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Franchina M, Pizzimenti C, Fiorentino V, Martini M, Ricciardi GRR, Silvestris N, Ieni A, Tuccari G. Low and Ultra-Low HER2 in Human Breast Cancer: An Effort to Define New Neoplastic Subtypes. Int J Mol Sci 2023; 24:12795. [PMID: 37628975 PMCID: PMC10454084 DOI: 10.3390/ijms241612795] [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: 07/24/2023] [Revised: 08/09/2023] [Accepted: 08/13/2023] [Indexed: 08/27/2023] Open
Abstract
HER2-low and ultra-low breast cancer (BC) have been recently proposed as new subcategories of HER2 BC, supporting a re-consideration of immunohistochemical negative scores of 0, 1+ and the 2+/in situ hybridization (ISH) negative phenotype. In the present review, we outline the criteria needed to exactly distinguish HER2-low and ultra-low BC. Recent clinical trials have demonstrated significant clinical benefits of novel HER2 directing antibody-drug conjugates (ADCs) in treating these groups of tumors. In particular, trastuzumab-deruxtecan (T-Dxd), a HER2-directing ADC, has been recently approved by the US Food and Drug Administration as the first targeted therapy to treat HER2-low BC. Furthermore, ongoing trials, such as the DESTINY-Breast06 trial, are currently evaluating ADCs in patients with HER2-ultra low BC. Finally, we hope that new guidelines may help to codify HER2-low and ultra-low BC, increasing our knowledge of tumor biology and improving a targetable new therapeutical treatment.
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Affiliation(s)
- Mariausilia Franchina
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, Section of Pathology, University of Messina, 98125 Messina, Italy; (M.F.); (V.F.); (M.M.); (N.S.); (A.I.)
| | - Cristina Pizzimenti
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, 98125 Messina, Italy;
| | - Vincenzo Fiorentino
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, Section of Pathology, University of Messina, 98125 Messina, Italy; (M.F.); (V.F.); (M.M.); (N.S.); (A.I.)
| | - Maurizio Martini
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, Section of Pathology, University of Messina, 98125 Messina, Italy; (M.F.); (V.F.); (M.M.); (N.S.); (A.I.)
| | | | - Nicola Silvestris
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, Section of Pathology, University of Messina, 98125 Messina, Italy; (M.F.); (V.F.); (M.M.); (N.S.); (A.I.)
| | - Antonio Ieni
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, Section of Pathology, University of Messina, 98125 Messina, Italy; (M.F.); (V.F.); (M.M.); (N.S.); (A.I.)
| | - Giovanni Tuccari
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, Section of Pathology, University of Messina, 98125 Messina, Italy; (M.F.); (V.F.); (M.M.); (N.S.); (A.I.)
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Colombo N, Gadducci A, Landoni F, Lorusso D, Sabbatini R, Artioli G, Berardi R, Ceccherini R, Cecere SC, Cormio G, De Angelis C, Legge F, Lissoni A, Mammoliti S, Mangili G, Naglieri E, Petrella MC, Ricciardi GRR, Ronzino G, Salutari V, Sambataro D, Savarese A, Scandurra G, Tasca G, Tomao F, Valabrega G, Zavallone L, Pignata S. Consensus statements and treatment algorithm to guide clinicians in the selection of maintenance therapy for patients with newly diagnosed, advanced ovarian carcinoma: Results of a Delphi study. Gynecol Oncol 2023; 175:182-189. [PMID: 37355448 DOI: 10.1016/j.ygyno.2023.05.065] [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: 04/04/2023] [Revised: 05/17/2023] [Accepted: 05/20/2023] [Indexed: 06/26/2023]
Abstract
INTRODUCTION Standard treatment of newly diagnosed, advanced ovarian carcinoma (OC) consists of cytoreductive surgery followed by platinum-based chemotherapy with or without bevacizumab. Maintenance therapy with PARP inhibitors and olaparib-bevacizumab has recently shown to significantly improve progression-free survival in the first-line setting. Some practical aspects of maintenance therapy, however, are still poorly defined. AIM OF THE STUDY To provide guidance to clinicians in the selection of maintenance therapy for newly diagnosed, advanced ovarian carcinoma. METHODS A board of six gynecologic oncologists with expertise in the treatment of OC in Italy convened to address issues related to the new options for maintenance treatment. Based on scientific evidences, the board produced practice-oriented statements. Consensus was reached via a modified Delphi study that involved a panel of 22 experts from across Italy. RESULTS Twenty-seven evidence- and consensus-based statements are presented, covering the following areas of interest: use of biomarkers (BRCA mutations and presence of homologous recombination deficiency); timing and outcomes of surgery; selection of patients eligible for bevacizumab; definition of response to treatment; toxicity and contraindications; evidence of synergy of bevacizumab plus PARP inhibitor. Two treatment algorithms are also included, for selecting maintenance therapy based on timing and outcomes of surgery, response to platinum-based chemotherapy and biomarker status. A score for the assessment of response to chemotherapy is proposed, but its validation is ongoing. CONCLUSIONS We provide here consensus statements and treatment algorithms to guide clinicians in the selection of appropriate and personalized maintenance therapy in the first-line setting of advanced OC management.
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Affiliation(s)
- Nicoletta Colombo
- Gynecologic Oncology Program, European Institute of Oncology, IRCSS, Milano, Italy; Department of Medicine and Surgery, University of Milano Bicocca, Milano, Italy
| | - Angiolo Gadducci
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy
| | - Fabio Landoni
- Department of Obstetrics and Gynecology, San Gerardo Hospital and University of Milano Bicocca, Milano, Italy
| | - Domenica Lorusso
- Fondazione Policlinico Gemelli IRCSS and Università Cattolica del Sacro Cuore, Roma, Italy.
| | - Roberto Sabbatini
- Medical Oncology Division, Department of Oncology and Hematology, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Rossana Berardi
- Department of Oncology, Università Politecnica delle Marche, AOU delle Marche, Ancona, Italy
| | - Rita Ceccherini
- Department of Oncology, Azienda Sanitaria Universitaria Integrata Giuliano Isontina, Trieste, Italy
| | - Sabrina Chiara Cecere
- U.O.C. of Experimental Uro-Gynecological Clinical Oncology, Istituto Nazionale Tumori, IRCSS, Fondazione G. Pascale, Napoli, Italy
| | - Gennaro Cormio
- Ginecologic Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Italy; Department of Interdisciplinary Medicine (DIM), University of Bari, 70121 Bari, Italy
| | - Carmine De Angelis
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Francesco Legge
- Gynecologic Oncology Unit, General Regional Hospital "F. Miulli" of Acquaviva delle Fonti, Italy
| | - Andrea Lissoni
- Department of Medicine and Surgery, Clinic of Obstetrics and Gynecology, San Gerardo Hospital, Monza, University of Milan Bicocca, Milan, Italy
| | | | - Giorgia Mangili
- Gynecology/Obstetrics Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Emanuele Naglieri
- Department of Medical Oncology, IRCCS Istituto Tumori "Giovanni Paolo II", Bari 70124, Italy
| | | | | | | | - Vanda Salutari
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | | | - Antonella Savarese
- Division of Medical Oncology 1, IRCCS - Regina Elena National Cancer Institute, Rome, Italy
| | | | - Giulia Tasca
- Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
| | - Federica Tomao
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Italy
| | - Giorgio Valabrega
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, 10128 Turin, Italy
| | - Laura Zavallone
- Department Medical Oncology, Infermi Hospital, Biella, Italy
| | - Sandro Pignata
- U.O.C. of Experimental Uro-Gynecological Clinical Oncology, Istituto Nazionale Tumori, IRCSS, Fondazione G. Pascale, Napoli, Italy
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Puliafito I, Chillari F, Russo A, Cantale O, Sciacca D, Castorina L, Colarossi C, Franchina T, Vitale MP, Ricciardi GRR, Adamo V, Esposito F, Giuffrida D. Therapeutic efficacy of platinum/etoposide regimens in the treatment of advanced poorly differentiated neuroendocrine carcinomas of the lung: A retrospective analysis. Front Endocrinol (Lausanne) 2023; 14:1065599. [PMID: 36793289 PMCID: PMC9922698 DOI: 10.3389/fendo.2023.1065599] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 01/16/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Lung neuroendocrine neoplasms (NENs) are rare malignancies developed from bronchial mucosa. Because of its rarity and complex histopathology, there is limited data on the role of chemotherapy in this subset of tumors. Few studies regarding the treatment of poorly differentiated lung NENs, known as neuroendocrine carcinomas (NECs), are available and many limits are detectable as heterogeneity of tumor samples including different origins and different clinical behaviors, moreover, no evidence of therapeutic advances have been achieved along the last thirty years. METHOD We performed a retrospective analysis of 70 patients affected by poorly differentiated lung NECs: half of patients underwent a first line therapy with a combination of cisplatin plus etoposide; the remaining patients receiving carboplatin instead of cisplatin, plus etoposide. Results: In our analysis, the outcomes of patients treated with either cisplatin or carboplatin schedule are similar in terms of ORR (44% versus 33%), DCR (75% versus 70%), PFS (6.0 versus 5.0 months) and OS (13.0 versus 10 months). Median number of chemotherapy cycles was 4 (range 1-8). The 18% of patients required a dose reduction. Main toxicities reported were hematological (70.5%), gastrointestinal (26.5%) and fatigue (18%). CONCLUSION Survival rate in our study suggests that high grade lung NENs are characterized by an aggressive behavior and a poor prognosis, despite the treatment with platinum/etoposide according to available data. Clinical results of present study contribute to strengthen available data on the usefulness of platinum/etoposide regimen in the treatment of poorly differentiated lung NENs.
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Affiliation(s)
- Ivana Puliafito
- Medical Oncology Unit, Istituto Oncologico del Mediterraneo SpA, Viagrande, Italy
| | - Federico Chillari
- Medical Oncology Unit, Istituto Oncologico del Mediterraneo SpA, Viagrande, Italy
| | - Alessandro Russo
- Department of Medical Oncology, Papardo Hospital & University of Messina, Messina, Italy
| | - Ornella Cantale
- Medical Oncology Unit, Istituto Oncologico del Mediterraneo SpA, Viagrande, Italy
| | - Dorotea Sciacca
- Medical Oncology Unit, Istituto Oncologico del Mediterraneo SpA, Viagrande, Italy
| | - Luigi Castorina
- Nuclear Medicine, Istituto Oncologico del Mediterraneo SpA, Viagrande, Italy
| | - Cristina Colarossi
- Pathology Unit, Istituto Oncologico del Mediterraneo SpA, Viagrande, Italy
| | - Tindara Franchina
- Department of Medical Oncology, Papardo Hospital & University of Messina, Messina, Italy
| | - Maria Paola Vitale
- Medical Oncology Unit, Istituto Oncologico del Mediterraneo SpA, Viagrande, Italy
| | | | - Vincenzo Adamo
- Department of Medical Oncology, Papardo Hospital & University of Messina, Messina, Italy
| | - Francesca Esposito
- Hospital Pharmaceutical Unit, ASL Roma 6, Ariccia, Italy
- *Correspondence: Francesca Esposito, ; Dario Giuffrida,
| | - Dario Giuffrida
- Medical Oncology Unit, Istituto Oncologico del Mediterraneo SpA, Viagrande, Italy
- *Correspondence: Francesca Esposito, ; Dario Giuffrida,
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Cagnazzo C, Franchina V, Toscano G, Fagioli F, Franchina T, Ricciardi GRR, Antonuzzo L, Di Costanzo A, Russo A, Cusenza S, Gori S, Marchetti F, Tambaro M, Piccirillo P, Nanni O, Cenna R, Delfanti S, Di Maio M, Dascanio F, Adamo V. Cancer patients’ awareness about clinical research in the era of social media and “fake news”: Preliminary results from ELPIS Study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e24121] [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
e24121 Background: Barriers for low recruitment in clinical trials have been classified based on three main sources: physician, patient, system. A primary role is played by a low patient awareness, which often leads to a lack of confidence in science and a substantial inability to estimate the benefits deriving from trial participation, aggravated by the spread of fake news. A prospective observational study was conducted to investigate the views of cancer patients on aspects of clinical research, their expectations, the level of comprehensibility of informed consent and the impact of the fake news phenomenon. Methods: From January 2018, after Ethics Committees approval, the ELPIS study was initiated in 9 Italian Medical Oncology Units. After signing the informed consent, patients were asked to complete a questionnaire, consisting of a set of multiple choice and Likert-score questions. Results: As of January 2021, 115 patients were enrolled, with a balanced sex distribution and a prevalence of subjects older than 55-years (79.8%). Regarding the previous knowledge about clinical research, the average score was 3.9 (range 1-5). The vast majority of respondents (91.3%) had already started experimental therapy and many of them constantly used internet (65.2%) and social networks (34.8%). More than half (53.9%) stated the interview with the physician was sufficient for a full understanding of informed consent. In case of doubt, the majority seeked support in the clinician (39.1%) while very few (1.7%) relied on the web. The average score attributed to doctor-patient relationship was equal to 8.89 (range 1-10). Respondents were quite confident in their ability to independently search for information on their disease, discriminate fake news and identify reliable sites (average score 3.26, 3.27, 3.09 respectively, over a range of 1-5). The scores related to the presumed ability to understand the results of a clinical study and to actively collaborate to produce research were high (average score 4.72 and 4.39 over a range of 1-5). Conclusions: Preliminary data from our research show a good level of patient awareness and a fine ability to understand information, discerning real from fake news. Continuing and implementing the training initiatives of the population in the health sector will certainly contribute to further improvement, hopefully obtaining an even greater involvement of patients in the early phases of research.
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Affiliation(s)
- Celeste Cagnazzo
- Department of Sciences of Public Health and Pediatrics - University of Turin & Division of Pediatric Onco-Hematology, Regina Margherita Hospital, Turin, Italy
| | | | | | - Franca Fagioli
- Department of Sciences of Public Health and Pediatrics - University of Turin & Division of Pediatric Onco-Hematology, Regina Margherita Hospital, Turin, Italy
| | | | | | | | | | - Antonio Russo
- Unit of Medical Oncology-Department of Oncology-AOUP, Palermo, Italy
| | - Stefania Cusenza
- Unit of Medical Oncology-Department of Oncology-AOUP, Palermo, Italy
| | - Stefania Gori
- Oncology Unit, Ospedale Sacro Cuore-don Calabria, Negrar, Italy
| | - Fabiana Marchetti
- Oncology Unit, Ospedale Sacro Cuore-don Calabria, Negrar (VR), Italy
| | - Margherita Tambaro
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Napoli, Italy
| | - Patrizia Piccirillo
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Napoli, Italy
| | - Oriana Nanni
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Rosita Cenna
- Division of Pediatric Onco-Hematology, Regina Margherita Hospital, Turin, Italy
| | - Sara Delfanti
- Division of Medical Oncology, SS. Antonio e Biagio General Hospital, Alessandria, Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin, AO Ordine Mauriziano, Turin, Italy
| | - Fabio Dascanio
- Department of Oncology, University of Turin, AO Ordine Mauriziano, Turin, Italy
| | - Vincenzo Adamo
- Medical Oncology Unit-A.O. Papardo, Messina and Department of Human Pathology University of Messina, Messina, Italy
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Adamo V, Ricciardi GRR, Giuffrida D, Scandurra G, Russo A, Blasi L, Spadaro P, Iacono C, Soto Parra HJ, Savarino A, Ferraú F, Zerilli F, Verderame F, Butera A, Santangelo C, Franchina V, Caruso M. Eribulin mesylate use as third-line therapy in patients with metastatic breast cancer (VESPRY): a prospective, multicentre, observational study. Ther Adv Med Oncol 2019; 11:1758835919895755. [PMID: 31903098 PMCID: PMC6923689 DOI: 10.1177/1758835919895755] [Citation(s) in RCA: 10] [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: 03/29/2019] [Accepted: 11/15/2019] [Indexed: 11/15/2022] Open
Abstract
Background In real-world practice, eribulin mesylate provides significant survival benefit, with a manageable safety profile in heavily pretreated patients with metastatic breast cancer (MBC). Methods In this prospective, open-label, multicentre, observational study we evaluated the effectiveness and tolerability of eribulin as third-line treatment in a homogeneous population. The primary endpoints were the safety profile and response in metastatic sites; secondary endpoints included the response in different subtypes, overall response rate (ORR), progression-free survival (PFS) and overall survival (OS). Results From 2013 to 2016, 118 women were treated in 21 Sicilian institutions; the median age was 58 years (range 29-79), with 69% of patients under 65. The median cycles of eribulin were 5.5 (range 1-26). The most common adverse event was neutropenia (9.3%, 3 cases of grade 3, 4 of grade 4); only 1 case of QT prolongation was reported. Eribulin was effective in controlling metastatic disease in all sites, and it achieved the highest ORR in brain (16%) and liver (14.9%). Median OS was 31.8 months (95% CI 27.9-34.4) and median PFS 5.5 months (95% CI 4.2-6.6). PFS was 5.2 months (95% CI 2.8-8.4) in patients with triple-negative subtype. Median PFS was longer in patients over 65 years (6.1 months, 95% CI 4.4-8.3). In patients who had visceral metastases PFS was 5.5 months (95% CI 95% 3.5-6.6) and OS 33.9 months (95% CI 29.8-40.8). Conclusions Eribulin as third-line treatment shows an acceptable safety profile and a substantial antitumour activity in the treatment of MBC, even in elderly patients and in those with visceral disease.
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Affiliation(s)
- Vincenzo Adamo
- Medical Oncology Unit A.O. Papardo and Department of Human Pathology University of Messina, Contrada Papardo, Messina, Italy
| | | | - Dario Giuffrida
- Department of Medical Oncology, Mediterranean Institute of Oncology, Viagrande, CT, Italy
| | | | - Antonio Russo
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - Livio Blasi
- UOC Oncologia Medica, ARNAS Civico, Palermo, Piazza Nicola Leotta, Italy
| | - Pietro Spadaro
- U.O. di Oncologia ed Ematologia, Casa di Cura Villa Salus, Messina, Italy
| | - Carmelo Iacono
- Medical Oncology Department, Ospedale Maria Paterno Arezzo, Ragusa, Italy
| | - Hector J Soto Parra
- Medical Oncology Department, University Hospital Policlinico Vittorio Emanuele, Catania, Italy
| | - Antonino Savarino
- Unità Operativa di Oncologia, Ospedale "Barone Lombardo" di Canicattì, Contrada Giarre, Canicattì, AG, Italy
| | - Francesco Ferraú
- Medical Oncology Department, Ospedale S Vincenzo, Taormina, ME, Italy
| | | | | | | | | | - Veronica Franchina
- Medical Oncology Unit A.O. Papardo & Department of Human Pathology University of Messina, Contrada Papardo, Messina, Italy
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Adamo B, Ricciardi GRR, Ieni A, Franchina T, Fazzari C, Sanò MV, Angelico G, Caruso M, Tuccari G, Adamo V. Correction: The prognostic significance of combined androgen receptor, E-Cadherin, Ki67 and CK5/6 expression in patients with triple negative breast cancer. Oncotarget 2019; 10:917. [PMID: 30783520 PMCID: PMC6368234 DOI: 10.18632/oncotarget.26650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Barbara Adamo
- Department of Medical Oncology, Hospital Clínic of Barcelona, Barcelona, Spain
| | | | - Antonio Ieni
- Department of Human Pathology of Adult and Evolutive Age "Gaetano Barresi", Section of Pathology, University of Messina, AOU Policlinico "G. Martino" Messina, Italy
| | - Tindara Franchina
- Medical Oncology Unit A.O. Papardo & Department of Human Pathology University of Messina, Messina, Italy
| | - Carmine Fazzari
- Pathology Unit, Humanitas Center of Oncology, Catania, Italy
| | - Maria Vita Sanò
- Medical Oncology, Humanitas Catania Oncology Center, Catania, Italy
| | - Giuseppe Angelico
- G. F. Ingrassia Department, Section of Anatomic Pathology, University Hospital "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Michele Caruso
- Medical Oncology, Humanitas Catania Oncology Center, Catania, Italy
| | - Giovanni Tuccari
- Department of Human Pathology of Adult and Evolutive Age "Gaetano Barresi", Section of Pathology, University of Messina, AOU Policlinico "G. Martino" Messina, Italy
| | - Vincenzo Adamo
- Medical Oncology Unit A.O. Papardo & Department of Human Pathology University of Messina, Messina, Italy
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Russo A, Franchina T, Ricciardi GRR, Toscano G, Schifano S, Lo Certo G, Battaglia A, Pantò E, Scaffidi Fonti M, Adamo V. The changing scenario of 1 st line therapy in non-oncogene addicted NSCLCs in the era of immunotherapy. Crit Rev Oncol Hematol 2018; 130:1-12. [PMID: 30196906 DOI: 10.1016/j.critrevonc.2018.06.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 02/26/2018] [Revised: 04/23/2018] [Accepted: 06/13/2018] [Indexed: 11/27/2022] Open
Abstract
During the last two decades front-line treatment of metastatic Non Small Cell Lung Cancer (NSCLC) has profoundly changed moving from the old "one size fits all" concept to a "histology-based" approach and then, for a small subgroup of patients to a "molecularly-selected" one. The development of immune checkpoint inhibitors and the unprecedented results reported in 2nd/3rd line prompted the evaluation of these novel therapeutic agents in chemotherapy-naïve patients either alone or in combination with platinum-based chemotherapy. Several randomized trials are evaluating the impact of immune-checkpoint inhibitors in 1st line and some of them have yet produced preliminary evidence of efficacy. However, still a long way to go and several questions are still unanswered, including proper patients selection, optimal sequential/combinatorial use of these agents, appropriate treatment duration, and finally the identification of predictive biomarkers. The aim of this paper is to provide a comprehensive overview on the growing role of immune checkpoint inhibitors in the upfront treatment of advanced non-oncogene addicted NSCLC either as single agent or in combination with other agents.
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Affiliation(s)
- A Russo
- Medical Oncology Unit A.O. Papardo & Department of Human Pathology, University of Messina, Italy
| | - T Franchina
- Medical Oncology Unit A.O. Papardo & Department of Human Pathology, University of Messina, Italy
| | - G R R Ricciardi
- Medical Oncology Unit A.O. Papardo & Department of Human Pathology, University of Messina, Italy
| | - G Toscano
- Medical Oncology Unit A.O. Papardo & Department of Human Pathology, University of Messina, Italy
| | - S Schifano
- Medical Oncology Unit A.O. Papardo & Department of Human Pathology, University of Messina, Italy
| | - G Lo Certo
- Medical Oncology Unit A.O. Papardo & Department of Human Pathology, University of Messina, Italy
| | - A Battaglia
- Medical Oncology Unit A.O. Papardo & Department of Human Pathology, University of Messina, Italy
| | - E Pantò
- Medical Oncology Unit A.O. Papardo & Department of Human Pathology, University of Messina, Italy
| | - M Scaffidi Fonti
- Medical Oncology Unit A.O. Papardo & Department of Human Pathology, University of Messina, Italy
| | - V Adamo
- Medical Oncology Unit A.O. Papardo & Department of Human Pathology, University of Messina, Italy.
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Russo A, Franchina T, Ricciardi GRR, Fanizza C, Scimone A, Chiofalo G, Giordano A, Adamo V. Influence of EGFR mutational status on metastatic behavior in non squamous non small cell lung cancer. Oncotarget 2018; 8:8717-8725. [PMID: 28060728 PMCID: PMC5352435 DOI: 10.18632/oncotarget.14427] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 11/10/2016] [Accepted: 12/01/2016] [Indexed: 12/25/2022] Open
Abstract
Epidermal Growth Factor Receptor (EGFR) mutated Non Small Cell Lung Cancers (NSCLCs) are a molecularly subgroup of patients with peculiar clinic-pathological characteristics. Previous studies have suggested a possible interaction between oncogene status and metastatic behavior in non squamous NSCLCs with conflicting results. The aim of this study was to compare the different metastatic patterns, at baseline and during the course of the disease, in a cohort of 137 Caucasian patients with non-squamous NSCLC according to the EGFR mutational status and survival differences according to the different metastatic behavior. We observed unique metastatic distributions between EGFR-mutated and EGFR wild type non-squamous NSCLCs. These data support the hypothesis that tumor bio-molecular characteristics and genotype may influence the metastatic process in NSCLC and might help the development of enrichment strategies for tumor genotyping in these tumors, especially in the presence of limited tissue availability.
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Affiliation(s)
- Alessandro Russo
- Medical Oncology Unit A.O. Papardo & Department of Human Pathology University of Messina, Italy
| | - Tindara Franchina
- Medical Oncology Unit A.O. Papardo & Department of Human Pathology University of Messina, Italy
| | | | | | - Antonino Scimone
- Medical Oncology Unit A.O. Papardo & Department of Human Pathology University of Messina, Italy
| | - Giuseppe Chiofalo
- Medical Oncology Unit A.O. Papardo & Department of Human Pathology University of Messina, Italy
| | - Antonio Giordano
- Department of Medicine, Surgery and Neuroscience, University of Siena and Istituto Toscano Tumori (ITT), Siena, Italy.,Sbarro Institute for Cancer Research and Molecular Medicine, Center for Biotechnology, College of Science and Technology, Temple University, Philadelphia PA, USA
| | - Vincenzo Adamo
- Medical Oncology Unit A.O. Papardo & Department of Human Pathology University of Messina, Italy
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Russo A, Franchina T, Ricciardi GRR, Adamo V. Rapid Acquisition of T790M Mutation after Treatment with Afatinib in an NSCLC Patient Harboring EGFR Exon 20 S768I Mutation. J Thorac Oncol 2018; 12:e6-e8. [PMID: 27988103 DOI: 10.1016/j.jtho.2016.09.132] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 09/26/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Alessandro Russo
- Medical Oncology Unit A.O. Papardo and Department of Human Pathology, University of Messina, Italy
| | - Tindara Franchina
- Medical Oncology Unit A.O. Papardo and Department of Human Pathology, University of Messina, Italy
| | | | - Vincenzo Adamo
- Medical Oncology Unit A.O. Papardo and Department of Human Pathology, University of Messina, Italy.
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10
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Ricciardi GRR, Russo A, Franchina T, Schifano S, Mastroeni G, Santacaterina A, Adamo V. Efficacy of T-DM1 for leptomeningeal and brain metastases in a HER2 positive metastatic breast cancer patient: new directions for systemic therapy - a case report and literature review. BMC Cancer 2018; 18:97. [PMID: 29370839 PMCID: PMC5784540 DOI: 10.1186/s12885-018-3994-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [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: 08/23/2017] [Accepted: 01/16/2018] [Indexed: 11/10/2022] Open
Abstract
Background Herein, we report a complete response after whole brain radiotherapy (WBRT) and concomitant T-DM1 in a patient with HER2-positive metastatic breast cancer (MBC) and extensive brain and leptomeningeal involvement. Case presentation A 46 years old Caucasian woman with HER2-positive MBC and no baseline CNS involvement, started in August 2015 1st line therapy with Pertuzumab-Trastuzumab-Docetaxel, with partial response. However, in April 2016 the patient eventually progressed with emergence of brain and leptomeningeal metastases. Hence, she started in May 2016 2nd line therapy with T-DM1 and concomitant WBRT, with complete response (CR) after 3 courses of therapy, with complete resolution of neurological symptoms and no relevant toxicities. The CR is lasting over 13 months and the patient is out of corticosteroid use. Conclusions To the best of our knowledge, this is the first case reporting interesting antitumor activity of T-DM1 and concomitant WBRT in both brain and leptomeningeal metastases, with a favorable safety profile and prolonged extracranial disease control. Further prospective studies should confirm these findings.
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Affiliation(s)
| | - Alessandro Russo
- Medical Oncology Unit, A.O. Papardo & Department of Human Pathology University of Messina, Messina, Italy
| | - Tindara Franchina
- Medical Oncology Unit, A.O. Papardo & Department of Human Pathology University of Messina, Messina, Italy
| | - Silvia Schifano
- Medical Oncology Unit, A.O. Papardo & Department of Human Pathology University of Messina, Messina, Italy
| | | | | | - Vincenzo Adamo
- Medical Oncology Unit, A.O. Papardo & Department of Human Pathology University of Messina, Messina, Italy.
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11
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Adamo B, Ricciardi GRR, Ieni A, Franchina T, Fazzari C, Sanò MV, Angelico G, Michele C, Tuccari G, Adamo V. The prognostic significance of combined androgen receptor, E-Cadherin, Ki67 and CK5/6 expression in patients with triple negative breast cancer. Oncotarget 2017; 8:76974-76986. [PMID: 29100362 PMCID: PMC5652756 DOI: 10.18632/oncotarget.20293] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [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: 01/30/2017] [Accepted: 06/27/2017] [Indexed: 12/29/2022] Open
Abstract
Background Triple Negative Breast Cancer (TNBC) represents a heterogeneous group of tumors with poor prognosis owing to aggressive tumor biology and lack of targeted therapies. No clear prognostic biomarkers have been identified to date for this subgroup. Materials and Methods In this retrospective study we evaluated the prognostic role of 4 different molecular determinants, including androgen receptor (AR), E-cadherin (CDH1), Ki67 index, and basal cytokeratins (CKs) 5/6, in a cohort of 99 patients with TNBC. All patients received neo/adjuvant chemotherapy (mostly anthracycline/taxane-based). Immunohistochemistry (IHC) was performed in formalin-fixed paraffin-embedded primary tumor samples. CDH1 expression was considered positive as ≥ 30% of the membrane cells staining. AR positivity was defined as > 10% of positive tumor cells. High Ki67 was defined as ≥20% positive tumor cells. CK5/6 expression was judged positive if the score was ≥1. Results The absence of AR expression was significantly associated with highly undifferentiated tumors. Univariate analyses showed that lack of expression of CDH1, tumor size and nodal status were significantly correlated with worse RFS and OS (p< 0.05). AR expression and low Ki67 showed a trend towards better RFS and OS. Patients with absent CK5/6 expression in univariate and multivariate analyses had poorer RFS (p=0.02 and p=0.002, respectively) and OS (p=0.05 and p=0.02, respectively). Multivariate analysis showed an independent association between CDH1 expression and better RFS and OS (p< 0.05) beyond tumor size, nodal status, and grade. The Kaplan-Meier curves showed that patients with AR and CDH1 negative expression and high Ki-67 levels have a significant correlation with poor outcome. Conclusions Our study supports the use of IHC expression of AR, CDH1, Ki67, and CK5/6 as prognostic markers in TNBCs and suggests a link between their expression and prognosis and may help to stratify TNBC patients in different prognostic classes.
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Affiliation(s)
- Barbara Adamo
- Department of Medical Oncology, Hospital Clínic of Barcelona, Barcelona, Spain
| | | | - Antonio Ieni
- Department of Human Pathology of Adult and Evolutive Age "Gaetano Barresi", Section of Pathology, University of Messina, AOU Policlinico "G. Martino" Messina, Italy
| | - Tindara Franchina
- Medical Oncology Unit A.O. Papardo & Department of Human Pathology University of Messina, Messina, Italy
| | - Carmine Fazzari
- Pathology Unit, Humanitas Center of Oncology, Catania, Italy
| | - Maria Vita Sanò
- Medical Oncology, Humanitas Catania Oncology Center, Catania, Italy
| | - Giuseppe Angelico
- G. F. Ingrassia Department, Section of Anatomic Pathology, University Hospital "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Caruso Michele
- Medical Oncology, Humanitas Catania Oncology Center, Catania, Italy
| | - Giovanni Tuccari
- Department of Human Pathology of Adult and Evolutive Age "Gaetano Barresi", Section of Pathology, University of Messina, AOU Policlinico "G. Martino" Messina, Italy
| | - Vincenzo Adamo
- Medical Oncology Unit A.O. Papardo & Department of Human Pathology University of Messina, Messina, Italy
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12
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Russo A, Franchina T, Ricciardi GRR, Smiroldo V, Picciotto M, Zanghì M, Rolfo C, Adamo V. Third generation EGFR TKIs in EGFR-mutated NSCLC: Where are we now and where are we going. Crit Rev Oncol Hematol 2017; 117:38-47. [PMID: 28807234 DOI: 10.1016/j.critrevonc.2017.07.003] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 06/25/2017] [Accepted: 07/04/2017] [Indexed: 12/17/2022] Open
Abstract
The therapeutic landscape of Non Small Lung Cancer (NSCLC) has been profoundly changed over the last decade with the clinical introduction of Epidermal Growth Factor Receptor (EGFR) tyrosine kinase inhibitors (TKIs) and the discovery of EGFR activating mutations as the major predictive factor to these agents. Despite impressive clinical activity against EGFR-mutated NSCLCs, the benefit seen with 1st and 2nd generation EGFR TKIs is usually transient and virtually all patients become resistant. Several different mechanisms of acquired resistance have been reported to date, but the vast majority of patients develop a secondary exon 20 mutation in the ATP-binding site of EGFR, namely T790M. The discovery of mutant-selective EGFR TKIs that selectively inhibit EGFR-mutants, including T790M-harboring NSCLCs, while sparing EGFR wild type, provide the opportunity for overcoming the major mechanism of acquired resistance to 1st and 2nd generation EGFR TKIs, with a relatively favorable toxicity profile. The development of this novel class of EGFR inhibitors poses novel challenges in the rapidly evolving therapeutic paradigm of EGFR-mutated NSCLCs and the next few years will witness the beginning of a new era for EGFR inhibition in lung cancer. The aim of this paper is to provide a comprehensive overview of the increasing body of data emerging from the ongoing clinical trials with this promising novel therapeutic class of EGFR inhibitors.
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Affiliation(s)
- A Russo
- Medical Oncology Unit A.O. Papardo & Department of Human Pathology University of Messina, Italy
| | - T Franchina
- Medical Oncology Unit A.O. Papardo & Department of Human Pathology University of Messina, Italy
| | - G R R Ricciardi
- Medical Oncology Unit A.O. Papardo & Department of Human Pathology University of Messina, Italy
| | - V Smiroldo
- Medical Oncology Unit A.O. Papardo & Department of Human Pathology University of Messina, Italy
| | - M Picciotto
- Medical Oncology Unit A.O. Papardo & Department of Human Pathology University of Messina, Italy
| | - M Zanghì
- Medical Oncology Unit A.O. Papardo & Department of Human Pathology University of Messina, Italy
| | - C Rolfo
- Phase I - Early Clinical Trials Unit, Oncology Department, Antwerp University Hospital and Center for Oncological Research (CORE), Antwerp University, Edegem, Belgium
| | - V Adamo
- Medical Oncology Unit A.O. Papardo & Department of Human Pathology University of Messina, Italy.
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13
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Picciotto M, Franchina T, Russo A, Ricciardi GRR, Provazza G, Sava S, Baldari S, Caffo O, Adamo V. Emerging role of Radium-223 in the growing therapeutic armamentarium of metastatic castration-resistant prostate cancer. Expert Opin Pharmacother 2017; 18:899-908. [DOI: 10.1080/14656566.2017.1323875] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Maria Picciotto
- Medical Oncology Unit A.O. Papardo & Department of Human Pathology, University of Messina, Messina, Italy
| | - Tindara Franchina
- Medical Oncology Unit A.O. Papardo & Department of Human Pathology, University of Messina, Messina, Italy
| | - Alessandro Russo
- Medical Oncology Unit A.O. Papardo & Department of Human Pathology, University of Messina, Messina, Italy
| | | | - Giusy Provazza
- Medical Oncology Unit A.O. Papardo & Department of Human Pathology, University of Messina, Messina, Italy
| | - Serena Sava
- Medical Oncology Unit A.O. Papardo & Department of Human Pathology, University of Messina, Messina, Italy
| | - Sergio Baldari
- Department of Biomedical and Dental Sciences and of Morphological and Functional Images, University of Messina, Messina, Italy
| | - Orazio Caffo
- Medical Oncology Department, Santa Chiara Hospital, Trento, Italy
| | - Vincenzo Adamo
- Medical Oncology Unit A.O. Papardo & Department of Human Pathology, University of Messina, Messina, Italy
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14
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Russo A, Franchina T, Ricciardi GRR, Picone A, Ferraro G, Zanghì M, Toscano G, Giordano A, Adamo V. A decade of EGFR inhibition in EGFR-mutated non small cell lung cancer (NSCLC): Old successes and future perspectives. Oncotarget 2016; 6:26814-25. [PMID: 26308162 PMCID: PMC4694955 DOI: 10.18632/oncotarget.4254] [Citation(s) in RCA: 132] [Impact Index Per Article: 16.5] [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: 04/25/2015] [Accepted: 06/01/2015] [Indexed: 12/23/2022] Open
Abstract
The discovery of Epidermal Growth Factor Receptor (EGFR) mutations in Non Small Cell Lung Cancer (NSCLC) launched the era of personalized medicine in advanced NSCLC, leading to a dramatic shift in the therapeutic landscape of this disease. After ten years from the individuation of activating mutations in the tyrosine kinase domain of the EGFR in NSCLC patients responding to the EGFR tyrosine kinase inhibitor (TKI) Gefitinib, several progresses have been done and first line treatment with EGFR TKIs is a firmly established option in advanced EGFR-mutated NSCLC patients. During the last decade, different EGFR TKIs have been developed and three inhibitors have been approved so far in these selected patients. However, despite great breakthroughs have been made, treatment of these molecularly selected patients poses novel therapeutic challenges, such as emerging of acquired resistance, brain metastases development or the need to translate these treatments in earlier clinical settings, such as adjuvant therapy. The aim of this paper is to provide a comprehensive review of the major progresses reported so far in the EGFR inhibition in this molecularly-selected subgroup of NSCLC patients, from the early successes with first generation EGFR TKIs, Erlotinib and Gefitinib, to the novel irreversible and mutant-selective inhibitors and ultimately the emerging challenges that we, in the next future, are called to deal with.
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Affiliation(s)
- Alessandro Russo
- Medical Oncology Unit AOOR Papardo-Piemonte & Department of Human Pathology, University of Messina, Messina, Italy
| | - Tindara Franchina
- Medical Oncology Unit AOOR Papardo-Piemonte & Department of Human Pathology, University of Messina, Messina, Italy
| | | | - Antonio Picone
- Medical Oncology Unit AOOR Papardo-Piemonte & Department of Human Pathology, University of Messina, Messina, Italy
| | - Giuseppa Ferraro
- Medical Oncology Unit AOOR Papardo-Piemonte & Department of Human Pathology, University of Messina, Messina, Italy
| | - Mariangela Zanghì
- Medical Oncology Unit AOOR Papardo-Piemonte & Department of Human Pathology, University of Messina, Messina, Italy
| | - Giuseppe Toscano
- Medical Oncology Unit AOOR Papardo-Piemonte & Department of Human Pathology, University of Messina, Messina, Italy
| | - Antonio Giordano
- Sbarro Institute for Cancer Research and Molecular Medicine, Center for Biotechnology, Temple University, Philadelphia, Pennsylvania, USA
| | - Vincenzo Adamo
- Medical Oncology Unit AOOR Papardo-Piemonte & Department of Human Pathology, University of Messina, Messina, Italy
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Ieni A, Barresi V, Ricciardi GRR, Adamo B, Adamo V, Tuccari G. Prognostic value of androgen receptor expression in triple negative breast carcinomas: personal experience and comments on a review about "Triple-negative breast cancer: treatment challenges and solutions" by Collignon et al. Breast Cancer (Dove Med Press) 2016; 8:157-9. [PMID: 27578997 PMCID: PMC4998015 DOI: 10.2147/bctt.s113577] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Antonio Ieni
- Department of Human Pathology of Adult and Evolutive Age "Gaetano Barresi", Section of Pathology, University of Messina, AOU "Policlinico G Martino"
| | - Valeria Barresi
- Department of Human Pathology of Adult and Evolutive Age "Gaetano Barresi", Section of Pathology, University of Messina, AOU "Policlinico G Martino"
| | - Giuseppina Rosaria Rita Ricciardi
- Medical Oncology Unit AOOR Papardo-Piemonte, Department of Human Pathology of Adult And Evolutive Age "Gaetano Barresi", University of Messina, Messina, Italy
| | | | - Vincenzo Adamo
- Medical Oncology Unit AOOR Papardo-Piemonte, Department of Human Pathology of Adult And Evolutive Age "Gaetano Barresi", University of Messina, Messina, Italy
| | - Giovanni Tuccari
- Department of Human Pathology of Adult and Evolutive Age "Gaetano Barresi", Section of Pathology, University of Messina, AOU "Policlinico G Martino"
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Ricciardi GRR, Franchina T, Russo A, Schifano S, Ferraro G, Adamo V. Nab-paclitaxel and trastuzumab combination: a promising approach for neoadjuvant treatment in HER2-positive breast cancer. Onco Targets Ther 2016; 9:4351-5. [PMID: 27499629 PMCID: PMC4959577 DOI: 10.2147/ott.s107930] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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] [Indexed: 01/03/2023] Open
Abstract
Neoadjuvant therapy is a well-established approach for the treatment of locally advanced or inflammatory breast cancer (BC) and has been increasingly used in recent years not only as a management strategy but also as a research tool. Recently, nanoparticle albumin-bound paclitaxel (nab-paclitaxel)/trastuzumab combinations have been associated with promising activity in different clinical settings. In the present case, we report a complete pathological response after neoadjuvant treatment with the trastuzumab/nab-paclitaxel combination in a locally advanced human epidermal growth factor receptor 2 (HER2)-positive BC patient, with a good toxicity profile. This combination may represent a valid therapeutic option in the neoadjuvant therapy for HER2-positive locally advanced BC.
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Affiliation(s)
| | - Tindara Franchina
- Human Pathology University Department & Medical Oncology Unit AO Papardo, Messina, Italy
| | - Alessandro Russo
- Human Pathology University Department & Medical Oncology Unit AO Papardo, Messina, Italy
| | - Silvia Schifano
- Human Pathology University Department & Medical Oncology Unit AO Papardo, Messina, Italy
| | - Giuseppa Ferraro
- Human Pathology University Department & Medical Oncology Unit AO Papardo, Messina, Italy
| | - Vincenzo Adamo
- Human Pathology University Department & Medical Oncology Unit AO Papardo, Messina, Italy
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Russo A, Franchina T, Ricciardi GRR, Ferraro G, Scimone A, Bronte G, Russo A, Rolfo C, Adamo V. Central nervous system involvement in ALK-rearranged NSCLC: promising strategies to overcome crizotinib resistance. Expert Rev Anticancer Ther 2016; 16:615-23. [PMID: 27109446 DOI: 10.1080/14737140.2016.1182427] [Citation(s) in RCA: 16] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION ALK rearranged Non Small Cell Lung Cancers (NSCLCs) represent a distinct subgroup of patients with peculiar clinic-pathological features. These patients exhibit dramatic responses when treated with the ALK tyrosine kinase inhibitor Crizotinib, albeit Central Nervous System (CNS) activity is much less impressive than that observed against extracranial lesions. CNS involvement has become increasingly observed in these patients, given their prolonged survival. Several novel generation ALK inhibitors have been developing to increase CNS penetration and to provide more complete ALK inhibition.. AREAS COVERED The CNS activity of Crizotinib and novel generation ALK inhibitors will be summarized in this review, evaluating the strengths and weaknesses of the therapeutic strategies developed to date in this specific subgroup of NSCLCs with a look towards the future. Expert commentary: In the next few years, the results of ongoing comparative head-to-head trials will provide the definitive conclusions on the optimal treatment sequence in ALK-rearranged NSCLCs. Moreover, ongoing clinical trials with novel-generation ALK inhibitors will produce more evidences on the best approach in the growing number of ALK-positive NSCLCs with CNS involvement.
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Affiliation(s)
- Alessandro Russo
- a Medical Oncology Unit A.O. Papardo and Department of Human Pathology , University of Messina , Messina , Italy
| | - Tindara Franchina
- a Medical Oncology Unit A.O. Papardo and Department of Human Pathology , University of Messina , Messina , Italy
| | | | - Giuseppa Ferraro
- a Medical Oncology Unit A.O. Papardo and Department of Human Pathology , University of Messina , Messina , Italy
| | - Antonino Scimone
- a Medical Oncology Unit A.O. Papardo and Department of Human Pathology , University of Messina , Messina , Italy
| | - Giuseppe Bronte
- b Department of Surgical, Oncological and Oral Sciences , University of Palermo , Palermo , Italy
| | - Antonio Russo
- b Department of Surgical, Oncological and Oral Sciences , University of Palermo , Palermo , Italy
| | - Christian Rolfo
- c Department of Medical Oncology , Antwerp University Hospital , Antwerp , Belgium
| | - Vincenzo Adamo
- a Medical Oncology Unit A.O. Papardo and Department of Human Pathology , University of Messina , Messina , Italy
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Ricciardi GRR, Proto C, Ferraro G, Adamo V. Uncommon breast metastatic site and eribulin responsiveness in a heavily pretreated patient. Future Oncol 2015; 10:2417-22. [PMID: 25525850 DOI: 10.2217/fon.14.160] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
During the last decades, the introduction of new cytotoxics and targeted therapies resulted in a prolongation of survival and a minimization of toxicity in the treatment of metastatic breast cancer. However, to date, there was no standard of care following second-line therapy in this setting. In Phase III EMBRACE study, eribulin obtained a statistically significant improvement in the overall survival of pretreated metastatic breast cancer patients. This case report describes a heavily chemo-pretreated woman with important bone, nodal, hepatic and choroidal involvement from breast cancer who had a remarkable, unexpected and lasting disease response after treatment with eribulin. This case underlines how this well-tolerated monochemotherapy may be able to obtain a prolonged disease control and a good clinical outcome.
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19
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Ricciardi GRR, Adamo B, Ieni A, Licata L, Cardia R, Ferraro G, Franchina T, Tuccari G, Adamo V. Androgen Receptor (AR), E-Cadherin, and Ki-67 as Emerging Targets and Novel Prognostic Markers in Triple-Negative Breast Cancer (TNBC) Patients. PLoS One 2015; 10:e0128368. [PMID: 26039245 PMCID: PMC4454487 DOI: 10.1371/journal.pone.0128368] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [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: 03/04/2015] [Accepted: 04/26/2015] [Indexed: 11/19/2022] Open
Abstract
Background TNBC is an aggressive subset of breast cancer (BC) without specific target therapy. Methods This observational, retrospective study included 45 cases of TNBC. The aim of this study was to evaluate the expression of the AR, E-cadherin and Ki-67 in relation to histological type, time to relapse and overall survival (OS). Immunohistochemistry (IHC) was carried out on formalin-fixed paraffin-embedded tumor samples obtained from patients defined TNBC. Results The AR was positive (IHC >10%) in 26.6%. E-cadherin (CDH1) expression was considered positive if the score was ≥ 2. This expression was negative in 53.3% cases. The Ki-67 index was ≥ 20% in 37.7%. Univariate analyses showed that AR, CDH1 and Ki-67 are significantly associated with OS. Multivariate analysis showed that AR and Ki-67 expression are independent variables associated with OS. The statistical analysis showed that patients with AR negative and Ki-67 positive expression have a significant correlation with poor outcome. Conclusions Our data suggest that the combination of AR and E-cadherin expression as well as Ki-67 status might be useful prognostic markers in TNBC. Hence, these molecular determinants could play an interesting role to classify subgroups of TNBC.
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MESH Headings
- Adult
- Aged
- Antigens, CD
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/metabolism
- Cadherins/genetics
- Cadherins/metabolism
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/genetics
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Lobular/diagnosis
- Carcinoma, Lobular/genetics
- Carcinoma, Lobular/mortality
- Carcinoma, Lobular/pathology
- Carcinoma, Medullary/diagnosis
- Carcinoma, Medullary/genetics
- Carcinoma, Medullary/mortality
- Carcinoma, Medullary/pathology
- Female
- Gene Expression Regulation, Neoplastic
- Humans
- Ki-67 Antigen/genetics
- Ki-67 Antigen/metabolism
- Middle Aged
- Multivariate Analysis
- Neoplasm Recurrence, Local/diagnosis
- Neoplasm Recurrence, Local/genetics
- Neoplasm Recurrence, Local/mortality
- Neoplasm Recurrence, Local/pathology
- Prognosis
- Receptors, Androgen/genetics
- Receptors, Androgen/metabolism
- Retrospective Studies
- Survival Analysis
- Triple Negative Breast Neoplasms/diagnosis
- Triple Negative Breast Neoplasms/genetics
- Triple Negative Breast Neoplasms/mortality
- Triple Negative Breast Neoplasms/pathology
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Affiliation(s)
| | | | - Antonio Ieni
- Department of Human Pathology “Gaetano Barresi”, Section of Anatomic Pathology, University of Messina, Messina, Italy
| | - Luana Licata
- Department of Human Pathology “Gaetano Barresi”, Section of Anatomic Pathology, University of Messina, Messina, Italy
| | - Roberta Cardia
- Department of Human Pathology “Gaetano Barresi”, Section of Anatomic Pathology, University of Messina, Messina, Italy
| | - Giuseppa Ferraro
- Medical Oncology Unit AOOR Papardo-Piemonte & Department of Human Pathology University of Messina, Messina, Italy
| | - Tindara Franchina
- Medical Oncology Unit AOOR Papardo-Piemonte & Department of Human Pathology University of Messina, Messina, Italy
| | - Giovanni Tuccari
- Department of Human Pathology “Gaetano Barresi”, Section of Anatomic Pathology, University of Messina, Messina, Italy
| | - Vincenzo Adamo
- Medical Oncology Unit AOOR Papardo-Piemonte & Department of Human Pathology University of Messina, Messina, Italy
- * E-mail:
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20
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Ricciardi GRR, Adamo B, Barresi V, Ieni A, Franchina T, Caruso M, Zacchia A, Fazzari C, Tuccari G, Adamo V. Prognostic markers in triple-negative breast cancer (TNBC): The role of androgen receptor, e-cadherin, and Ki67. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.1089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Barbara Adamo
- Oncologia Mèdica Hospital Clínic, Barcelona, Barcelona, Spain
| | - Valeria Barresi
- Department of Human Pathology , Section of Anatomic Pathology, University of Messina,, Messina, Italy
| | - Antonio Ieni
- Department of Human Pathology, Section of Anatomic Pathology, University of Messina, Messina, Italy
| | - Tindara Franchina
- Medical Oncology Unit AOOR Papardo-Piemonte, Department of Human Pathology, University of Messina, Messina, Italy
| | | | | | | | - Giovanni Tuccari
- Department of Human Pathology, Section of Anatomic Pathology, University of Messina, Messina, Italy
| | - Vincenzo Adamo
- Medical Oncology Unit AOOR Papardo-Piemonte, Department of Human Pathology, University of Messina, Messina, Italy
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21
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Adamo V, Ricciardi GRR, Franchina V, Ferraro G, Caruso M, Bronte G, Banna GL, Spadaro P, Savarino A, Iacono C, Soto Parra HJ, Spada M, Safina V, Blasi L, Zerilli F, Prestifilippo A, Giannitto-Giorgio C, Alberio D, Cottini L, Russo A. Multi-istitutional study of the evaluation of eribulin (E) use in Sicily in metastatic breast cancer (MBC): A prospective registry (VESPRY trial). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e12023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Vincenzo Adamo
- Medical Oncology Unit AOOR Papardo-Piemonte, Department of Human Pathology, University of Messina, Messina, Italy
| | | | - Veronica Franchina
- Medical Oncology Unit AOOR Papardo-Piemonte, Department of Human Pathology, University of Messina, Messina, Italy
| | - Giuseppa Ferraro
- Medical Oncology Unit AOOR Papardo-Piemonte, Department of Human Pathology, University of Messina, Messina, Italy
| | | | - Giuseppe Bronte
- Section of Oncology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | | | | | | | - Carmelo Iacono
- Medical Oncology Unit, M. Paternò Hospital, Ragusa, Italy
| | - Hector J. Soto Parra
- Medical Oncology, University Hospital Policlinico, Vittorio Emanuele, Catania, Italy
| | | | | | - Livio Blasi
- UOC Oncologia Medica, ARNAS Civico, Palermo, Italy
| | | | | | | | | | | | - Antonio Russo
- Medical Oncology Unit, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
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22
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Ricciardi GRR, Russo A, Franchina T, Ferraro G, Adamo V. Efficacy of nab-paclitaxel plus trastuzumab in a long-surviving heavily pretreated HER2-positive breast cancer patient with brain metastases. Onco Targets Ther 2015; 8:289-94. [PMID: 25678799 PMCID: PMC4322880 DOI: 10.2147/ott.s74110] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Brain metastases (BMs) represent a major issue in clinical practice and are associated with a significant worsening of patient’s quality of life and, often, a dismal prognosis. Breast cancer (BC) is the second most common solid malignancy that metastasizes to the central nervous system. Incidence of BM varies according to the tumor subtype, with higher rates in patients with epidermal growth factor receptor 2 (HER2) overexpression and in triple negative breast cancers. The incidence of BM in HER2-positive BC patients has increased as a consequence of the success of trastuzumab-based therapy. BM represents an emerging unmet medical need and no specific treatment options exist because, until recently, nearly all randomized clinical trials in metastatic breast cancer (MBC) excluded such patients. Therefore, novel approaches in this setting are eagerly awaited. Herein, we report a lengthy progression-free survival with the combination trastuzumab/nanoparticle albumin-bound (nab)-paclitaxel in a heavily pretreated HER2-positive BC patient with BM. The long-term disease stabilization reported in the present case (>13 months) is of note for several reasons. First, the nab-paclitaxel plus trastuzumab combination, despite several previous lines of treatment, some of which were associated with known activity on BM, was the first systemic therapy not associated with central nervous system recurrence, avoiding recourse to additional locoregional treatments. Moreover, this combination was associated with long extracranial stabilization with minimal toxicity. The remarkably lengthy progression-free survival reported in our case with the nab-paclitaxel plus trastuzumab combination further confirms the efficacy and the favorable toxicity profile of this promising schedule that showed intriguing results in two phase II studies in first-line MBC and suggests a possible activity on BM. In conclusion, weekly nab-paclitaxel plus trastuzumab may represent a valuable option in the treatment of HER2-positive MBC with BM after radiotherapy and is effective and associated with a good toxicity profile, even in heavily pretreated patients.
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Affiliation(s)
- Giuseppina Rosaria Rita Ricciardi
- Department of Human Pathology, University of Messina, Messina, Italy ; Medical Oncology Unit, Azienda Ospedaliera Ospedali Riuniti Papardo-Piemonte, Messina, Italy
| | - Alessandro Russo
- Department of Human Pathology, University of Messina, Messina, Italy ; Medical Oncology Unit, Azienda Ospedaliera Ospedali Riuniti Papardo-Piemonte, Messina, Italy
| | - Tindara Franchina
- Department of Human Pathology, University of Messina, Messina, Italy ; Medical Oncology Unit, Azienda Ospedaliera Ospedali Riuniti Papardo-Piemonte, Messina, Italy
| | - Giuseppa Ferraro
- Department of Human Pathology, University of Messina, Messina, Italy ; Medical Oncology Unit, Azienda Ospedaliera Ospedali Riuniti Papardo-Piemonte, Messina, Italy
| | - Vincenzo Adamo
- Department of Human Pathology, University of Messina, Messina, Italy ; Medical Oncology Unit, Azienda Ospedaliera Ospedali Riuniti Papardo-Piemonte, Messina, Italy
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23
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Adamo V, Ricciardi GRR, Adamo B, Ferraro G, Franchina T, Rossello R, Zanghì M, Cicero G, Rizzo S, Caristi N, Russo A. The risk of toxicities from trastuzumab, alone or in combination, in an elderly breast cancer population. Oncology 2013; 86:16-21. [PMID: 24335608 DOI: 10.1159/000353450] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 05/31/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Breast cancer in the elderly is associated with high recurrence and death rates, due mostly to undertreatment. Human epidermal growth factor receptor type 2 (HER2) overexpression is infrequent in older patients. Trastuzumab-based chemotherapy is often withheld from elderly patients because of its cardiotoxicity. PATIENTS AND METHODS Medical records of consecutive HER2-positive breast cancer patients aged ≥70 years old treated between 2005 and 2010 in the participating centers were retrospectively reviewed. All patients underwent multidimensional geriatric assessment (MGA). RESULTS Among 59 patients identified, 51 patients were evaluable (median age 76 years). The rate of any adverse event was 20% (10/51). The most relevant cardiac adverse event consisted of symptomatic congestive heart failure (CHF; n = 1, 2%) followed by asymptomatic decreases of left ventricular ejection fraction (LVEF; n = 6, 12%). Other toxicities included moderate hypersensitivity reactions during trastuzumab infusions (n = 3, 6%). Hypertension, obesity, prior anthracyclines exposure and concurrent chemotherapy were associated with a higher incidence of toxic events. Previous radiotherapy, concurrent endocrine therapy and different trastuzumab-based regimens did not seem to influence toxicity. CONCLUSIONS Our data suggest that trastuzumab has a good safety profile in nonfrail women aged 70 years and older. These favorable findings may be related to a limited number of anthracycline pretreatments, patient selection and a close cardiologic monitoring.
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Affiliation(s)
- Vincenzo Adamo
- Department of Human Pathology, Medical Oncology Unit, University of Messina, Messina, Italy
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