
- Medical Oncology Department, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Luigi De Petris
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
- Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Jeffrey Yachnin
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
- Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Christophe Massard
- Département d'Innovation Thérapeutique et d'Essais Précoces, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Frans L Opdam
- Department of Medical Oncology and Clinical Pharmacology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Richard Schlenk
- NCT Trial Center, German Cancer Research Center and Heidelberg University Hospital, Heidelberg, Germany
| | - Claudio Vernieri
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- IFOM, Fondazione Istituto FIRC di Oncologia Molecolare, Milan, Italy
| | - Elena Garralda
- Medical Oncology Department, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Michele Masucci
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Xenia Villalobos
- Research Coordination Area, Vall d'Hebron Institute of Oncology, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Elena Chavarria
- Research Coordination Area, Vall d'Hebron Institute of Oncology, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Fabien Calvo
- Gustave Roussy Cancer Campus Grand Paris, Villejuif, France Cancer Core Europe, Villejuif, France
| | - Stefan Fröhling
- Division of Translational Medical Oncology, National Center for Tumor Diseases Heidelberg and German Cancer Research Center, Heidelberg, Germany
- German Cancer Consortium, Heidelberg, Germany
| | | | - Giovanni Apolone
- Scientific Directorate, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Emile E Voest
- Division of Molecular Oncology & Immunology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Oncode Institute, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | | | - Josep Tabernero
- Vall d'Hebron Institute of Oncology, Vall d'Hebron Barcelona Hospital Campus, UVic-UCC, Barcelona, Spain
| | - Ingemar Ernberg
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Jordi Rodon
- Medical Oncology Department, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- Investigational Cancer Therapeutics Department, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Janne Lehtiö
- Department of Oncology and Pathology, Science for Life Laboratory, Karolinska Institutet, Stockholm, Sweden.
| |
Collapse
|
43
|
Rea F, Ieva F, Pastorino U, Apolone G, Barni S, Merlino L, Franchi M, Corrao G. Number of lung resections performed and long-term mortality rates of patients after lung cancer surgery: evidence from an Italian investigation. Eur J Cardiothorac Surg 2020; 58:70-77. [PMID: 32034907 DOI: 10.1093/ejcts/ezaa031] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 12/18/2019] [Accepted: 12/25/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Although it has been postulated that patients might benefit from the centralization of high-volume specialized centres, conflicting results have been reported on the relationship between the number of lung resections performed and the long-term, all-cause mortality rates among patients who underwent surgery for lung cancer. A population-based observational study was performed to contribute to the ongoing debate. METHODS The 2613 patients, all residents of the Lombardy region (Italy), who underwent lung resection for lung cancer from 2012 to 2014 were entered into the cohort and were followed until 2018. The hospitals were classified according to the annual number of pulmonary resections performed. Three categories of lung resection cases were identified: low (≤30), intermediate (31-95) and high (>95). The outcome of interest was all-cause death. A frailty model was used to estimate the death risk associated with the categories of numbers of lung resections performed, taking into account the multilevel structure of the data. A set of sensitivity analyses was performed to account for sources of systematic uncertainty. RESULTS The 1-year and 5-year survival rates of cohort members were 90% and 63%. Patients operated on in high-volume centres were on average younger and more often women. Compared to patients operated on in a low-volume centre, the mortality risk exhibited a significant, progressive reduction as the numbers of lung resections performed increased to intermediate (-13%; 95% confidence interval +10% to -31%) and high (-26%; 0% to -45%). Sensitivity analyses revealed that the association was consistent. CONCLUSIONS Further evidence that the volume of lung resection cases performed strongly affects the long-term survival of lung cancer patients has been supplied.
Collapse
Affiliation(s)
- Federico Rea
- National Centre for Healthcare Research and Pharmacoepidemiology, Milan, Italy.,Laboratory of Healthcare Research & Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Francesca Ieva
- National Centre for Healthcare Research and Pharmacoepidemiology, Milan, Italy.,MOX, Department of Mathematics, Politecnico di Milano, Milan, Italy.,CADS-Center for Analysis Decisions and Society, Human Technopole, Milan, Italy
| | - Ugo Pastorino
- Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | | | - Sandro Barni
- Department of Oncology, ASST Bergamo Ovest, Bergamo, Italy
| | - Luca Merlino
- Epidemiologic Observatory, Lombardy Regional Health Service, Milan, Italy
| | - Matteo Franchi
- National Centre for Healthcare Research and Pharmacoepidemiology, Milan, Italy.,Laboratory of Healthcare Research & Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Giovanni Corrao
- National Centre for Healthcare Research and Pharmacoepidemiology, Milan, Italy.,Laboratory of Healthcare Research & Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| |
Collapse
|
44
|
Abstract
BACKGROUND A potential association between the use of angiotensin-receptor blockers (ARBs) and angiotensin-converting-enzyme (ACE) inhibitors and the risk of coronavirus disease 2019 (Covid-19) has not been well studied. METHODS We carried out a population-based case-control study in the Lombardy region of Italy. A total of 6272 case patients in whom infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was confirmed between February 21 and March 11, 2020, were matched to 30,759 beneficiaries of the Regional Health Service (controls) according to sex, age, and municipality of residence. Information about the use of selected drugs and patients' clinical profiles was obtained from regional databases of health care use. Odds ratios and 95% confidence intervals for associations between drugs and infection, with adjustment for confounders, were estimated by means of logistic regression. RESULTS Among both case patients and controls, the mean (±SD) age was 68±13 years, and 37% were women. The use of ACE inhibitors and ARBs was more common among case patients than among controls, as was the use of other antihypertensive and non-antihypertensive drugs, and case patients had a worse clinical profile. Use of ARBs or ACE inhibitors did not show any association with Covid-19 among case patients overall (adjusted odds ratio, 0.95 [95% confidence interval {CI}, 0.86 to 1.05] for ARBs and 0.96 [95% CI, 0.87 to 1.07] for ACE inhibitors) or among patients who had a severe or fatal course of the disease (adjusted odds ratio, 0.83 [95% CI, 0.63 to 1.10] for ARBs and 0.91 [95% CI, 0.69 to 1.21] for ACE inhibitors), and no association between these variables was found according to sex. CONCLUSIONS In this large, population-based study, the use of ACE inhibitors and ARBs was more frequent among patients with Covid-19 than among controls because of their higher prevalence of cardiovascular disease. However, there was no evidence that ACE inhibitors or ARBs affected the risk of COVID-19.
Collapse
Affiliation(s)
- Giuseppe Mancia
- From the University of Milano-Bicocca (G.M.), the National Center of Healthcare Research and Pharmacoepidemiology (F.R., G.C.) and the Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods (F.R., G.C.), University of Milano-Bicocca, Azienda Regionale per l'Innovazione e gli Acquisti (M.L.), and Fondazione IRCCS Istituto Nazionale dei Tumori (G.A.), Milan, and Policlinico di Monza, Monza (G.M.) - all in Italy
| | - Federico Rea
- From the University of Milano-Bicocca (G.M.), the National Center of Healthcare Research and Pharmacoepidemiology (F.R., G.C.) and the Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods (F.R., G.C.), University of Milano-Bicocca, Azienda Regionale per l'Innovazione e gli Acquisti (M.L.), and Fondazione IRCCS Istituto Nazionale dei Tumori (G.A.), Milan, and Policlinico di Monza, Monza (G.M.) - all in Italy
| | - Monica Ludergnani
- From the University of Milano-Bicocca (G.M.), the National Center of Healthcare Research and Pharmacoepidemiology (F.R., G.C.) and the Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods (F.R., G.C.), University of Milano-Bicocca, Azienda Regionale per l'Innovazione e gli Acquisti (M.L.), and Fondazione IRCCS Istituto Nazionale dei Tumori (G.A.), Milan, and Policlinico di Monza, Monza (G.M.) - all in Italy
| | - Giovanni Apolone
- From the University of Milano-Bicocca (G.M.), the National Center of Healthcare Research and Pharmacoepidemiology (F.R., G.C.) and the Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods (F.R., G.C.), University of Milano-Bicocca, Azienda Regionale per l'Innovazione e gli Acquisti (M.L.), and Fondazione IRCCS Istituto Nazionale dei Tumori (G.A.), Milan, and Policlinico di Monza, Monza (G.M.) - all in Italy
| | - Giovanni Corrao
- From the University of Milano-Bicocca (G.M.), the National Center of Healthcare Research and Pharmacoepidemiology (F.R., G.C.) and the Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods (F.R., G.C.), University of Milano-Bicocca, Azienda Regionale per l'Innovazione e gli Acquisti (M.L.), and Fondazione IRCCS Istituto Nazionale dei Tumori (G.A.), Milan, and Policlinico di Monza, Monza (G.M.) - all in Italy
| |
Collapse
|
45
|
Silvestris N, Apolone G, Botti G, Ciliberto G, Costantini M, De Paoli P, Franceschi S, Opocher G, Paradiso A, Pronzato P, Sgambato A, De Maria R. A moonshot approach toward the management of cancer patients in the COVID-19 time: what have we learned and what could the Italian network of cancer centers (Alliance Against Cancer, ACC) do after the pandemic wave? J Exp Clin Cancer Res 2020; 39:109. [PMID: 32522223 PMCID: PMC7286743 DOI: 10.1186/s13046-020-01614-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 06/02/2020] [Indexed: 11/10/2022]
Abstract
If we focus our attention on seven main features of COVID-19 infection (heterogeneity, fragility, lack of effective treatments and vaccines, “miraculous cures”, psychological suffering, deprivation, and globalization), we may establish parallelism with the challenges faced in the steep road to the understanding and treatment of neoplastic diseases. How the similarities between these two conditions can help us cope with the emergency effort represented by the management of cancer patients in the COVID-19 era, today and in the future? In a manner similar to the Cancer Moonshot initiative in the United States, we can hypothesize a multinational moonshot project towards the management of cancer patients during COVID-19 pandemic. In particular, we believe that the main road to elaborate meaningful scientific evidence is represented by the collection of all the data on COVID-19 and cancer comorbidity that are and will become available in cancer centers, coupled with the design of large clinical studies. To address this goal, it is essential to identify the entity that can produce this scientific evidences and the potentially most successful research strategy to undertake. The largest Italian organization for cancer research, Alliance Against Cancer (Alleanza Contro il Cancro, ACC), is called to play a scientific leadership in addressing these challenges, which requires the coordination of oncology teams at regional, national, and international levels. To fulfill this commitment, ACC will create a liaison with health government agencies in order to develop “dynamic” indications able to fight such an unpredictable pandemic.
Collapse
Affiliation(s)
- Nicola Silvestris
- IRCCS Istituto Tumori "Giovanni Paolo II", 70124, Bari, Italy. .,Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy.
| | - Giovanni Apolone
- Scientific Directorate, Fondazione IRCCS Istituto Tumori di Milano, Milan, Italy
| | - Gerardo Botti
- Scientific Directorate, Istituto Nazionale Tumori, "Fondazione G. Pascale" - IRCCS Naples, Naples, Italy
| | - Gennaro Ciliberto
- Scientific Directorate, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Massimo Costantini
- Scientific Directorate, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Silvia Franceschi
- Scientific Directorate, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Giuseppe Opocher
- Scientific Directorate, Veneto Institute of Oncology, IOV-IRCCS, Padova, Italy
| | - Angelo Paradiso
- Scientific Directorate IRCCS Istituto Tumori "Giovanni Paolo II" of Bari, Bari, Italy
| | - Paolo Pronzato
- Department of Oncology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alessandro Sgambato
- Scientific Directorate IRCCS CROB Rionero in Vulture, Rionero in Vulture, Italy
| | - Ruggero De Maria
- Alliance Against Cancer, Rome, Italy.,Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| |
Collapse
|
46
|
Corradini P, Gobbi G, de Braud F, Rosa J, Rusconi C, Apolone G, Carniti C. Rapid Antibody Testing for SARS-CoV-2 in Asymptomatic and Paucisymptomatic Healthcare Professionals in Hematology and Oncology Units Identifies Undiagnosed Infections. Hemasphere 2020; 4:e408. [PMID: 32647806 PMCID: PMC7306305 DOI: 10.1097/hs9.0000000000000408] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/01/2020] [Indexed: 01/01/2023] Open
Affiliation(s)
- Paolo Corradini
- Division of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
- Dept. of Oncology and Hemato-oncology, University of Milano, Italy
| | - Giorgia Gobbi
- Division of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Filippo de Braud
- Dept. of Oncology and Hemato-oncology, University of Milano, Italy
- Division of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Jessica Rosa
- Dept. of Oncology and Hemato-oncology, University of Milano, Italy
| | - Chiara Rusconi
- Division of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | - Cristiana Carniti
- Division of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| |
Collapse
|
47
|
Valenza F, Papagni G, Marchianò A, Daidone MG, DeBraud F, Colombo MP, Frignani A, Galmozzi G, Ladisa V, Pruneri G, Salvioni R, Spada P, Torresani M, Rinaldi O, Manfredi S, Votta M, Apolone G. Response of a comprehensive cancer center to the COVID-19 pandemic: the experience of the Fondazione IRCCS-Istituto Nazionale dei Tumori di Milano. Tumori 2020. [PMID: 32364028 DOI: 10.1177/0300891620923790.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The rapid spread of coronavirus disease (COVID-19) is affecting many countries. While healthcare systems need to cope with the need to treat a large number of people with different degrees of respiratory failure, actions to preserve aliquots of the healthcare system to guarantee treatment to patients are mandatory. METHODS In order to protect the Fondazione IRCCS-Istituto Nazionale dei Tumori di Milano from the spread of COVID-19, a number of to-hospital and within-hospital filters were applied. Among others, a triage process to detect severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positivity in patients with cancer was developed consisting of high-resolution low-dose computed tomography (CT) scan followed by reverse transcription polymerase chain reaction (RT-PCR) detection of SARS-CoV-2 in nose-throat swabs whenever CT was suggestive of lung infection. To serve symptomatic patients who were already admitted to the hospital or in need of hospitalization while waiting for RT-PCR laboratory confirmation of infection, a COVID-19 surveillance zone was set up. RESULTS A total of 301 patients were screened between March 6 and April 3, 2020. Of these, 47 were hospitalized, 53 needed a differential diagnosis to continue with their cancer treatment, and 201 were about to undergo surgery. RT-PCR was positive in 13 of 40 hospitalized patients (32%), 14 of 52 day hospital patients (27%), and 6 of 201 surgical patients (3%). CONCLUSION Applying filters to protect our comprehensive cancer center from COVID-19 spread contributed to guaranteeing cancer care during the COVID-19 crisis in Milan. A surveillance area and surgical triage allowed us to protect the hospital from as many as 33 patients infected with SARS-CoV-2.
Collapse
Affiliation(s)
- Franco Valenza
- Department of Anesthesia and Critical Care, Fondazione IRCCS Istituto Tumori di Milano, Milan, Italy.,Department of Oncology and Oncohematology, University of Milan, Milan, Italy
| | - Gabriele Papagni
- Department of Anesthesia and Critical Care, Fondazione IRCCS Istituto Tumori di Milano, Milan, Italy
| | - Alfonso Marchianò
- Department of Diagnostic Imaging and Radiotherapy, Fondazione IRCCS Istituto Tumori di Milano, Milan, Italy
| | - Maria Grazia Daidone
- Biomarker Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Tumori di Milano, Milan, Italy
| | - Filippo DeBraud
- Department of Oncology and Oncohematology, University of Milan, Milan, Italy.,Department of Medical Oncology and Hematology, Fondazione IRCCS Istituto Tumori di Milano, Milan, Italy
| | - Mario Paolo Colombo
- Molecular Immunology Unit, Department of Research, Fondazione IRCCS Istituto Tumori di Milano, Milan, Italy
| | - Andrea Frignani
- Managing Director, Fondazione IRCCS Istituto Tumori di Milano, Milan, Italy
| | - Gustavo Galmozzi
- Medical Directorate, Fondazione IRCCS Istituto Tumori di Milano, Milan, Italy
| | - Vito Ladisa
- Pharmacy Unit, Fondazione IRCCS Istituto Tumori di Milano, Milan, Italy
| | - Giancarlo Pruneri
- Department of Oncology and Oncohematology, University of Milan, Milan, Italy.,Department of Pathology and Laboratory Medicine University of Milan, School of Medicine, Milan, Italy
| | - Roberto Salvioni
- Urology Unit, Department of Surgery, Fondazione IRCCS Istituto Tumori di Milano, Milan, Italy
| | - Pierangelo Spada
- Director, Nursing and Rehabilitation Management Service (SITRA), Fondazione IRCCS Istituto Tumori di Milano, Milan, Italy
| | - Michele Torresani
- Health Directorate, Fondazione IRCCS Istituto Tumori di Milano, Milan, Italy
| | - Oliviero Rinaldi
- Chief Medical Officer, Fondazione IRCCS Istituto Tumori di Milano, Milan, Italy
| | - Stefano Manfredi
- General Director, Fondazione IRCCS Istituto Tumori di Milano, Milan, Italy
| | - Marco Votta
- President, Fondazione IRCCS Istituto Tumori di Milano, Milan, Italy
| | - Giovanni Apolone
- Scientific Director, Fondazione IRCCS Istituto Tumori di Milano, Milan, Italy
| |
Collapse
|
48
|
Valenza F, Papagni G, Marchianò A, Daidone MG, DeBraud F, Colombo MP, Frignani A, Galmozzi G, Ladisa V, Pruneri G, Salvioni R, Spada P, Torresani M, Rinaldi O, Manfredi S, Votta M, Apolone G. Response of a comprehensive cancer center to the COVID-19 pandemic: the experience of the Fondazione IRCCS-Istituto Nazionale dei Tumori di Milano. Tumori 2020; 106:300891620923790. [PMID: 32364028 DOI: 10.1177/0300891620923790] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND The rapid spread of coronavirus disease (COVID-19) is affecting many countries. While healthcare systems need to cope with the need to treat a large number of people with different degrees of respiratory failure, actions to preserve aliquots of the healthcare system to guarantee treatment to patients are mandatory. METHODS In order to protect the Fondazione IRCCS-Istituto Nazionale dei Tumori di Milano from the spread of COVID-19, a number of to-hospital and within-hospital filters were applied. Among others, a triage process to detect severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positivity in patients with cancer was developed consisting of high-resolution low-dose computed tomography (CT) scan followed by reverse transcription polymerase chain reaction (RT-PCR) detection of SARS-CoV-2 in nose-throat swabs whenever CT was suggestive of lung infection. To serve symptomatic patients who were already admitted to the hospital or in need of hospitalization while waiting for RT-PCR laboratory confirmation of infection, a COVID-19 surveillance zone was set up. RESULTS A total of 301 patients were screened between March 6 and April 3, 2020. Of these, 47 were hospitalized, 53 needed a differential diagnosis to continue with their cancer treatment, and 201 were about to undergo surgery. RT-PCR was positive in 13 of 40 hospitalized patients (32%), 14 of 52 day hospital patients (27%), and 6 of 201 surgical patients (3%). CONCLUSION Applying filters to protect our comprehensive cancer center from COVID-19 spread contributed to guaranteeing cancer care during the COVID-19 crisis in Milan. A surveillance area and surgical triage allowed us to protect the hospital from as many as 33 patients infected with SARS-CoV-2.
Collapse
Affiliation(s)
- Franco Valenza
- Department of Anesthesia and Critical Care, Fondazione IRCCS Istituto Tumori di Milano, Milan, Italy
- Department of Oncology and Oncohematology, University of Milan, Milan, Italy
| | - Gabriele Papagni
- Department of Anesthesia and Critical Care, Fondazione IRCCS Istituto Tumori di Milano, Milan, Italy
| | - Alfonso Marchianò
- Department of Diagnostic Imaging and Radiotherapy, Fondazione IRCCS Istituto Tumori di Milano, Milan, Italy
| | - Maria Grazia Daidone
- Biomarker Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Tumori di Milano, Milan, Italy
| | - Filippo DeBraud
- Department of Oncology and Oncohematology, University of Milan, Milan, Italy
- Department of Medical Oncology and Hematology, Fondazione IRCCS Istituto Tumori di Milano, Milan, Italy
| | - Mario Paolo Colombo
- Molecular Immunology Unit, Department of Research, Fondazione IRCCS Istituto Tumori di Milano, Milan, Italy
| | - Andrea Frignani
- Managing Director, Fondazione IRCCS Istituto Tumori di Milano, Milan, Italy
| | - Gustavo Galmozzi
- Medical Directorate, Fondazione IRCCS Istituto Tumori di Milano, Milan, Italy
| | - Vito Ladisa
- Pharmacy Unit, Fondazione IRCCS Istituto Tumori di Milano, Milan, Italy
| | - Giancarlo Pruneri
- Department of Oncology and Oncohematology, University of Milan, Milan, Italy
- Department of Pathology and Laboratory Medicine University of Milan, School of Medicine, Milan, Italy
| | - Roberto Salvioni
- Urology Unit, Department of Surgery, Fondazione IRCCS Istituto Tumori di Milano, Milan, Italy
| | - Pierangelo Spada
- Director, Nursing and Rehabilitation Management Service (SITRA), Fondazione IRCCS Istituto Tumori di Milano, Milan, Italy
| | - Michele Torresani
- Health Directorate, Fondazione IRCCS Istituto Tumori di Milano, Milan, Italy
| | - Oliviero Rinaldi
- Chief Medical Officer, Fondazione IRCCS Istituto Tumori di Milano, Milan, Italy
| | - Stefano Manfredi
- General Director, Fondazione IRCCS Istituto Tumori di Milano, Milan, Italy
| | - Marco Votta
- President, Fondazione IRCCS Istituto Tumori di Milano, Milan, Italy
| | - Giovanni Apolone
- Scientific Director, Fondazione IRCCS Istituto Tumori di Milano, Milan, Italy
| |
Collapse
|
49
|
van de Haar J, Hoes LR, Coles CE, Seamon K, Fröhling S, Jäger D, Valenza F, de Braud F, De Petris L, Bergh J, Ernberg I, Besse B, Barlesi F, Garralda E, Piris-Giménez A, Baumann M, Apolone G, Soria JC, Tabernero J, Caldas C, Voest EE. Caring for patients with cancer in the COVID-19 era. Nat Med 2020; 26:665-671. [PMID: 32405058 DOI: 10.1038/s41591-020-0874-8] [Citation(s) in RCA: 228] [Impact Index Per Article: 57.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 04/06/2020] [Indexed: 11/09/2022]
Abstract
The current COVID-19 pandemic challenges oncologists to profoundly re-organize oncological care in order to dramatically reduce hospital visits and admissions and therapy-induced immune-related complications without compromising cancer outcomes. Since COVID-19 is a novel disease, guidance by scientific evidence is often unavailable, and impactful decisions are inevitably made on the basis of expert opinions. Here we report how the seven comprehensive cancer centers of Cancer Core Europe have organized their healthcare systems at an unprecedented scale and pace to make their operations 'pandemic proof'. We identify and discuss many commonalities, but also important local differences, and pinpoint critical research priorities to enable evidence-based remodeling of cancer care during the COVID-19 pandemic. Also, we discuss how the current situation offers a unique window of opportunity for assessing the effects of de-escalating anticancer regimens, which may fast-forward the development of more-refined and less-toxic treatments. By sharing our joint experiences, we offer a roadmap for proceeding and aim to mobilize the global research community to generate the data that are critically needed to offer the best possible care to patients.
Collapse
Affiliation(s)
- Joris van de Haar
- Division of Molecular Oncology & Immunology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Division of Molecular Carcinogenesis, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Oncode Institute, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Louisa R Hoes
- Division of Molecular Oncology & Immunology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Oncode Institute, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | | | - Kenneth Seamon
- Cancer Research UK Cambridge Cancer Center, Cambridge, UK
| | - Stefan Fröhling
- German Cancer Consortium, Heidelberg, Germany
- Division of Translational Medical Oncology, National Center for Tumor Diseases Heidelberg and German Cancer Research Center, Heidelberg, Germany
| | - Dirk Jäger
- Department of Medical Oncology, National Center for Tumor Diseases Heidelberg and Heidelberg University Hospital, Heidelberg, Germany
| | - Franco Valenza
- Università Statale di Milano, Milan, Italy
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Filippo de Braud
- Università Statale di Milano, Milan, Italy
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Luigi De Petris
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
- Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Jonas Bergh
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
- Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Ingemar Ernberg
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institute, Stockholm, Sweden
| | | | - Fabrice Barlesi
- Gustave Roussy Cancer Campus, Villejuif, France
- Aix Marseille University, CNRS, INSERM, CRCM, Marseille, France
| | - Elena Garralda
- Department of Medical Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Alejandro Piris-Giménez
- Department of Medical Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Michael Baumann
- German Cancer Consortium, Heidelberg, Germany
- German Cancer Research Center, Heidelberg, Germany
| | - Giovanni Apolone
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | | | - Josep Tabernero
- Department of Medical Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Carlos Caldas
- Cancer Research UK Cambridge Cancer Center, Cambridge, UK.
- Department of Oncology and Cancer Research UK Cambridge Institute, Li Ka Shing Center, University of Cambridge, Cambridge, UK.
| | - Emile E Voest
- Division of Molecular Oncology & Immunology, The Netherlands Cancer Institute, Amsterdam, the Netherlands.
- Oncode Institute, The Netherlands Cancer Institute, Amsterdam, the Netherlands.
| |
Collapse
|
50
|
Di Cosimo S, Appierto V, Pizzamiglio S, Silvestri M, Baselga J, Piccart M, Huober J, Izquierdo M, de la Pena L, Hilbers FS, de Azambuja E, Untch M, Pusztai L, Pritchard K, Nuciforo P, Vincent-Salomon A, Symmans F, Apolone G, de Braud FG, Iorio MV, Verderio P, Daidone MG. Early Modulation of Circulating MicroRNAs Levels in HER2-Positive Breast Cancer Patients Treated with Trastuzumab-Based Neoadjuvant Therapy. Int J Mol Sci 2020; 21:ijms21041386. [PMID: 32085669 PMCID: PMC7073028 DOI: 10.3390/ijms21041386] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 02/11/2020] [Accepted: 02/13/2020] [Indexed: 12/12/2022] Open
Abstract
Circulating microRNA (ct-miRNAs) are able to identify patients with differential response to HER2-targeted therapy. However, their dynamics are largely unknown. We assessed 752 miRNAs from 52 NeoALTTO patients with plasma pairs prior and two weeks after trastuzumab. Increased levels of ct-miR-148a-3p and ct-miR-374a-5p were significantly associated with pathological complete response (pCR) (p = 0.008 and 0.048, respectively). At a threshold ≥ the upper limit of the 95%CI of the mean difference, pCR resulted 45% (95%CI 24%–68%), and 44% (95%CI 22%–69%) for ct-miR-148a-3p and ct-miR-374a-5p, respectively. Notably, ct-miR-148a-3p retained its predictive value (OR 3.42, 95%CI 1.23–9.46, p = 0.018) in bivariate analysis along with estrogen receptor status. Combined information from ct-miR-148a-3p and ct-miR140-5p, which we previously reported to identify trastuzumab-responsive patients, resulted in greater predictive capability over each other, with pCR of 54% (95%CI 25%–81%) and 0% (95%CI 0%–31%) in ct-miR-148a/ct-miR-140-5p high/present and low/absent, respectively. GO and KEGG analyses showed common enriched terms between the targets of these ct-miRNAs, including cell metabolism regulation, AMPK and MAPK signaling, and HCC progression. In conclusion, early modulated ct-miR-148-3p may inform on the functional processes underlying treatment response, integrate the information from already available predictive biomarkers, and identify patients likely to respond to single agent trastuzumab-based neoadjuvant therapy.
Collapse
Affiliation(s)
- Serena Di Cosimo
- Biomarker Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, 20100 Milan, Italy; (S.D.C.); (V.A.); (M.S.); (M.G.D.)
| | - Valentina Appierto
- Biomarker Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, 20100 Milan, Italy; (S.D.C.); (V.A.); (M.S.); (M.G.D.)
| | - Sara Pizzamiglio
- Bioinformatics and Biostatistics Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, 20100 Milan, Italy;
- Correspondence:
| | - Marco Silvestri
- Biomarker Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, 20100 Milan, Italy; (S.D.C.); (V.A.); (M.S.); (M.G.D.)
| | - José Baselga
- Vall D’Hebron Institute of Oncology, 08035 Barcelona, Spain; (J.B.); (P.N.)
| | - Martine Piccart
- Department of Medical Oncology, Institut Jules Bordet and l’Université Libre de Bruxelles (U.L.B), 1000 Brussels, Belgium; (M.P.); (E.d.A.)
| | - Jens Huober
- Department of Obstetrics and Gynecology, University of Ulm, 89081 Ulm, Germany;
| | | | | | | | - Evandro de Azambuja
- Department of Medical Oncology, Institut Jules Bordet and l’Université Libre de Bruxelles (U.L.B), 1000 Brussels, Belgium; (M.P.); (E.d.A.)
| | - Michael Untch
- Department of Gynecology and Obstetrics, Helios Klinikum Berlin-Buch, 13125 Berlin, Germany;
| | - Lajos Pusztai
- Yale Cancer Center, Yale School of Medicine, New Haven, CT 06511, USA;
| | - Kathleen Pritchard
- Division of Medical Oncology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, M4N 3M5 ON, Canada;
| | - Paolo Nuciforo
- Vall D’Hebron Institute of Oncology, 08035 Barcelona, Spain; (J.B.); (P.N.)
| | - Anne Vincent-Salomon
- Groupe d’étude des facteurs pronostiques immunohistochimiques dans le cancer du sein, 75013 Unicancer, France;
| | - Fraser Symmans
- Department of Pathology, The UT M.D. Anderson Cancer Center, Houston, TX 77030, USA;
| | - Giovanni Apolone
- Scientific Directorate, Fondazione IRCCS Istituto Nazionale dei Tumori, 20100 Milan, Italy;
| | - Filippo G. de Braud
- Department of Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20100 Milan, Italy;
| | - Marilena V. Iorio
- Molecular Targeting Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, 20100 Milan, Italy;
| | - Paolo Verderio
- Bioinformatics and Biostatistics Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, 20100 Milan, Italy;
| | - Maria Grazia Daidone
- Biomarker Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, 20100 Milan, Italy; (S.D.C.); (V.A.); (M.S.); (M.G.D.)
| |
Collapse
|