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Ghose A, Lapitan P, Apte V, Ghosh A, Kandala A, Basu S, Parkes J, Shinde SD, Boussios S, Sharma A, Das P, Vasdev N, Rebuzzi SE, Ürün Y, Kanesvaran R, Maniam A, Banna GL. Antibody Drug Conjugates in Urological Cancers: A Review of the Current Landscape. Curr Oncol Rep 2024:10.1007/s11912-024-01524-7. [PMID: 38652426 DOI: 10.1007/s11912-024-01524-7] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE OF REVIEW Our review delves into the progress across urological malignancies and discusses ongoing challenges and future directions in antibody-drug conjugate (ADC) development, emphasising their transformative potential in cancer care. RECENT FINDINGS ADCs have advanced from hematologic to solid tumours, notably in breast cancer, and are now pivotal in metastatic urological cancers as both monotherapies and in combination regimens, underscored by the FDA's approval of enfortumab vedotin and sacituzumab govitecan for metastatic urothelial cancer. Progress in metastatic prostate cancer, particularly with ADCs targeting PSMA and STEAP1, is noteworthy, although renal cell cancer presents ongoing challenges. There is a continual search for agents in the metastatic, relapsed testicular cancer landscape. ADCs have emerged as a pivotal innovation in oncology, blending targeted antibody therapy with potent cytotoxic drugs, significantly advancing treatment options for urological malignancies.
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Affiliation(s)
- Aruni Ghose
- Department of Medical Oncology, Barts Cancer Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
- Department of Medical Oncology, Medway NHS Foundation Trust, Kent, UK
- Department of Medical Oncology, Mount Vernon Cancer Centre, Mount Vernon and Watford NHS Trust, Watford, UK
- Hertfordshire and Bedfordshire Urological Cancer Centre, Department of Urology, Lister Hospital, East and North Herts NHS Trust, Stevenage, UK
- Immuno-Oncology Clinical Network, London, UK
- The Meet-URO Group, Italian Network for Research in Uro-Oncology, Milan, Italy
- British Oncology Network for Undergraduate Societies, London, UK
- United Kingdom and Ireland Global Cancer Network, London, UK
| | - Patricia Lapitan
- British Oncology Network for Undergraduate Societies, London, UK
- United Kingdom and Ireland Global Cancer Network, London, UK
- School of Medical Sciences, University of Manchester, Manchester, UK
- UCL Cancer Institute, University College London, London, UK
- Division of Genetics and Epidemiology, Institute of Cancer Research, Surrey, UK
| | - Vedika Apte
- University College London Medical School, London, UK
- University College London Oncology Society, London, UK
| | - Adheesh Ghosh
- UCL Cancer Institute, University College London, London, UK
| | | | - Sreejana Basu
- UCL Cancer Institute, University College London, London, UK
- University College London Oncology Society, London, UK
| | - Jo Parkes
- Immuno-Oncology Clinical Network, London, UK
- Worcestershire Oncology Centre, Worcestershire Acute Hospitals NHS Trust, Worcester, UK
- British Oncology Pharmacy Association, London, UK
| | - Sayali D Shinde
- Cancer Academic Sciences Unit, University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Stergios Boussios
- Department of Medical Oncology, Medway NHS Foundation Trust, Kent, UK
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, Canterbury, UK
- Kent and Medway Medical School, University of Kent, Canterbury, UK
- AELIA Organisation, 9Th Km Thessaloniki - Thermi, 57001, Thessaloniki, Greece
| | - Anand Sharma
- Department of Medical Oncology, Mount Vernon Cancer Centre, Mount Vernon and Watford NHS Trust, Watford, UK
- Hertfordshire and Bedfordshire Urological Cancer Centre, Department of Urology, Lister Hospital, East and North Herts NHS Trust, Stevenage, UK
| | - Prantik Das
- Department of Oncology, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Nikhil Vasdev
- Hertfordshire and Bedfordshire Urological Cancer Centre, Department of Urology, Lister Hospital, East and North Herts NHS Trust, Stevenage, UK
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
- Apollo Hospitals Educational and Research Foundation (AHERF), Chennai, India
| | - Sara E Rebuzzi
- The Meet-URO Group, Italian Network for Research in Uro-Oncology, Milan, Italy
- Medical Oncology Unit, Ospedale San Paolo, Savona, Italy
- Department of Internal Medicine and Medical Specialties, University of Genoa, Genoa, Italy
| | - Yüksel Ürün
- Department of Medical Oncology, Ankara University School of Medicine, Ankara, Turkey
- Ankara University Cancer Research Institute, Ankara, Turkey
| | - Ravindran Kanesvaran
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, SingHealth Duke-NUS Oncology Academic Clinical Programme, Singapore, Singapore
| | - Akash Maniam
- Department of Medical Oncology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK.
- Faculty of Science and Health, School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK.
- Caribbean Cancer Research Institute, Port of Spain, Trinidad and Tobago.
| | - Giuseppe L Banna
- The Meet-URO Group, Italian Network for Research in Uro-Oncology, Milan, Italy
- Department of Medical Oncology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
- Faculty of Science and Health, School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
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Maffezzoli M, Santoni M, Mazzaschi G, Rodella S, Lai E, Maruzzo M, Basso U, Bimbatti D, Iacovelli R, Anghelone A, Fiala O, Rebuzzi SE, Fornarini G, Lolli C, Massari F, Rosellini M, Mollica V, Nasso C, Acunzo A, Silini EM, Quaini F, De Filippo M, Brunelli M, Banna GL, Rescigno P, Signori A, Buti S. External validation of a red cell-based blood prognostic score in patients with metastatic renal cell carcinoma treated with first-line immunotherapy combinations. Clin Exp Metastasis 2024; 41:117-129. [PMID: 38363410 PMCID: PMC10973030 DOI: 10.1007/s10585-024-10266-6] [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: 09/30/2023] [Accepted: 01/04/2024] [Indexed: 02/17/2024]
Abstract
Immunotherapy combinations with tyrosine-kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs) had significantly improved outcomes of patients with mRCC. Predictive and prognostic factors are crucial to improve patients' counseling and management. The present study aimed to externally validate the prognostic value of a previously developed red cell-based score, including hemoglobin (Hb), mean corpuscular volume (MCV) and red cell distribution width (RDW), in patients with mRCC treated with first-line immunotherapy combinations (TKI plus ICI or ICI plus ICI). We performed a sub-analysis of a multicentre retrospective observational study (ARON-1 project) involving patients with mRCC treated with first-line immunotherapy combinations. Uni- and multivariable Cox regression models were used to assess the correlation between the red cell-based score and progression-free survival (PFS), and overall survival (OS). Logistic regression were used to estimate the correlation between the score and the objective response rate (ORR). The prognostic impact of the red cell-based score on PFS and OS was confirmed in the whole population regardless of the immunotherapy combination used [median PFS (mPFS): 17.4 vs 8.2 months, HR 0.66, 95% CI 0.47-0.94; median OS (mOS): 42.0 vs 17.3 months, HR 0.60, 95% CI 0.39-0.92; p < 0.001 for both]. We validated the prognostic significance of the red cell-based score in patients with mRCC treated with first-line immunotherapy combinations. The score is easy to use in daily clinical practice and it might improve patient counselling.
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Affiliation(s)
- Michele Maffezzoli
- Department of Medicine and Surgery, University of Parma, Parma, Italy.
- Medical Oncology Unit, University Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy.
| | - Matteo Santoni
- Oncology Unit, Macerata Hospital, 62100, Macerata, Italy
| | - Giulia Mazzaschi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Medical Oncology Unit, University Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Sara Rodella
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Eleonora Lai
- Department of Oncology, Oncology Unit, Istituto Oncologico Veneto IOV IRCCS, Padua, Italy
| | - Marco Maruzzo
- Department of Oncology, Oncology Unit, Istituto Oncologico Veneto IOV IRCCS, Padua, Italy
| | - Umberto Basso
- Department of Oncology, Oncology Unit, Istituto Oncologico Veneto IOV IRCCS, Padua, Italy
| | - Davide Bimbatti
- Department of Oncology, Oncology Unit, Istituto Oncologico Veneto IOV IRCCS, Padua, Italy
| | - Roberto Iacovelli
- Medical Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Annunziato Anghelone
- Medical Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Ondřej Fiala
- Department of Oncology and Radiotherapeutics, Faculty of Medicine and University Hospital in Pilsen, Charles University, Pilsen, Czech Republic
- Biomedical Centre, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Sara Elena Rebuzzi
- Medical Oncology Unit, Ospedale San Paolo, Savona, Italy
- Department of Internal Medicine and Medical Specialties (Di.M.I.), University of Genova, Genoa, Italy
| | - Giuseppe Fornarini
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Cristian Lolli
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Francesco Massari
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Matteo Rosellini
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Veronica Mollica
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Cecilia Nasso
- Medical Oncology, Ospedale Santa Corona, 17027, Pietra Ligure, Italy
| | - Alessandro Acunzo
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Medical Oncology Unit, University Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Enrico Maria Silini
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Pathology Unit, University Hospital of Parma, Parma, Italy
| | - Federico Quaini
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Massimo De Filippo
- Department of Medicine and Surgery, Section of Radiology, University of Parma, Parma, Italy
| | - Matteo Brunelli
- Department of Diagnostic and Public Health, Section of Pathology, University of Verona, Verona, Italy
| | - Giuseppe L Banna
- Department of Oncology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
- Faculty of Science and Health, School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
| | - Pasquale Rescigno
- Centre for Cancer, Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Alessio Signori
- Section of biostatistics, Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy
| | - Sebastiano Buti
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Medical Oncology Unit, University Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy
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Carter L, Apte V, Shukla A, Ghose A, Mamidi R, Petohazi A, Makker S, Banerjee S, Boussios S, Banna GL. Stage 3 N2 Lung Cancer: A Multidisciplinary Therapeutic Conundrum. Curr Oncol Rep 2024; 26:65-79. [PMID: 38180692 PMCID: PMC10858814 DOI: 10.1007/s11912-023-01486-2] [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] [Accepted: 12/15/2023] [Indexed: 01/06/2024]
Abstract
PURPOSE OF REVIEW The treatment of stage III N2 non-small cell lung cancer (NSCLC) remains debated. There is an absence of a universally agreed definition of resectability for this heterogeneous group and a lack of trial data. RECENT FINDINGS We reviewed and compared current international guidelines and evidence surrounding management of stage III N2 NSCLC. The Irish and Australian guidelines advise subcategorising N2 disease into N2a (may be resectable) and N2b (never resectable). On the contrary, American and British guidelines avoid subcategorising N2 disease, emphasising importance of local MDT decisions. It is suggested that evidence for resection of stage III tumours is relatively weak, but that stage IIIA should generally be considered for resection, and stage IIIB is not recommended for resection. For resectable disease, surgery may be combined with neoadjuvant chemoimmunotherapy, or adjuvant chemotherapy followed by immunotherapy and radiotherapy in selected patients. There is some evidence that technically resectable disease can be treated solely with radiotherapy with similar outcomes to resection. In the event of unresectable disease, chemoradiotherapy has been the traditional management option. However, recent studies with chemoradiotherapy alongside immunotherapy appear promising. There are many factors that influence the treatment pathway offered to patients with stage III N2 NSCLC, including patient factors, team expertise, and local resources. Therefore, the role of MDTs in defining resectability and formulating an individualised treatment plan is crucial.
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Affiliation(s)
- Lily Carter
- Division of Surgery, Cancer and Cardiovascular Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - Vedika Apte
- University College London Medical School, London, UK
- University College London Oncology Society, London, UK
| | - Arushi Shukla
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- School of Biosciences Education, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Barts and the London Oncology Society, London, UK
| | - Aruni Ghose
- Department of Medical Oncology, Barts Cancer Centre and Cardio-Oncology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
- Department of Medical Oncology, Medway NHS Foundation Trust, Gillingham, Kent, UK.
- Department of Medical Oncology, Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, London, UK.
- Immuno-Oncology Clinical Network, Liverpool, UK.
- Future Cancer Leaders, United Kingdom and Ireland Global Cancer Network, London, UK.
- Health Systems and Treatment Optimisation Network, European Cancer Organisation, Brussels, Belgium.
- Oncology Council, Royal Society of Medicine, London, UK.
| | - Raj Mamidi
- Division of Surgery, Cancer and Cardiovascular Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - Alexandra Petohazi
- Department of General Surgery, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Shania Makker
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Barts and the London Oncology Society, London, UK
- University College London Cancer Institute, London, UK
| | | | - Stergios Boussios
- Department of Medical Oncology, Medway NHS Foundation Trust, Gillingham, Kent, UK
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Kent and Medway Medical School, University of Kent, Canterbury, UK
- AELIA Organisation, 9th Km Thessaloniki - Thermi, 57001, Thessaloniki, Greece
| | - Giuseppe L Banna
- Department of Medical Oncology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
- Faculty of Science and Health, School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
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4
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Anpalakhan S, Signori A, Cortellini A, Verzoni E, Giusti R, Aprile G, Ermacora P, Catino A, Pipitone S, Di Napoli M, Scotti V, Mazzoni F, Guglielmini PF, Veccia A, Maruzzo M, Schinzari G, Casadei C, Grossi F, Rizzo M, Montesarchio V, Verderame F, Mencoboni M, Zustovich F, Fratino L, Accettura C, Cinieri S, Tondini CA, Camerini A, Banzi MC, Sorarù M, Zucali PA, Vignani F, Ricciardi S, Russo A, Cosenza A, Di Maio M, De Giorgi U, Pignata S, Giannarelli D, Pinto C, Buti S, Fornarini G, Rebuzzi SE, Rescigno P, Addeo A, Banna GL, Bersanelli M. Using peripheral immune-inflammatory blood markers in tumors treated with immune checkpoint inhibitors: An INVIDIa-2 study sub-analysis. iScience 2023; 26:107970. [PMID: 37860695 PMCID: PMC10583024 DOI: 10.1016/j.isci.2023.107970] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 07/29/2023] [Accepted: 09/15/2023] [Indexed: 10/21/2023] Open
Abstract
The neutrophil-to-lymphocyte ratio (NLR) and systemic immune-inflammatory index (SII) have been reported as prognosticators in non-small cell lung cancer (NSCLC), renal cell carcinoma (RCC), and melanoma. This analysis of the INVIDIa-2 study on influenza vaccination in patients with cancer treated with immune checkpoint inhibitors (ICIs) assessed NLR and SII on overall survival (OS) by literature-reported (LR), receiver operating characteristic curve (ROC)-derived (ROC) cutoffs or as continuous variable (CV). NLR and SII with ROC cutoffs of <3.4 (p < 0.001) and <831 (p < 0.001) were independent factors for OS in multivariate analysis. SII with LR, ROC, or CV significantly predicted OS in NSCLC (p = 0.002, p = 0.003, p = 0.003), RCC (p = 0.034, p = 0.014, p = 0.014), and melanoma (p = 0.038, p = 0.022, p = 0.019). NLR with LR and ROC cutoffs predicted OS in first line (p < 0.001 for both) and second line or beyond (p = 0.006 for both); likewise SII (p < 0.001; p = 0.002 and p < 0.001). NLR and SII are prognosticators in NSCLC, RCC, and melanoma treated with ICIs.
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Affiliation(s)
| | | | - Alessio Cortellini
- Operative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Roma, Italy
- Department of Surgery and Cancer, Hammersmith Hospital Campus, Imperial College London, London, UK
| | - Elena Verzoni
- SS. Oncologia Genitourinaria, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Raffaele Giusti
- Medical Oncology Unit, Azienda Ospedaliero-Universitaria Sant'Andrea, Roma, Italy
| | - Giuseppe Aprile
- Department of Oncology, San Bortolo General Hospital, Unità Locale Socio-Sanitaria (ULSS) 8 Berica-East District, Vicenza, Italy
| | - Paola Ermacora
- Department of Oncology, Presidio Ospedaliero Universitario Santa Maria della Misericordia, Azienda Sanitaria Universitaria Integrata Friuli Centrale, Udine, Italy
| | - Annamaria Catino
- Medical Thoracic Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Stefania Pipitone
- Department of Oncology and Hematology, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria of Modena, Modena, Italy
| | - Marilena Di Napoli
- Oncologia Medica Uro-Ginecologica, Istituto Nazionale Tumori "Fondazione G. Pascale," IRCCS, Napoli, Italy
| | - Vieri Scotti
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | - Francesca Mazzoni
- Medical Oncology Unit, Oncology Department, Careggi University Hospital, Firenze, Italy
| | | | | | - Marco Maruzzo
- Oncologia Medica 1, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy
| | - Giovanni Schinzari
- Medical Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Chiara Casadei
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Italy
| | - Francesco Grossi
- Medical Oncology Division, University of Insubria, ASST dei Sette Laghi, Varese, Italy
| | - Mimma Rizzo
- Division of Translational Oncology, IRCCS Istituti Clinici Scientifici Maugeri, Pavia, Italy
- Medical Oncology Unit, Azienda Ospesaliera Universitaria Consorziale – Policlinico di Bari, Bari, Italy
| | - Vincenzo Montesarchio
- U.O.C. Oncologia, Azienda Ospedaliera Specialistica dei Colli, Ospedale Monaldi, Napoli, Italy
| | - Francesco Verderame
- Oncology Unit AO Azienda Ospedaliera Ospedali Riuniti "Villa Sofia - Cervello", Palermo, Italy
| | | | - Fable Zustovich
- UOC Oncologia di Belluno, Dipartimento di Oncologia Clinica, AULSS 1 Dolomiti, Ospedale S.Martino, Belluno, Italy
| | - Lucia Fratino
- Medical Oncology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Pordenone, Italy
| | | | - Saverio Cinieri
- Medical Oncology Division and Breast Unit, Senatore Antonio Perrino Hospital, ASL Brindisi, Brindisi, Italy
| | | | - Andrea Camerini
- Oncologia Medica, Ospedale della Versilia, Lido di Camaiore, Italy
| | - Maria Chiara Banzi
- Medical Oncology, Comprehensive Cancer Centre, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Mariella Sorarù
- Medical Oncology, Camposampiero Hospital, Camposampiero (Padua), Italy
| | - Paolo Andrea Zucali
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Oncology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Francesca Vignani
- Department of Oncology, University of Turin, Turin, Italy
- Medical Oncology, AO Ordine Mauriziano, Turin, Italy
| | - Serena Ricciardi
- Pulmonary Oncology Unit, San Camillo-Forlanini Hospital, Rome, Italy
| | - Antonio Russo
- Dipartimento di Discipline Chirurgiche, Oncologiche e Stomatologiche, Università degli Studi di Palermo, Palermo, Italy
| | - Agnese Cosenza
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin, Turin, Italy
- Medical Oncology, AO Ordine Mauriziano, Turin, Italy
| | - Ugo De Giorgi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Italy
| | - Sandro Pignata
- Oncologia Medica Uro-Ginecologica, Istituto Nazionale Tumori "Fondazione G. Pascale," IRCCS, Napoli, Italy
| | - Diana Giannarelli
- Facility of Epidemiology & Biostatistics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Carmine Pinto
- Medical Oncology, Comprehensive Cancer Centre, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Giuseppe Fornarini
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Sara Elena Rebuzzi
- Medical Oncology Unit, Ospedale San Paolo, 17100 Savona, Italy
- Department of Internal Medicine and Medical Specialties (Di. M. I.), University of Genoa, Genoa, Italy
| | - Pasquale Rescigno
- Translational and Clinical Research Institute, Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
| | | | - Giuseppe L. Banna
- Portsmouth Hospitals University NHS Trust, Portsmouth, UK
- Faculty of Science and Health, School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
| | - Melissa Bersanelli
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
- Federation of Italian Cooperative Oncology Groups (FICOG), Milan, Italy
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Maffezzoli M, Campobasso D, Rebuzzi SE, Banna GL, Fornarini G, Signori A, Rescigno P, Buti S. Prognostic models for patients with metastatic urothelial carcinoma: why use them? Minerva Urol Nephrol 2023; 75:419-421. [PMID: 37166132 DOI: 10.23736/s2724-6051.23.05347-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
| | | | - Sara E Rebuzzi
- Unit of Medical Oncology, San Paolo Hospital, Savona, Italy
- Department of Internal Medicine and Medical Specialties (Di.M.I.), University of Genoa, Genoa, Italy
| | - Giuseppe L Banna
- Department of Oncology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Giuseppe Fornarini
- Unit of Medical Oncology, IRCCS San Martino University Hospital, Genoa, Italy
| | - Alessio Signori
- Section of Biostatistics, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Pasquale Rescigno
- Center for Cancer, Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Sebastiano Buti
- Unit of Medical Oncology, University Hospital of Parma, Parma, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
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6
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Anpalakhan S, Huddar P, Behrouzi R, Signori A, Cave J, Comins C, Cortellini A, Addeo A, Escriu C, McKenzie H, Barone G, Murray L, Pinato DJ, Ottensmeier C, Campos S, Muthuramalingam S, Chan S, Gomes F, Banna GL. Immunotherapy-related adverse events in real-world patients with advanced non-small cell lung cancer on chemoimmunotherapy: a Spinnaker study sub-analysis. Front Oncol 2023; 13:1163768. [PMID: 37324003 PMCID: PMC10265987 DOI: 10.3389/fonc.2023.1163768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 05/15/2023] [Indexed: 06/17/2023] Open
Abstract
Background The Spinnaker study evaluated survival outcomes and prognostic factors in patients with advanced non-small-cell lung cancer receiving first-line chemoimmunotherapy in the real world. This sub-analysis assessed the immunotherapy-related adverse effects (irAEs) seen in this cohort, their impact on overall survival (OS) and progression-free survival (PFS), and related clinical factors. Methods The Spinnaker study was a retrospective multicentre observational cohort study of patients treated with first-line pembrolizumab plus platinum-based chemotherapy in six United Kingdom and one Swiss oncology centres. Data were collected on patient characteristics, survival outcomes, frequency and severity of irAEs, and peripheral immune-inflammatory blood markers, including the neutrophil-to-lymphocyte ratio (NLR) and systemic immune-inflammation index (SII). Results A total of 308 patients were included; 132 (43%) experienced any grade irAE, 100 (32%) Grade 1-2, and 49 (16%) Grade 3-4 irAEs. The median OS in patients with any grade irAES was significantly longer (17.5 months [95% CI, 13.4-21.6 months]) than those without (10.1 months [95% CI, 8.3-12.0 months]) (p<0.001), either if Grade 1-2 (p=0.003) or Grade 3-4 irAEs (p=0.042). The median PFS in patients with any grade irAEs was significantly longer (10.1 months [95% CI, 9.0-11.2 months]) than those without (6.1 months [95% CI, 5.2-7.1 months]) (p<0.001), either if Grade 1-2 (p=0.011) or Grade 3-4 irAEs (p=0.036). A higher rate of irAEs of any grade and specifically Grade 1-2 irAEs correlated with NLR <4 (p=0.013 and p=0.018), SII <1,440 (p=0.029 ad p=0.039), response to treatment (p=0.001 and p=0.034), a higher rate of treatment discontinuation (p<0.00001 and p=0.041), and the NHS-Lung prognostic classes (p=0.002 and p=0.008). Conclusions These results confirm survival outcome benefits in patients with irAEs and suggest a higher likelihood of Grade 1-2 irAEs in patients with lower NLR or SII values or according to the NHS-Lung score.
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Affiliation(s)
| | - Prerana Huddar
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Roya Behrouzi
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | | | - Judith Cave
- University of Southampton, Southampton, United Kingdom
| | | | - Alessio Cortellini
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | | | - Carles Escriu
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | | | - Gloria Barone
- University Hospitals of Northamptonshire, Northampton, United Kingdom
| | - Lisa Murray
- Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom
| | - David J. Pinato
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Christian Ottensmeier
- The Clatterbridge Cancer Centre NHS Foundation Trust, University of Liverpool, Liverpool, United Kingdom
| | - Sara Campos
- Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom
| | | | - Samuel Chan
- Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom
| | - Fabio Gomes
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Giuseppe L. Banna
- Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom
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7
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Vitale S, Palumbo E, Polesel J, Hebert JR, Shivappa N, Montagnese C, Porciello G, Calabrese I, Luongo A, Prete M, Pica R, Grimaldi M, Crispo A, Esindi N, Falzone L, Mattioli V, Martinuzzo V, Poletto L, Cubisino S, Dainotta P, De Laurentiis M, Pacilio C, Rinaldo M, Thomas G, D'Aiuto M, Serraino D, Massarut S, Ferraù F, Rossello R, Catalano F, Banna GL, Messina F, Gatti D, Riccardi G, Libra M, Celentano E, Jenkins DJA, Augustin LSA. One-year nutrition counselling in the context of a Mediterranean diet reduced the dietary inflammatory index in women with breast cancer: a role for the dietary glycemic index. Food Funct 2023; 14:1560-1572. [PMID: 36655860 DOI: 10.1039/d2fo02198f] [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: 01/20/2023]
Abstract
Background: the Mediterranean diet, the low dietary glycemic index (GI) and the dietary inflammation index (DII®) have been associated with lower risk of breast cancer (BC) incidence and mortality. Objective: to investigate whether one-year nutrition counselling in the context of a Mediterranean diet, with or without low-GI carbohydrates counselling, may influence the DII in women with BC. Methods: data were obtained from participants of DEDiCa trial randomized to a Mediterranean diet (MD, n = 112) or a Mediterranean diet with low-GI carbohydrates (MDLGI, n = 111). The diet-derived DII and GI were calculated from 7-day food records while Mediterranean diet adherence from PREDIMED questionnaire. Differences between study arms were evaluated through Fisher's exact test or Mann-Whitney test and associations with multivariable regression analyses. Results: Mediterranean diet adherence significantly increased by 15% in MD and 20% in MDLGI with no difference between arms (p < 0.326). Dietary GI significantly decreased from 55.5 to 52.4 in MD and 55.1 to 47.6 in MDLGI with significant difference between arms (p < 0.001). DII significantly decreased by 28% in MD and 49% in MDLGI with no difference between arms (p < 0.360). Adjusting for energy intake (E-DII) did not change the results. Higher Mediterranean diet adherence and lower dietary GI independently contributed to DII lowering (β-coefficient -0.203, p < 0.001; 0.046, p = 0.003, respectively). Conclusions: DII and E-DII scores decreased significantly after one-year with 4 nutrition counselling sessions on the Mediterranean diet and low GI. Increased adherence to the Mediterranean diet and low GI independently contributed to the DII changes. These results are relevant given that lowering the inflammatory potential of the diet may have implications in cancer prognosis and overall survival.
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Affiliation(s)
- Sara Vitale
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy.
| | - Elvira Palumbo
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy.
| | - Jerry Polesel
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO) IRCSS, Aviano, Italy
| | - James R Hebert
- Cancer Prevention and Control Program and Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA.,Department of Nutrition, Connecting Health Innovations LLC, Columbia, SC, 29201, USA
| | - Nitin Shivappa
- Cancer Prevention and Control Program and Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA.,Department of Nutrition, Connecting Health Innovations LLC, Columbia, SC, 29201, USA
| | | | - Giuseppe Porciello
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy.
| | - Ilaria Calabrese
- Healtcare Direction, "A. Cardarelli" Hospital, 80131 Naples, Italy
| | - Assunta Luongo
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy.
| | - Melania Prete
- Division of Radiotherapy, "Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli", 80131, Naples, Italy
| | - Rosa Pica
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy.
| | - Maria Grimaldi
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy.
| | - Anna Crispo
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy.
| | - Nadia Esindi
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Luca Falzone
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy.
| | - Veronica Mattioli
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO) IRCSS, Aviano, Italy
| | - Valentina Martinuzzo
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO) IRCSS, Aviano, Italy
| | - Luigina Poletto
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO) IRCSS, Aviano, Italy
| | - Serena Cubisino
- Department of Biomedical and Biotechnological Sciences, Oncologic, Clinical and General Pathology Section, University of Catania, Catania, Italy
| | - Patrizia Dainotta
- Department of Biomedical and Biotechnological Sciences, Oncologic, Clinical and General Pathology Section, University of Catania, Catania, Italy
| | - Michelino De Laurentiis
- Division of Breast Oncology, Istituto Nazionale Tumori - IRCCS "Fondazione Giovanni Pascale", Naples, Italy
| | - Carmen Pacilio
- Division of Breast Oncology, Istituto Nazionale Tumori - IRCCS "Fondazione Giovanni Pascale", Naples, Italy
| | | | | | | | - Diego Serraino
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO) IRCSS, Aviano, Italy
| | - Samuele Massarut
- Chirurgia Oncologica del Seno - Centro di Riferimento Oncologico (CRO) IRCCS, Aviano, Italy
| | | | | | | | | | | | | | - Gabriele Riccardi
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Massimo Libra
- Department of Biomedical and Biotechnological Sciences, Oncologic, Clinical and General Pathology Section, University of Catania, Catania, Italy
| | - Egidio Celentano
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy.
| | - David J A Jenkins
- Department of Nutritional Sciences and Medicine, Temerty, Faculty of Medicine, University of Toronto, Toronto, Canada.,Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Canada.,Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Canada.,Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada
| | - Livia S A Augustin
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy.
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8
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Banna GL, Cantale O, Muthuramalingam S, Cave J, Comins C, Cortellini A, Addeo A, Signori A, McKenzie H, Escriu C, Barone G, Chan S, Hicks A, Bainbridge H, Pinato DJ, Ottensmeier C, Gomes F. Efficacy outcomes and prognostic factors from real-world patients with advanced non-small-cell lung cancer treated with first-line chemoimmunotherapy: The Spinnaker retrospective study. Int Immunopharmacol 2022; 110:108985. [PMID: 35777264 DOI: 10.1016/j.intimp.2022.108985] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 12/18/2022]
Abstract
BACKGROUND Efficacy outcomes and prognostic factors of real-world patients with advanced non-small cell lung cancer (aNSCLC) treated with first-line chemoimmunotherapy are still limited. PATIENTS AND METHODS In the retrospective Spinnaker study, data was collected from patients in six United Kingdom and one Swiss oncology centres with first-line pembrolizumab plus platinum-based chemotherapy. Efficacy outcomes and potential prognostic factors were estimated aiming at developing a prognostic model. RESULTS Three-hundred-eight patients were included, 32% ≥ 70 years, with ≥ 3 metastatic sites in 33%, brain or liver metastases in 10% and 12%, respectively. With a median follow-up of 18.0 months (mo.) (range, 15.9-20.1), median overall survival (OS) and progression-free survival (PFS) were 12.7 mo. (range, 10.2-15.2), and 8.0 mo. (range, 7.1-8.8), respectively. The neutrophils-to-lymphocytes ratio (NLR) and systemic immune-inflammatory index (SII) (i.e., NLR × platelet count) were both significantly higher in ECOG PS 1 (p = 0.0147 and p = 0.0018, respectively), underweight or normal body mass index (p = 0.0456 and p = 0.0062, respectively), ≥3 metastatic sites (p = 0.0069 and p = 0.112), pretreatment steroids (p = 0.0019 and p = 0.0017). By MVA, the number of metastatic sites ≥ 3 (p < 0.001 and p = 0.002), squamous histology (p = 0.033 and p = 0.013) and SII ≥ 1444 (p = 0.031 and p = 0.009, respectively) were associated with both worse OS and PFS and led to a highly discriminating three-class risk prognostic model. CONCLUSION Real-world PFS with chemoimmunotherapy in aNSCLC patients is similar to that reported in clinical trials. A high number of metastatic sites, squamous histology and high SII are adverse prognostic factors that might contribute to a clinically useful prognostic model.
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Affiliation(s)
| | - Ornella Cantale
- Medical Oncology Department, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | | | | | | | | | | | | | | | - Carles Escriu
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
| | - Gloria Barone
- United Lincolnshire Hospitals NHS Trust, Lincoln, UK
| | - Samuel Chan
- Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | | | | | - David J Pinato
- Imperial College London, Hammersmith Hospital, London, UK; Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Christian Ottensmeier
- Clatterbridge Cancer Centre NHS Foundation Trust, University of Liverpool, Liverpool, UK
| | - Fabio Gomes
- The Christie NHS Foundation Trust, Manchester, UK
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9
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Cortellini A, Ricciuti B, Borghaei H, Naqash AR, D'Alessio A, Fulgenzi CAM, Addeo A, Banna GL, Pinato DJ. Differential prognostic effect of systemic inflammation in patients with non-small cell lung cancer treated with immunotherapy or chemotherapy: A post hoc analysis of the phase 3 OAK trial. Cancer 2022; 128:3067-3079. [PMID: 35727053 DOI: 10.1002/cncr.34348] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 04/28/2022] [Accepted: 05/10/2022] [Indexed: 01/16/2023]
Abstract
BACKGROUND A proinflammatory diathesis, as measured by the neutrophil to lymphocyte ratio (NLR), heralds an adverse disease course for non-small cell lung cancer (NSCLC). METHODS This post hoc analysis used data from the phase 3 OAK trial (NCT02008227), which randomized previously treated patients with NSCLC to atezolizumab or docetaxel. The main objective was assessing the differential impact of the pretreatment NLR on overall survival according to the treatment modality. In addition, patients' genomic characteristics were assessed according to their inflammatory status with a circulating free DNA (cfDNA) next-generation sequencing (NGS) analysis. RESULTS In all, 600 and 575 patients with NLR data were included in the atezolizumab and docetaxel cohorts, respectively, with a median NLR of 4 (interquartile range, 2.6-6.7) for the pooled population. An NLR ≥4 was associated with a positive smoking status (88.6% vs. 78.1%; p < .01), male sex (66.4% vs. 57.6%; p = .01), a worse performance status (71.3% vs. 55.2%; p < .01), a higher number of metastatic sites (63.2% vs. 51.6%; p = .01), squamous histology (32.1% vs. 21.4%; p < .01), and tissue KRAS mutations (30% vs. 18.7%; p = .02) but not with programmed death ligand 1 (PD-L1) expression or the tissue epidermal growth factor receptor (EGFR)/anaplastic lymphoma kinase (ALK) status. A pretreatment NLR ≥4 was more strongly associated with mortality after atezolizumab (adjusted hazard ratio [HR], 1.64; 95% confidence interval [CI], 1.35-2.01) versus docetaxel (HR, 1.32; 95% CI, 1.08-1.60; multivariable [MVA] interaction p = .0869). The HR for an increased risk of death for PD-L1-negative/NLR ≥4 patients (compared with PD-L1-positive/NLR <4 patients) was significantly higher in the atezolizumab cohort (MVA interaction p = .01). The exclusion of EGFR/ALK-positive patients further increased the prognostic ability of the baseline NLR in favor of atezolizumab (MVA interaction p = .02). Pretreatment cfDNA data from NGS showed that patients with a high blood tumor mutation burden (cutoff, 16 mut/Mb) had a higher median NLR (4.6 vs. 3.7; p = .01). After adjustments for multiple comparisons, none of the selected variants of interest (EGFR, KRAS, TP53, KEAP1, STK11, SMARCA4, ARID1A, and targeted DNA damage response and repair genes) were significantly associated with the NLR. CONCLUSIONS A low baseline NLR identified patients with NSCLC who derived a greater survival benefit from atezolizumab in comparison with those identified in the docetaxel cohort. The NLR could complement PD-L1 expression in tailoring treatment in this setting.
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Affiliation(s)
- Alessio Cortellini
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Biagio Ricciuti
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Hossein Borghaei
- Department of Hematology-Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania, USA
| | - Abdul Rafeh Naqash
- Medical Oncology/TSET Phase 1 Program, Stephenson Cancer Center, University of Oklahoma, Oklahoma City, Oklahoma, USA
| | - Antonio D'Alessio
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, UK.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (Milan), Italy
| | - Claudia A M Fulgenzi
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, UK.,Department of Medical Oncology, University Campus Bio-Medico of Rome, Rome, Italy
| | - Alfredo Addeo
- Oncology Department, University Hospital of Geneva, Geneva, Switzerland
| | - Giuseppe L Banna
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy.,Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - David James Pinato
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, UK.,Department of Translational Medicine, Università del Piemonte Orientale "A. Avogadro," Novara, Italy
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10
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Addeo A, Banna GL. The clinical fallout of organizational resilience in oncology during the pandemic. Mediastinum 2022; 6:11. [PMID: 35832239 PMCID: PMC9272089 DOI: 10.21037/med-21-34] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/03/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Alfredo Addeo
- Department of Oncology, Geneva University Hospitals, University of Geneva, Swiss Cancer Center Leman, Geneva, Switzerland
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11
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Cortellini A, Ricciuti B, Vaz VR, Soldato D, Alessi JV, Dall'Olio FG, Banna GL, Muthuramalingam S, Chan S, Majem M, Piedra A, Lamberti G, Andrini E, Addeo A, Friedlaender A, Facchinetti F, Gorría T, Mezquita L, Hoton D, Valerie L, Nana FA, Artingstall J, Comins C, Di Maio M, Caglio A, Cave J, McKenzie H, Newsom-Davis T, Evans JS, Tiseo M, D'Alessio A, Fulgenzi CAM, Besse B, Awad MM, Pinato DJ. Prognostic effect of body mass index in patients with advanced NSCLC treated with chemoimmunotherapy combinations. J Immunother Cancer 2022; 10:jitc-2021-004374. [PMID: 35173031 PMCID: PMC8852707 DOI: 10.1136/jitc-2021-004374] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction It has been recognized that increasing body mass index (BMI) is associated with improved outcome from immune checkpoint inhibitors (ICIs) in patients with various malignancies including non-small cell lung cancer (NSCLC). However, it is unclear whether baseline BMI may influence outcomes from first-line chemoimmunotherapy combinations. Methods In this international multicenter study, we evaluated the association between baseline BMI, progression-free survival (PFS) and overall survival (OS) in a cohort of patients with stage IV NSCLC consecutively treated with first-line chemoimmunotherapy combinations. BMI was categorized according to WHO criteria. Results Among the 853 included patients, 5.3% were underweight; 46.4% were of normal weight; 33.8% were overweight; and 14.5% were obese. Overweight and obese patients were more likely aged ≥70 years (p=0.00085), never smokers (p<0.0001), with better baseline Eastern Cooperative Oncology Group—Performance Status (p=0.0127), and had lower prevalence of central nervous system (p=0.0002) and liver metastases (p=0.0395). Univariable analyses showed a significant difference in the median OS across underweight (15.5 months), normal weight (14.6 months), overweight (20.9 months), and obese (16.8 months) patients (log-rank: p=0.045, log rank test for trend: p=0.131), while no difference was found with respect to the median PFS (log-rank for trend: p=0.510). Neither OS nor PFS was significantly associated with baseline BMI on multivariable analysis. Conclusions In contrast to what was observed in the context of chemotherapy-free ICI-based regimens, baseline BMI does not affect clinical outcomes from chemoimmunotherapy combinations in patients with advanced NSCLC.
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Affiliation(s)
| | - Biagio Ricciuti
- Lowe Center for Thoracic Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Victor R Vaz
- Lowe Center for Thoracic Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Davide Soldato
- Cancer Medicine Department, Gustave Roussy, Villejuif, France
| | - Joao V Alessi
- Lowe Center for Thoracic Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | | | | | | | - Samuel Chan
- Oncology Department, Queen Alexandra University Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Margarita Majem
- Medical Oncology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Aida Piedra
- Medical Oncology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Giuseppe Lamberti
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi University Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Elisa Andrini
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi University Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Alfredo Addeo
- Medical Oncology, University Hospital of Geneva, Geneva, Switzerland
| | - Alex Friedlaender
- Medical Oncology, University Hospital of Geneva, Geneva, Switzerland
| | - Francesco Facchinetti
- Biomarqueurs Prédictifs et Nouvelles Stratégies Thérapeutiques en Oncologie, Université Paris-Saclay, Institut Gustave Roussy, Inserm, Villejuif, France
| | - Teresa Gorría
- Department of Medical Oncology, Hospital Clinic, Barcelona, Spain
| | - Laura Mezquita
- Medical Oncology Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Delphine Hoton
- Department of Pathology, Cliniques universitaires Saint-Luc, Bruxelles, Belgium
| | - Lacroix Valerie
- Department of Cardiovascular and Thoracic Surgery, IREC, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
| | - Frank Aboubakar Nana
- Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL et Dermatologie (PNEU), Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | | | | | - Massimo Di Maio
- Department of Oncology, University of Turin and Mauriziano Hospital, Turin, Italy
| | - Andrea Caglio
- Department of Oncology, University of Turin and Mauriziano Hospital, Turin, Italy
| | - Judith Cave
- Department of Medical Oncology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Hayley McKenzie
- Department of Medical Oncology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Thomas Newsom-Davis
- Department of Oncology and National Centre for HIV Malignancies, Chelsea and Westminster Hospital, London, UK
| | - Joanne S Evans
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Marcello Tiseo
- Department of Medicine and Surgery, University of Parma, Parma, Italy.,Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Antonio D'Alessio
- Department of Surgery and Cancer, Imperial College London, London, UK.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (Milan), Italy
| | - Claudia A M Fulgenzi
- Department of Surgery and Cancer, Imperial College London, London, UK.,Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
| | - Benjamin Besse
- Cancer Medicine Department, Gustave Roussy, Villejuif, France.,School of Medicine, University Paris-Saclay, Villejuif, France
| | - Mark M Awad
- Lowe Center for Thoracic Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - David J Pinato
- Department of Surgery and Cancer, Imperial College London, London, UK.,Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
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12
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Cortellini A, Giusti R, Filetti M, Citarella F, Adamo V, Santini D, Buti S, Nigro O, Cantini L, Di Maio M, Aerts JGJV, Bria E, Bertolini F, Ferrara MG, Ghidini M, Grossi F, Guida A, Berardi R, Morabito A, Genova C, Mazzoni F, Antonuzzo L, Gelibter A, Marchetti P, Chiari R, Macerelli M, Rastelli F, Della Gravara L, Gori S, Tuzi A, De Tursi M, Di Marino P, Mansueto G, Pecci F, Zoratto F, Ricciardi S, Migliorino MR, Passiglia F, Metro G, Spinelli GP, Banna GL, Friedlaender A, Addeo A, Ficorella C, Porzio G, Tiseo M, Russano M, Russo A, Pinato DJ. High familial burden of cancer correlates with improved outcome from immunotherapy in patients with NSCLC independent of somatic DNA damage response gene status. J Hematol Oncol 2022; 15:9. [PMID: 35062993 PMCID: PMC8780322 DOI: 10.1186/s13045-022-01226-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/05/2022] [Indexed: 12/26/2022] Open
Abstract
Family history of cancer (FHC) is a hallmark of cancer risk and an independent predictor of outcome, albeit with uncertain biologic foundations. We previously showed that FHC-high patients experienced prolonged overall (OS) and progression-free survival (PFS) following PD-1/PD-L1 checkpoint inhibitors. To validate our findings in patients with NSCLC, we evaluated two multicenter cohorts of patients with metastatic NSCLC receiving either first-line pembrolizumab or chemotherapy. From each cohort, 607 patients were randomly case–control matched accounting for FHC, age, performance status, and disease burden. Compared to FHC-low/negative, FHC-high patients experienced longer OS (HR 0.67 [95% CI 0.46–0.95], p = 0.0281), PFS (HR 0.65 [95% CI 0.48–0.89]; p = 0.0074) and higher disease control rates (DCR, 86.4% vs 67.5%, p = 0.0096), within the pembrolizumab cohort. No significant associations were found between FHC and OS/PFS/DCR within the chemotherapy cohort. We explored the association between FHC and somatic DNA damage response (DDR) gene alterations as underlying mechanism to our findings in a parallel cohort of 118 NSCLC, 16.9% of whom were FHC-high. The prevalence of ≥ 1 somatic DDR gene mutation was 20% and 24.5% (p = 0.6684) in FHC-high vs. FHC-low/negative, with no differences in tumor mutational burden (6.0 vs. 7.6 Mut/Mb, p = 0.6018) and tumor cell PD-L1 expression. FHC-high status identifies NSCLC patients with improved outcomes from pembrolizumab but not chemotherapy, independent of somatic DDR gene status. Prospective studies evaluating FHC alongside germline genetic testing are warranted.
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13
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Sonpavde GP, Sternberg CN, Loriot Y, Marabelle A, Lee JL, Fléchon A, Roubaud G, Pouessel D, Zagonel V, Calabro F, Banna GL, Shin SJ, Vera-Badillo FE, Powles T, Hellmis E, Miranda PAP, Lima AR, Emeribe U, Oh SM, Hotte SJ. Primary results of STRONG: An open-label, multicenter, phase 3b study of fixed-dose durvalumab monotherapy in previously treated patients with urinary tract carcinoma. Eur J Cancer 2022; 163:55-65. [PMID: 35042068 DOI: 10.1016/j.ejca.2021.12.012] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/03/2021] [Accepted: 12/06/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Prior durvalumab (anti-PD-L1 agent) studies in platinum-refractory metastatic urothelial carcinoma evaluated a dose of 10 mg/kg administered every two weeks. The nonrandomised phase 3b STRONG study (NCT03084471) evaluated the safety and efficacy of fixed-dose durvalumab at a more convenient dosing schedule in a previously treated patient population, more similar to a real-world clinical setting. PATIENTS AND METHODS 867 patients with urothelial or nonurothelial urinary tract carcinoma (UTC) who progressed on or after platinum or nonplatinum chemotherapy were treated with durvalumab 1500 mg every four weeks; 87% had an Eastern Cooperative Oncology Group performance status (ECOG PS) of 0-1, and 13% had an ECOG PS of 2. The primary end-point was the incidence of adverse events of special interest (AESIs), including immune-mediated AEs (imAEs). Secondary and exploratory end-points included overall survival (OS), objective response rate (ORR) and disease control rate (at six and 12 months) (DCR). RESULTS AESIs of any grade were reported in 51% of patients (8% grade ≥ 3). The incidence of imAEs was 11% (2% grade ≥ 3). The median OS was 7.0 months (95% confidence interval [CI]: 6.4-8.2) and ORR was 18% (95% CI: 14.8-20.6), with complete responses in 5% of patients and a DCR at six months of 19% (95% CI: 16.1-22.1). CONCLUSION Fixed-dose durvalumab monotherapy every four weeks has an acceptable safety profile and yields durable clinical activity in previously chemotherapy-treated patients with UTC. Safety and efficacy are consistent with previous durvalumab studies and other anti-PD-1/PD-L1 agents in this setting. CLINICALTRIALS. GOV IDENTIFIER NCT03084471https://clinicaltrials.gov/ct2/show/NCT03084471.
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Affiliation(s)
- Guru P Sonpavde
- Medical Oncology, Dana Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA.
| | - Cora N Sternberg
- Englander Institute for Precision Medicine, Weill Cornell Medicine, Division of Hematology and Oncology, Sandra and Edward Meyer Cancer Center, Hematology/Oncology, 413 E 69th Street, Belfer Research Building, New York, NY 10021, USA; Presbyterian Hospital, 1305 York Avenue, New York, NY 10021, USA.
| | - Yohann Loriot
- Department of Cancer Medicine, Gustave Roussy, Université Paris-Saclay, Villejuif, France.
| | - Aurelien Marabelle
- Department of Cancer Medicine, Gustave Roussy, Université Paris-Saclay, Villejuif, France.
| | - Jae Lyun Lee
- Department of Oncology and Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, South Korea.
| | - Aude Fléchon
- Department of Medical Oncology, Centre Léon-Bérard, 28 Rue Laennec, 69008 Lyon, France.
| | - Guilhem Roubaud
- Medical Oncology, Institut Bergonié, 229 Cours de l'Argonne, 33000 Bordeaux, France.
| | - Damien Pouessel
- Medical Oncology Department, Institut Claudius Régaud, IUCT Oncopole, 1 avenue Irène Joliot-Curie, 31059 Toulouse Cedex 9, Toulouse, France.
| | - Vittorina Zagonel
- Oncology Department, Oncology Unit 1, Veneto Institute of Oncology, IOV, IRCCS, Padua, Italy.
| | - Fabio Calabro
- Medical Oncology, San Camillo Forlanini Hospital, 75 Circonvallazione Gianicolense, 00152 Rome RM, Italy.
| | - Giuseppe L Banna
- (1)Department of Oncology, Ospedale Cannizzaro, 95126 Catania, Province of Catania, Italy.
| | - Sang Joon Shin
- Department of Internal Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea.
| | | | - Thomas Powles
- Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, Mile End Road, London E1 4NS, UK.
| | - Eva Hellmis
- Institut Urologicum Duisburg, Kometenplatz 29-33, 47179, Duisburg, Germany.
| | - Paulo A P Miranda
- Oncology Business Unit (OBU), Global Medical Affairs, AstraZeneca, 1 MedImmune Way, Gaithersburg, MD 20878, USA.
| | - Ana Rita Lima
- Oncology Business Unit (OBU), Global Medical Affairs, AstraZeneca, 1 MedImmune Way, Gaithersburg, MD 20878, USA.
| | - Ugochi Emeribe
- Statistical Science Immuno-Oncology, AstraZeneca, 1 MedImmune Way, Gaithersburg, MD 20878, USA.
| | - Sun Min Oh
- Oncology Business Unit (OBU), Global Medical Affairs, AstraZeneca, 1 MedImmune Way, Gaithersburg, MD 20878, USA.
| | - Sebastien J Hotte
- Department of Oncology, Juravinski Cancer Centre (JCC), Hamilton Health Sciences 699 Concession Street, Hamilton, ON, Canada.
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14
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Banna GL, Tiseo M, Cortinovis DL, Facchinetti F, Aerts JGJV, Baldessari C, Giusti R, Bria E, Grossi F, Berardi R, Morabito A, Catino A, Genova C, Mazzoni F, Gelibter A, Rastelli F, Macerelli M, Chiari R, Gori S, Mansueto G, Citarella F, Cantini L, Rijavec E, Bertolini F, Cappuzzo F, De Toma A, Friedlaender A, Metro G, Pensieri MV, Porzio G, Ficorella C, Pinato DJ, Cortellini A, Addeo A. Host immune-inflammatory markers to unravel the heterogeneous outcome and assessment of patients with PD-L1 ≥50% metastatic non-small cell lung cancer and poor performance status receiving first-line immunotherapy. Thorac Cancer 2021; 13:483-488. [PMID: 34939342 PMCID: PMC8807213 DOI: 10.1111/1759-7714.14256] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/12/2021] [Accepted: 11/13/2021] [Indexed: 12/28/2022] Open
Abstract
Background Patients with programmed cell death‐ligand 1 (PD‐L1) ≥50% metastatic non‐small cell lung cancer (mNSCLC) and ECOG performance status (PS) of 2 treated with first‐line immunotherapy have heterogeneous clinical assessment and outcomes. Methods To explore the role of immune‐inflammatory surrogates by the validated lung immuno‐oncology prognostic score (LIPS) score, including the neutrophil‐to‐lymphocyte ratio (NLR) and the pretreatment use of steroids, alongside other prognostic variables. A retrospective analysis of 128 patients with PS2 and PD‐L1 ≥50% mNSCLC treated between April 2018 and September 2019 with first‐line pembrolizumab in a real‐world setting was performed. Results With a median follow‐up of 15.3 months, the 1‐year overall survival (OS) and median progression‐free survival (PFS) were 32.3% (95% CI: 30.9–33.9) and 3.3 months (95% CI: 1.8–4.7), respectively. The NLR, lactate dehydrogenase (LDH) and pretreatment steroids results were the only significant prognostic factors on the univariate analysis and independent prognostic factors by the multivariate analysis on both OS and PFS. The LIPS score, including the NLR and pretreatment steroids, identified 29 (23%) favourable‐risk patients, with 0 factors, 1‐year OS of 67.6% and median PFS of 8.2 months; 57 (45%) intermediate‐risk patients, with 1 factor, 1‐year OS 32.1% and median PFS 2.7 months; 42 (33%) poor‐risk patients, with both factors, 1‐year OS of 10.7% and median PFS of 1.2 months. Conclusions The assessment of pre‐existing imbalance of the host immune response by combined blood and clinical immune‐inflammatory markers may represent a way to unravel the heterogeneous outcome and assessment of patients with mNSCLC and poor PS in the immune‐oncology setting.
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Affiliation(s)
| | - Marcello Tiseo
- Department of Medicine and Surgery, University of Parma, Parma, Italy.,Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | | | - Francesco Facchinetti
- Université Paris-Saclay, Institut Gustave Roussy, Inserm, Biomarqueurs Prédictifs et Nouvelles Stratégies Thérapeutiques en Oncologie, Villejuif, France
| | - Joachim G J V Aerts
- Department of Pulmonary Diseases, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Cinzia Baldessari
- Dipartimento di Oncologia ed Ematologia, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | | | - Emilio Bria
- Comprehensive Cancer Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.,Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Grossi
- Division of Medical Oncology, University of Insubria, Varese, Italy
| | - Rossana Berardi
- Oncology Clinic, Università Politecnica Delle Marche, Ospedali Riuniti Di Ancona, Ancona, Italy
| | - Alessandro Morabito
- Thoracic Medical Oncology, Istituto Nazionale Tumori 'Fondazione G Pascale', IRCCS, Naples, Italy
| | - Annamaria Catino
- Thoracic Oncology Unit, Clinical Cancer Center IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Carlo Genova
- Lung Cancer Unit; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Francesca Mazzoni
- Department of Oncology, Careggi University Hospital, Florence, Italy
| | - Alain Gelibter
- Medical Oncology (B), Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | | | - Marianna Macerelli
- Department of Oncology, University Hospital Santa Maria Della Misericordia, Udine, Italy
| | - Rita Chiari
- Medical Oncology, Ospedali Riuniti Padova Sud "Madre Teresa Di Calcutta", Monselice, Italy
| | - Stefania Gori
- Oncology Unit, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Italy
| | | | | | - Luca Cantini
- Department of Pulmonary Diseases, Erasmus Medical Center, Rotterdam, the Netherlands.,Oncology Clinic, Università Politecnica Delle Marche, Ospedali Riuniti Di Ancona, Ancona, Italy
| | - Erika Rijavec
- Medical Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Federica Bertolini
- Dipartimento di Oncologia ed Ematologia, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Federico Cappuzzo
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Alessandro De Toma
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alex Friedlaender
- Oncology Department, University Hospital of Geneva, Geneva, Switzerland
| | - Giulio Metro
- Department of Medical Oncology, Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia, Perugia, Italy
| | - Maria Vittoria Pensieri
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - Corrado Ficorella
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.,Medical Oncology, St. Salvatore Hospital, L'Aquila, Italy
| | - David J Pinato
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK.,Department of Translational Medicine, Università del Piemonte Orientale "A. Avogadro", Novara, Italy
| | - Alessio Cortellini
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK
| | - Alfredo Addeo
- Oncology Department, University Hospital of Geneva, Geneva, Switzerland
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15
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Raggi D, Giannatempo P, Marandino L, Pierantoni F, Maruzzo M, Lipari H, Banna GL, De Giorgi U, Casadei C, Naglieri E, Buti S, Bersanelli M, Stellato M, Santini D, Vignani F, Roviello G, Veccia A, Caffo O, Losanno T, Calabrò F, Mucciarini C, Pignata S, Necchi A, Maio MD. Role of Bone Metastases in Patients Receiving Immunotherapy for Pre-Treated Urothelial Carcinoma: The Multicentre, Retrospective Meet-URO-1 Bone Study. Clin Genitourin Cancer 2021; 20:155-164. [PMID: 35000876 DOI: 10.1016/j.clgc.2021.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 12/06/2021] [Accepted: 12/12/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Considerable numbers of patients with metastatic urothelial carcinoma (mUC) develop bone metastases (BoM). Their impact on the efficacy of immune-checkpoint inhibitors (ICIs) is not yet investigated. METHODS Between July 2014 and August 2020 data on pts treated with single-agent ICIs after failure of at least 1 previous line of chemotherapy for advanced disease, were retrospectively collected across 14 Italian centers. Overall survival (OS) and progression-free survival (PFS) were analyzed using the Kaplan-Meier method. Cox regression analysis was performed evaluating potential prognostic factors for OS and PFS. Each factor was evaluated in univariable (UVA) and multivariable analysis (MVA). RESULTS A total of 208 evaluable patients treated with ICIs were identified, including 122 (59%) without BoM (BoM-) and 86 (41%) with bone metastases (BoM+). After a median follow-up of 22.3 months, BoM+ patients showed shorter OS (median 3.9 vs 7.8 months, HR 1.59 [95%CI, 1.15-2.20], P = .005) and shorter PFS (median 2.0 vs 2.6 months, HR 1.76 [95%CI, 1.31-2.37], P < .001). Probability of being alive was 62% vs 40% after 6 months, 38% vs 23% after 1 year and 24% vs 13% after 2 years, in BoM- and BoM+ respectively. Within each Bellmunt score, OS and PFS of BoM+ patients were shorter. Both presence of BoM and higher Bellmunt risk score were significantly associated with shorter OS and PFS in UVA and MVA. CONCLUSION Patients treated with single-agent ICIs for BoM+ mUC have a dismal prognosis compared to BoM-. Further research is needed to understand the mechanism behind these outcomes.
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Affiliation(s)
- Daniele Raggi
- Department of Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Patrizia Giannatempo
- Department of Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Laura Marandino
- Department of Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Marco Maruzzo
- Department of Oncology, Istituto Oncologico Veneto, Padova, Italy
| | - Helga Lipari
- Department of Oncology, Medical Oncology Cannizzaro Hospital, Catania, Italy
| | - Giuseppe L Banna
- Department of Oncology, Medical Oncology Cannizzaro Hospital, Catania, Italy
| | - Ugo De Giorgi
- Department of Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Italy
| | - Chiara Casadei
- Department of Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Italy
| | - Emanuele Naglieri
- Department of Oncology, Policlinico di Bari Ospedale Giovanni XXIII, Bari, Italy
| | - Sebastiano Buti
- Department of Oncology, University Hospital of Parma, Parma, Italy
| | | | - Marco Stellato
- Department of Oncology, Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Daniele Santini
- Department of Oncology, Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Francesca Vignani
- Department of Oncology, University of Turin, Mauriziano Umberto I Hospital, Turin, Italy
| | | | | | - Orazio Caffo
- Department of Oncology, Santa Chiara Hospital, Trento, Italy
| | - Tania Losanno
- Department of Oncology, San Camillo Forlanini Hospital, Rome, Italy
| | - Fabrizio Calabrò
- Department of Oncology, San Camillo Forlanini Hospital, Rome, Italy
| | | | - Sandro Pignata
- Department of Urology and Gynecology, Oncologia Medica Uro-Ginecologica, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Napoli, Italy
| | - Andrea Necchi
- Deptartment of Oncology from Vita-Salute University IRCCS San Raffaele, Milan, Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin, Mauriziano Umberto I Hospital, Turin, Italy
| | -
- Department of Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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16
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Porciello G, Montagnese C, Crispo A, Grimaldi M, Libra M, Vitale S, Palumbo E, Pica R, Calabrese I, Cubisino S, Falzone L, Poletto L, Martinuzzo V, Prete M, Esindi N, Thomas G, Cianniello D, Pinto M, De Laurentiis M, Pacilio C, Rinaldo M, D'Aiuto M, Serraino D, Massarut S, Evangelista C, Steffan A, Catalano F, Banna GL, Scandurra G, Ferraù F, Rossello R, Antonelli G, Guerra G, Farina A, Messina F, Riccardi G, Gatti D, Jenkins DJA, Minopoli A, Grilli B, Cavalcanti E, Celentano E, Botti G, Montella M, Augustin LSA. Correction: Mediterranean diet and quality of life in women treated for breast cancer: A baseline analysis of DEDiCa multicentre trial. PLoS One 2021; 16:e0256944. [PMID: 34437624 PMCID: PMC8389445 DOI: 10.1371/journal.pone.0256944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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17
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Addeo A, Friedlaender A, Banna GL, Weiss GJ. TMB or not TMB as a biomarker: That is the question. Crit Rev Oncol Hematol 2021; 163:103374. [PMID: 34087341 DOI: 10.1016/j.critrevonc.2021.103374] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/10/2021] [Accepted: 05/29/2021] [Indexed: 12/11/2022] Open
Abstract
Immune checkpoint inhibitors (ICIs) have revolutionized the landscape of therapeutic options for many cancers. These treatments have demonstrated improved efficacy and often a more favourable toxicity profile compared to standard cytotoxic chemotherapy. There are considerable differences among responders, with some patients experiencing durable long-term disease control and even remission. Given this variability, determining a proper biomarker to select patients for ICI therapy has become increasingly important. The only biomarker proven to be predictive of overall survival benefit with ICI therapy is PD-L1 expression level measured by immunohistochemistry. Several attempts have been made to identify different predictive biomarkers. One of the most intriguing and divisive is tumor mutational burden (TMB). TMB represents the number of mutations per megabase (Mut/Mb) of DNA that were sequenced in a specific cancer. With a higher number of mutations detected, and consequentially an increase in the number neo-epitopes, then it is more likely that one or more of those neo-antigens could be immunogenic and trigger a T cell response. Initially, TMB was identified as a biomarker for ICIs in melanoma and subsequent studies suggested a possible clinical role for TMB in non-small cell lung cancer. The initial data were not confirmed in a prospective study assessing OS as the primary endpoint. Recently, the FDA has approved pembrolizumab in all cancers with a TMB > 10Mut/Mb[12] based on findings from the phase 2 KEYNOTE-158. Much criticism has emerged about this pan-cancer approval, in particular about the use of TMB as biomarker to select patients. Here we review the data about the importance and role of TMB as possible pan-cancer one-size-fits-all biomarker. We highlight the strengths and intrinsic limitations of such a complex biomarker and its adoption in the daily practice.
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Affiliation(s)
- Alfredo Addeo
- Oncology Department, University Hospital of Geneva, Switzerland.
| | - Alex Friedlaender
- Oncology Department, University Hospital of Geneva, Switzerland; Clinique Générale Beaulieu, Geneva, Switzerland
| | | | - Glen J Weiss
- MiRanostics Consulting, Oro Valley, AZ, United States
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18
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Fornarini G, Rebuzzi SE, Banna GL, Calabrò F, Scandurra G, De Giorgi U, Masini C, Baldessari C, Naglieri E, Caserta C, Manacorda S, Maruzzo M, Milella M, Buttigliero C, Tambaro R, Ermacora P, Morelli F, Nolè F, Astolfi C, Sternberg CN. Immune-inflammatory biomarkers as prognostic factors for immunotherapy in pretreated advanced urinary tract cancer patients: an analysis of the Italian SAUL cohort. ESMO Open 2021; 6:100118. [PMID: 33984678 PMCID: PMC8134706 DOI: 10.1016/j.esmoop.2021.100118] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/04/2021] [Accepted: 03/17/2021] [Indexed: 12/18/2022] Open
Abstract
Background Reliable and affordable prognostic and predictive biomarkers for urothelial carcinoma treated with immunotherapy may allow patients' outcome stratification and drive therapeutic options. The SAUL trial investigated the safety and efficacy of atezolizumab in a real-world setting on 1004 patients with locally advanced or metastatic urothelial carcinoma who progressed to one to three prior systemic therapies. Patients and methods Using the SAUL Italian cohort of 267 patients, we investigated the prognostic role of neutrophil-to-lymphocyte ratio (NLR) and systemic immune-inflammation index (SII) and the best performing one of these in combination with programmed death-ligand 1 (PD-L1) with or without lactate dehydrogenase (LDH). Previously reported cut-offs (NLR >3 and NLR >5; SII >1375) in addition to study-defined ones derived from receiver operating characteristic (ROC) analysis were used. Results The cut-off values for NLR and SII by the ROC analysis were 3.65 (sensitivity 60.4; specificity 63.0) and 884 (sensitivity 64.4; specificity 67.5), respectively. The median overall survival (OS) was 14.7 months for NLR <3.65 [95% confidence interval (CI) 9.9-not reached (NR)] versus 6.0 months for NLR ≥3.65 (95% CI 3.9-9.4); 14.7 months for SII <884 (95% CI 10.6-NR) versus 6.0 months for SII ≥884 (95% CI 3.7-8.6). The combination of SII, PD-L1, and LDH stratified OS better than SII plus PD-L1 through better identification of patients with intermediate prognosis (77% versus 48%, respectively). Multivariate analyses confirmed significant correlations with OS and progression-free survival for both the SII + PD-L1 + LDH and SII + PD-L1 combinations. Conclusion The combination of immune-inflammatory biomarkers based on SII, PD-L1, with or without LDH is a potentially useful and easy-to-assess prognostic tool deserving validation to identify patients who may benefit from immunotherapy alone or alternative therapies. Reliable biomarkers for immunotherapy may assist in treatment decision making and clinical trial design and interpretation. Immune-inflammatory biomarkers were investigated for their prognostic role within the Italian SAUL study cohort. ROC-based cut-offs were 3.65 for NLR and 884 for SII. Both NLR and SII were prognostic with SII performing slightly better than NLR. The combination of SII, PD-L1, and LDH stratified OS better than SII + PD-L1; both were independent prognostic factors.
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Affiliation(s)
- G Fornarini
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - S E Rebuzzi
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Internal Medicine and Medical Specialties, University of Genoa, Genoa, Italy
| | - G L Banna
- Department of Oncology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - F Calabrò
- Medical Oncology, Azienda Ospedaliera S. Camillo-Forlanini, Rome, Italy
| | - G Scandurra
- Medical Oncology, Azienda Ospedaliera Cannizzaro di Catania, Catania, Italy
| | - U De Giorgi
- Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) - IRCCS, Meldola, Italy
| | - C Masini
- Medical Oncology, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - C Baldessari
- Oncology, Azienda Ospedaliero - Universitaria di Modena, Modena, Italy
| | - E Naglieri
- Division of Medical Oncology, IRCCS Istituto Tumori Bari Giovanni Paolo II - IRCCS, Bari, Italy
| | - C Caserta
- Medical Oncology Unit, Azienda Ospedaliera S. Maria, Terni, Italy
| | - S Manacorda
- Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - M Maruzzo
- Medical Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto, IOV-IRCCS, Padua, Italy
| | - M Milella
- Dipartimento di Oncologia, Policlinico Universitario G.B. Rossi Borgo Roma, Verona, Italy
| | - C Buttigliero
- Medical Oncology, Università degli Studi di Torino, Turin, Italy
| | - R Tambaro
- U.O.C di Oncologia Sperimentale Uroginecologica, I.N.T. IRCCS Fondazione G. Pascale, Naples, Italy
| | - P Ermacora
- Dipartimento di Oncologia, Azienda Ospedaliero Universitaria di Udine, Udine, Italy
| | - F Morelli
- Casa Sollievo della Sofferenza, S. Giovanni Rotondo, Foggia, Italy
| | - F Nolè
- IEO, Istituto Europeo di Oncologia IRCCS, Milan, Italy
| | - C Astolfi
- Medical Affairs & Clinical Operation, Roche S.p.A., Monza, Italy
| | - C N Sternberg
- Hematology and Oncology, Englander Institute for Precision Medicine Weill Cornell Medicine, New York-Presbyterian, New York, USA.
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Buti S, Bersanelli M, Perrone F, Bracarda S, Di Maio M, Giusti R, Nigro O, Cortinovis DL, Aerts JGJV, Guaitoli G, Barbieri F, Ferrara MG, Bria E, Grossi F, Bareggi C, Berardi R, Torniai M, Cantini L, Sforza V, Genova C, Chiari R, Rocco D, Della Gravara L, Gori S, De Tursi M, Di Marino P, Mansueto G, Zoratto F, Filetti M, Citarella F, Russano M, Mazzoni F, Garassino MC, De Toma A, Signorelli D, Gelibter A, Siringo M, Follador A, Bisonni R, Tuzi A, Minuti G, Landi L, Ricciardi S, Migliorino MR, Tabbò F, Olmetto E, Metro G, Adamo V, Russo A, Spinelli GP, Banna GL, Addeo A, Friedlaender A, Cannita K, Porzio G, Ficorella C, Carmisciano L, Pinato DJ, Mazzaschi G, Tiseo M, Cortellini A. Predictive ability of a drug-based score in patients with advanced non-small-cell lung cancer receiving first-line immunotherapy. Eur J Cancer 2021; 150:224-231. [PMID: 33934059 DOI: 10.1016/j.ejca.2021.03.041] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/16/2021] [Accepted: 03/18/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND We previously demonstrated the cumulative poor prognostic role of concomitant medications on the clinical outcome of patients with advanced cancer treated with immune checkpoint inhibitors, creating and validating a drug-based prognostic score to be calculated before immunotherapy initiation in patients with advanced solid tumours. This 'drug score' was calculated assigning score 1 for each between proton-pump inhibitor and antibiotic administration until a month before cancer therapy initiation and score 2 in case of corticosteroid intake. The good risk group included patients with score 0, intermediate risk with score 1-2 and poor risk with score 3-4. METHODS Aiming at validating the prognostic and putative predictive ability depending on the anticancer therapy, we performed the present comparative analysis in two cohorts of advanced non-small-cell lung cancer (NSCLC), respectively, receiving first-line pembrolizumab or chemotherapy through a random case-control matching and through a pooled multivariable analysis including the interaction between the computed score and the therapeutic modality (pembrolizumab vs chemotherapy). RESULTS Nine hundred fifty and 595 patients were included in the pembrolizumab and chemotherapy cohorts, respectively. After the case-control random matching, 589 patients from the pembrolizumab cohort and 589 from the chemotherapy cohort were paired, with no statistically significant differences between the characteristics of the matched subjects. Among the pembrolizumab-treated group, good, intermediate and poor risk evaluable patients achieved an objective response rate (ORR) of 50.0%, 37.7% and 23.4%, respectively, (p < 0.0001), whereas among the chemotherapy-treated group, patients achieved an ORR of 37.0%, 40.0% and 32.4%, respectively (p = 0.4346). The median progression-free survival (PFS) of good, intermediate and poor risk groups was 13.9 months, 6.3 months and 2.8 months, respectively, within the pembrolizumab cohort (p < 0.0001), and 6.2 months, 6.2 months and 4.3 months, respectively, within the chemotherapy cohort (p = 0.0280). Among the pembrolizumab-treated patients, the median overall survival (OS) for good, intermediate and poor risk patients was 31.4 months, 14.5 months and 5.8 months, respectively, (p < 0.0001), whereas among the chemotherapy-treated patients, it was 18.3 months, 16.8 months and 10.6 months, respectively (p = 0.0003). A similar trend was reported considering the two entire populations. At the pooled analysis, the interaction term between the score and the therapeutic modality was statistically significant with respect to ORR (p = 0.0052), PFS (p = 0.0003) and OS (p < 0.0001), confirming the significantly different effect of the score within the two cohorts. CONCLUSION Our 'drug score' showed a predictive ability with respect to ORR in the immunotherapy cohort only, suggesting it might be a useful tool for identifying patients unlikely to benefit from first-line single-agent pembrolizumab. In addition, the prognostic stratification in terms of PFS and OS was significantly more pronounced among the pembrolizumab-treated patients.
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Affiliation(s)
- Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | | | - Fabiana Perrone
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Sergio Bracarda
- Struttura Complessa di Oncologia Medica e Traslazionale, Azienda Ospedaliera Santa Maria di Terni, Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin and Medical Oncology, AO Ordine Mauriziano, Turin, Italy
| | | | - Olga Nigro
- Medical Oncology, ASST-Sette Laghi, Varese, Italy
| | | | - Joachim G J V Aerts
- Department of Pulmonary Diseases, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Giorgia Guaitoli
- Dipartimeto di Oncologia Ed Ematologia, AOU Policlinico Modena, Modena, Italy
| | - Fausto Barbieri
- Dipartimeto di Oncologia Ed Ematologia, AOU Policlinico Modena, Modena, Italy
| | - Miriam G Ferrara
- Comprehensive Cancer Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy; Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Lazio, Italy
| | - Emilio Bria
- Comprehensive Cancer Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy; Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Lazio, Italy
| | - Francesco Grossi
- Division of Medical Oncology, University of Insubria, Varese, Italy
| | - Claudia Bareggi
- Medical Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Rossana Berardi
- Oncology Clinic, Università Politecnica Delle Marche, Ospedali Riuniti Di Ancona, Ancona, Italy
| | - Mariangela Torniai
- Oncology Clinic, Università Politecnica Delle Marche, Ospedali Riuniti Di Ancona, Ancona, Italy
| | - Luca Cantini
- Department of Pulmonary Diseases, Erasmus Medical Center, Rotterdam, the Netherlands; Oncology Clinic, Università Politecnica Delle Marche, Ospedali Riuniti Di Ancona, Ancona, Italy
| | - Vincenzo Sforza
- Thoracic Medical Oncology, Istituto Nazionale Tumori "Fondazione G Pascale", IRCCS, Napoli, Italy
| | - Carlo Genova
- Lung Cancer Unit IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Rita Chiari
- Medical Oncology, Ospedali Riuniti Padova Sud "Madre Teresa Di Calcutta", Monselice, Italy
| | - Danilo Rocco
- Pneumo-Oncology Unit, Monaldi Hospital, Naples, Italy
| | | | - Stefania Gori
- Oncology Unit, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, VR, Italy
| | - Michele De Tursi
- Dipartimento di Terapie Innovative in Medicina e Odontoiatria, Università G. D'Annunzio, Chieti-Pescara, Chieti, Italy
| | | | | | | | | | | | - Marco Russano
- Medical Oncology, Campus Bio-Medico University, Rome, Italy
| | - Francesca Mazzoni
- Department of Oncology, Careggi University Hospital, Florence, Italy
| | - Marina C Garassino
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Alessandro De Toma
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Diego Signorelli
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy; Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alain Gelibter
- Medical Oncology (B), Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Marco Siringo
- Medical Oncology (B), Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Alessandro Follador
- Department of Oncology, University Hospital Santa Maria Della Misericordia, Udine, Italy
| | | | | | - Gabriele Minuti
- Department of Oncology and Hematology, AUSL Romagna, Ravenna, Italy
| | - Lorenza Landi
- Department of Oncology and Hematology, AUSL Romagna, Ravenna, Italy
| | - Serena Ricciardi
- Pneumo-Oncology Unit, St. Camillo-Forlanini Hospital, Rome, Italy
| | | | - Fabrizio Tabbò
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, (TO), Italy
| | - Emanuela Olmetto
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, (TO), Italy
| | - Giulio Metro
- Department of Medical Oncology, Santa Maria Della Misericordia Hospital, Azienda Ospedaliera di Perugia, Perugia, Italy
| | - Vincenzo Adamo
- Medical Oncology, A.O. Papardo & Department of Human Pathology, University of Messina, Italy
| | - Alessandro Russo
- Medical Oncology, A.O. Papardo & Department of Human Pathology, University of Messina, Italy
| | - Gian P Spinelli
- UOC Territorial Oncology of Aprilia, AUSL Latina, University of Rome Sapienza, Aprilia, Italy
| | | | - Alfredo Addeo
- Oncology Department, University Hospital of Geneva, Geneva, Switzerland
| | - Alex Friedlaender
- Oncology Department, University Hospital of Geneva, Geneva, Switzerland
| | - Katia Cannita
- Medical Oncology, St. Salvatore Hospital, L'Aquila, Italy
| | | | - Corrado Ficorella
- Medical Oncology, St. Salvatore Hospital, L'Aquila, Italy; Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - David J Pinato
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK; Department of Translational Medicine, Università del Piemonte Orientale "A. Avogadro", Novara, Italy
| | - Giulia Mazzaschi
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Marcello Tiseo
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy; Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Alessio Cortellini
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy; Division of Cancer, Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK.
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20
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Cortellini A, Di Maio M, Nigro O, Leonetti A, Cortinovis DL, Aerts JG, Guaitoli G, Barbieri F, Giusti R, Ferrara MG, Bria E, D'Argento E, Grossi F, Rijavec E, Guida A, Berardi R, Torniai M, Sforza V, Genova C, Mazzoni F, Garassino MC, De Toma A, Signorelli D, Gelibter A, Siringo M, Marchetti P, Macerelli M, Rastelli F, Chiari R, Rocco D, Della Gravara L, Inno A, Michele DT, Grassadonia A, Di Marino P, Mansueto G, Zoratto F, Filetti M, Santini D, Citarella F, Russano M, Cantini L, Tuzi A, Bordi P, Minuti G, Landi L, Ricciardi S, Migliorino MR, Passiglia F, Bironzo P, Metro G, Adamo V, Russo A, Spinelli GP, Banna GL, Friedlaender A, Addeo A, Cannita K, Ficorella C, Porzio G, Pinato DJ. Differential influence of antibiotic therapy and other medications on oncological outcomes of patients with non-small cell lung cancer treated with first-line pembrolizumab versus cytotoxic chemotherapy. J Immunother Cancer 2021; 9:e002421. [PMID: 33827906 PMCID: PMC8031700 DOI: 10.1136/jitc-2021-002421] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Some concomitant medications including antibiotics (ATB) have been reproducibly associated with worse survival following immune checkpoint inhibitors (ICIs) in unselected patients with non-small cell lung cancer (NSCLC) (according to programmed death-ligand 1 (PD-L1) expression and treatment line). Whether such relationship is causative or associative is matter of debate. METHODS We present the outcomes analysis according to concomitant baseline medications (prior to ICI initiation) with putative immune-modulatory effects in a large cohort of patients with metastatic NSCLC with a PD-L1 expression ≥50%, receiving first-line pembrolizumab monotherapy. We also evaluated a control cohort of patients with metastatic NSCLC treated with first-line chemotherapy. The interaction between key medications and therapeutic modality (pembrolizumab vs chemotherapy) was validated in pooled multivariable analyses. RESULTS 950 and 595 patients were included in the pembrolizumab and chemotherapy cohorts, respectively. Corticosteroid and proton pump inhibitor (PPI) therapy but not ATB therapy was associated with poorer performance status at baseline in both the cohorts. No association with clinical outcomes was found according to baseline statin, aspirin, β-blocker and metformin within the pembrolizumab cohort. On the multivariable analysis, ATB emerged as a strong predictor of worse overall survival (OS) (HR=1.42 (95% CI 1.13 to 1.79); p=0.0024), and progression free survival (PFS) (HR=1.29 (95% CI 1.04 to 1.59); p=0.0192) in the pembrolizumab but not in the chemotherapy cohort. Corticosteroids were associated with shorter PFS (HR=1.69 (95% CI 1.42 to 2.03); p<0.0001), and OS (HR=1.93 (95% CI 1.59 to 2.35); p<0.0001) following pembrolizumab, and shorter PFS (HR=1.30 (95% CI 1.08 to 1.56), p=0.0046) and OS (HR=1.58 (95% CI 1.29 to 1.94), p<0.0001), following chemotherapy. PPIs were associated with worse OS (HR=1.49 (95% CI 1.26 to 1.77); p<0.0001) with pembrolizumab and shorter OS (HR=1.12 (95% CI 1.02 to 1.24), p=0.0139), with chemotherapy. At the pooled analysis, there was a statistically significant interaction with treatment (pembrolizumab vs chemotherapy) for corticosteroids (p=0.0020) and PPIs (p=0.0460) with respect to OS, for corticosteroids (p<0.0001), ATB (p=0.0290), and PPIs (p=0.0487) with respect to PFS, and only corticosteroids (p=0.0033) with respect to objective response rate. CONCLUSION In this study, we validate the significant negative impact of ATB on pembrolizumab monotherapy but not chemotherapy outcomes in NSCLC, producing further evidence about their underlying immune-modulatory effect. Even though the magnitude of the impact of corticosteroids and PPIs is significantly different across the cohorts, their effects might be driven by adverse disease features.
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Affiliation(s)
- Alessio Cortellini
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Biotechnology and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
| | - Massimo Di Maio
- Department of Oncology and Medical Oncology, University of Turin and AO Ordine Mauriziano, Turin, Italy
| | - Olga Nigro
- Medical Oncology, ASST dei Sette Laghi, Varese, Italy
| | | | | | - Joachim Gjv Aerts
- Department of Pulmonary Disease, Erasmus Medical Center, Rotterdam, Netherlands
| | - Giorgia Guaitoli
- Dipartimento di Oncologia ed Ematologia, AOU Policlinico di Modena, Modena, Italy
| | - Fausto Barbieri
- Dipartimento di Oncologia ed Ematologia, AOU Policlinico di Modena, Modena, Italy
| | - Raffaele Giusti
- Medical Oncology Unit, Sant'Andrea Hospital of Rome, Roma, Italy
| | - Miriam G Ferrara
- Comprehensive Cancer Center, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Roma, Italy
- Department of Translational Medicine and Surgery, Universitá Cattolica del Sacro Cuore, Roma, Italy
| | - Emilio Bria
- Comprehensive Cancer Center, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Roma, Italy
- Department of Translational Medicine and Surgery, Universitá Cattolica del Sacro Cuore, Roma, Italy
| | - Ettore D'Argento
- Comprehensive Cancer Center, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Roma, Italy
| | - Francesco Grossi
- Division of Medical Oncology, University of Insubria, Varese, Italy
| | - Erika Rijavec
- Medical Oncology, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Annalisa Guida
- Struttura Complessa di Oncologia Medica e Traslazionale, Azienda Ospedaliera Santa Maria di Terni, Terni, Italy
| | - Rossana Berardi
- Oncology Clinic, Università Politecnica delle Marche, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Mariangela Torniai
- Oncology Clinic, Università Politecnica delle Marche, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Vincenzo Sforza
- Thoracic Medical Oncology, National Cancer Institute IRCCS Pascale Foundation, Napoli, Italy
| | - Carlo Genova
- Lung Cancer Unit, IRCCS Ospedal Policlinico San Martino, Genova, Italy
| | - Francesca Mazzoni
- Department of Medical Oncology, Careggi University Hospital, Firenze, Toscana, Italy
| | | | - Alessandro De Toma
- Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Diego Signorelli
- Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alain Gelibter
- Medical Oncology Unit B, Policlinico Umberto I, Sapienza University of Rome, Roma, Italy
| | - Marco Siringo
- Medical Oncology Unit B, Policlinico Umberto I, Sapienza University of Rome, Roma, Italy
| | - Paolo Marchetti
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Roma, Italy
| | - Marianna Macerelli
- Medical Oncology, University Hospital Santa Maria della Misericordia, Udine, Italy
| | | | - Rita Chiari
- Medical Oncology, Ospedali riuniti Padova Sud "Madre Teresa Di Calcutta", Monselice, Padova, Italy
| | - Danilo Rocco
- Pneumo-Oncology Unit, Ospedali dei Colli Monaldi Cotugno CTO, Napoli, Italy
| | | | - Alessandro Inno
- Oncology Unit, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Italy
| | - De Tursi Michele
- Dipartimento di Terapie Innovative in Medicina ed Odontoiatria, Universitá G. D'Annunzio, Chieti-Pescara, Italy
| | - Antonino Grassadonia
- Dipartimento di Terapie Innovative in Medicina ed Odontoiatria, Universitá G. D'Annunzio, Chieti-Pescara, Italy
| | | | - Giovanni Mansueto
- Medical Oncology, Azienda Sanitaria Locale Frosinone, Frosinone, Italy
| | | | - Marco Filetti
- Medical Oncology Unit, Sant'Andrea Hospital of Rome, Roma, Italy
| | | | | | - Marco Russano
- Medical Oncology, Campus Bio-Medico University, Roma, Italy
| | - Luca Cantini
- Department of Pulmonary Disease, Erasmus Medical Center, Rotterdam, Netherlands
- Oncology Clinic, Università Politecnica delle Marche, Ospedali Riuniti di Ancona, Ancona, Italy
| | | | - Paola Bordi
- Medical Oncology, University Hospital of Parma, Parma, Italy
| | - Gabriele Minuti
- Department of Oncology and Hematology, AUSL della Romagna, Ravenna, Italy
| | - Lorenza Landi
- Department of Oncology and Hematology, AUSL della Romagna, Ravenna, Italy
| | - Serena Ricciardi
- Pneumo-Oncology Unit, San Camillo Forlanini Hospital, Roma, Italy
| | | | - Francesco Passiglia
- Department of Oncology, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Paolo Bironzo
- Department of Oncology, San Luigi Hospital, Orbassano, Italy
| | - Giulio Metro
- Department of Medical Oncology, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Vincenzo Adamo
- Medical Oncology and Department of Human Pathology, Azienda Ospedaliera Papardo and Università degli Studi di Messina, Messina, Italy
| | - Alessandro Russo
- Medical Oncology and Department of Human Pathology, Azienda Ospedaliera Papardo and Università degli Studi di Messina, Messina, Italy
| | - Gian Paolo Spinelli
- UOC Territorial Oncology of Aprilia, AUSL Latina, Sapienza University of Rome, Aprilia, Italy
| | - Giuseppe L Banna
- Medical Oncology, Portsmouth University Hospitals NHS Trust, Portsmouth, UK
| | - Alex Friedlaender
- Oncology Department, University Hospital of Geneva, Geneve, Switzerland
| | - Alfredo Addeo
- Oncology Department, University Hospital of Geneva, Geneve, Switzerland
| | - Katia Cannita
- Medical Oncology, San Salvatore Hospital, L'Aquila, Italy
| | - Corrado Ficorella
- Department of Biotechnology and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
- Medical Oncology, San Salvatore Hospital, L'Aquila, Italy
| | | | - David J Pinato
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Translational Medicine, Universitá del Piemonte Orientale "A. Avogadro", Novara, Italy
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21
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Banna GL, Cortellini A, Cortinovis DL, Tiseo M, Aerts JGJV, Barbieri F, Giusti R, Bria E, Grossi F, Pizzutilo P, Berardi R, Morabito A, Genova C, Mazzoni F, Di Noia V, Signorelli D, Gelibter A, Macerelli M, Rastelli F, Chiari R, Rocco D, Gori S, De Tursi M, Di Marino P, Mansueto G, Zoratto F, Filetti M, Montrone M, Citarella F, Marco R, Cantini L, Nigro O, D'Argento E, Buti S, Minuti G, Landi L, Guaitoli G, Lo Russo G, De Toma A, Donisi C, Friedlaender A, De Giglio A, Metro G, Porzio G, Ficorella C, Addeo A. The lung immuno-oncology prognostic score (LIPS-3): a prognostic classification of patients receiving first-line pembrolizumab for PD-L1 ≥ 50% advanced non-small-cell lung cancer. ESMO Open 2021; 6:100078. [PMID: 33735802 PMCID: PMC7988288 DOI: 10.1016/j.esmoop.2021.100078] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 01/26/2021] [Accepted: 02/02/2021] [Indexed: 12/30/2022] Open
Abstract
Background To stratify the prognosis of patients with programmed cell death-ligand 1 (PD-L1) ≥ 50% advanced non-small-cell lung cancer (aNSCLC) treated with first-line immunotherapy. Methods Baseline clinical prognostic factors, the neutrophil-to-lymphocyte ratio (NLR), PD-L1 tumour cell expression level, lactate dehydrogenase (LDH) and their combination were investigated by a retrospective analysis of 784 patients divided between statistically powered training (n = 201) and validation (n = 583) cohorts. Cut-offs were explored by receiver operating characteristic (ROC) curves and a risk model built with validated independent factors by multivariate analysis. Results NLR < 4 was a significant prognostic factor in both cohorts (P < 0.001). It represented 53% of patients in the validation cohort, with 1-year overall survival (OS) of 76.6% versus 44.8% with NLR > 4, in the validation series. The addition of PD-L1 ≥ 80% (21% of patients) or LDH < 252 U/l (25%) to NLR < 4 did not result in better 1-year OS (of 72.6% and 74.1%, respectively, in the validation cohort). Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 2 [P < 0.001, hazard ratio (HR) 2.04], pretreatment steroids (P < 0.001, HR 1.67) and NLR < 4 (P < 0.001, HR 2.29) resulted in independent prognostic factors. A risk model with these three factors, namely, the lung immuno-oncology prognostic score (LIPS)-3, accurately stratified three OS risk-validated categories of patients: favourable (0 risk factors, 40%, 1-year OS of 78.2% in the whole series), intermediate (1 or 2 risk factors, 54%, 1-year OS 53.8%) and poor (>2 risk factors, 5%, 1-year OS 10.7%) prognosis. Conclusions We advocate the use of LIPS-3 as an easy-to-assess and inexpensive adjuvant prognostic tool for patients with PD-L1 ≥ 50% aNSCLC. Immunotherapy/chemoimmunotherapy combinations are currently not superior to immunotherapy alone for high PD-L1 aNSCLC. NLR with a cut-off of 4 was validated as an independent prognostic factor for immunotherapy in high PD-L1 aNSCLC. The addition of either PD-L1 ≥ 80% or LDH < 252 U/l to NLR < 4 did not result in better prognostic stratification. The LIPS-3 is a validated 3-class prognostic classification based on the NLR, ECOG PS and pretreatment steroids. The LIPS-3 is a routinely assessable adjuvant prognostic tool for high PD-L1 aNSCLC patients.
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Affiliation(s)
- G L Banna
- Oncology Department, Portsmouth University Hospitals NHS Trust, Portsmouth, UK
| | - A Cortellini
- Department of Surgery and Cancer, Imperial College London, London, UK; Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
| | | | - M Tiseo
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy; Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - J G J V Aerts
- Department of Pulmonary Diseases, Erasmus Medical Center, Rotterdam, the Netherlands
| | - F Barbieri
- Department of Oncology and Hematology, Modena University Hospital, Modena, Italy
| | - R Giusti
- Medical Oncology, St. Andrea Hospital, Rome, Italy
| | - E Bria
- Comprehensive Cancer Center, Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Rome, Italy; Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - F Grossi
- Medical Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - P Pizzutilo
- Thoracic Oncology Unit, Clinical Cancer Center IRCCS Istituto Temorid 'Giovanni Paolo II', Bari, Italy
| | - R Berardi
- Oncology Clinic, Università Politecnica Delle Marche, Ospedali Riuniti Di Ancona, Ancona, Italy
| | - A Morabito
- Thoracic Medical Oncology, Istituto Nazionale Tumori 'Fondazione G Pascale', IRCCS, Napoli, Italy
| | - C Genova
- Lung Cancer Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - F Mazzoni
- Department of Oncology, Careggi University Hospital, Florence, Italy
| | - V Di Noia
- Medical Oncology, University Hospital of Foggia, Foggia, Italy
| | - D Signorelli
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - A Gelibter
- Medical Oncology (B), Policlinico Umberto I, 'Sapienza' University of Rome, Rome, Italy
| | - M Macerelli
- Department of Oncology, University Hospital Santa Maria Della Misericordia, Udine, Italy
| | - F Rastelli
- Medical Oncology, Fermo Area Vasta 4, Fermo, Italy
| | - R Chiari
- Medical Oncology, Ospedali Riuniti Padova Sud 'Madre Teresa Di Calcutta', Monselice, Italy
| | - D Rocco
- Pneumo-Oncology Unit, Monaldi Hospital, Naples, Italy
| | - S Gori
- Oncology Unit, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella VR, Italy
| | - M De Tursi
- Department of Medical, Oral & Biotechnological Sciences University G. D'Annunzio, Chieti-Pescara, Chieti, Italy
| | - P Di Marino
- Clinical Oncology Unit, S.S. Annunziata Hospital, Chieti, Italy
| | - G Mansueto
- Medical Oncology, F. Spaziani Hospital, Frosinone, Italy
| | - F Zoratto
- Medical Oncology, Santa Maria Goretti Hospital, Latina, Italy
| | - M Filetti
- Medical Oncology, St. Andrea Hospital, Rome, Italy
| | - M Montrone
- Thoracic Oncology Unit, Clinical Cancer Center IRCCS Istituto Temorid 'Giovanni Paolo II', Bari, Italy
| | - F Citarella
- Medical Oncology, Campus Bio-Medico University, Rome, Italy
| | - R Marco
- Medical Oncology, Campus Bio-Medico University, Rome, Italy
| | - L Cantini
- Department of Pulmonary Diseases, Erasmus Medical Center, Rotterdam, the Netherlands; Oncology Clinic, Università Politecnica Delle Marche, Ospedali Riuniti Di Ancona, Ancona, Italy
| | - O Nigro
- Medical Oncology, ASST-Sette Laghi, Varese, Italy
| | - E D'Argento
- Comprehensive Cancer Center, Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Rome, Italy
| | - S Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - G Minuti
- Department of Oncology and Hematology, AUSL Romagna, Ravenna, Italy
| | - L Landi
- Department of Oncology and Hematology, AUSL Romagna, Ravenna, Italy
| | - G Guaitoli
- Department of Oncology and Hematology, Modena University Hospital, Modena, Italy
| | - G Lo Russo
- Medical Oncology (B), Policlinico Umberto I, 'Sapienza' University of Rome, Rome, Italy
| | - A De Toma
- Medical Oncology (B), Policlinico Umberto I, 'Sapienza' University of Rome, Rome, Italy
| | - C Donisi
- Medical Oncology Unit, University Hospital and University of Cagliari, Cagliari, Italy
| | - A Friedlaender
- Oncology Department, University Hospital of Geneva, Geneva, Switzerland
| | - A De Giglio
- Division of Medical Oncology, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - G Metro
- Department of Medical Oncology, Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia, Perugia, Italy
| | - G Porzio
- Medical Oncology, St. Salvatore Hospital, L'Aquila, Italy
| | - C Ficorella
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy; Medical Oncology, St. Salvatore Hospital, L'Aquila, Italy
| | - A Addeo
- Oncology Department, University Hospital of Geneva, Geneva, Switzerland
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22
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Sonpavde G, Marabelle A, Loriot Y, Sternberg CN, Lee JL, Flechon A, Roubaud G, Pouessel D, Zagonel V, Calabro F, Banna GL, Shin SJ, Vera Badillo FE, Powles T, Hellmis E, Palhares de Miranda PA, Lima AR, Sawyer W, Hotte SJ. An open-label, multicenter, phase IIIb study of patients with urinary tract carcinoma (UTC) (STRONG): Final analysis for fixed-dose durvalumab monotherapy (module A). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.6_suppl.429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
429 Background: Patients (pts) with advanced UTC who fail first-line therapy have poor prognoses. Durvalumab (D; anti-PD-L1) 10 mg/kg every 2 weeks is approved for treatment of metastatic urothelial carcinoma (mUC) after progression on platinum-based chemotherapy (CT). Further understanding of long-term safety and efficacy of D in platinum and non-platinum pretreated pts, using a fixed dose every 4 weeks (Q4W), is of value. Methods: Module A of the phase IIIb STRONG study (NCT03084471) investigated the safety of fixed-dose D (1500 mg, Q4W) in pts with urothelial and nonurothelial UTC who progressed on or after platinum/non-platinum CT. The primary endpoint was the number of pts with adverse events of special interest (AESIs) – events with an inflammatory or immune-mediated mechanism that may require interventions (eg, steroids/immunosuppressants), including immune-mediated adverse events (imAE). AEs with onset date on or after the date of first dose and up to 90 days after study discontinuation were included. Secondary endpoints included serious AEs and overall survival (OS). Exploratory endpoints included objective response rate (ORR) and disease control rate (DCR) (investigator assessed per RECIST 1.1). Results: A total of 867 pts received D monotherapy. Median age was 68.1 yr and 80.0% were male; 87.1% had an ECOG PS 0-1 and 12.7% had ECOG PS 2. Most (96.3%) had urothelial UTC, including urothelial variants. Tumor PD-L1 expression was high (≥25%) in 239/577 (41.4%) pts with available data. Median treatment and follow-up duration were 12.1 wk (range 1-128) and 13.8 mo (range 0.0-28.8), respectively. Safety data are reported in the table. Deaths related to study treatment occurred in 9 pts (1.0%). At data cutoff (March 31, 2020), 30.8% of pts were in survival follow-up. Median OS was 7.0 mo (95% CI: 6.4-8.2); OS rate at 1 and 2 yr was 35.8% (95% CI: 32.5-39.2) and 20.2% (95% CI: 16.5-24.1), respectively. ORR was 17.7% with complete responses in 5.1% of pts. DCR at 6 mo was 33.0%. Median OS of subgroups: PD-L1 high or low: 9.3 mo (95% CI: 6.7-12.7) and 6.5 mo (95% CI: 5.8-8.1); ECOG PS 0-1 or 2: 8.4 mo (95% CI: 7.2–9.8) and 3 mo (95% CI: 2.0-4.1); urothelial and nonurothelial UTC: 7.0 mo (95% CI: 6.4-8.2) and 7.0 mo (95% CI: 2.7-10.2), respectively. Conclusions: Fixed-dose D monotherapy Q4W is convenient with an acceptable safety profile in previously treated pts for UTC. Long-term safety and efficacy data reported are consistent with published studies of D and other IO agents in this setting. Clinical trial information: NCT03084471 . [Table: see text]
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Affiliation(s)
| | | | - Yohann Loriot
- Department of Cancer Medicine, Institute Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Cora N. Sternberg
- Weill Cornell Medicine, Hematology/Oncology, New York Presbyterian Hospital, New York, NY
| | - Jae-Lyun Lee
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | | | | | | | | | | | | | - Sang Joon Shin
- Yonsei University Severance Hospital, Seoul, South Korea
| | | | - Thomas Powles
- Barts Cancer Centre, Queen Mary University of London, London, United Kingdom
| | - Eva Hellmis
- Institut Urologicum Duisburg, Duisburg, Germany
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23
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Cortellini A, De Giglio A, Cannita K, Cortinovis DL, Cornelissen R, Baldessari C, Giusti R, D'Argento E, Grossi F, Santoni M, Catino A, Berardi R, Sforza V, Rossi G, Antonuzzo L, Di Noia V, Signorelli D, Gelibter A, Occhipinti MA, Follador A, Rastelli F, Chiari R, Gravara LD, Inno A, De Tursi M, Di Marino P, Mansueto G, Zoratto F, Filetti M, Montrone M, Citarella F, Pensieri MV, Russano M, Cantini L, Nigro O, Leonetti A, Bordi P, Minuti G, Landi L, De Toma A, Donisi C, Ricciardi S, Migliorino MR, Napoli VM, Leone G, Metro G, Banna GL, Friedlaender A, Addeo A, Ficorella C, Porzio G. Smoking status during first-line immunotherapy and chemotherapy in NSCLC patients: A case-control matched analysis from a large multicenter study. Thorac Cancer 2021; 12:880-889. [PMID: 33527756 PMCID: PMC7952794 DOI: 10.1111/1759-7714.13852] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/05/2021] [Accepted: 01/06/2021] [Indexed: 12/11/2022] Open
Abstract
Background Improved outcome in tobacco smoking patients with non‐small cell lung cancer (NSCLC) following immunotherapy has previously been reported. However, little is known regarding this association during first‐line immunotherapy in patients with high PD‐L1 expression. In this study we compared clinical outcomes according to the smoking status of two large multicenter cohorts. Methods We compared clinical outcomes according to the smoking status (never smokers vs. current/former smokers) of two retrospective multicenter cohorts of metastatic NSCLC patients, treated with first‐line pembrolizumab and platinum‐based chemotherapy. Results A total of 962 NSCLC patients with PD‐L1 expression ≥50% who received first‐line pembrolizumab and 462 NSCLC patients who received first‐line platinum‐based chemotherapy were included in the study. Never smokers were confirmed to have a significantly higher risk of disease progression (hazard ratio [HR] = 1.49 [95% CI: 1.15–1.92], p = 0.0022) and death (HR = 1.38 [95% CI: 1.02–1.87], p = 0.0348) within the pembrolizumab cohort. On the contrary, a nonsignificant trend towards a reduced risk of disease progression (HR = 0.74 [95% CI: 0.52–1.05], p = 0.1003) and death (HR = 0.67 [95% CI: 0.45–1.01], p = 0.0593) were reported for never smokers within the chemotherapy cohort. After a random case–control matching, 424 patients from both cohorts were paired. Within the matched pembrolizumab cohort, never smokers had a significantly shorter progression‐free survival (PFS) (HR = 1.68 [95% CI: 1.17–2.40], p = 0.0045) and a nonsignificant trend towards a shortened overall survival (OS) (HR = 1.32 [95% CI: 0.84–2.07], p = 0.2205). On the contrary, never smokers had a significantly longer PFS (HR = 0.68 [95% CI: 0.49–0.95], p = 0.0255) and OS (HR = 0.66 [95% CI: 0.45–0.97], p = 0,0356) compared to current/former smoker patients within the matched chemotherapy cohort. On pooled multivariable analysis, the interaction term between smoking status and treatment modality was concordantly statistically significant with respect to ORR (p = 0.0074), PFS (p = 0.0001) and OS (p = 0.0020), confirming the significantly different impact of smoking status across the two cohorts. Conclusions Among metastatic NSCLC patients with PD‐L1 expression ≥50% receiving first‐line pembrolizumab, current/former smokers experienced improved PFS and OS. On the contrary, worse outcomes were reported among current/former smokers receiving first‐line chemotherapy.
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Affiliation(s)
- Alessio Cortellini
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom.,Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Andrea De Giglio
- Division of Medical Oncology, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Katia Cannita
- Medical Oncology, St. Salvatore Hospital, L'Aquila, Italy
| | | | - Robin Cornelissen
- Department of Pulmonary Diseases, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Cinzia Baldessari
- Department of Oncology and Hematology, Modena University Hospital, Modena, Italy
| | | | - Ettore D'Argento
- Comprehensive Cancer Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Francesco Grossi
- Medical Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Annamaria Catino
- Thoracic Oncology Unit, Clinical Cancer Center IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Rossana Berardi
- Oncology Clinic, Università Politecnica Delle Marche, Ospedali Riuniti Di Ancona, Ancona, Italy
| | - Vincenzo Sforza
- Thoracic Medical Oncology, Istituto Nazionale Tumori 'Fondazione G Pascale', IRCCS, Naples, Italy
| | - Giovanni Rossi
- Lung Cancer Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Lorenzo Antonuzzo
- Department of Oncology, Careggi University Hospital, Florence, Italy
| | - Vincenzo Di Noia
- Unità di Oncologia medica e Terapia Biomolecolare, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Foggia, Foggia, Italy
| | - Diego Signorelli
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alain Gelibter
- Medical Oncology (B), Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | | | - Alessandro Follador
- Department of Oncology, University Hospital Santa Maria Della Misericordia, Udine, Italy
| | | | - Rita Chiari
- Medical Oncology, Ospedali Riuniti Padova Sud "Madre Teresa Di Calcutta", Monselice, Italy
| | | | - Alessandro Inno
- Oncology Unit, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Italy
| | - Michele De Tursi
- Department of Medical, Oral & Biotechnological Sciences, University G. D'Annunzio, Chieti-Pescara, Chieti, Italy
| | | | | | | | | | - Michele Montrone
- Thoracic Oncology Unit, Clinical Cancer Center IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | | | - Maria Vittoria Pensieri
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom.,Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Marco Russano
- Medical Oncology, Campus Bio-Medico University, Rome, Italy
| | - Luca Cantini
- Department of Pulmonary Diseases, Erasmus Medical Center, Rotterdam, The Netherlands.,Oncology Clinic, Università Politecnica Delle Marche, Ospedali Riuniti Di Ancona, Ancona, Italy
| | - Olga Nigro
- Medical Oncology, ASST-Sette Laghi, Varese, Italy
| | | | - Paola Bordi
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Gabriele Minuti
- Department of Oncology and Hematology, AUSL Romagna, Ravenna, Italy
| | - Lorenza Landi
- Division of Medical Oncology, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Alessandro De Toma
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Clelia Donisi
- Medical Oncology Unit, University Hospital and University of Cagliari, Cagliari, Italy
| | - Serena Ricciardi
- Pneumo-Oncology Unit, St. Camillo-Forlanini Hospital, Rome, Italy
| | | | - Valerio Maria Napoli
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Italy
| | - Gianmarco Leone
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Italy
| | - Giulio Metro
- Department of Medical Oncology, Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia, Perugia, Italy
| | - Giuseppe L Banna
- Oncology Department, Queen Alexandra University Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Alex Friedlaender
- Oncology Department, University Hospital of Geneva, Geneva, Switzerland
| | - Alfredo Addeo
- Oncology Department, University Hospital of Geneva, Geneva, Switzerland
| | - Corrado Ficorella
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.,Medical Oncology, St. Salvatore Hospital, L'Aquila, Italy
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24
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Qiang H, Lei Y, Shen Y, Li J, Zhong H, Zhong R, Zhang X, Chang Q, Lu J, Feng H, Zhu Y, Addeo A, Banna GL, Oh IJ, Qian J, Chu T. Pembrolizumab monotherapy or combination therapy for bone metastases in advanced non-small cell lung cancer: a real-world retrospective study. Transl Lung Cancer Res 2021; 11:87-99. [PMID: 35242630 PMCID: PMC8825649 DOI: 10.21037/tlcr-21-1033] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/19/2022] [Indexed: 11/13/2022]
Abstract
Background The incidence of bone metastases in non-small cell lung cancer (NSCLC) patients is about 30–40% and bone-related events can seriously affect quality of life. Immune checkpoint inhibitor (ICI) therapy has become the standard treatment for advanced NSCLC patients. However, the specific efficacy of ICIs in NSCLC patients with bone metastases remains unclear. The aim of the present study was to explore the prognosis of immunotherapy in this population and to find potential biomarkers. Methods In this retrospective study, a total of 110 advanced NSCLC patients with bone metastases who received pembrolizumab therapy were enrolled. Patient characteristics; palliative bone radiotherapy or bone-targeted therapy; serum levels of lactate dehydrogenase (LDH), and the neutrophil-to-lymphocyte ratio (NLR) at baseline were assessed. The correlation of these factors with progression-free survival (PFS), overall survival (OS), and objective response rate (ORR) was analyzed. Results The ORR of the total population was 29.1%, and PFS and OS were 7.0 and 14.8 months, respectively. Fifty-eight patients (52.7%) received pembrolizumab treatment as first-line therapy, and 52 patients (47.3%) as second-line therapy or beyond [ORR: 41.4% vs. 15.4%, P=0.011; PFS: 9.0 vs. 4.0 months, P=0.004; OS: not reached (NR) vs. 11.5 months, P<0.0001]. Bone therapy, including palliative bone radiotherapy and bone-targeted therapy, increased the ORR (34.9% vs. 11.1%, P<0.0001) and prolonged PFS (8.5 vs. 2.0 months, P=0.002). Eastern Cooperative Oncology Group performance status score of 0–1 [OS: hazard ratio (HR) =0.117, P<0.0001] and first-line pembrolizumab therapy (OS: HR =0.372, P=0.004) were independent predictors of OS. Patients whose baseline serum LDH level was ≤240.5 IU/L (NR vs. 10.0 months, P<0.0001) or NLR ≤5.55 (NR vs. 18.0 months, P=0.039) showed longer OS. Conclusions The efficacy of Pembrolizumab therapy is confirmed in advanced NSCLC patients with bone metastases, particularly when palliative bone radiotherapy or bone-targeted therapy is delivered. Baseline serum LDH level ≤240.5 IU/L and NLR ≤5.55 might predict the prognosis of patients with bone metastases from advanced NSCLC treated with immunotherapy.
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Affiliation(s)
- Huiping Qiang
- Department of Respiratory Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yuqiong Lei
- Department of Respiratory Medicine, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yinchen Shen
- Department of Respiratory Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jiaqi Li
- Department of Respiratory Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Hua Zhong
- Department of Respiratory Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Runbo Zhong
- Department of Respiratory Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xueyan Zhang
- Department of Respiratory Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Qing Chang
- Department of Respiratory Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jiahuan Lu
- Department of Respiratory Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Hui Feng
- Department of Respiratory Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yan Zhu
- Department of Respiratory Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Alfredo Addeo
- Oncology Department, University Hospital of Geneva, Geneva, Switzerland
| | | | - In-Jae Oh
- Department of Internal Medicine, Chonnam National University Medical School and Hwasun Hospital, Jeonnam, Republic of Korea
| | - Jialin Qian
- Department of Respiratory Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Tianqing Chu
- Department of Respiratory Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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25
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Cortellini A, Ricciuti B, Tiseo M, Bria E, Banna GL, Aerts JG, Barbieri F, Giusti R, Cortinovis DL, Migliorino MR, Catino A, Passiglia F, Torniai M, Morabito A, Genova C, Mazzoni F, Di Noia V, Signorelli D, Gelibter A, Occhipinti MA, Rastelli F, Chiari R, Rocco D, Inno A, De Tursi M, Di Marino P, Mansueto G, Zoratto F, Grossi F, Filetti M, Pizzutilo P, Russano M, Citarella F, Cantini L, Targato G, Nigro O, Ferrara MG, Buti S, Scodes S, Landi L, Guaitoli G, Della Gravara L, Tabbò F, Ricciardi S, De Toma A, Friedlaender A, Petrelli F, Addeo A, Porzio G, Ficorella C. Baseline BMI and BMI variation during first line pembrolizumab in NSCLC patients with a PD-L1 expression ≥ 50%: a multicenter study with external validation. J Immunother Cancer 2020; 8:jitc-2020-001403. [PMID: 33077515 PMCID: PMC7574933 DOI: 10.1136/jitc-2020-001403] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The association between obesity and outcomes in patients receiving programmed death-1/programmed death ligand-1 (PD-L1) checkpoint inhibitors has already been confirmed in pre-treated non-small cell lung cancer (NSCLC) patients, regardless of PD-L1 tumor expression. METHODS We present the outcomes analysis according to baseline body mass index (BMI) and BMI variation in a large cohort of metastatic NSCLC patients with a PD-L1 expression ≥50%, receiving first line pembrolizumab. We also evaluated a control cohort of metastatic NSCLC patients treated with first line platinum-based chemotherapy. Normal weight was set as control group. RESULTS 962 patients and 426 patients were included in the pembrolizumab and chemotherapy cohorts, respectively. Obese patients had a significantly higher objective response rate (ORR) (OR=1.61 (95% CI: 1.04-2.50)) in the pembrolizumab cohort, while overweight patients had a significantly lower ORR (OR=0.59 (95% CI: 0.37-0.92)) within the chemotherapy cohort. Obese patients had a significantly longer progression-free survival (PFS) (HR=0.61 (95% CI: 0.45-0.82)) in the pembrolizumab cohort. Conversely, they had a significantly shorter PFS in the chemotherapy cohort (HR=1.27 (95% CI: 1.01-1.60)). Obese patients had a significantly longer overall survival (OS) within the pembrolizumab cohort (HR=0.70 (95% CI: 0.49-0.99)), while no significant differences according to baseline BMI were found in the chemotherapy cohort. BMI variation significantly affected ORR, PFS and OS in both the pembrolizumab and the chemotherapy cohorts. CONCLUSIONS Baseline obesity is associated to significantly improved ORR, PFS and OS in metastatic NSCLC patients with a PD-L1 expression of ≥50%, receiving first line pembrolizumab, but not among patients treated with chemotherapy. BMI variation is also significantly related to clinical outcomes.
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Affiliation(s)
- Alessio Cortellini
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy .,Medical Oncology, St. Salvatore Hospital, L'Aquila, Italy
| | - Biagio Ricciuti
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA.,Medical Oncology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Marcello Tiseo
- Medical Oncology, University Hospital of Parma, Parma, Emilia-Romagna, Italy.,Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Emilio Bria
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Romae, Lazio, Italy.,Comprehensive Cancer Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Giuseppe L Banna
- Oncology Department, Queen Alexandra University Hospital, Portsmouth Hospitals NHS Trust, Portsmuth, UK
| | - Joachim Gjv Aerts
- Department of Pulmonary Diseases, Erasmus Medical Center, Rotterdam, Zuid-Holland, Netherlands
| | - Fausto Barbieri
- Department of Oncology and Hematology, University Hospital Modena, Modena, Emilia-Romagna, Italy
| | - Raffaele Giusti
- Medical Oncology Unit, Sant'Andrea Hospital, Roma, Lazio, Italy
| | - Diego L Cortinovis
- Medical Oncology, Azienda Ospedaliera San Gerardo, Monza, Lombardia, Italy
| | - Maria R Migliorino
- Pneumo-Oncology Unit, San Camillo Forlanini Hospital, Roma, Lazio, Italy
| | - Annamaria Catino
- Thoracic Oncology Unit, Clinical Cancer Center IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Puglia, Italy
| | - Francesco Passiglia
- Department of Oncology, University of Turin, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Mariangela Torniai
- Oncology Clinic, Università Politecnica delle Marche, Ospedali Riuniti di Ancona, Ancona, Marche, Italy
| | - Alessandro Morabito
- Thoracic Medical Oncology, Istituto Nazionale Tumori "Fondazione G Pascale" IRCCS, Napoli, Campania, Italy
| | - Carlo Genova
- Lung Cancer Unit, IRCCS Ospedale Policlinnico San Martino, Genova, Liguria, Italy
| | - Francesca Mazzoni
- Medical Oncology, University Hospital Careggi, Firenze, Toscana, Italy
| | - Vincenzo Di Noia
- Oncologia Medica e Terapia Biomolecolare, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Foggia, Foggia, Puglia, Italy
| | - Diego Signorelli
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Lombardia, Italy
| | - Alain Gelibter
- Medical Oncology Unit B, Policlinico Umberto I, Sapienza University of Rome, Roma, Lazio, Italy
| | | | | | - Rita Chiari
- Medical Oncology, Ospedali Riuniti Padova Sud "Madre Teresa di Calcutta", Monselice, Veneto, Italy
| | - Danilo Rocco
- Pneumo-Oncology Unit, Ospedali dei Colli Monaldi Cotugno CTO, Napoli, Campania, Italy
| | - Alessandro Inno
- Oncology Unit, IRCCS Ospedale Sacro Cuore don Calabria, Negrar, Veneto, Italy
| | - Michele De Tursi
- Department of Medical, Oral and Biotechnological Sciences, University G. D'Annunzio Chieti-Pescara, Chieti, CH, Italy
| | | | | | - Federica Zoratto
- Medical Oncology, Ospedale Santa Maria Goretti, Latina, Lazio, Italy
| | - Francesco Grossi
- Medical Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore di Milano Policlinico, Milano, Lombardia, Italy
| | - Marco Filetti
- Medical Oncology Unit, Sant'Andrea Hospital, Roma, Lazio, Italy
| | - Pamela Pizzutilo
- Thoracic Oncology Unit, Clinical Cancer Center IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Puglia, Italy
| | - Marco Russano
- Medical Oncology, Campus Bio-Medico University, Rome, Italy
| | | | - Luca Cantini
- Department of Pulmonary Diseases, Erasmus Medical Center, Rotterdam, Zuid-Holland, Netherlands.,Oncology Clinic, Università Politecnica delle Marche, Ospedali Riuniti di Ancona, Ancona, Marche, Italy
| | - Giada Targato
- Department of Oncology, University Hospital Santa Maria della Misericordia, Udine, Friuli-Venezia Giulia, Italy
| | - Olga Nigro
- Medical Oncology, ASST-Sette Laghi, Varese, Lombardia, Italy
| | - Miriam G Ferrara
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Romae, Lazio, Italy.,Comprehensive Cancer Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Sebastiano Buti
- Medical Oncology, University Hospital of Parma, Parma, Emilia-Romagna, Italy
| | - Simona Scodes
- Department of Oncology and Hematology, AUSL della Romagna, Ravenna, Emilia-Romagna, Italy
| | - Lorenza Landi
- Department of Oncology and Hematology, AUSL della Romagna, Ravenna, Emilia-Romagna, Italy
| | - Giorgia Guaitoli
- Department of Oncology and Hematology, University Hospital Modena, Modena, Emilia-Romagna, Italy
| | - Luigi Della Gravara
- Pneumo-Oncology Unit, Ospedali dei Colli Monaldi Cotugno CTO, Napoli, Campania, Italy
| | - Fabrizio Tabbò
- Department of Oncology, University of Turin, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Serena Ricciardi
- Pneumo-Oncology Unit, San Camillo Forlanini Hospital, Roma, Lazio, Italy
| | - Alessandro De Toma
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Lombardia, Italy
| | - Alex Friedlaender
- Oncology Department, University Hospital of Geneva, Geneve, Genève, Switzerland
| | - Fausto Petrelli
- Oncology Unit, ASST Bergamo Ovest, Treviglio, Lombardia, Italy
| | - Alfredo Addeo
- Oncology Department, University Hospital of Geneva, Geneve, Genève, Switzerland
| | | | - Corrado Ficorella
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.,Medical Oncology, St. Salvatore Hospital, L'Aquila, Italy
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26
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Porciello G, Montagnese C, Crispo A, Grimaldi M, Libra M, Vitale S, Palumbo E, Pica R, Calabrese I, Cubisino S, Falzone L, Poletto L, Martinuzzo V, Prete M, Esindi N, Thomas G, Cianniello D, Pinto M, Laurentiis MD, Pacilio C, Rinaldo M, D’Aiuto M, Serraino D, Massarut S, Evangelista C, Steffan A, Catalano F, Banna GL, Scandurra G, Ferraù F, Rossello R, Antonelli G, Guerra G, Farina A, Messina F, Riccardi G, Gatti D, Jenkins DJA, Minopoli A, Grilli B, Cavalcanti E, Celentano E, Botti G, Montella M, Augustin LSA. Mediterranean diet and quality of life in women treated for breast cancer: A baseline analysis of DEDiCa multicentre trial. PLoS One 2020; 15:e0239803. [PMID: 33031478 PMCID: PMC7544033 DOI: 10.1371/journal.pone.0239803] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 09/15/2020] [Indexed: 02/08/2023] Open
Abstract
Evidence suggests a beneficial role of the Mediterranean Diet (MedDiet) on health-related quality of life (HRQoL) in healthy subjects. HRQoL is relevant in cancer therapy and disease outcomes, therefore we investigated the association between adherence to the MedDiet and HRQoL in breast cancer survivors participating in the multicentre trial DEDiCa. Diet and HRQoL were assessed at baseline in a subgroup of 309 women enrolled within 12 months of breast cancer diagnosis without metastasis (stages I-III, mean age 52±1 yrs, BMI 27±7 kg/m2). The 14-item PREDIMED questionnaire was used to analyse adherence to the MedDiet. HRQoL was assessed with three validated questionnaires measuring physical, mental, emotional and social factors: EQ-5D-3L, EORTC QLQ-C30 and EORTC QLQ-BR23. Analysis of variance (ANOVA) and multivariate analyses were performed to assess the possible role of the MedDiet on HRQoL. Patients with higher adherence to MedDiet (PREDIMED score >7) showed significantly higher scores for physical functioning (p = 0.02) and lower scores on the symptomatic pain scale (p = 0.04) assessed by the EORTC QLQ-C30 questionnaire compared to patients with a lower adherence to MedDiet (PREDIMED score ≤7). Higher scores from the EQ-5D-3L indicating higher well-being were observed mainly in participants with higher MedDiet adherence (p = 0.05). In adjusted multivariate analyses significant positive associations were found between MedDiet, physical functioning (p = 0.001) and EQ 5D-3L score (p = 0.003) while inverse associations were found with pain and insomnia symptoms (p = 0.005 and p = 0.029, respectively). These results suggest that higher adherence to the MedDiet in breast cancer survivors is associated with better aspects of quality of life, specifically higher physical functioning, better sleep, lower pain and generally higher well-being confirming findings in healthy subjects.
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Affiliation(s)
- Giuseppe Porciello
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori—IRCCS "Fondazione G. Pascale", Napoli, Italy
| | - Concetta Montagnese
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori—IRCCS "Fondazione G. Pascale", Napoli, Italy
- * E-mail:
| | - Anna Crispo
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori—IRCCS "Fondazione G. Pascale", Napoli, Italy
| | - Maria Grimaldi
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori—IRCCS "Fondazione G. Pascale", Napoli, Italy
| | - Massimo Libra
- Department of Biomedical and Biotechnological Sciences Oncologic, Clinical and General Pathology Section, University of Catania, Catania, Italy
| | - Sara Vitale
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori—IRCCS "Fondazione G. Pascale", Napoli, Italy
| | - Elvira Palumbo
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori—IRCCS "Fondazione G. Pascale", Napoli, Italy
| | - Rosa Pica
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori—IRCCS "Fondazione G. Pascale", Napoli, Italy
| | - Ilaria Calabrese
- Department of Clinical Medicine and Surgery, Federico II University, Napoli, Italy
| | - Serena Cubisino
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori—IRCCS "Fondazione G. Pascale", Napoli, Italy
| | - Luca Falzone
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori—IRCCS "Fondazione G. Pascale", Napoli, Italy
| | - Luigina Poletto
- Cancer Epidemiology Unit, National Cancer Institute Centro di Riferimento Oncologico, IRCCS, Aviano, Italy
| | - Valentina Martinuzzo
- Cancer Epidemiology Unit, National Cancer Institute Centro di Riferimento Oncologico, IRCCS, Aviano, Italy
| | - Melania Prete
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori—IRCCS "Fondazione G. Pascale", Napoli, Italy
| | - Nadia Esindi
- School of Life and Environmental Sciences and Charles Perkins Centre, University of Sydney, Sydney, Australia
| | | | - Daniela Cianniello
- Division of Breast Oncology, Istituto Nazionale Tumori—IRCCS "Fondazione G. Pascale", Napoli, Italy
| | - Monica Pinto
- Rehabilitation Medicine Unit, Istituto Nazionale Tumori—IRCCS "Fondazione G. Pascale", Napoli, Italy
| | - Michelino De Laurentiis
- Division of Breast Oncology, Istituto Nazionale Tumori—IRCCS "Fondazione G. Pascale", Napoli, Italy
| | - Carmen Pacilio
- Division of Breast Oncology, Istituto Nazionale Tumori—IRCCS "Fondazione G. Pascale", Napoli, Italy
| | - Massimo Rinaldo
- Division of Breast Oncology, Istituto Nazionale Tumori—IRCCS "Fondazione G. Pascale", Napoli, Italy
| | | | - Diego Serraino
- Cancer Epidemiology Unit, National Cancer Institute Centro di Riferimento Oncologico, IRCCS, Aviano, Italy
| | - Samuele Massarut
- Division of Breast Cancer Surgery, Centro di Riferimento Oncologico, IRCCS, Aviano, Italy
| | - Chiara Evangelista
- Cancer Epidemiology Unit, National Cancer Institute Centro di Riferimento Oncologico, IRCCS, Aviano, Italy
| | - Agostino Steffan
- Immunopathology and Cancer Biomarkers Unit, National Cancer Institute Centro di Riferimento Oncologico IRCCS, Aviano, Italy
| | | | | | | | | | | | | | | | | | | | - Gabriele Riccardi
- Department of Clinical Medicine and Surgery, Federico II University, Napoli, Italy
| | - Davide Gatti
- Rheumatology Unit, University of Verona, Verona, Italy
| | - David J. A. Jenkins
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, ON, Canada
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, ON, Canada
| | - Anita Minopoli
- Laboratory Medicine Unit, Istituto Nazionale Tumori—IRCCS "Fondazione G. Pascale", Napoli, Italy
| | - Bruna Grilli
- Laboratory Medicine Unit, Istituto Nazionale Tumori—IRCCS "Fondazione G. Pascale", Napoli, Italy
| | - Ernesta Cavalcanti
- Laboratory Medicine Unit, Istituto Nazionale Tumori—IRCCS "Fondazione G. Pascale", Napoli, Italy
| | - Egidio Celentano
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori—IRCCS "Fondazione G. Pascale", Napoli, Italy
| | - Gerardo Botti
- Scientific Directorate, Istituto Nazionale Tumori—IRCCS "Fondazione G. Pascale", Napoli, Italy
| | - Maurizio Montella
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori—IRCCS "Fondazione G. Pascale", Napoli, Italy
| | - Livia S. A. Augustin
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori—IRCCS "Fondazione G. Pascale", Napoli, Italy
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27
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Nappi L, Ottaviano M, Rescigno P, Tortora M, Banna GL, Baciarello G, Basso U, Canil C, Cavo A, Cossu Rocca M, Czaykowski P, De Giorgi U, Garcia Del Muro X, Di Napoli M, Fornarini G, Gietema JA, Heng DYC, Hotte SJ, Kollmannsberger C, Maruzzo M, Messina C, Morelli F, Mulder S, Nichols C, Nolè F, Oing C, Sava T, Secondino S, Simone G, Soulieres D, Vincenzi B, Zucali PA, De Placido S, Palmieri G. Management of Germ Cell Tumors During the Outbreak of the Novel Coronavirus Disease-19 Pandemic: A Survey of International Expertise Centers. Oncologist 2020; 25:e1509-e1515. [PMID: 32735386 DOI: 10.1634/theoncologist.2020-0420] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/07/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has become a public health emergency affecting frail populations, including patients with cancer. This poses the question of whether cancer treatments can be postponed or modified without compromising their efficacy, especially for highly curable cancers such as germ cell tumors (GCTs). MATERIALS AND METHODS To depict the state-of-the-art management of GCTs during the COVID-19 pandemic, a survey including 26 questions was circulated by e-mail among the physicians belonging to three cooperative groups: (a) Italian Germ Cell Cancer Group; (b) European Reference Network-Rare Adult Solid Cancers, Domain G3 (rare male genitourinary cancers); and (c) Genitourinary Medical Oncologists of Canada. Percentages of agreement between Italian respondents (I) versus Canadian respondents (C), I versus European respondents (E), and E versus C were compared by using Fisher's exact tests for dichotomous answers and chi square test for trends for the questions with three or more options. RESULTS Fifty-three GCT experts responded to the survey: 20 Italian, 6 in other European countries, and 27 from Canada. Telemedicine was broadly used; there was high consensus to interrupt chemotherapy in COVID-19-positive patients (I = 75%, C = 55%, and E = 83.3%) and for use of granulocyte colony-stimulating factor primary prophylaxis for neutropenia (I = 65%, C = 62.9%, and E = 50%). The main differences emerged regarding the management of stage I and stage IIA disease, likely because of cultural and geographical differences. CONCLUSION Our study highlights the common efforts of GCT experts in Europe and Canada to maintain high standards of treatment for patients with GCT with few changes in their management during the COVID-19 pandemic. IMPLICATIONS FOR PRACTICE Despite the chaos, disruptions, and fears fomented by the COVID-19 illness, oncology care teams in Italy, other European countries, and Canada are delivering the enormous promise of curative management strategies for patients with testicular cancer and other germ cell tumors. At the same time, these teams are applying safe and innovative solutions and sharing best practices to minimize frequency and intensity of patient contacts with thinly stretched health care capacity.
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Affiliation(s)
- Lucia Nappi
- British Columbia Cancer, Vancouver Cancer Center, Vancouver, BC, Canada
- Department of Urologic Sciences, Vancouver Prostate Centre, University of British Columbia, Vancouver, Canada
| | - Margaret Ottaviano
- Ospedale del Mare, Naples, Italy
- Department of Clinical Medicine and Surgery, University of Naples "Federico II,", Naples, Italy
- Centro di riferimento Campania per i tumori rar (CRCTR) Regional Rare Tumors Reference Center, Naples, Italy
| | - Pasquale Rescigno
- The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
- The Institute of Cancer Research, London, United Kingdom
| | - Marianna Tortora
- Department of Clinical Medicine and Surgery, University of Naples "Federico II,", Naples, Italy
- Centro di riferimento Campania per i tumori rar (CRCTR) Regional Rare Tumors Reference Center, Naples, Italy
| | | | - Giulia Baciarello
- Oncology Medicine Department, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Umberto Basso
- Oncology Unit, Oncology Department, Istituto Oncologico Veneto (IOV), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padua, Italy
| | - Christina Canil
- The Ottawa Hospital Cancer Center, University of Ottawa, Ottawa, Canada
| | | | | | | | - Ugo De Giorgi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | | | | | | | | | - Daniel Y C Heng
- Tom Baker Cancer Center, University of Calgary, Calgary, Canada
| | | | | | - Marco Maruzzo
- Oncology Unit, Oncology Department, Istituto Oncologico Veneto (IOV), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padua, Italy
| | | | - Franco Morelli
- IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Sasja Mulder
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - Craig Nichols
- Testicular Cancer Commons, Portland, Oregon, USA
- Southwest Oncology Group (SWOG) Group Chair's Office, Portland, Oregon, USA
| | - Franco Nolè
- European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | | | - Teodoro Sava
- Oncologia Azienda Unità Locale Socio Sanitaria 6 (AUSLSS6) EUGANEA, Padua, Italy
| | | | | | - Denis Soulieres
- Center Hospitalier de l'Université de Montréal, Montreal, Canada
| | | | - Paolo A Zucali
- Humanitas Clinical and Research Center, IRCCS, Rozzano (Milan), Italy
| | - Sabino De Placido
- Department of Clinical Medicine and Surgery, University of Naples "Federico II,", Naples, Italy
- Centro di riferimento Campania per i tumori rar (CRCTR) Regional Rare Tumors Reference Center, Naples, Italy
| | - Giovannella Palmieri
- Department of Clinical Medicine and Surgery, University of Naples "Federico II,", Naples, Italy
- Centro di riferimento Campania per i tumori rar (CRCTR) Regional Rare Tumors Reference Center, Naples, Italy
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28
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Britschgi C, Addeo A, Rechsteiner M, Delaloye R, Früh M, Metro G, Banini M, Gautschi O, Rothschild SI, Wild PJ, Banna GL, Curioni-Fontecedro A. Real-World Treatment Patterns and Survival Outcome in Advanced Anaplastic Lymphoma Kinase (ALK) Rearranged Non-Small-Cell Lung Cancer Patients. Front Oncol 2020; 10:1299. [PMID: 32974130 PMCID: PMC7472246 DOI: 10.3389/fonc.2020.01299] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 03/04/2020] [Accepted: 06/22/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction: Survival of ALK-rearranged NSCLC patients has dramatically improved by the use of multiple ALK-tyrosine kinase inhibitors (ALK-TKI). However, still little is known about the impact of drug sequencing and clinical features on survival in a real-world setting. Methods: Patients with stage IV ALK-rearranged NSCLC treated at six centers in Switzerland and Italy were identified and standard clinical variables collected. OS curves were constructed using the Kaplan–Meier method and compared with the log-rank test. Multivariate Cox proportional hazard analysis was applied to determine the correlations between clinical features and OS. In four patients, biopsies were subjected to NGS. Results: One-hundred and twenty-one patients with stage IV ALK-rearranged NSCLC diagnosed between 2011 and 2016 were included. With a median follow-up time of 39.5 months, the median OS from diagnosis of stage IV disease was 48.0 months. First-line treatment consisted of an ALK-TKI in 24% of patients, with crizotinib in 83% of them. Chemotherapy as first-line treatment did not influence OS (p = 0.955). The use of more than one ALK-TKI line positively correlated with OS (p = 0.016), as well as the use of alectinib or lorlatinib in any treatment line, as compared to the use of crizotinib ± ceritinib (p = 0.022). A never smoking history was an independent prognostic factor for OS (p = 0.032). Moreover, treatment with alectinib significantly improved OS. Conclusions: Targeted treatment for ALK-positive NSCLC patients lead to prolonged OS. Smoking status was a negative independent prognostic factor in a multi-variate analysis. The use of alectinib or lorlatinib in any treatment line improved overall outcome.
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Affiliation(s)
- Christian Britschgi
- Department of Medical Oncology and Hematology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Alfredo Addeo
- Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Markus Rechsteiner
- Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Raphaël Delaloye
- Department of Medical Oncology and Hematology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Martin Früh
- Department of Oncology and Hematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.,Department of Oncology, University Hospital of Bern, Bern, Switzerland
| | - Giulio Metro
- Medical Oncology, Azienda Ospedaliera Di Perugia, Perugia, Italy
| | - Marco Banini
- Medical Oncology, Azienda Ospedaliera Di Perugia, Perugia, Italy
| | - Oliver Gautschi
- University of Bern and Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Sacha I Rothschild
- Department of Internal Medicine, Medical Oncology, University Hospital Basel, Basel, Switzerland
| | - Peter J Wild
- Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | | | - Alessandra Curioni-Fontecedro
- Department of Medical Oncology and Hematology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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29
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Cortellini A, Friedlaender A, Banna GL, Porzio G, Bersanelli M, Cappuzzo F, Aerts JGJV, Giusti R, Bria E, Cortinovis D, Grossi F, Migliorino MR, Galetta D, Passiglia F, Berardi R, Mazzoni F, Di Noia V, Signorelli D, Tuzi A, Gelibter A, Marchetti P, Macerelli M, Rastelli F, Chiari R, Rocco D, Inno A, Di Marino P, Mansueto G, Zoratto F, Santoni M, Tudini M, Ghidini M, Filetti M, Catino A, Pizzutilo P, Sala L, Occhipinti MA, Citarella F, Russano M, Torniai M, Cantini L, Follador A, Sforza V, Nigro O, Ferrara MG, D'Argento E, Leonetti A, Pettoruti L, Antonuzzo L, Scodes S, Landi L, Guaitoli G, Baldessari C, Bertolini F, Della Gravara L, Dal Bello MG, Belderbos RA, De Filippis M, Cecchi C, Ricciardi S, Donisi C, De Toma A, Proto C, Addeo A, Cantale O, Ricciuti B, Genova C, Morabito A, Santini D, Ficorella C, Cannita K. Immune-related Adverse Events of Pembrolizumab in a Large Real-world Cohort of Patients With NSCLC With a PD-L1 Expression ≥ 50% and Their Relationship With Clinical Outcomes. Clin Lung Cancer 2020; 21:498-508.e2. [PMID: 32680806 DOI: 10.1016/j.cllc.2020.06.010] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/05/2020] [Accepted: 06/11/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The role of immune-related adverse events (irAEs), as a surrogate predictor of the efficacy of checkpoint inhibitors, has not yet been described in the setting of first-line, single-agent pembrolizumab for patients with metastatic non-small-cell lung-cancer (NSCLC) with a programmed death-ligand 1 (PD-L1) expression of ≥ 50%. PATIENTS AND METHODS We previously conducted a multicenter retrospective analysis in patients with treatment-naive metastatic NSCLC and a PD-L1 expression of ≥ 50% receiving first-line pembrolizumab. Here, we report the results of the irAE analysis and the potential correlation between irAEs and clinical outcomes. RESULTS A total of 1010 patients were included in this analysis; after a 6-week landmark selection, 877 (86.8%) patients were included in the efficacy analysis. Any grade irAEs (P < .0001), grade 3/4 irAEs (P = .0025), leading to discontinuation irAEs (P = .0144), multiple-site and single-site irAEs (P < .0001), cutaneous irAEs (P = .0001), endocrine irAEs (P = .0227), pulmonary irAEs (P = .0479), and rheumatologic irAEs (P = .0018) were significantly related to a higher objective response rate. Any grade irAEs (P < .0001), single-site irAEs (P < .0001), multiple-site irAEs (P = .0005), cutaneous irAEs (P = .0042), endocrine irAEs (P < .0001), gastrointestinal irAEs (P = .0391), and rheumatologic irAEs (P = .0086) were significantly related to progression-free survival. Any grade irAEs (P < .0001), single-site irAEs (P < .0001), multiple-site irAEs (P = .0003), cutaneous irAEs (P = .0002), endocrine irAEs (P = .0001), and rheumatologic irAEs (P = .0214) were significantly related to overall survival. CONCLUSIONS This study confirms the feasibility and the safety of first-line, single-agent pembrolizumab, in a large, real-world cohort of patients with NSCLC with PD-L1 expression ≥ 50%. The occurrence of irAEs may be a surrogate of clinical activity and improved outcomes in this setting.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal, Humanized/adverse effects
- Antineoplastic Agents, Immunological/adverse effects
- B7-H1 Antigen/metabolism
- Carcinoma, Non-Small-Cell Lung/drug therapy
- Carcinoma, Non-Small-Cell Lung/metabolism
- Carcinoma, Non-Small-Cell Lung/pathology
- Carcinoma, Squamous Cell/drug therapy
- Carcinoma, Squamous Cell/metabolism
- Carcinoma, Squamous Cell/pathology
- Drug-Related Side Effects and Adverse Reactions/etiology
- Drug-Related Side Effects and Adverse Reactions/pathology
- Female
- Follow-Up Studies
- Humans
- Lung Neoplasms/drug therapy
- Lung Neoplasms/metabolism
- Lung Neoplasms/pathology
- Male
- Middle Aged
- Prognosis
- Retrospective Studies
- Survival Rate
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Affiliation(s)
- Alessio Cortellini
- Medical Oncology, St Salvatore Hospital, L'Aquila, Italy; Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
| | - Alex Friedlaender
- Oncology Department, University Hospital of Geneva, Geneva, Switzerland
| | - Giuseppe L Banna
- Oncology Department, United Lincolnshire Hospital NHS Trust, Lincoln, UK
| | - Giampiero Porzio
- Medical Oncology, St Salvatore Hospital, L'Aquila, Italy; Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | | | | | - Joachim G J V Aerts
- Department of Pulmonary Diseases, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Emilio Bria
- Comprehensive Cancer Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy; Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Francesco Grossi
- Medical Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Domenico Galetta
- Thoracic Oncology Unit, Clinical Cancer Centre IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Francesco Passiglia
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano (TO), Italy
| | - Rossana Berardi
- Oncology Clinic, Università Politecnica Delle Marche, Ospedali Riuniti Di Ancona, Ancona, Italy
| | - Francesca Mazzoni
- Department of Oncology, Careggi University Hospital, Florence, Italy
| | | | - Diego Signorelli
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Alain Gelibter
- Medical Oncology (B), Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Paolo Marchetti
- Medical Oncology, St. Andrea Hospital, Rome, Italy; Medical Oncology (B), Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy; Department of Clinical and Molecular Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Marianna Macerelli
- Department of Oncology, University Hospital Santa Maria Della Misericordia, Udine, Italy
| | | | - Rita Chiari
- Medical Oncology, Ospedali Riuniti Padova Sud "Madre Teresa Di Calcutta", Monselice, Italy
| | - Danilo Rocco
- Pneumo-Oncology Unit, Monaldi Hospital, Naples, Italy
| | - Alessandro Inno
- Oncology Unit, Ospedale Sacro Cuore don Calabria Cancer Care Center, Negrar, VR, Italy
| | | | | | | | - Matteo Santoni
- Department of Oncology, Macerata Hospital, Macerata, Italy
| | | | - Michele Ghidini
- Medical Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Annamaria Catino
- Thoracic Oncology Unit, Clinical Cancer Centre IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Pamela Pizzutilo
- Thoracic Oncology Unit, Clinical Cancer Centre IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Luca Sala
- Medical Oncology, Ospedale San Gerardo, Monza, Italy
| | | | | | - Marco Russano
- Medical Oncology, Campus Bio-Medico University, Rome, Italy
| | - Mariangela Torniai
- Oncology Clinic, Università Politecnica Delle Marche, Ospedali Riuniti Di Ancona, Ancona, Italy
| | - Luca Cantini
- Department of Pulmonary Diseases, Erasmus Medical Center, Rotterdam, the Netherlands; Oncology Clinic, Università Politecnica Delle Marche, Ospedali Riuniti Di Ancona, Ancona, Italy
| | - Alessandro Follador
- Department of Oncology, University Hospital Santa Maria Della Misericordia, Udine, Italy
| | - Vincenzo Sforza
- Thoracic Medical Oncology, Istituto Nazionale Tumori 'Fondazione G Pascale', IRCCS, Napoli, Italy
| | - Olga Nigro
- Medical Oncology, ASST-Sette Laghi, Varese, Italy
| | - Miriam G Ferrara
- Comprehensive Cancer Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy; Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ettore D'Argento
- Comprehensive Cancer Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | | | - Linda Pettoruti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Lorenzo Antonuzzo
- Department of Oncology, Careggi University Hospital, Florence, Italy
| | - Simona Scodes
- Department of Oncology and Hematology, AUSL Romagna, Ravenna, Italy
| | - Lorenza Landi
- Department of Oncology and Hematology, AUSL Romagna, Ravenna, Italy
| | - Giorgia Guaitoli
- Department of Oncology and Hematology, Modena University Hospital, Modena, Italy
| | - Cinzia Baldessari
- Department of Oncology and Hematology, Modena University Hospital, Modena, Italy
| | - Federica Bertolini
- Department of Oncology and Hematology, Modena University Hospital, Modena, Italy
| | | | | | - Robert A Belderbos
- Department of Pulmonary Diseases, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Marco De Filippis
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano (TO), Italy
| | - Cristina Cecchi
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano (TO), Italy
| | - Serena Ricciardi
- Pneumo-Oncology Unit, St. Camillo-Forlanini Hospital, Rome, Italy
| | - Clelia Donisi
- Medical Oncology Unit, University Hospital and University of Cagliari, Cagliari, Italy
| | - Alessandro De Toma
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Claudia Proto
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alfredo Addeo
- Oncology Department, University Hospital of Geneva, Geneva, Switzerland
| | - Ornella Cantale
- Oncology Department, United Lincolnshire Hospital NHS Trust, Lincoln, UK
| | - Biagio Ricciuti
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Division of Medical Oncology, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Carlo Genova
- Lung Cancer Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Alessandro Morabito
- Thoracic Medical Oncology, Istituto Nazionale Tumori 'Fondazione G Pascale', IRCCS, Napoli, Italy
| | | | - Corrado Ficorella
- Medical Oncology, St Salvatore Hospital, L'Aquila, Italy; Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Katia Cannita
- Medical Oncology, St Salvatore Hospital, L'Aquila, Italy
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Banna GL, Di Quattro R, Malatino L, Fornarini G, Addeo A, Maruzzo M, Urzia V, Rundo F, Lipari H, De Giorgi U, Basso U. Neutrophil-to-lymphocyte ratio and lactate dehydrogenase as biomarkers for urothelial cancer treated with immunotherapy. Clin Transl Oncol 2020; 22:2130-2135. [PMID: 32232716 DOI: 10.1007/s12094-020-02337-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/12/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE To identify patients with metastatic urothelial cancer (mUC) unlikely to benefit from immune-checkpoint inhibitors (ICIs). METHODS/PATIENTS We explored the predictive and prognostic values of baseline neutrophil-to-lymphocyte ratio (NLR), with cut-offs ≥ 3 and ≥ 5, and of a urothelial immune prognostic index (UIPI, based on increased NLR and LDH), on 146 patients. RESULTS NLR and UIPI significantly predicted progressive disease and progression-free survival with both cut-offs (p = 0.0069, p = 0.0034, p = 0.0160, p = 0.0063; p < 0.001, p = 0.021, p = 0.014, p = 0.026; for NLR-3, NLR-5, UIPI-3, UIPI-5, respectively) and overall survival when NLR cut-off was ≥ 5 (p = 0.03 and p = 0.024, for NLR-5 and UIPI-5, respectively). CONCLUSIONS NLR-5 deserves prospective validation to identify mUC patients with poor prognosis following ICIs.
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Affiliation(s)
- G L Banna
- Division of Medical Oncology, Cannizzaro Hospital, Catania, Italy.,Deparment of Oncology, United Lincolnshire NHS Hospital Trust, Lincoln, UK
| | - R Di Quattro
- Department of Clinical and Experimental Medicine, University of Catania, Cannizzaro Hospital, Catania, Italy
| | - L Malatino
- Department of Clinical and Experimental Medicine, University of Catania, Cannizzaro Hospital, Catania, Italy
| | - G Fornarini
- Medical Oncology Unit, Ospedale Policlinico San Martino, Genoa, Italy
| | - A Addeo
- Oncology Department, Geneva University Hospital, Geneva, Switzerland
| | - M Maruzzo
- Medical Oncology Unit 1, Istituto Oncologico Veneto IOV IRCCS, Padua, Italy
| | - V Urzia
- Department of Clinical and Experimental Medicine, University of Catania, Cannizzaro Hospital, Catania, Italy
| | - F Rundo
- STMicroelectronics ADG Central R&D, Catania, Italy
| | - H Lipari
- Division of Medical Oncology, Cannizzaro Hospital, Catania, Italy
| | - U De Giorgi
- Istituto Scientifico Romagnolo per io Studio e La Cura Dei Tumori (IRST) IRCCS, Meldola, FC, Italy.
| | - U Basso
- Medical Oncology Unit 1, Istituto Oncologico Veneto IOV IRCCS, Padua, Italy
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Affiliation(s)
- Alfredo Addeo
- Oncology Department, Geneva University Hospital, Geneva, Switzerland
| | - Giuseppe L Banna
- Division of Medical Oncology, Cannizzaro Hospital, Catania, Italy
| | - Glen J Weiss
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Friedlaender A, Drilon A, Weiss GJ, Banna GL, Addeo A. KRAS as a druggable target in NSCLC: Rising like a phoenix after decades of development failures. Cancer Treat Rev 2020; 85:101978. [PMID: 32062493 DOI: 10.1016/j.ctrv.2020.101978] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/27/2020] [Accepted: 01/31/2020] [Indexed: 02/07/2023]
Abstract
Cancers of nearly all lineages harbor alterations that deregulate mitogen-activated protein kinase signaling, a crucial signaling pathway for tumor formation and maintenance. Of these, KRAS mutations are the most frequent gain-of-function alterations found in patients with cancer. In particular they represents the most common molecular alteration detected in non-small cell lung cancer (NSCLC) accounting for up to 25% of all oncogenic mutations. They were identified decades ago and prior efforts to target these proteins have been unsuccessful. KRAS mutation profiles (i.e. frequency of specific codon substitutions) in smokers and never-smokers are distinct and not all KRAS alterations are driver mutations. KRAS has evolved from a mutation with possible predictive value to a therapeutic target with great promise. Here, we will discuss the biology of KRAS in lung cancer and its clinical implications in oncology today and in the foreseeable future.
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Affiliation(s)
| | - Alexander Drilon
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, NY, USA
| | - Glen J Weiss
- MiRanostics Consulting, Oro Valley, AZ, United States
| | | | - Alfredo Addeo
- Oncology Department, University Hospital of Geneva, Switzerland.
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Banna GL, Urzia V, Benanti C, Pitrè A, Lipari H, Di Quattro R, De Giorgi U, Schepisi G, Basso U, Bimbatti D, Rundo F, Libra M, Malatino L. Adherence to abiraterone or enzalutamide in elderly metastatic castration-resistant prostate cancer. Support Care Cancer 2020; 28:4687-4695. [PMID: 31960124 DOI: 10.1007/s00520-020-05311-5] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 01/14/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate adherence to abiraterone or enzalutamide for the treatment of metastatic castration-resistant prostate cancer (mCRPC). METHODS In an observational prospective cohort study, we monitored patients with mCRPC for their adherence to abiraterone or enzalutamide in the pre- or post-chemotherapy setting. RESULTS Fifty-eight patients with median age of 76 years (range 56-94), age-adjusted Charlson comorbidity score of 10 (range, 4-15), and geriatric G8 score of 14 (range, 6-17) were enrolled. Twenty-two (38%) patients were treated with abiraterone and 36 (62%) with enzalutamide, while forty-two (72%) were in the pre-chemotherapy setting. Forty-seven patients (81%) had a caregiver. Based on the pill counting, a non-adherence rate of 4.8% and 6.2% was observed for the whole period and the first 3 months, respectively, without a statistically significant difference between abiraterone and enzalutamide cohorts. A lower non-adherence rate (1.3%) was reported by patients during the whole period, mainly due to a misperception (77%) and forgetfulness (19%). Non-adherence rate to the fulfilling of the clinical diary was 38% for the whole period. Non-adherence in the whole period was related to the radiological response (p = 0.03) and geriatric G8 score (p = 0.005). By the receiver operating characteristic (ROC) curve based on the radiological response, non-adherence cut-off was 1.87% (p = 0.04). By this non-adherence cut-off, the G8 cut-off was 14.75 (p = 0.0003). CONCLUSION Non-adherence to abiraterone or enzalutamide for mCRPC may have an impact on disease response and be related to patients' frailty, suggesting their geriatric assessment and clinical interventions to monitor and increase their adherence.
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Affiliation(s)
- Giuseppe L Banna
- Division of Medical Oncology, Cannizzaro Hospital, Catania, Italy.
- Department of Medical Oncology, United Lincolnshire Hospitals NHS Trust, Lincoln, UK.
| | - Valeria Urzia
- Department of Clinical and Experimental Medicine, Cannizzaro Hospital, University of Catania, Catania, Italy
| | - Chiara Benanti
- Division of Medical Oncology, Cannizzaro Hospital, Catania, Italy
| | - Alessandra Pitrè
- Division of Medical Oncology, Cannizzaro Hospital, Catania, Italy
| | - Helga Lipari
- Division of Medical Oncology, Cannizzaro Hospital, Catania, Italy
| | - Rosario Di Quattro
- Department of Clinical and Experimental Medicine, Cannizzaro Hospital, University of Catania, Catania, Italy
| | - Ugo De Giorgi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per Io Studio e La Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Giuseppe Schepisi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per Io Studio e La Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Umberto Basso
- Medical Oncology Unit 1, Istituto Oncologico Veneto IOV IRCCS, Padua, Italy
| | - Davide Bimbatti
- Medical Oncology Unit 1, Istituto Oncologico Veneto IOV IRCCS, Padua, Italy
| | | | - Massimo Libra
- Department of Biomedical and Biotechnological Sciences, Pathology and Oncology Section, University of Catania, Catania, Italy
| | - Lorenzo Malatino
- Department of Clinical and Experimental Medicine, Cannizzaro Hospital, University of Catania, Catania, Italy
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Affiliation(s)
- Alfredo Addeo
- Department of Oncology, Geneva University Hospital, Geneva, Switzerland
| | - Giuseppe L Banna
- Division of Medical Oncology, Cannizzaro Hospital, Catania, Italy
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Sternberg CN, Loriot Y, James N, Choy E, Castellano D, Lopez-Rios F, Banna GL, De Giorgi U, Masini C, Bamias A, Garcia Del Muro X, Duran I, Powles T, Gamulin M, Zengerling F, Geczi L, Gedye C, de Ducla S, Fear S, Merseburger AS. Primary Results from SAUL, a Multinational Single-arm Safety Study of Atezolizumab Therapy for Locally Advanced or Metastatic Urothelial or Nonurothelial Carcinoma of the Urinary Tract. Eur Urol 2019; 76:73-81. [PMID: 30910346 DOI: 10.1016/j.eururo.2019.03.015] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 03/13/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND Atezolizumab, a humanised monoclonal antibody targeting PD-L1, is approved for locally advanced/metastatic urothelial carcinoma. SAUL evaluated atezolizumab in a broader, pretreated population, including patients ineligible for the pivotal IMvigor211 phase 3 trial of atezolizumab. OBJECTIVE To determine the safety and efficacy of atezolizumab in an international real-world setting. DESIGN, SETTING, AND PARTICIPANTS Between November 2016 and March 2018 (median follow-up 12.7mo), 1004 patients with locally advanced or metastatic urothelial or nonurothelial urinary tract carcinoma who experienced progression during or after one to three prior therapies for inoperable, locally advanced, or metastatic disease were enrolled. Patients with renal impairment, treated central nervous system metastases, or stable controlled autoimmune disease were eligible; 10% had Eastern Cooperative Oncology Group performance status (ECOG PS) 2 and 98% were platinum pretreated (Clinicaltrials.gov: NCT02928406). INTERVENTION Atezolizumab 1200mg every 3wk until progression or unacceptable toxicity. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary endpoint was safety. Secondary efficacy endpoints included overall survival (OS), progression-free survival (PFS), and overall response rate (ORR). RESULTS AND LIMITATIONS The median treatment duration was 2.8mo (range 0-19); 22% remained on treatment and 8% discontinued because of toxicity. Grade ≥3 adverse events occurred in 45% of patients. The most common grade ≥3 treatment-related adverse events were fatigue, asthenia, colitis, and hypertension (each in 1%). Median OS was 8.7mo (95% confidence interval [CI] 7.8-9.9). The 6-mo OS rate was 60% (95% CI 57-63%), median PFS was 2.2mo (95% CI 2.1-2.4), and the ORR was 13% (95% CI 11-16%; 3% complete responses). Among IMvigor211-like patients (excluding ECOG PS 2 and other IMvigor211 exclusion criteria), median OS was 10.0mo (95% CI 8.8-11.9) and 6-mo OS was 65% (95% CI 61-69%). CONCLUSIONS SAUL confirms the tolerability of atezolizumab in a real-world pretreated population with urinary tract carcinoma. Efficacy overall and in the IMvigor211-like subgroup is consistent with previous pivotal anti-PD-L1/PD-1 urothelial carcinoma trials. These results support the use of atezolizumab in urinary tract carcinoma, including patients with limited treatment options. PATIENT SUMMARY In this international study we investigated the efficacy and safety of atezolizumab treatment for advanced urinary tract cancer in a large population of pretreated patients, including those who would not normally be candidates for clinical trials. Patients tolerated the treatment well, even if they had autoimmune disease, were being treated with corticosteroids, or had disease that had spread to their brain. Life expectancy in this study for patients typical of everyday clinical practice was similar to that seen in trials that enrolled only selected fitter patients.
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Affiliation(s)
| | - Yohann Loriot
- Department of Cancer Medicine and INSERM U981, Université Paris-Sud, Université Paris-Saclay, Gustave Roussy, Villejuif, France
| | - Nicholas James
- Institute of Cancer and Genomic Services, University of Birmingham, and Cancer Centre, Queen Elizabeth Hospital, Birmingham, UK
| | - Ernest Choy
- CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK
| | - Daniel Castellano
- Medical Oncology Service, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | - Ugo De Giorgi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Meldola, Italy
| | - Cristina Masini
- Medical Oncology Unit, AUSL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Aristotelis Bamias
- Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Ignacio Duran
- Hospital Universitario Virgen del Rocio, Seville, Spain
| | - Thomas Powles
- Barts Cancer Institute, Experimental Cancer Medicine Centre, Queen Mary University of London, St Bartholomew's Hospital, London, UK
| | | | | | - Lajos Geczi
- National Institute of Oncology, Budapest, Hungary
| | | | | | - Simon Fear
- F. Hoffmann-La Roche, Basel, Switzerland
| | - Axel S Merseburger
- Department of Urology, Campus Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
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Camerini A, Banna GL, Cinieri S, Pezzuto A, Mencoboni M, Rosetti F, Figueiredo A, Rizzo P, Ricci A, Langenhoven L, Santo A, Addeo A, Amoroso D, Barata F. Metronomic oral vinorelbine for the treatment of advanced non-small cell lung cancer: a multicenter international retrospective analysis. Clin Transl Oncol 2018; 21:790-795. [PMID: 30448956 DOI: 10.1007/s12094-018-1989-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 11/09/2018] [Indexed: 01/14/2023]
Abstract
PURPOSE Metronomic oral vinorelbine (MOV) could be a treatment option for unfit patients with advanced non-small cell lung cancer (NSCLC) based on its safety profile and high patient compliance. METHODS We retrospectively collected data on 270 patients [median age 76 (range 48-92) years, M/F 204/66, PS 0 (27)/1 (110)/≥ 2 (133), median of 3 serious comorbidities] with stage IIIB-IV NSCLC treated with MOV as first (T1) (67%), second (T2) (19%) or subsequent (T3) (14%) line. Schedules consisted of vinorelbine 50 mg (138), 40 mg (68) or 30 mg (64) three times a week continuously. RESULTS Patients received an overall median of 6 (range 1-25) cycles with a total of 1253 cycles delivered. The overall response rate was 17.8% with 46 partial and 2 complete responses and 119 patients (44.1%) experienced stable disease > 12 weeks with an overall disease control rate of 61.9%. Median overall time to progression was 5 (range 1-21) months [T1 7 (1-21), T2 5.5 (1-19) and T3 4 (1-19) months] and median overall survival 9 (range 1-36) months [T1 10 (1-31), T2 8 (1-36) and T3 6.5 (2-29) months]. Treatment was extremely well tolerated with 2% (25/1253) G3/4 toxicity (mainly G3 fatigue and anemia) and no toxic deaths. We observed the longer OS 14 (range 7-36) months in a subset of squamous NSCLC patients receiving immunotherapy after metronomic oral vinorelbine. CONCLUSION We confirmed MOV as an extremely safe treatment in a large real world population of advanced NSCLC with an interesting activity mainly consisting of long-term disease stabilization. We speculate the possibility of a synergistic effect with subsequent immunotherapy.
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Affiliation(s)
- A Camerini
- Medical Oncology, Versilia Hospital - ASL Toscana Nord-Ovest, via Aurelia 335, 55043, Lido di Camaiore, LU, Italy.
| | - G L Banna
- Division of Medical Oncology, Cannizzaro Hospital, via Messina 829, 95126, Catania, Italy
| | - S Cinieri
- Medical Oncology, Perrino Hospital, Strada Statale 7 per Mesagne, 72100, Brindisi, Italy
| | - A Pezzuto
- Department of Cardio-Thoracic-Vascular Science, S. Andrea Hospital, Via di Grottarossa, 1035, 00189, Rome, Italy
| | - M Mencoboni
- Medical Oncology, ASL 3 Genovese, Ospedale Villa Scassi, Corso Onofrio Scassi 1, 16121, Genoa, Italy
| | - F Rosetti
- Medical Oncology, ULSS3 Serenissima, Distretto Mirano-Dolo, Via Pasteur, 30031, Dolo, VE, Italy
| | - A Figueiredo
- Pneumology, Centro Hospitalar e Universitario de Coimbra, Avenida Doutor Bissaya Barreto S/N, Praceta De Mota Pinto, Celas-Coimbra, Portugal
| | - P Rizzo
- Medical Oncology, Perrino Hospital, Strada Statale 7 per Mesagne, 72100, Brindisi, Italy
| | - A Ricci
- Department of Molecular and Clinical Medicine, S. Andrea Hospital, Via di Grottarossa, 1035, 00189, Rome, Italy
| | - L Langenhoven
- Clinical Oncology, Panorama Oncology Centre, 43 Hennie Winterbach St, Panorama, Cape Town, 7500, South Africa
| | - A Santo
- Medical Oncology, University Hospital of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - A Addeo
- Oncology Department, University Hospital Geneva, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - D Amoroso
- Medical Oncology, Versilia Hospital - ASL Toscana Nord-Ovest, via Aurelia 335, 55043, Lido di Camaiore, LU, Italy
| | - F Barata
- Pneumology, Centro Hospitalar e Universitario de Coimbra, Avenida Doutor Bissaya Barreto S/N, Praceta De Mota Pinto, Celas-Coimbra, Portugal
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Banna GL, Camerini A, Bronte G, Anile G, Addeo A, Rundo F, Zanghì G, Lal R, Libra M. Oral Metronomic Vinorelbine in Advanced Non-small Cell Lung Cancer Patients Unfit for Chemotherapy. Anticancer Res 2018; 38:3689-3697. [PMID: 29848729 DOI: 10.21873/anticanres.12647] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 05/13/2018] [Accepted: 05/15/2018] [Indexed: 11/10/2022]
Abstract
AIM To explore the feasibility and activity of oral metronomic vinorelbine patients with advanced NSCLC not eligible to standard chemotherapy because of old age (≥70 years), and/or poor Eastern Cooperative Oncology Group performance status (≥2), and/or extensive brain or bone disease, and/or active comorbidities (≥2) requiring for pharmacological treatment. PATIENTS AND METHODS In a prospective phase II not randomized study, patients with stage IV NSCLC unfit to chemotherapy were treated with oral metronomic vinorelbine at 30 mg fixed dose three times a week until disease progression. RESULTS Fifty patients were treated, 19 (38%) in the first-line setting. Five patients (11%) experienced a grade 3 toxicity; no grade 4 toxicity occurred. Overall disease control rate was 32%, 44% and 26% in first and subsequent lines, respectively (p=0.39). Median OS and PFS were 7.3 months (95% confidence interval [CI]=4.7-10.0) and 2.7 months (95%CI=2.0-3.4), respectively. CONCLUSION These data support the activity and safety of metronomic vinorelbine in a relevant proportion of patients usually excluded from any specific treatment.
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Affiliation(s)
- Giuseppe L Banna
- Division of Medical Oncology, Cannizzaro Hospital, Catania, Italy
| | - Andrea Camerini
- Medical Oncology, Versilia Hospital and Istituto Toscano Tumori, Lido di Camaiore, Italy
| | - Giuseppe Bronte
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Giuseppe Anile
- Division of Medical Oncology, Istituto Oncologico Veneto, Paduva, Italy
| | - Alfredo Addeo
- Oncology Department, University Hospital Geneva, Geneva, Switzerland
| | - Francesco Rundo
- ADG Central R&D - STMicroelectronics of Catania, Catania, Italy
| | - Guido Zanghì
- Department of Surgery, Policlinico Vittorio Emanuele University Hospital, University of Catania, Catania, Italy
| | - Rohit Lal
- Lung Cancer Unit, Guy's and St Thomas' Hospital, London, U.K
| | - Massimo Libra
- Department of Biomedical and Biotechnological Sciences, Pathology and Oncology Section, University of Catania, Catania, Italy
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Banna GL, Sheel A, Sheel V, Bille A, Routledge T, Fernando S, Nair A, Lal R. Treatment and prognostic factors of patients with thymic epithelial tumors at first recurrence or progression. Future Oncol 2017; 13:2429-2439. [PMID: 29121777 DOI: 10.2217/fon-2017-0236] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
AIM The treatment of patients with recurrent or progressive thymic epithelial tumors remains uncertain due to limited data in this rare disease. MATERIALS & METHODS A retrospective 10-year monoinstitutional analysis was conducted on 25 patients with first recurrence or disease progression following primary treatment. RESULTS Twenty patients had thymoma, five thymic carcinomas. Ten patients (40%) received surgery, four (40%) following chemotherapy; 17 (68%) had chemotherapy, with a combination regimen in 16 of them (94%). Surgery had a significant effect both on overall survival and progression-free survival-2 by univariate analysis (p = 0.04), combination chemotherapy only on progression-free survival-2 (p = 0.03). CONCLUSION Combination chemotherapy and surgery at first recurrence/progression of thymic epithelial tumors were associated with improved survival. DISCUSSION Although several limitations may have affected this retrospective study on a relatively small number of patients with this rare entity of recurrent thymic malignancies, we suggest the use of combination chemotherapy and surgery at their first recurrence may have contributed to the high overall and progression-free survival observed with adequate follow-up and deserve further investigations in broader retrospective and comparative studies.
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Affiliation(s)
- Giuseppe L Banna
- Guy's Cancer Centre, Great Maze Pond, London SE1 9RT, UK.,Cannizzaro Hospital, via Messina 829, 95126, Catania, Italy
| | - Ankur Sheel
- University of Massachusetts School of Medicine, 55 N Lake Ave, Worcester, MA 01655, USA
| | - Varun Sheel
- University of Massachusetts Amherst, Amherst, MA 01003, USA
| | - Andrea Bille
- Guy's Cancer Centre, Great Maze Pond, London SE1 9RT, UK
| | - Tom Routledge
- Guy's Cancer Centre, Great Maze Pond, London SE1 9RT, UK
| | | | - Arjun Nair
- University of Massachusetts Amherst, Amherst, MA 01003, USA
| | - Rohit Lal
- Guy's Cancer Centre, Great Maze Pond, London SE1 9RT, UK
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Banna GL, Torino F, Marletta F, Santagati M, Salemi R, Cannarozzo E, Falzone L, Ferraù F, Libra M. Lactobacillus rhamnosus GG: An Overview to Explore the Rationale of Its Use in Cancer. Front Pharmacol 2017; 8:603. [PMID: 28919861 PMCID: PMC5585742 DOI: 10.3389/fphar.2017.00603] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [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: 06/13/2017] [Accepted: 08/21/2017] [Indexed: 12/14/2022] Open
Abstract
Cancer is the second leading cause of death in the western world. In the era of precision medicine, a significant number of cancer patients can be cured with several anti-cancer therapeutic regimens. However, therapy failure may be caused by treatment side effects, such as diarrhea, especially occurring in patients with gastrointestinal or pelvic malignancies. In particular, diarrhea is one of the most frequent gastrointestinal toxicity during cancer treatment and it can result from nearly bot chemo- and radio-therapeutic strategies currently used. Diarrhea has a serious impact on patients’ quality of life and treatment dosing and schedule modification due to its severity can negatively influence treatment outcomes. In this context, probiotics may play an interesting role in several human diseases with an inflammatory bowel involvement and, among these, Lactobacillus rhamnosus GG (LGG) is one of the most characterized and utilized. In particular, LGG is able to reverse intestinal dysbiosis and moderate diarrhea. Moreover, preclinical studies have documented its effects in reducing chronic inflammation associated with cancer development. This review summarizes the preclinical results of LGG on cancer cells proliferation and tumor invasion as well as the potential role of LGG use in cancer patients for the prevention and management of diarrhea associated with cancer treatment. Overall, these encouraging data support further investigation on the use of LGG in stratified patients undergoing specific therapeutic protocols, including chemotherapy and pelvic radiotherapy, in order to reduce the development of severe diarrhea and thus improve the adherence to the therapy and patients’ quality of life.
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Affiliation(s)
| | - Francesco Torino
- Department of Systems Medicine, Chair of Medical Oncology, Tor Vergata University of RomeRome, Italy
| | | | - Maria Santagati
- Department of Biomedical and Biotechnological Sciences, Section of Microbiology, University of CataniaCatania, Italy
| | - Rossella Salemi
- Department of Biomedical and Biotechnological Sciences, Laboratory of Translational Oncology and Functional Genomics, Section of General and Clinical Pathology and Oncology, University of CataniaCatania, Italy
| | - Elisa Cannarozzo
- Department of Biomedical and Biotechnological Sciences, Laboratory of Translational Oncology and Functional Genomics, Section of General and Clinical Pathology and Oncology, University of CataniaCatania, Italy
| | - Luca Falzone
- Department of Biomedical and Biotechnological Sciences, Laboratory of Translational Oncology and Functional Genomics, Section of General and Clinical Pathology and Oncology, University of CataniaCatania, Italy
| | - Francesco Ferraù
- Division of Medical Oncology, San Vincenzo HospitalTaormina, Italy
| | - Massimo Libra
- Department of Biomedical and Biotechnological Sciences, Laboratory of Translational Oncology and Functional Genomics, Section of General and Clinical Pathology and Oncology, University of CataniaCatania, Italy
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Banna GL, Parra HJS, Castaing M, Dieci MV, Anile G, Nicolosi M, Strano S, Marletta F, Guarneri V, Conte P, Lal R. Histology-based Combination Induction Chemotherapy for Elderly Patients with Clinical Stage III Non-small Cell Lung Cancer. Anticancer Res 2017; 37:3723-3728. [PMID: 28668866 DOI: 10.21873/anticanres.11745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 05/15/2017] [Accepted: 05/17/2017] [Indexed: 11/10/2022]
Abstract
AIM To explore the feasibility and activity of a histology-based induction combination chemotherapy for elderly patients with clinical stage III non-small cell lung cancer (NSCLC). PATIENTS AND METHODS Patients aged ≥70 years with stage IIIA and IIIB lung squamous cell carcinoma (SCC) or adenocarcinoma were treated with three cycles of carboplatin and gemcitabine or pemetrexed, respectively, followed by definitive radiotherapy or surgery. The primary endpoint was the overall response rate (ORR) following induction. RESULTS Twenty-seven patients, with a median age of 74 years (range=70-80 years) were treated for adenocarcinoma in 14 (52%) and SCC in 13 (48%), clinical stage IIIA in eight (30%) and IIIB in 19 (70%). Grade 3 or 4 toxicity was reported for five patients (18.5%). The ORR was 46% in 12 (partial responses) out of 26 assessable patients. CONCLUSION Histology-based induction combination chemotherapy is active and feasible in elderly patients with stage III NSCLC.
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Affiliation(s)
- Giuseppe L Banna
- Division of Medical Oncology, Cannizzaro Hospital, Catania, Italy
| | | | - Marine Castaing
- G.F. Ingrassia Department, University of Catania, Catania, Italy
| | - Maria Vittoria Dieci
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
| | - Giuseppe Anile
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
| | | | - Salvatore Strano
- Division of Thoracic Surgery, Cannizzaro Hospital, Catania, Italy
| | | | - Valentina Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
| | - Pierfranco Conte
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
| | - Rohit Lal
- Lung Cancer Unit, Guy's and St Thomas' Hospital, London, U.K
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Abstract
BACKGROUND Based on the high chemosensitivity of germ-cell tumors (GCTs), the concept of high-dose chemotherapy (HDCT) has been developed worldwide and investigated through many clinical trials. It has been carried out in different clinical settings, ranging from resistant or absolute refractory disease to chemosensitive relapse. HDCT with stem-cell support has been also explored as a part of first-line strategy for poor-prognosis patients. PATIENTS AND METHODS Our review summarized results from clinical trials evaluating the role of HDCT in patients with advanced GCTs. So far available data were obtained through a Medline search of English-language literature. RESULTS Several phase II trials and retrospective series have shown a possible benefit for GCT patients with recurrent disease as well as in first-line setting. Despite these results, data derived from randomized phase III studies failed to demonstrate any survival advantage for HDCT over conventional chemotherapy. CONCLUSIONS The role of HDCT in GCTs remains controversial. We need new prospective studies based on prognostic factors with multiple transplants of carboplatin and etoposide as the preferred high dose regimen. At present, based mainly on retrospective and phase II studies, HDCT may represent a therapeutic option for patients with primary refractory disease or for those with a second or further relapse.
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Affiliation(s)
- M Simonelli
- Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano.
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Guarneri V, Frassoldati A, Gebbia V, Bisagni G, Cavanna L, Donadio M, Lelli G, Musolino A, Colucci G, Banna GL, Degli Esposti R, Ferro A, Grasso F, Zamagni C, Amadori D, Aieta M, Molino A, Garrone O, Aitini E, Fornari G, Cascinu S, Rossi G, D'Amico R, Conte PF. Abstract P5-12-05: 9 Weeks vs 1 Year Adjuvant Trastuzumab in Combination with Chemotherapy: Preliminary Cardiac Safety Data of the Phase III Multicentric Italian Study Short-HER. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p5-12-05] [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
Introduction: Several large randomized trials have shown the superiority of combining trastuzumab with chemotherapy versus chemotherapy alone as adjuvant treatment for HER2+ breast cancer patients. We are running a large phase III trial comparing two different trastuzumab durations (Short-HER study). We are reporting the preliminary cardiac safety data.
Methods: The Short-HER study is a phase III, multicentric, Italian trial where 2500 HER2+ breast cancer patients will be randomized to: Arm A (Long) 4 courses of anthracycline based chemotherapy (AC or EC) followed by 4 courses of docetaxel in combination with trastuzumab, followed by 14 additional courses of 3-weekly trastuzumab; or Arm B (Short) 3 courses of 3-weekly docetaxel in combination with weekly trastuzumab followed by FEC x3. this is a non-inferiority trial with DFS and OS as primary end points, and 2-yr failure rate and incidence of cardiac events as secondary end points. Left ventricular ejection fraction (LVEF) is measured at baseline, at the end of each sequence of chemotherapy in both arms, and after 9 and 12 months since randomization thereafter. A cardiac event (CE) was defined as the occurrence of any of the followings: 1) LVEF decrease of more than 15 percentage points from baseline ; 2) LVEF decrease of more than 10 percentage points with absolute value below 50%; 3) symptomatic cardiac failure; 4) other cardiac side effects of grade 2 or more.
Results: 510 patients from 69 Italian centers have been randomized so far, 251 in arm A (long) and 259 in Arm B (Short). 146 patients enrolled in arm A and 150 patients enrolled in arm B have received at least 3 months of therapy, and are eligible for the present analysis. In arm A (long), 20 patients (13.7%) experienced a CE: 12 patients experienced a LVEF decline of > 15 percentage points (5 patients with LVEF below 50%, one patient with concomitant atrial fibrillation); 3 patients had a LVEF decline of >10 percentage points with an absolute value below 50%. One patient had symptomatic cardiac failure. Two patients developed Grade 2 hypertension. Two patients developed Grade 2 arrhythmia.
In arm B (short), 11 patients (7.3%) experienced a CE: 7 patients had a LVEF decline of > 15 percentage points; one patient had a LVEF decline of > 10 percentage points with an absolute value below 50%. Three patients developed Grade 2 arrhythmia
Conclusions: This is a non-inferiority study designed on the assumption that a shorter treatment duration is associated with a significantly lower incidence of cardiac events. With 9 clinically relevant CEs (symptomatic cardiac failure or LVEF below 50%) in arm A (Long) and 1 in arm B (Short), these preliminary data support the assumption, and recruitment is ongoing.
Supported by Agenzia Italiana del FArmaco (AIFA).
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-12-05.
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Affiliation(s)
- V Guarneri
- Modena University Hospital, Italy; La Maddalena Hospital, Palermo; S Maria Nuova Hospital, Reggio Emilia; Hospital of Piacenza; San Giovanni Battista Hospital, Torino; S. Anna Hospital, Ferrara; Medical Oncology Unit, University Hospital of Parma; Medical and Experimental Oncology Unit, Oncology Institute Giovanni Paolo II, Bari, Italy; Vittorio Emanuele University Hospital, Catania; Bellaria Hospital, University of Bologna; Hospital of Trento; Hospital of Aosta; Medical Oncology Unit, S. Orsola-Malpighi University Hospital, Bologna; Istituto Scientifico Romagnolo perlo Studio e la Cura dei Tumori, Meldola; Hospital of Rionero in Vulture; OCM, Verona University Hospital; Oncology Division, Santa Croce-Carle Hospital, Cuneo; Hospital of Mantova; Ospedale Evangelico Valdese, Torino; Ancona University Hospital; Hospital of Guastalla
| | - A Frassoldati
- Modena University Hospital, Italy; La Maddalena Hospital, Palermo; S Maria Nuova Hospital, Reggio Emilia; Hospital of Piacenza; San Giovanni Battista Hospital, Torino; S. Anna Hospital, Ferrara; Medical Oncology Unit, University Hospital of Parma; Medical and Experimental Oncology Unit, Oncology Institute Giovanni Paolo II, Bari, Italy; Vittorio Emanuele University Hospital, Catania; Bellaria Hospital, University of Bologna; Hospital of Trento; Hospital of Aosta; Medical Oncology Unit, S. Orsola-Malpighi University Hospital, Bologna; Istituto Scientifico Romagnolo perlo Studio e la Cura dei Tumori, Meldola; Hospital of Rionero in Vulture; OCM, Verona University Hospital; Oncology Division, Santa Croce-Carle Hospital, Cuneo; Hospital of Mantova; Ospedale Evangelico Valdese, Torino; Ancona University Hospital; Hospital of Guastalla
| | - V Gebbia
- Modena University Hospital, Italy; La Maddalena Hospital, Palermo; S Maria Nuova Hospital, Reggio Emilia; Hospital of Piacenza; San Giovanni Battista Hospital, Torino; S. Anna Hospital, Ferrara; Medical Oncology Unit, University Hospital of Parma; Medical and Experimental Oncology Unit, Oncology Institute Giovanni Paolo II, Bari, Italy; Vittorio Emanuele University Hospital, Catania; Bellaria Hospital, University of Bologna; Hospital of Trento; Hospital of Aosta; Medical Oncology Unit, S. Orsola-Malpighi University Hospital, Bologna; Istituto Scientifico Romagnolo perlo Studio e la Cura dei Tumori, Meldola; Hospital of Rionero in Vulture; OCM, Verona University Hospital; Oncology Division, Santa Croce-Carle Hospital, Cuneo; Hospital of Mantova; Ospedale Evangelico Valdese, Torino; Ancona University Hospital; Hospital of Guastalla
| | - G Bisagni
- Modena University Hospital, Italy; La Maddalena Hospital, Palermo; S Maria Nuova Hospital, Reggio Emilia; Hospital of Piacenza; San Giovanni Battista Hospital, Torino; S. Anna Hospital, Ferrara; Medical Oncology Unit, University Hospital of Parma; Medical and Experimental Oncology Unit, Oncology Institute Giovanni Paolo II, Bari, Italy; Vittorio Emanuele University Hospital, Catania; Bellaria Hospital, University of Bologna; Hospital of Trento; Hospital of Aosta; Medical Oncology Unit, S. Orsola-Malpighi University Hospital, Bologna; Istituto Scientifico Romagnolo perlo Studio e la Cura dei Tumori, Meldola; Hospital of Rionero in Vulture; OCM, Verona University Hospital; Oncology Division, Santa Croce-Carle Hospital, Cuneo; Hospital of Mantova; Ospedale Evangelico Valdese, Torino; Ancona University Hospital; Hospital of Guastalla
| | - L Cavanna
- Modena University Hospital, Italy; La Maddalena Hospital, Palermo; S Maria Nuova Hospital, Reggio Emilia; Hospital of Piacenza; San Giovanni Battista Hospital, Torino; S. Anna Hospital, Ferrara; Medical Oncology Unit, University Hospital of Parma; Medical and Experimental Oncology Unit, Oncology Institute Giovanni Paolo II, Bari, Italy; Vittorio Emanuele University Hospital, Catania; Bellaria Hospital, University of Bologna; Hospital of Trento; Hospital of Aosta; Medical Oncology Unit, S. Orsola-Malpighi University Hospital, Bologna; Istituto Scientifico Romagnolo perlo Studio e la Cura dei Tumori, Meldola; Hospital of Rionero in Vulture; OCM, Verona University Hospital; Oncology Division, Santa Croce-Carle Hospital, Cuneo; Hospital of Mantova; Ospedale Evangelico Valdese, Torino; Ancona University Hospital; Hospital of Guastalla
| | - M Donadio
- Modena University Hospital, Italy; La Maddalena Hospital, Palermo; S Maria Nuova Hospital, Reggio Emilia; Hospital of Piacenza; San Giovanni Battista Hospital, Torino; S. Anna Hospital, Ferrara; Medical Oncology Unit, University Hospital of Parma; Medical and Experimental Oncology Unit, Oncology Institute Giovanni Paolo II, Bari, Italy; Vittorio Emanuele University Hospital, Catania; Bellaria Hospital, University of Bologna; Hospital of Trento; Hospital of Aosta; Medical Oncology Unit, S. Orsola-Malpighi University Hospital, Bologna; Istituto Scientifico Romagnolo perlo Studio e la Cura dei Tumori, Meldola; Hospital of Rionero in Vulture; OCM, Verona University Hospital; Oncology Division, Santa Croce-Carle Hospital, Cuneo; Hospital of Mantova; Ospedale Evangelico Valdese, Torino; Ancona University Hospital; Hospital of Guastalla
| | - G Lelli
- Modena University Hospital, Italy; La Maddalena Hospital, Palermo; S Maria Nuova Hospital, Reggio Emilia; Hospital of Piacenza; San Giovanni Battista Hospital, Torino; S. Anna Hospital, Ferrara; Medical Oncology Unit, University Hospital of Parma; Medical and Experimental Oncology Unit, Oncology Institute Giovanni Paolo II, Bari, Italy; Vittorio Emanuele University Hospital, Catania; Bellaria Hospital, University of Bologna; Hospital of Trento; Hospital of Aosta; Medical Oncology Unit, S. Orsola-Malpighi University Hospital, Bologna; Istituto Scientifico Romagnolo perlo Studio e la Cura dei Tumori, Meldola; Hospital of Rionero in Vulture; OCM, Verona University Hospital; Oncology Division, Santa Croce-Carle Hospital, Cuneo; Hospital of Mantova; Ospedale Evangelico Valdese, Torino; Ancona University Hospital; Hospital of Guastalla
| | - A Musolino
- Modena University Hospital, Italy; La Maddalena Hospital, Palermo; S Maria Nuova Hospital, Reggio Emilia; Hospital of Piacenza; San Giovanni Battista Hospital, Torino; S. Anna Hospital, Ferrara; Medical Oncology Unit, University Hospital of Parma; Medical and Experimental Oncology Unit, Oncology Institute Giovanni Paolo II, Bari, Italy; Vittorio Emanuele University Hospital, Catania; Bellaria Hospital, University of Bologna; Hospital of Trento; Hospital of Aosta; Medical Oncology Unit, S. Orsola-Malpighi University Hospital, Bologna; Istituto Scientifico Romagnolo perlo Studio e la Cura dei Tumori, Meldola; Hospital of Rionero in Vulture; OCM, Verona University Hospital; Oncology Division, Santa Croce-Carle Hospital, Cuneo; Hospital of Mantova; Ospedale Evangelico Valdese, Torino; Ancona University Hospital; Hospital of Guastalla
| | - G Colucci
- Modena University Hospital, Italy; La Maddalena Hospital, Palermo; S Maria Nuova Hospital, Reggio Emilia; Hospital of Piacenza; San Giovanni Battista Hospital, Torino; S. Anna Hospital, Ferrara; Medical Oncology Unit, University Hospital of Parma; Medical and Experimental Oncology Unit, Oncology Institute Giovanni Paolo II, Bari, Italy; Vittorio Emanuele University Hospital, Catania; Bellaria Hospital, University of Bologna; Hospital of Trento; Hospital of Aosta; Medical Oncology Unit, S. Orsola-Malpighi University Hospital, Bologna; Istituto Scientifico Romagnolo perlo Studio e la Cura dei Tumori, Meldola; Hospital of Rionero in Vulture; OCM, Verona University Hospital; Oncology Division, Santa Croce-Carle Hospital, Cuneo; Hospital of Mantova; Ospedale Evangelico Valdese, Torino; Ancona University Hospital; Hospital of Guastalla
| | - GL Banna
- Modena University Hospital, Italy; La Maddalena Hospital, Palermo; S Maria Nuova Hospital, Reggio Emilia; Hospital of Piacenza; San Giovanni Battista Hospital, Torino; S. Anna Hospital, Ferrara; Medical Oncology Unit, University Hospital of Parma; Medical and Experimental Oncology Unit, Oncology Institute Giovanni Paolo II, Bari, Italy; Vittorio Emanuele University Hospital, Catania; Bellaria Hospital, University of Bologna; Hospital of Trento; Hospital of Aosta; Medical Oncology Unit, S. Orsola-Malpighi University Hospital, Bologna; Istituto Scientifico Romagnolo perlo Studio e la Cura dei Tumori, Meldola; Hospital of Rionero in Vulture; OCM, Verona University Hospital; Oncology Division, Santa Croce-Carle Hospital, Cuneo; Hospital of Mantova; Ospedale Evangelico Valdese, Torino; Ancona University Hospital; Hospital of Guastalla
| | - R Degli Esposti
- Modena University Hospital, Italy; La Maddalena Hospital, Palermo; S Maria Nuova Hospital, Reggio Emilia; Hospital of Piacenza; San Giovanni Battista Hospital, Torino; S. Anna Hospital, Ferrara; Medical Oncology Unit, University Hospital of Parma; Medical and Experimental Oncology Unit, Oncology Institute Giovanni Paolo II, Bari, Italy; Vittorio Emanuele University Hospital, Catania; Bellaria Hospital, University of Bologna; Hospital of Trento; Hospital of Aosta; Medical Oncology Unit, S. Orsola-Malpighi University Hospital, Bologna; Istituto Scientifico Romagnolo perlo Studio e la Cura dei Tumori, Meldola; Hospital of Rionero in Vulture; OCM, Verona University Hospital; Oncology Division, Santa Croce-Carle Hospital, Cuneo; Hospital of Mantova; Ospedale Evangelico Valdese, Torino; Ancona University Hospital; Hospital of Guastalla
| | - A Ferro
- Modena University Hospital, Italy; La Maddalena Hospital, Palermo; S Maria Nuova Hospital, Reggio Emilia; Hospital of Piacenza; San Giovanni Battista Hospital, Torino; S. Anna Hospital, Ferrara; Medical Oncology Unit, University Hospital of Parma; Medical and Experimental Oncology Unit, Oncology Institute Giovanni Paolo II, Bari, Italy; Vittorio Emanuele University Hospital, Catania; Bellaria Hospital, University of Bologna; Hospital of Trento; Hospital of Aosta; Medical Oncology Unit, S. Orsola-Malpighi University Hospital, Bologna; Istituto Scientifico Romagnolo perlo Studio e la Cura dei Tumori, Meldola; Hospital of Rionero in Vulture; OCM, Verona University Hospital; Oncology Division, Santa Croce-Carle Hospital, Cuneo; Hospital of Mantova; Ospedale Evangelico Valdese, Torino; Ancona University Hospital; Hospital of Guastalla
| | - F Grasso
- Modena University Hospital, Italy; La Maddalena Hospital, Palermo; S Maria Nuova Hospital, Reggio Emilia; Hospital of Piacenza; San Giovanni Battista Hospital, Torino; S. Anna Hospital, Ferrara; Medical Oncology Unit, University Hospital of Parma; Medical and Experimental Oncology Unit, Oncology Institute Giovanni Paolo II, Bari, Italy; Vittorio Emanuele University Hospital, Catania; Bellaria Hospital, University of Bologna; Hospital of Trento; Hospital of Aosta; Medical Oncology Unit, S. Orsola-Malpighi University Hospital, Bologna; Istituto Scientifico Romagnolo perlo Studio e la Cura dei Tumori, Meldola; Hospital of Rionero in Vulture; OCM, Verona University Hospital; Oncology Division, Santa Croce-Carle Hospital, Cuneo; Hospital of Mantova; Ospedale Evangelico Valdese, Torino; Ancona University Hospital; Hospital of Guastalla
| | - C Zamagni
- Modena University Hospital, Italy; La Maddalena Hospital, Palermo; S Maria Nuova Hospital, Reggio Emilia; Hospital of Piacenza; San Giovanni Battista Hospital, Torino; S. Anna Hospital, Ferrara; Medical Oncology Unit, University Hospital of Parma; Medical and Experimental Oncology Unit, Oncology Institute Giovanni Paolo II, Bari, Italy; Vittorio Emanuele University Hospital, Catania; Bellaria Hospital, University of Bologna; Hospital of Trento; Hospital of Aosta; Medical Oncology Unit, S. Orsola-Malpighi University Hospital, Bologna; Istituto Scientifico Romagnolo perlo Studio e la Cura dei Tumori, Meldola; Hospital of Rionero in Vulture; OCM, Verona University Hospital; Oncology Division, Santa Croce-Carle Hospital, Cuneo; Hospital of Mantova; Ospedale Evangelico Valdese, Torino; Ancona University Hospital; Hospital of Guastalla
| | - D Amadori
- Modena University Hospital, Italy; La Maddalena Hospital, Palermo; S Maria Nuova Hospital, Reggio Emilia; Hospital of Piacenza; San Giovanni Battista Hospital, Torino; S. Anna Hospital, Ferrara; Medical Oncology Unit, University Hospital of Parma; Medical and Experimental Oncology Unit, Oncology Institute Giovanni Paolo II, Bari, Italy; Vittorio Emanuele University Hospital, Catania; Bellaria Hospital, University of Bologna; Hospital of Trento; Hospital of Aosta; Medical Oncology Unit, S. Orsola-Malpighi University Hospital, Bologna; Istituto Scientifico Romagnolo perlo Studio e la Cura dei Tumori, Meldola; Hospital of Rionero in Vulture; OCM, Verona University Hospital; Oncology Division, Santa Croce-Carle Hospital, Cuneo; Hospital of Mantova; Ospedale Evangelico Valdese, Torino; Ancona University Hospital; Hospital of Guastalla
| | - M Aieta
- Modena University Hospital, Italy; La Maddalena Hospital, Palermo; S Maria Nuova Hospital, Reggio Emilia; Hospital of Piacenza; San Giovanni Battista Hospital, Torino; S. Anna Hospital, Ferrara; Medical Oncology Unit, University Hospital of Parma; Medical and Experimental Oncology Unit, Oncology Institute Giovanni Paolo II, Bari, Italy; Vittorio Emanuele University Hospital, Catania; Bellaria Hospital, University of Bologna; Hospital of Trento; Hospital of Aosta; Medical Oncology Unit, S. Orsola-Malpighi University Hospital, Bologna; Istituto Scientifico Romagnolo perlo Studio e la Cura dei Tumori, Meldola; Hospital of Rionero in Vulture; OCM, Verona University Hospital; Oncology Division, Santa Croce-Carle Hospital, Cuneo; Hospital of Mantova; Ospedale Evangelico Valdese, Torino; Ancona University Hospital; Hospital of Guastalla
| | - A Molino
- Modena University Hospital, Italy; La Maddalena Hospital, Palermo; S Maria Nuova Hospital, Reggio Emilia; Hospital of Piacenza; San Giovanni Battista Hospital, Torino; S. Anna Hospital, Ferrara; Medical Oncology Unit, University Hospital of Parma; Medical and Experimental Oncology Unit, Oncology Institute Giovanni Paolo II, Bari, Italy; Vittorio Emanuele University Hospital, Catania; Bellaria Hospital, University of Bologna; Hospital of Trento; Hospital of Aosta; Medical Oncology Unit, S. Orsola-Malpighi University Hospital, Bologna; Istituto Scientifico Romagnolo perlo Studio e la Cura dei Tumori, Meldola; Hospital of Rionero in Vulture; OCM, Verona University Hospital; Oncology Division, Santa Croce-Carle Hospital, Cuneo; Hospital of Mantova; Ospedale Evangelico Valdese, Torino; Ancona University Hospital; Hospital of Guastalla
| | - O Garrone
- Modena University Hospital, Italy; La Maddalena Hospital, Palermo; S Maria Nuova Hospital, Reggio Emilia; Hospital of Piacenza; San Giovanni Battista Hospital, Torino; S. Anna Hospital, Ferrara; Medical Oncology Unit, University Hospital of Parma; Medical and Experimental Oncology Unit, Oncology Institute Giovanni Paolo II, Bari, Italy; Vittorio Emanuele University Hospital, Catania; Bellaria Hospital, University of Bologna; Hospital of Trento; Hospital of Aosta; Medical Oncology Unit, S. Orsola-Malpighi University Hospital, Bologna; Istituto Scientifico Romagnolo perlo Studio e la Cura dei Tumori, Meldola; Hospital of Rionero in Vulture; OCM, Verona University Hospital; Oncology Division, Santa Croce-Carle Hospital, Cuneo; Hospital of Mantova; Ospedale Evangelico Valdese, Torino; Ancona University Hospital; Hospital of Guastalla
| | - E Aitini
- Modena University Hospital, Italy; La Maddalena Hospital, Palermo; S Maria Nuova Hospital, Reggio Emilia; Hospital of Piacenza; San Giovanni Battista Hospital, Torino; S. Anna Hospital, Ferrara; Medical Oncology Unit, University Hospital of Parma; Medical and Experimental Oncology Unit, Oncology Institute Giovanni Paolo II, Bari, Italy; Vittorio Emanuele University Hospital, Catania; Bellaria Hospital, University of Bologna; Hospital of Trento; Hospital of Aosta; Medical Oncology Unit, S. Orsola-Malpighi University Hospital, Bologna; Istituto Scientifico Romagnolo perlo Studio e la Cura dei Tumori, Meldola; Hospital of Rionero in Vulture; OCM, Verona University Hospital; Oncology Division, Santa Croce-Carle Hospital, Cuneo; Hospital of Mantova; Ospedale Evangelico Valdese, Torino; Ancona University Hospital; Hospital of Guastalla
| | - G Fornari
- Modena University Hospital, Italy; La Maddalena Hospital, Palermo; S Maria Nuova Hospital, Reggio Emilia; Hospital of Piacenza; San Giovanni Battista Hospital, Torino; S. Anna Hospital, Ferrara; Medical Oncology Unit, University Hospital of Parma; Medical and Experimental Oncology Unit, Oncology Institute Giovanni Paolo II, Bari, Italy; Vittorio Emanuele University Hospital, Catania; Bellaria Hospital, University of Bologna; Hospital of Trento; Hospital of Aosta; Medical Oncology Unit, S. Orsola-Malpighi University Hospital, Bologna; Istituto Scientifico Romagnolo perlo Studio e la Cura dei Tumori, Meldola; Hospital of Rionero in Vulture; OCM, Verona University Hospital; Oncology Division, Santa Croce-Carle Hospital, Cuneo; Hospital of Mantova; Ospedale Evangelico Valdese, Torino; Ancona University Hospital; Hospital of Guastalla
| | - S Cascinu
- Modena University Hospital, Italy; La Maddalena Hospital, Palermo; S Maria Nuova Hospital, Reggio Emilia; Hospital of Piacenza; San Giovanni Battista Hospital, Torino; S. Anna Hospital, Ferrara; Medical Oncology Unit, University Hospital of Parma; Medical and Experimental Oncology Unit, Oncology Institute Giovanni Paolo II, Bari, Italy; Vittorio Emanuele University Hospital, Catania; Bellaria Hospital, University of Bologna; Hospital of Trento; Hospital of Aosta; Medical Oncology Unit, S. Orsola-Malpighi University Hospital, Bologna; Istituto Scientifico Romagnolo perlo Studio e la Cura dei Tumori, Meldola; Hospital of Rionero in Vulture; OCM, Verona University Hospital; Oncology Division, Santa Croce-Carle Hospital, Cuneo; Hospital of Mantova; Ospedale Evangelico Valdese, Torino; Ancona University Hospital; Hospital of Guastalla
| | - G Rossi
- Modena University Hospital, Italy; La Maddalena Hospital, Palermo; S Maria Nuova Hospital, Reggio Emilia; Hospital of Piacenza; San Giovanni Battista Hospital, Torino; S. Anna Hospital, Ferrara; Medical Oncology Unit, University Hospital of Parma; Medical and Experimental Oncology Unit, Oncology Institute Giovanni Paolo II, Bari, Italy; Vittorio Emanuele University Hospital, Catania; Bellaria Hospital, University of Bologna; Hospital of Trento; Hospital of Aosta; Medical Oncology Unit, S. Orsola-Malpighi University Hospital, Bologna; Istituto Scientifico Romagnolo perlo Studio e la Cura dei Tumori, Meldola; Hospital of Rionero in Vulture; OCM, Verona University Hospital; Oncology Division, Santa Croce-Carle Hospital, Cuneo; Hospital of Mantova; Ospedale Evangelico Valdese, Torino; Ancona University Hospital; Hospital of Guastalla
| | - R D'Amico
- Modena University Hospital, Italy; La Maddalena Hospital, Palermo; S Maria Nuova Hospital, Reggio Emilia; Hospital of Piacenza; San Giovanni Battista Hospital, Torino; S. Anna Hospital, Ferrara; Medical Oncology Unit, University Hospital of Parma; Medical and Experimental Oncology Unit, Oncology Institute Giovanni Paolo II, Bari, Italy; Vittorio Emanuele University Hospital, Catania; Bellaria Hospital, University of Bologna; Hospital of Trento; Hospital of Aosta; Medical Oncology Unit, S. Orsola-Malpighi University Hospital, Bologna; Istituto Scientifico Romagnolo perlo Studio e la Cura dei Tumori, Meldola; Hospital of Rionero in Vulture; OCM, Verona University Hospital; Oncology Division, Santa Croce-Carle Hospital, Cuneo; Hospital of Mantova; Ospedale Evangelico Valdese, Torino; Ancona University Hospital; Hospital of Guastalla
| | - PF. Conte
- Modena University Hospital, Italy; La Maddalena Hospital, Palermo; S Maria Nuova Hospital, Reggio Emilia; Hospital of Piacenza; San Giovanni Battista Hospital, Torino; S. Anna Hospital, Ferrara; Medical Oncology Unit, University Hospital of Parma; Medical and Experimental Oncology Unit, Oncology Institute Giovanni Paolo II, Bari, Italy; Vittorio Emanuele University Hospital, Catania; Bellaria Hospital, University of Bologna; Hospital of Trento; Hospital of Aosta; Medical Oncology Unit, S. Orsola-Malpighi University Hospital, Bologna; Istituto Scientifico Romagnolo perlo Studio e la Cura dei Tumori, Meldola; Hospital of Rionero in Vulture; OCM, Verona University Hospital; Oncology Division, Santa Croce-Carle Hospital, Cuneo; Hospital of Mantova; Ospedale Evangelico Valdese, Torino; Ancona University Hospital; Hospital of Guastalla
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Banna GL, Aversa SML, Crivellari G, Ghiotto C, Chiarion-Sileni V, Monfardini S. Administration of anti-HER2 antibody after nonmyeloablative allogeneic stem cell transplantation in metastatic breast cancer. Br J Cancer 2006; 94:1550-2. [PMID: 16641905 PMCID: PMC2361276 DOI: 10.1038/sj.bjc.6603114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- G L Banna
- Division of Medical Oncology, Istituto Oncologico Veneto, Via Gattamelata 64, Padova 35100, Italy
- Division of Medical Oncology, Istituto Oncologico Veneto, Via Gattamelata 64, Padova 35100, Italy. E-mail:
| | - S M L Aversa
- Division of Medical Oncology, Istituto Oncologico Veneto, Via Gattamelata 64, Padova 35100, Italy
| | - G Crivellari
- Division of Medical Oncology, Istituto Oncologico Veneto, Via Gattamelata 64, Padova 35100, Italy
| | - C Ghiotto
- Division of Medical Oncology, Istituto Oncologico Veneto, Via Gattamelata 64, Padova 35100, Italy
| | - V Chiarion-Sileni
- Division of Medical Oncology, Istituto Oncologico Veneto, Via Gattamelata 64, Padova 35100, Italy
| | - S Monfardini
- Division of Medical Oncology, Istituto Oncologico Veneto, Via Gattamelata 64, Padova 35100, Italy
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Banna GL, Santoro A. Trastuzumab in breast cancer. N Engl J Med 2006; 354:640-4; author reply 640-4. [PMID: 16470951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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Menin C, Banna GL, De Salvo G, Lazzarotto V, De Nicolo A, Agata S, Montagna M, Sordi G, Nicoletto O, Chieco-Bianchi L, D'Andrea E. Lack of association between androgen receptor CAG polymorphism and familial breast/ovarian cancer. Cancer Lett 2001; 168:31-6. [PMID: 11368874 DOI: 10.1016/s0304-3835(01)00473-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The human androgen receptor (AR) gene contains a highly polymorphic CAG repeat in exon 1 that is inversely correlated with AR transcriptional activity in vitro. Several studies have shown that fewer CAG repeats are associated with an increased risk as well as more aggressive forms of prostate cancer. More recently, AR allele length was also inversely correlated with the histological grade of breast cancer, but no association was found between the AR-CAG polymorphism and the risk of either breast or ovary cancer. On the contrary, it was proposed that a longer CAG repeat sequence might be associated with an increased risk of breast cancer in BRCA1 mutation carriers, thus suggesting a different role of the AR-CAG polymorphism in sporadic and inherited breast cancers. With the intent of better understanding the role of the AR-CAG polymorphism as a cancer risk modifier, we defined the AR genotype of 151 patients (101 with breast and 50 with ovary cancer) belonging to high-risk breast/ovary cancer families. No difference in CAG repeat length was found between either breast and ovary cancer patients or age at diagnosis of both tumors. These results were also confirmed in a sub-group of 47 breast cancer cases, that either carried a BRCA gene mutation (11 cases) or were identified by very stringent operational criteria as hereditary breast cancers. Even though a substantially larger sample size would be required to reach conclusive evidence, our findings suggest that the AR-CAG polymorphism does not act as a modifier of tumor onset or tumor phenotype in breast/ovarian cancer families.
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Affiliation(s)
- C Menin
- IST Biotechnology Section, University Hospital, Padova, Italy.
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