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Lido P, Romanello D, Tesauro M, Bei A, Perrone MA, Palazzetti D, Noce A, Di Lullo L, Calò L, Cice G. Verapamil: prevention and treatment of cardio-renal syndromes in diabetic hypertensive patients? Eur Rev Med Pharmacol Sci 2022; 26:1524-1534. [PMID: 35302215 DOI: 10.26355/eurrev_202203_28217] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Patients with diabetes mellitus (DM) often present other chronic comorbidities including arterial hypertension (AH), chronic kidney disease (CKD), ischemic heart disease (IHD) and heart failure with preserved ejection fraction (HFpEF). The frequent association of the latter conditions is considered part of the spectrum of cardio-renal syndromes (CRS), a group of disorders of the heart and kidneys whereby acute or chronic dysfunction in one organ may induce acute or chronic dysfunction of the other. Verapamil is a non-dihydropyridine calcium channel blocker (CCB) widely used in the treatment of hypertension, chronic stable angina, secondary prevention of reinfarction, paroxysmal supra-ventricular tachycardia and for rate control in atrial fibrillation/flutter. In addition to its antihypertensive and anti-ischemic actions verapamil exerts favorable effects also on glycemic control, proteinuric diabetic nephropathy, left ventricular diastolic dysfunction and sympathetic nervous system overactivity which may potentially benefit patients with DM and CRS. In this narrative review, we summarize the current evidence on the potential role of verapamil in the prevention and treatment of CRS in diabetic hypertensive patients.
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Affiliation(s)
- P Lido
- Italian Medicines Agency (AIFA), Rome, Italy.
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2
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Lio V, Pasceri V, Di Lullo L, Russo V, Fimiani F, Calabro' P, Petroni R, Grimaldi M, Renda G, Pignatelli P, Romano S, Penco M, Patti G. Clinical outcome with NOACs vs VKAs in patients with atrial fibrillation and severe chronic kidney disease: results of a retrospective, multicenter, real-world study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Patients with atrial fibrillation (AF) and severe chronic kidney disease (CKD) are at higher risk of both bleeding and thromboembolic events. Non-vitamin K antagonist oral anticoagulants (NOACs) are licensed to be used in these patients, although they were excluded from phase III controlled randomized trials comparing NOACs vs warfarin in AF. Thus, current evidence on NOACs use in such setting of patients is not definitive.
Purpose
Aim of our multicenter study was to perform a real-world comparison of clinical outcome with NOACs vs vitamin K antagonist anticoagulants (VKAs) also in AF patients having an estimated glomerular filtration rate (eGFR) 15–29 mL/min.
Methods
We retrospectively included a total of 266 patients receiving NOACs (N=159) or VKAs (N=107). Primary outcome measure was the cumulative incidence of the net composite endpoint including ischemic stroke, systemic thromboembolism or any bleeding. Mean follow-up was 2.6 years.
Results
CHA2DS2-VASc and HAS-BLED scores at baseline were similar in the two groups (3.4±1.3 with NOACs vs 3.4±0.9 with VKAs and 3.1±1.0 vs 3.0±0.7, respectively); eGFR and hemoglobin values were also comparable (31.8±12.3 vs 32±11.9 mL/min and 10.2±2.1 vs 11.0±2.3 g/dL, respectively). NOACs were not inferior to VKAs for the primary net composite endpoint: incidence 20.7% vs 29.9%, p<0.01 for non-inferiority, p=0.11 for superiority. In proportional Cox regression model, hazard ratio for the primary outcome measure with NOACs use was 0.74 (95% CI 0.45–1.21, p=0.22). In the NOAC group there was a trend towards reduction in minor bleeding complications (p=0.08).
Conclusions
Our real-world data indicate that in patients with AF and severe renal failure NOACs are not inferior to VKAs for both safety and efficacy. The use of NOACs was associated with a numerically lower incidence of minor bleeding.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- V Lio
- University of Eastern Piedmont, Cardiology Department, Novara, Italy
| | - V Pasceri
- San Filippo Neri Hospital, Rome, Italy
| | - L Di Lullo
- L. Parodi - Delfino Hospital, Rome, Italy
| | - V Russo
- AORN Ospedali dei Colli - Monaldi Hospital, Naples, Italy
| | - F Fimiani
- S. Anna-S. Sebastiano Hospital, University of Campania “Luigi Vanvitelli”, Caserta, Italy
| | - P Calabro'
- S. Anna-S. Sebastiano Hospital, University of Campania “Luigi Vanvitelli”, Caserta, Italy
| | - R Petroni
- University della Campania Luigi Vanvitelli, Naples, Italy
| | | | - G Renda
- Regional General Hospital F. Miulli, Acquaviva Delle Fonti, Italy
| | | | - S Romano
- Sapienza University of Rome, Rome, Italy
| | - M Penco
- University of L'Aquila, L'Aquila, Italy
| | - G Patti
- University of Eastern Piedmont, Cardiology Department, Novara, Italy
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3
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Di Lullo L, Ronco C, Cozzolino M, Russo D, Russo L, Di Iorio B, De Pascalis A, Barbera V, Galliani M, Vitaliano E, Campana C, Santoboni F, Bellasi A. Nonvitamin K-dependent oral anticoagulants (NOACs) in chronic kidney disease patients with atrial fibrillation. Thromb Res 2017; 155:38-47. [PMID: 28482261 DOI: 10.1016/j.thromres.2017.04.027] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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: 01/27/2017] [Revised: 04/24/2017] [Accepted: 04/28/2017] [Indexed: 12/17/2022]
Abstract
Atrial fibrillation (AF) represents the most common arrhythmia in patients with chronic kidney disease (CKD). As in the general population, in CKD patients AF is associated with an increased risk of thromboembolism and stroke. However, CKD patients, especially those on renal replacement therapy (RRT), also exhibit an increased risk of bleeding, especially from the gastrointestinal tract. Oral anticoagulation is the most effective form of thromboprophylaxis in patients with AF presenting increased risk of stroke. Limited evidence on efficacy, the increased risk of bleeding as well as some concern regarding the use of warfarin in CKD, has often resulted in the underuse of anticoagulation CKD patients. A large body of evidence suggests that non-vitamin K-dependent oral anticoagulant agents (NOACs) significantly reduce the risk of stroke, intracranial hemorrhage, and mortality, with lower to similar major bleeding rates compared with vitamin K antagonist such as warfarin in normal renal function subjects. Hence, they are currently recommended for patients with atrial fibrillation at risk for stroke. However, NOACs metabolism is largely dependent on the kidneys for elimination and little is known in patients with creatinine clearance <25ml/min who were excluded from all pivotal phase 3 NOACs trials. This review focuses on the current pharmacokinetic, observational, and prospective data on NOACs in patients with moderate to advanced chronic kidney disease (creatinine clearance 15-49ml/min) and those on dialysis.
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Affiliation(s)
- L Di Lullo
- Department of Nephrology and Dialysis, Parodi - Delfino Hospital, Colleferro, Italy.
| | - C Ronco
- International Renal Research Institute, S. Bortolo Hospital, Vicenza, Italy
| | - M Cozzolino
- Department of Health Sciences, Renal Division, S. Paolo Hospital, Milano, Italy
| | - D Russo
- Division of Nephrology, University Federico II, Napoli, Italy
| | - L Russo
- Division of Nephrology, University Federico II, Napoli, Italy
| | - B Di Iorio
- Department of Nephrology and Dialysis, Landolfi Hospital, Solofra, Italy
| | - A De Pascalis
- Department of Nephrology and Dialysis, V. Fazzi Hospital, Lecce, Italy
| | - V Barbera
- Department of Nephrology and Dialysis, Parodi - Delfino Hospital, Colleferro, Italy
| | - M Galliani
- Department of Nephrology and Dialysis, S. Pertini Hospital, Roma, Italy
| | - E Vitaliano
- Department of Nephrology and Dialysis, S. Pertini Hospital, Roma, Italy
| | - C Campana
- Cardiology Unit, S. Anna Hospital, ASST - Lariana, Como, Italy
| | - F Santoboni
- Department of Nephrology and Dialysis, Parodi - Delfino Hospital, Colleferro, Italy
| | - A Bellasi
- Nephrology Unit, S. Anna Hospital, ASST - Lariana, Como, Italy
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Di Lullo L, Bellasi A, Barbera V, Russo D, Russo L, Di Iorio B, Cozzolino M, Ronco C. Pathophysiology of the cardio-renal syndromes types 1-5: An uptodate. Indian Heart J 2017; 69:255-265. [PMID: 28460776 PMCID: PMC5415026 DOI: 10.1016/j.ihj.2017.01.005] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [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: 08/26/2016] [Revised: 12/06/2016] [Accepted: 01/10/2017] [Indexed: 12/19/2022] Open
Abstract
According to the recent definition proposed by the Consensus conference on Acute Dialysis Quality Initiative Group, the term cardio-renal syndrome (CRS) has been used to define different clinical conditions in which heart and kidney dysfunction overlap. Type 1 CRS (acute cardio- renal syndrome) is characterized by acute worsening of cardiac function leading to AKI (5, 6) in the setting of active cardiac disease such as ADHF, while type - 2 CRS occurs in a setting of chronic heart disease. Type 3 CRS is closely link to acute kidney injury (AKI), while type 4 represent cardiovascular involvement in chronic kidney disese (CKD) patients. Type 5 CRS represent cardiac and renal involvement in several diseases such as sepsis, hepato - renal syndrome and immune - mediated diseases.
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Affiliation(s)
- L Di Lullo
- Department of Nephrology and Dialysis, L. Parodi - Delfino Hospital, Colleferro Rome, Italy.
| | - A Bellasi
- Department of Nephrology and Dialysis, S. Anna Hospital, Como, Italy
| | - V Barbera
- Department of Nephrology and Dialysis, L. Parodi - Delfino Hospital, Colleferro Rome, Italy
| | - D Russo
- Division of Nephrology, University of Naples "Federico II", Napoli, Italy
| | - L Russo
- Division of Nephrology, University of Naples "Federico II", Napoli, Italy
| | - B Di Iorio
- Department of Nephrology and Dialysis, A. Landolfi Hospital, Solofra, Avellino, Italy
| | - M Cozzolino
- Department of Health Sciences, Renal Division, San Paolo Hospital, University of Milan, Italy
| | - C Ronco
- International Renal Research Institute, S. Bortolo Hospital, Vicenza, Italy
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5
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Pieri M, Frakulli R, Macchia G, Farioli A, Cilla S, Deodato F, Ammendolia I, Tolento G, Cammelli S, Di Lullo L, Taffurelli M, Zamagni C, Smaniotto D, Marazzi F, Valentini V, Ferrandina G, Morganti A. Hypofractionated radiotherapy after conservative surgery in breast cancer patients: a phase I-II trial (MARA-1). Eur J Cancer 2017. [DOI: 10.1016/s0959-8049(17)30172-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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6
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Di Lullo L, Rivera R, Barbera V, Bellasi A, Cozzolino M, Russo D, De Pascalis A, Banerjee D, Floccari F, Ronco C. Sudden cardiac death and chronic kidney disease: From pathophysiology to treatment strategies. Int J Cardiol 2016; 217:16-27. [PMID: 27174593 DOI: 10.1016/j.ijcard.2016.04.170] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 04/27/2016] [Accepted: 04/30/2016] [Indexed: 02/07/2023]
Abstract
Chronic kidney disease (CKD) patients demonstrate higher rates of cardiovascular mortality and morbidity; and increased incidence of sudden cardiac death (SCD) with declining kidney failure. Coronary artery disease (CAD) associated risk factors are the major determinants of SCD in the general population. However, current evidence suggests that in CKD patients, traditional cardiovascular risk factors may play a lesser role. Complex relationships between CKD-specific risk factors, structural heart disease, and ventricular arrhythmias (VA) contribute to the high risk of SCD. In dialysis patients, the occurrence of VA and SCD could be exacerbated by electrolyte shifts, divalent ion abnormalities, sympathetic overactivity, inflammation and iron toxicity. As outcomes in CKD patients after cardiac arrest are poor, primary and secondary prevention of SCD and cardiac arrest could reduce cardiovascular mortality in patients with CKD.
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Affiliation(s)
- L Di Lullo
- Department of Nephrology and Dialysis, L. Parodi - Delfino Hospital, Colleferro, Rome, Italy.
| | - R Rivera
- Division of Nephrology, S. Gerardo Hospital, Monza, Italy
| | - V Barbera
- Department of Nephrology and Dialysis, L. Parodi - Delfino Hospital, Colleferro, Rome, Italy
| | - A Bellasi
- Department of Nephrology and Dialysis, S. Anna Hospital, Como, Italy
| | - M Cozzolino
- Department of Health Sciences, Renal Division, San Paolo Hospital, University of Milan, Italy
| | - D Russo
- Division of Nephrology, University of Naples "Federico II", Naples, Italy
| | - A De Pascalis
- Department of Nephrology and Dialysis, Vito Fazzi Hospital, Lecce, Italy
| | - D Banerjee
- Consultant Nephrologist and Reader, Clinical Sub Dean, Renal and Transplantation Unit, St George's University, London, UK
| | - F Floccari
- Department of Nephrology and Dialysis, S. Paolo Hospital, Civitavecchia, Italy
| | - C Ronco
- International Renal Research Institute, S. Bortolo Hospital, Vicenza, Italy
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7
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Picardi V, Macchia G, Di Bartolomeo M, Giordano M, Nuzzo M, Caravatta L, Gambacorta M, Di Lullo L, Guido A, Giaccherini L, Fuccio L, Golfieri R, Cuicchi D, Ugolini G, Cammelli S, Frezza G, Morganti A, Valentini V, Deodato F. PO-0715: Chemoradiation with concomitant boost in rectal cancer (T4&recurrences): a phase II study. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)31965-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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8
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Nuzzo M, Macchia G, Cilla S, Ingrosso M, Digesù C, Di Lullo L, Ippolito E, Deodato F, Siepe G, Ntreta M, Pieri M, Cammelli S, Schiavina R, Martorana G, Di Lallo A, Angelini A, Frezza G, Valentini V, Morganti A. EP-1348: Endoscopic evaluation of late rectal toxicity after radiotherapy in 597 prostate cancer patients. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32598-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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9
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Carrozza F, Spina C, Viglione M, Franchella C, Bellomo M, Antonecchia P, Manfredi Selvaggi T, Musacchio M, Antuzzi G, Specchia M, Piano S, Silvestri A, Giglio G, Fabrizio G, Di Lullo L. Integrated support in neoplastic patient and family: experience of molise in ccm 2012 project. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv347.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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10
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Di Lullo L, Viglione M, Spina C, Franchella C, Bellomo M, Antonecchia P, Manfredi Selvaggi T, Santella P, Marra G, Musacchio M, Antuzzi G, Silvestri A, Specchia M, Piano S, Giglio G, Fabrizio G, Carrozza F. The importance of network intervention for cancer patient welfare. the ccm 2012 project: the molise experience. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv347.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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11
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Di Lullo L, Gorini A, Rivera R, De Pascalis A, Bellasi A, Russo D, Barbera V, Ronco C, Balducci A, Santoboni A. [Cardiac magnetic resonance and uremic cardiomyopathy]. G Ital Nefrol 2014; 31:gin/00199.6. [PMID: 25504164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Cardiovascular disease (CV) represents the main risk factor for morbidity and mortality in chronic kidney disease (CKD) patients. Large epidemiological studies have shown direct association between severity of CKD and CV event rates. Although patients with end-stage renal disease (ESRD), including dialysis ones, are at greater CV risk, cardiovascular involvement is already evident at the early stages of CKD. End-stage CKD is characterized conventional atherosclerotic risk factor but they cannot account for CV risk as reflected in high rates of sudden cardiac death, heart failure and myocardial infarction. Non-atherosclerotic processes, including left ventricular hypertrophy and fibrosis, mostly account for the excess risk of CV. Employment of cardiac magnetic resonance (CMR) in CKD has brought an improved understanding of the adverse CV changes, known as uremic cardiomyopathy. It is due to ability of cardiac magnetic resonance to provide a comprehensive non - invasive examination of cardiac structure and function, arterial function, myocardial tissue characterization (T1 mapping and inversion recovery imaging), and myocardial metabolic function (spectroscopy).
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Gerakis A, Halapas A, Chrissoheris M, Giatras I, Andritsou R, Nikolaou I, Bouboulis N, Pattakos E, Spargias K, Kalaitzidis R, Karasavvidou D, Pappas K, Katatsis G, Tatsioni A, Siamopoulos K, de Borst MH, Hajhosseiny R, Tamez H, Wenger J, Thadhani R, Goldsmith DJ, Zanoli L, Rastelli S, Marcantoni C, Blanco J, Tamburino C, Castellino P, Larsen T, Jensen J, Bech J, Pedersen E, Mose F, Leckstrom D, Bhuvanakrishna T, McGrath A, Goldsmith D, Muras K, Masajtis-Zagajewska A, Nowicki M, Rayner HC, Baharani J, Smith S, Suresh V, Dasgupta I, Karasavvidou D, Kalaitzidis R, Zarzoulas F, Balafa O, Tatsioni A, Siamopoulos K, Di Lullo L, Floccari F, Rivera R, Gorini A, Malaguti M, Barbera V, Granata A, Santoboni A, Luczak M, Formanowicz D, Pawliczak E, Wanic-Kossowska M, Koziol L, Figlerowicz M, Bommer J, Fliser M, Roth P, Saure D, Vettoretti S, Alfieri C, Floreani R, Regalia A, Bonanomi C, Meazza R, Magrini F, Messa P, Jankowski V, Zidek W, Joachim J, Lee K, Hwang IH, Lee SB, Lee DW, Kim IY, Kwak IS, Seong EY, Shin MJ, Rhee H, Yang BY, Dattolo P, Michelassi S, Sisca S, Allinovi M, Amidone M, Mehmetaj A, Pizzarelli F, Filiopoulos V, Manolios N, Hadjiyannakos D, Arvanitis D, Panagiotopoulos K, Vlassopoulos D, Kim JS, Han BG, Choi SO, Yang JW, Shojai S, Babu A, Boddana P, Dipankar D, Alvarado R, Garcia-Pino G, Ruiz-Donoso E, Chavez E, Luna E, Caravaca F, Geiger H, Buttner S, Lv LL, Cao Y, Zheng M, Liu BC, Kouvelos GN, Raikou VD, Arnaoutoglou EM, Milionis HJ, Boletis JN, Matsagkas MI, Raiola I, Trepiccione F, Pluvio M, Raiola R, Capasso G, Kaykov I, Kukoleva L, Zverkov R, Smirnov A, Hammami S, Frih A, Hajem S, Hammami M, Wan L. Pathophysiology and clinical studies in CKD 1-5. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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13
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Di Lullo L, Floccari F, Rivera R, Barbera V, Granata A, Otranto G, Mudoni A, Malaguti M, Santoboni A, Ronco C. Pulmonary Hypertension and Right Heart Failure in Chronic Kidney Disease: New Challenge for 21st-Century Cardionephrologists. Cardiorenal Med 2013; 3:96-103. [PMID: 23922549 DOI: 10.1159/000350952] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Pulmonary hypertension is defined as an increased systolic pulmonary pressure of >30 mm Hg, and it shows a 40% prevalence in hemodialysis patients due to vascular access (both central venous catheter and arteriovenous fistula). Secondary pulmonary hypertension in chronic kidney disease patients is strictly related to pulmonary circulation impairment together with chronic volume overload and increased levels of cytokines and growth factors, such as FGF, PDGF, and TGF-β, leading to fibrosis. Endothelial dysfunction, together with lower activation of NOS, increased levels of serum endothelin and fibrin storages, involves an extensive growth of endothelial cells leading to complete obliteration of pulmonary vessels. Pulmonary hypertension has no pathognomonic and distinctive symptoms and signs; standard transthoracic echocardiography allows easy assessment of compliance of the right heart chambers. The therapeutic approach is based on traditional drugs such as digitalis-derived drugs, vasodilatory agents (calcium channel blockers), and oral anticoagulants. New pharmacological agents are under investigation, such as prostaglandin analogues, endothelin receptor blockers, and phosphodiesterase-5 inhibitors.
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Affiliation(s)
- L Di Lullo
- Department of Nephrology and Dialysis, L. Parodi Delfino Hospital, Colleferro, Italy
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14
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Floccari F, Granata A, Rivera R, Marrocco F, Santoboni A, Malaguti M, Andrulli S, Di Lullo L. Echocardiography and right ventricular function in NKF stage III cronic kidney disease: Ultrasound nephrologists' role. J Ultrasound 2012; 15:252-6. [PMID: 23730390 DOI: 10.1016/j.jus.2012.09.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
TAPSE measurement during echocardiography is a well known measure of right heart systo-diastolic function. Low TAPSE means reduced cranio-caudal excursion of tricuspidal annulus, sign of both reduced ejection fraction and reduced distensibility of right ventricle. It is a good prognostic index for cardiac mortality risk in CHF patients, adding significant prognostic information to NYHA stadiation. Nephrologists do not always fully aware of right ventricular function in their patients affected by chronic renal failure (CRF), even if this datum is probably crucial in vascular access policy. Our study was designed to study right ventricle function and TAPSE on 202 patients affected by moderate chronic renal failure, free from overt pulmonary hypertension. TAPSE, PAPs, right chambers diameters, classical Framingham factors, estimated glomerular filtration rate were recorded. TAPSE was reduced (<23 mm) in 43% of patients enrolled, while dilated right chambers were present in 24%. PAPs exceeded 30 mmHg in 29% of patients. Echocardiographic signs of left ventricular hypertrophy were found in 36% of patients. The ejection fraction was normal in all patients. Statistical analysis showed a significant indirect correlation between TAPSE and PAPs and between TAPSE and tele-diastolic diameters and volumes of the right ventricle, while a direct correlation was observed between TAPSE and Framingham score. TAPSE showed a bimodal distribution, with a subpopulation "low TAPSE - high PAPs", next to a population characterized by normal values ??for both parameters. A reduction in compliance and systolic function of the right heart chambers is quite early and frequent in course of CKD, a fact that the nephrologist should take in due consideration, managing blood volume or planning vascular access for hemodialysis.
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Affiliation(s)
- F Floccari
- Nephrology and Dialysis Unit, San Paolo Hospital, Civitavecchia, Italy
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15
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Digesù C, Macchia G, Deodato F, Cilla S, Massaccesi M, Borriello M, Di Lullo L, Pacelli F, Valentini V, Morganti A. PD-0215 A CLINICAL COMPARISON BETWEEN ACCELERATED IMRT VERSUS STANDARD TREATMENT ON 446 BREAST CANCER PATIENTS. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)70554-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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16
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Di Lullo L, Floccari F, Granata A, Fiorini F, Polito P. Dyspnea in hemodialysis and early echocardiographic examination at the bedside: Two case reports. J Ultrasound 2011; 14:110-2. [PMID: 23397469 DOI: 10.1016/j.jus.2011.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- L Di Lullo
- Department of Nephrology and Dialysis, S. Giovanni Evangelista Hospital, Tivoli (Rome), Italy
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Choi HJ, Lim JS, Park EJ, Jung HJ, Lee YJ, Kwon TH, Cesar KR, Araujo M, de Braganca AC, Magaldi AJ, Freisinger W, Ditting T, Heinlein S, Schatz J, Veelken R, Burki R, Mohebbi N, Wang X, Serra A, Wagner C, Ditting T, Freisinger W, Rodionova K, Heinlein S, Schmieder R, Veelken R, Yano Y, Kudo LH, Magaldi AJ, Choi HJ, Yoon YJ, Lim JS, Hwang GS, Kwon TH, Jo CH, Kim S, Park JS, Lee CH, Kang CM, Kim GH, Kokeny G, Szoleczky P, Fang L, Rosivall L, Mozes MM, Freisinger W, Schatz J, Lampert A, Ditting T, Veelken R, Yano Y, Magaldi AJ, LEE WC, Wang YC, Chen JB, Santos C, Gomes AM, Ventura A, Almeida C, Seabra J, Daher E, Leite de Figueiredo P, Montenegro R, Montenegro R, Martins M, Bezerra da Silva G, Liborio A, Sromicki J, Matter S, Sitzmann K, Hess B, Lee J, Kim S, Lee JW, Oh YK, Na KY, Joo KW, Earm JH, Han JS, Ninchoji T, Kaito H, Nozu K, Hashimura Y, Nakanishi K, Yoshikawa N, Iijima K, Matsuo M, Gorini A, Addesse R, Comegna C, Galderisi C, Cecilia A, Tomaselli M, Di Lullo L, Polito P. Acid-base/Na, K, Cl. Experimental and clinical. Clin Kidney J 2011. [DOI: 10.1093/ndtplus/4.s2.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Di Lullo L, Addesse R, Comegna C, Galderisi C, Iannacci G, Polito P. Th-P16:393 Effects on lipid profile, chronic inflammation and renal function of fluvastatin treatment in dyslipidaemic patients with chronic renal failure. ATHEROSCLEROSIS SUPP 2006. [DOI: 10.1016/s1567-5688(06)82351-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Di Lullo L, Addesse R, Comegna C, Firmi G, Galderisi C, Iannacci GR, Polito P. Effects of fluvastatin treatment on lipid profile, C-reactive protein trend, and renal function in dyslipidemic patients with chronic renal failure. Adv Ther 2005; 22:601-12. [PMID: 16510377 DOI: 10.1007/bf02849954] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [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: 12/21/2022]
Abstract
The purpose of this trial was to evaluate the effects of fluvastatin on the lipid pro-file and on renal function, as measured by creatinine clearance, in dyslipidemic patients with chronic renal failure. In this 8-month prospective, open-label, randomized, parallel-group trial, 130 patients (70 men and 60 women), after a 2-month washout period following previous lipid-lowering treatments, were randomly assigned to fluvastatin XL 80 mg given once daily (80 patients) or to standard treatment (50 patients). Mean total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and triglyceride values after 3 and 6 months of treatment with fluvastatin showed statistically significant improvement compared with standard treatment. Improved renal function, as measured by creatinine clearance, was observed at the end of the 6-month treatment period in approximately 65% of patients treated with fluvastatin. The increase in creatinine clearance consistently reached 10% to 15% of baseline values. A statistically significant reduction in C-reactive protein (CRP) over baseline values was observed in approximately 75% of patients treated with fluvastatin. Furthermore, mean values of CRP for the fluvastatin standard treatment groups, respectively, were 6.78 and 10.19 at 3 months and 4.47 and 11 at 6 months. Both treatments were well tolerated. No major adverse events were noted. Results of this study suggest that fluvastatin treatment in patients with chronic renal failure is effective in improving the lipid profile, and it demonstrates good safety and tolerability. Furthermore, fluvastatin may contribute to improved nephroprotection in this patient population.
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Affiliation(s)
- L Di Lullo
- Department of Nephrology and Dialysis, S. Giovanni Evangelista Hospital, Tivoli, Rome, Italy
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Adamo V, Ferrandina G, Spada M, Ferrau’ F, Condemi G, Di Lullo L, Lorusso D, Rossello R, Garipoli C, Scambia G. Gemcitabine (GEM) and liposomal doxorubicin (PLD) in recurrent/metastatic breast carcinoma: A phase II study. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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)
- V. Adamo
- Policlinico Univ “G. Martino”, Messina, Italy; Catholic Univ, Rome, Italy; Ospedale Oncologico, Bari, Italy; Presidio Ospedaliero S. Vincenzo, Taormina, Italy; Ospedale della Locride, Siderno, Italy; Presidio Ospedaliero F. Veneziale, Isernia, Italy; Catholic Univ, Campobasso, Italy; Policlinico Univ, Messina, Italy
| | - G. Ferrandina
- Policlinico Univ “G. Martino”, Messina, Italy; Catholic Univ, Rome, Italy; Ospedale Oncologico, Bari, Italy; Presidio Ospedaliero S. Vincenzo, Taormina, Italy; Ospedale della Locride, Siderno, Italy; Presidio Ospedaliero F. Veneziale, Isernia, Italy; Catholic Univ, Campobasso, Italy; Policlinico Univ, Messina, Italy
| | - M. Spada
- Policlinico Univ “G. Martino”, Messina, Italy; Catholic Univ, Rome, Italy; Ospedale Oncologico, Bari, Italy; Presidio Ospedaliero S. Vincenzo, Taormina, Italy; Ospedale della Locride, Siderno, Italy; Presidio Ospedaliero F. Veneziale, Isernia, Italy; Catholic Univ, Campobasso, Italy; Policlinico Univ, Messina, Italy
| | - F. Ferrau’
- Policlinico Univ “G. Martino”, Messina, Italy; Catholic Univ, Rome, Italy; Ospedale Oncologico, Bari, Italy; Presidio Ospedaliero S. Vincenzo, Taormina, Italy; Ospedale della Locride, Siderno, Italy; Presidio Ospedaliero F. Veneziale, Isernia, Italy; Catholic Univ, Campobasso, Italy; Policlinico Univ, Messina, Italy
| | - G. Condemi
- Policlinico Univ “G. Martino”, Messina, Italy; Catholic Univ, Rome, Italy; Ospedale Oncologico, Bari, Italy; Presidio Ospedaliero S. Vincenzo, Taormina, Italy; Ospedale della Locride, Siderno, Italy; Presidio Ospedaliero F. Veneziale, Isernia, Italy; Catholic Univ, Campobasso, Italy; Policlinico Univ, Messina, Italy
| | - L. Di Lullo
- Policlinico Univ “G. Martino”, Messina, Italy; Catholic Univ, Rome, Italy; Ospedale Oncologico, Bari, Italy; Presidio Ospedaliero S. Vincenzo, Taormina, Italy; Ospedale della Locride, Siderno, Italy; Presidio Ospedaliero F. Veneziale, Isernia, Italy; Catholic Univ, Campobasso, Italy; Policlinico Univ, Messina, Italy
| | - D. Lorusso
- Policlinico Univ “G. Martino”, Messina, Italy; Catholic Univ, Rome, Italy; Ospedale Oncologico, Bari, Italy; Presidio Ospedaliero S. Vincenzo, Taormina, Italy; Ospedale della Locride, Siderno, Italy; Presidio Ospedaliero F. Veneziale, Isernia, Italy; Catholic Univ, Campobasso, Italy; Policlinico Univ, Messina, Italy
| | - R. Rossello
- Policlinico Univ “G. Martino”, Messina, Italy; Catholic Univ, Rome, Italy; Ospedale Oncologico, Bari, Italy; Presidio Ospedaliero S. Vincenzo, Taormina, Italy; Ospedale della Locride, Siderno, Italy; Presidio Ospedaliero F. Veneziale, Isernia, Italy; Catholic Univ, Campobasso, Italy; Policlinico Univ, Messina, Italy
| | - C. Garipoli
- Policlinico Univ “G. Martino”, Messina, Italy; Catholic Univ, Rome, Italy; Ospedale Oncologico, Bari, Italy; Presidio Ospedaliero S. Vincenzo, Taormina, Italy; Ospedale della Locride, Siderno, Italy; Presidio Ospedaliero F. Veneziale, Isernia, Italy; Catholic Univ, Campobasso, Italy; Policlinico Univ, Messina, Italy
| | - G. Scambia
- Policlinico Univ “G. Martino”, Messina, Italy; Catholic Univ, Rome, Italy; Ospedale Oncologico, Bari, Italy; Presidio Ospedaliero S. Vincenzo, Taormina, Italy; Ospedale della Locride, Siderno, Italy; Presidio Ospedaliero F. Veneziale, Isernia, Italy; Catholic Univ, Campobasso, Italy; Policlinico Univ, Messina, Italy
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Recchia F, Saggio G, Nuzzo A, Lalli A, Lullo LD, Cesta A, Rea S. Multicentre phase II study of bifractionated CPT-11 with bimonthly leucovorin and 5-fluorouracil in patients with metastatic colorectal cancer pretreated with FOLFOX. Br J Cancer 2004; 91:1442-6. [PMID: 15467766 PMCID: PMC2409925 DOI: 10.1038/sj.bjc.6602194] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [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] [Indexed: 12/18/2022] Open
Abstract
This multicentre phase II study was designed to evaluate the antitumour activity and toxicity of bifractionated camptothecin (CPT-11) and 5-fluorouracil/ leucovorin (5-FU/LV) in the treatment of patients with metastatic colorectal cancer (MCC) who had been pretreated with 5-FU/LV-oxaliplatin (FOLFOX regimen). In all, 35 patients were enrolled in a two-stage trial. Treatment consisted of two daily doses of CPT-11, 90 mg m2 administered over 90 min, followed by LV, 200 mg m2 administered over 2 h plus 5-FU 400 mg m2 as a bolus and 600 mg m2 as a 22-h continuous infusion administered with disposable pumps as outpatient therapy. Toxicity was closely monitored. Response was evaluated by computed tomography scans every 8 weeks. All 35 patients were assessable for toxicity and response to treatment. Seven patients had a partial response, giving an overall response rate of 20%; 11 patients had stable disease (31.4%) and 17 progressed (48.5%). The median progression-free survival was 7.1 months and median survival was 14 months. A total of 10 patients (30%) experienced grade 3-4 toxicity, including nausea (15%), diarrhoea (12%) and neutropenia (15%), while seven patients (21%) had grade 2 alopecia. The bifractionated bimonthly schedule of CPT-11 plus 5-FU/LV showed substantial antitumour activity and was well tolerated in this group of patients with a poor prognosis, pretreated with the FOLFOX regimen.
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Affiliation(s)
- F Recchia
- Unità operativa di Oncologia, Ospedale Civile di Avezzano, Italy.
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Recchia F, Nuzzo A, Lalli A, Di Lullo L, De Filippis S, Saggio G, Di Blasio A, Rea S. Multicenter phase II study of CPT-11 fractionated over two days with bimonthly leucovorin and 5-fluorouracil in patients with metastatic colorectal cancer. Anticancer Res 2003; 23:2903-8. [PMID: 12926132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
PURPOSE This multicenter phase II study evaluated the activity and toxicity of the combination of fractionated camptothecin (CPT-11) and 5-fluorouracil/leucovorin (5-FU/LV) (de Gramont regimen) for the treatment of metastatic colorectal cancer (MCC) patients who had received no prior chemotherapy for metastatic disease. PATIENTS AND METHODS Fifty-four patients with a median age of 63.5 years (range: 43-75), received, every two weeks, a regimen consisting of 2 daily doses of CPT-11, 90 mg/m2 administered over a period of 90 minutes, followed by LV, 200 mg/m2 administered over 2 hours and 5-FU 400 mg/m2 as a bolus and 600 mg/m2 as a 22-hour continuous infusion. Sixty-five percent of patients had synchronous metastatic disease at diagnosis, while 35% of the patients had received adjuvant chemotherapy after radical surgery. RESULTS All 54 patients, receiving a total of 561 cycles of chemotherapy (median 12 per patient, range 1-26), were assessable for toxicity and response to treatment. The most common toxicities (grade 3-4) among treated patients were as follows: diarrhea in 3 patients, (6%), neutropenia in 9 patients (17%) and asthenia in 3 patients (6%), with no treatment-related death. We observed 4 complete (7.4%) and 18 partial responses (33.3%), giving an overall response rate of 40.7% (95% CI: 28% to 55%); 22 patients had stable disease (40.7%) and 10 patients progressed (18.5%). After a median follow-up of 22 months, the median time to progression was 8.7 months (range 2.3-43.9+), while overall median survival was 18.8 months (range 0.7-43.9+). CONCLUSION The fractionated bimonthly schedule of CPT-11 plus 5-FU/LV showed a lower gastrointestinal toxicity profile than expected, with substantial activity in patients with MCC.
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Affiliation(s)
- F Recchia
- Unità operative di Oncologia, Ospedale Civile di Avezzano, Fondazione Carlo Ferri, Monterotondo, Roma, Italy.
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Recchia F, Rea S, Nuzzo A, Lalli A, Di Lullo L, De Filippis S, Saggio G, Di Blasio A, Massa E, Mantovani G. Multicenter phase II study of fractionated bimonthly oxaliplatin with leucovorin and 5-fluorouracil in patients with metastatic colorectal cancer, pre-treated with chemotherapy. Oncol Rep 2003. [DOI: 10.3892/or.10.1.65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Recchia F, Rea S, Nuzzo A, Lalli A, Di Lullo L, De Filippis S, Saggio G, Di Blasio A, Massa E, Mantovani G. Multicenter phase II study of fractionated bimonthly oxaliplatin with leucovorin and 5-fluorouracil in patients with metastatic colorectal cancer, pre-treated with chemotherapy. Oncol Rep 2003; 10:65-9. [PMID: 12469146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
Abstract
In vitro and in vivo studies have shown that oxaliplatin (L-OHP), 5-fluorouracil (5-FU) and leucovorin (L) have a synergistic activity on metastatic colorectal cancer (MCC). In order to better exploit the synergism of action between the three drugs, L-OHP was administered over 2 days, together with 5-FU-L, in a cohort of patients with MCC that had been pre-treated with chemotherapy. Forty-six patients were entered into the trial. All had been pre-treated with chemotherapy for metastatic disease: 14 with the 'de Gramont' regimen alone, and 32 with the same regimen combined with irinotecan (CPT-11). The outpatient treatment consisted of L-OHP 50 mg/m(2), followed immediately by the 'de Gramont' regimen. All drugs were administered on days 1 and 2, every 14 days. Median patient age was 65 years (range: 46-78), male/female ratio was 29/17. All 46 patients were evaluated for response and toxicity. We observed 1 complete response (2.2%) and 14 partial responses (30.4%), giving an overall response rate of 32.6% (95% CI: 19.5-48.06%); 22 patients had stable disease (47.8%) and 9 patients progressed (19.6%). After a median follow-up of 13 months, median time to progression was 6.4 months (range: 3.1-31.2+), while overall median survival was 12.2 months (range: 3.7-31.2+). Toxicity was manageable: grade 3 or 4 neutropenia was observed in 33% of patients, while only 6% of patients had grade 1-2 neurotoxicity. The fractionated bimonthly schedule of L-OHP plus 5-FU-L, showed activity, with an acceptable toxicity profile, both in patients with MCC pre-treated with the 'de Gramont' regimen alone, or with this regimen associated with CPT-11.
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Affiliation(s)
- F Recchia
- Unita operative di Oncologia, Ospedale Civile di Avezzano, Universita degli studi de L'Aquila, Italy.
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Comella P, Biglietto M, Casaretti R, De Lucia L, Avallone A, Maiorino L, Di Lullo L, De Cataldis G, Rivellini F, Comella G. Irinotecan and mitomycin C in 5-fluorouracil-refractory colorectal cancer patients. A phase I/II study of the Southern Italy Cooperative Oncology Group. Oncology 2001; 60:127-33. [PMID: 11244327 DOI: 10.1159/000055309] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [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: 11/19/2022]
Abstract
PURPOSE To define the maximum tolerated dose (MTD) of irinotecan (CPT-11) given on days 1 and 8 with mitomycin C (MMC) given on day 1 in a monthly cycle, and to assess the toxicity and activity of this regimen in patients with previously treated colorectal carcinoma. METHODS Fifty-two patients, all pretreated with adjuvant 5-fluorouracil (20 patients) and/or one (35 patients) or two (8 patients) lines of chemotherapy, were entered in this study. Escalating doses of CPT-11 (starting from 150 mg/m2) were administered on days 1 and 8, with escalating doses of MMC (starting from 8 mg/m2) given on day 1, recycling every 28 days. At least 3 patients were treated at each dose level. Escalation proceeded unless 2 out of 3 or 4 out of 6 patients experienced a dose-limiting toxicity (DLT) after the first cycle. RESULTS Twelve patients were entered in the phase I study, and 4 consecutive dose levels were tested. At the last dose level (CPT-11 200 mg/m2 plus MMC 10 mg/m2) 4 of 6 patients experienced a DLT (i.e., grade 4 neutropenia in 2 patients and grade 3 diarrhea in 2 patients). Therefore, this dose level was considered as the MTD. Forty patients were treated at the previous dose level (CPT-11, 175 mg/m2 plus MMC 10 mg/m2). One complete, 4 partial, 3 minor responses and 11 cases of stable disease were registered, giving a response rate of 12% [95% confidence interval (CI), 4-27%] and an overall control of tumor growth in 47% (95% CI, 31-64%) of patients. The median time to treatment failure was 6 months (range 1-19+). The median survival time was 14.5 months, and the 1-year and 2-year probability of survival were 56 and 43%. Neutropenia and diarrhea affected 62 and 58% of patients, grade 3 or 4 being registered in 26 and 23% of them, respectively. One episode of neutropenic fever was reported. Other acute toxicities were usually mild and manageable. CONCLUSIONS CPT-11 175 mg/m2 on days 1 and 8 associated with MMC 10 mg/m2 on day 1, every 4 weeks, is a safe and moderately active regimen in heavily pretreated patients with advanced colorectal carcinoma. The role of MMC in this combination is doubtful, and further attempts with other new agents should be made to improve the outcome in these patients.
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Affiliation(s)
- P Comella
- Division of Medical Oncology A, National Tumour Institute, Naples, Italy.
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Mazzanti P, Massacesi C, Mattioli R, Trivisonne R, Buzzi F, De Signoribus G, Tuveri G, Rossi G, Di Lullo L, Bonsignori M. Gemcitabine-cisplatin (GP) vs gemcitabine-carboplatin (GC) in advanced non-small cell lung cancer (NSCLC): a multicenter phase II randomized trial. Eur J Cancer 2001. [DOI: 10.1016/s0959-8049(01)80664-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Recchia F, Lococo A, Campisi C, Lalli A, Di Lullo L, De Filippis S, Vaccarili M, Zappalà A, Corrao G, Rea S. Carboplatin, ifosfamide, and vinorelbine in the treatment of advanced non-small-cell lung cancer: a phase II study. Am J Clin Oncol 1999; 22:57-61. [PMID: 10025382 DOI: 10.1097/00000421-199902000-00014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 11/26/2022]
Abstract
The authors evaluated the efficacy and toxicity of the combination of carboplatin, ifosfamide, and vinorelbine in the treatment of advanced non-small-cell lung cancer. From March 1994 through March 1996, 56 previously untreated patients with stage IIIB or stage IV non-small-cell lung cancer with measurable lesions and good performance status were entered in the study. The chemotherapy schedule was as follows: carboplatin 100 mg/m2 and ifosfamide 1,500 mg/m2 with mesna on days 1, 2, and 3; vinorelbine 25 mg/m2 on days 1 and 8, every 21 days; for a total of six courses. Among 55 evaluable patients there were three complete responses (5%) and 22 partial responses (40%), for a response rate of 45% (95% confidence interval, 32-59%). The median response duration was 10.3 months (range, 2.5-27.7 months), and median survival time was 11.3 months (range, 1.1-28.1 months). The survival rate at 1 year was 48%. Toxicity included hematologic toxicity in 60% of the 247 treatment cycles administered, nausea, alopecia, and neuropathy. One pathologic complete response was observed in a patient with stage IIIB disease who became operable after four courses of chemotherapy. The outpatient treatment with carboplatin, ifosfamide, and vinorelbine shows activity in advanced non-small-cell lung cancer. The toxicity was well tolerated by patients with a good performance status.
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Affiliation(s)
- F Recchia
- Division of Oncology, Civil Hospital, Avezzano, Italy
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Cobelli S, Scanni A, Battelli T, Pisone A, Frontini L, Di Lullo L, Mattioli R. Vinorelbine (VNR) + 5-fluorouracil continuous infusion (5-FU c.i.) in pretreated advanced breast cancer — Adria Medica Group. Eur J Cancer 1998. [DOI: 10.1016/s0959-8049(98)80062-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Di Lullo L, De Rosa FG, Coviello R, Sorgi ML, Coen G, Zorzin LR, Casato M. Interferon toxicity in hepatitis C virus-associated type II cryoglobulinemia. Clin Exp Rheumatol 1998; 16:506. [PMID: 9706438] [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] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Recchia F, Nuzzo A, Lalli A, Lombardo M, Di Lullo L, Fabiani F, Fanini R, Venturoni L, Torchio P, Peretti G. Randomized trial of 5-fluorouracil and high-dose folinic acid with or without alpha-2B interferon in advanced colorectal cancer. Am J Clin Oncol 1996; 19:301-4. [PMID: 8638546 DOI: 10.1097/00000421-199606000-00019] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [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: 02/01/2023]
Abstract
We evaluated the role of low-dose alpha-2b interferon, added to chemotherapy, for advanced colorectal cancer; we randomized patients, to either a combination chemotherapy of 5-fluorouracil (5-FU) and high-dose folinic acid (HDFA) or the same regimen plus interferon. Between January 1990 and March 1992, 100 untreated patients (PTS) with advanced colorectal cancer, 53 men and 47 women, with an ECOG performance status (PS) of < or = 3, were randomized to either HDFA 200 mg/m2 iv bolus and 5FU 370 mg/m2 in 15-min iv infusion days 1-5 every 4 weeks (arm A), or the same chemotherapy plus IFN 3 x 10(6) IU subcutaneously three times a week in chemotherapy intervals (arm B). A total of 97 PTS are evaluable for response, toxicity, and survival; 3 PTS are not evaluable in arm B for major protocol violations. PTS characteristics were well balanced in both arms for age (median, 64 years), disease-free survival, and disease site. ECOG PS was 0 in 28% of PTS in arm A and in 13% in arm B. Response rates were as follows: arm A, 40%; and arm B, 23%. Median time to failure was as follows: 10.2 months arm A versus 9 months arm B. Median survival was as follows: 13.3 months arm A versus 10.9 months arm B. Grade 3 haematological toxicity was 9% of PTS in both arms. Gastrointestinal toxicity was as follows: 17% arm A versus 22% arm B. The cost of drugs expressed per m2/month was $60 in arm A and $390 in arm B. The results show that IFN at the schedule and doses employed adds no benefit to the combination of 5FU/HDFA.
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Affiliation(s)
- F Recchia
- Istituto Oncologico Regione Abruzzo e Molise (IORAM), Avezzano, Chieti, Italy
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Casato M, Antonelli G, Maggi F, Pucillo LP, Di Lullo L, Leoni M, Currenti M, Dianzani F, Bonomo L. Resistance to recombinant alpha interferon therapy in idiopathic mixed cryoglobulinemia: reinduction of remission by natural alpha interferon both in antibody-positive and -negative patients. J BIOL REG HOMEOS AG 1994; 8:56-9. [PMID: 7863814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A subset of patients treated with recombinant interferon alpha-2a (rIFN-alpha 2a) for idiopathic mixed cryoglobulinemia (IMC) developed clinical resistance to therapy after a sustained response. Neutralizing antibodies to rIFN-alpha 2a were found in the sera of three out of four such patients, and in none of the patients who remained responsive to treatment. rIFN-alpha 2a neutralizing antibodies appeared in serum samples of the former three patients 1, 5 and 6 months before evidence for clinical resistance, respectively. Antibody titres to rIFN-alpha 2a were consistently higher than those to natural interferon (nIFN). In the fourth patient with clinical resistance, neutralizing antibodies could not be detected by a very sensitive bioassay in any of several serum samples taken before and after relapse. All the four patients could be reinduced into remission by the administration of nIFN-alpha. These data indicate that mechanisms other than the production of neutralizing antibodies can mediate acquired resistance to IFN therapy. Furthermore, both antibody-related and -unrelated resistance can be overcome by switching to different species of IFN-alpha.
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Affiliation(s)
- M Casato
- Department of Clinical Medicine, University of Roma, La Sapienza, Italy
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