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Mandala M, Shaunak S, Kreitmair P, Phadnis J, Guryel E. Biomechanical comparison of headless compression screws versus independent locking screw for intra-articular fractures. Eur J Orthop Surg Traumatol 2024; 34:1319-1325. [PMID: 38112781 PMCID: PMC10980631 DOI: 10.1007/s00590-023-03792-8] [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] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 11/15/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE Headless compression screws (HCS) have a variable thread pitch and headless design enabling them to embed below the articular surface and generate compression force for fracture healing without restricting movement. Locking screws have greater variety of dimensions and a threaded pitch mirroring the design of the HCS. The objective of this study is to determine whether locking screws can generate compression force and compare the compressive forces generated by HCS versus locking screws. METHOD A comparison between 3.5-mm HCS versus 3.5-mm locking screws and 2.8-mm HCS versus 2.7-mm locking screws was performed using a synthetic foam bone model (Synbone) and FlexiForce sensors to record the compression forces (N). The mean peak compression force was calculated from a sample of 3 screws for each screw type. Statistical analysis was performed using the one-way ANOVA test and statistical significance was determined to be p = < 0.05. RESULTS The 3.5-mm Synthes and Smith and Nephew locking screws generated similar peak compression forces to the 3.5-mm Acutrak 2 headless compression screws with no statistically significant difference between them. The smaller 2.7-mm Synthes and Smith and Nephew locking screws initially generated similar compressive forces up to 1.5 and 2 revolutions, respectively, but their peak compression force was less compared to the 2.8-mm Micro Acutrak 2 HCS. CONCLUSION Locking screws are able to generate compressive forces and may be a viable alternative to headless compressive screws supporting their use for intra-articular fractures.
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Affiliation(s)
| | - Shalin Shaunak
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | | | - Joideep Phadnis
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Enis Guryel
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK.
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Falanga A, Ay C, Di Nisio M, Gerotziafas G, Jara-Palomares L, Langer F, Lecumberri R, Mandala M, Maraveyas A, Pabinger I, Sinn M, Syrigos K, Young A, Jordan K. Venous thromboembolism in cancer patients: ESMO Clinical Practice Guideline. Ann Oncol 2023; 34:452-467. [PMID: 36638869 DOI: 10.1016/j.annonc.2022.12.014] [Citation(s) in RCA: 56] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 12/09/2022] [Accepted: 12/11/2022] [Indexed: 01/11/2023] Open
Affiliation(s)
- A Falanga
- Division of Immunohaematology and Transfusion Medicine, Haemostasis and Thrombosis Center, Department of Oncology and Haematology, Hospital Papa Giovanni XXIII, Bergamo, Italy; University of Milan Bicocca, Department of Medicine and Surgery, Monza, Italy
| | - C Ay
- Department of Medicine I, Clinical Division of Haematology and Haemostaseology, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - M Di Nisio
- Department of Medicine and Ageing Sciences, G. d'Annunzio University, Chieti, Italy
| | - G Gerotziafas
- Sorbonne University, INSERM UMRS-938, Team "Cancer Vessels, Biology and Therapeutics", Group "Cancer-Hemostasis-Angiogenesis", Institut Universitaire de Cancérologie, Consultation Thrombosis in Oncology (COTHON), Tenon-Saint Antoine Hospital, AP-HP, Paris, France
| | - L Jara-Palomares
- Respiratory Department, Medical Surgical Unit of Respiratory Diseases, Hospital Virgen del Rocio, Sevilla; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - F Langer
- Centre for Oncology, University Cancer Centre Hamburg (UCCH), II Medical Clinic and Polyclinic, University Medical Centre Eppendorf, Hamburg, Germany
| | - R Lecumberri
- Servicio de Hematología, Clínica Universidad de Navarra, Pamplona (Navarra); CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
| | - M Mandala
- University of Perugia, Unit of Medical Oncology, Santa Maria Misericordia Hospital, Perugia, Italy
| | - A Maraveyas
- Queen's Centre for Oncology and Haematology, Faculty of Health Sciences, Hull York Medical School and Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - I Pabinger
- Department of Medicine I, Clinical Division of Haematology and Haemostaseology, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - M Sinn
- Centre for Oncology, University Cancer Centre Hamburg (UCCH), II Medical Clinic and Polyclinic, University Medical Centre Eppendorf, Hamburg, Germany
| | - K Syrigos
- Oncology Unit, 3rd Department of Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - A Young
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - K Jordan
- Department of Hematology, Oncology and Palliative Medicine, Ernst von Bergmann Hospital, Potsdam, Germany; Department of Rheumatology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
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van Akkooi A, Hauschild A, Long G, Mandala M, Kicinski M, Govaerts AS, Klauck I, Ouali M, Lorigan P, Eggermont A. 464TiP Phase III study of adjuvant encorafenib plus binimetinib vs placebo in fully resected stage IIB/C BRAFV600-mutated melanoma: COLUMBUS-AD study design. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.10.494] [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: 12/05/2022] Open
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Dummer R, Pathan N, Deng S, Robert C, Arance Fernandez A, de Groot J, Garbe C, Gogas H, Gutzmer R, Krajsova I, Liszkay G, Loquai C, Mandala M, Schadendorf D, Yamazaki N, di Pietro A, Xie T, Ascierto P, Flaherty K. 786O Tumor biomarker analysis from COLUMBUS part 1: Encorafenib + binimetinib for BRAF V600E/K-mutant advanced or metastatic melanoma. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.912] [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: 11/30/2022] Open
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5
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Nathan P, Grob J, Dummer R, Ascierto P, Ribas A, Robert C, Schadendorf D, Flaherty K, Tawbi H, Hauschild A, Mandala M, Shah R, Banerjee H, Sarkar R, Lau M, Long G. 819P Efficacy of dabrafenib (D) trametinib (T) plus spartalizumab (S) by baseline site of metastases in patients (pts) with previously untreated BRAF V600-mutant unresectable or metastatic melanoma: Post hoc analysis of phase III COMBI-i trial. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.945] [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: 11/29/2022] Open
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Eggermont A, Kicinski M, Blank C, Mandala M, Long G, Atkinson V, Dalle S, Haydon A, Meshcheryakov A, Khattak A, Carlino M, Sandhu S, Puig Sarda S, Ascierto P, Lorigan P, Grebennik D, Ibrahim N, Marreaud S, Suciu S, Robert C. 804P Pembrolizumab versus placebo after complete resection of high-risk stage III melanoma: 5-year results of the EORTC 1325-MG/Keynote-054 double-blinded phase III trial. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.930] [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] Open
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Bottomley A, Kicinski M, Long G, Mandala M, Atkinson V, Blank C, Haydon A, Dalle S, Khattak A, Carlino M, Meshcheryakov A, Sandhu S, Sarda SP, Coens C, Suciu S, Grebennik D, Krepler C, Lorigan P, Robert C, Eggermont A. LBA44 Pembrolizumab versus placebo after complete resection of high-risk stage III melanoma: Long-term quality of life analysis results of the EORTC 1325-MG/Keynote-054 double-blinded phase III trial. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.08.043] [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: 11/30/2022] Open
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Ascierto P, Mandala M, Ferrucci P, Guidoboni M, Rutkowski P, Ferraresi V, Fernandez AA, Guida M, Maiello E, Gogas H, Richtig E, Fierro M, Lebbe C, Helgadottir H, Melero I, Palmieri G, Giannarelli D, Grimaldi A, Dummer R, Sileni VC. LBA41 Phase II study SECOMBIT (sequential combo immuno and target therapy study): 4-years OS data and preliminary biomarkers evaluation. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.08.040] [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: 11/30/2022] Open
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Dimitriou F, Namikawa K, Reijers ILM, Buchbinder EI, Soon JA, Zaremba A, Teterycz P, Mooradian MJ, Armstrong E, Nakamura Y, Vitale MG, Tran LE, Bai X, Allayous C, Provent-Roy S, Indini A, Bhave P, Farid M, Kähler KC, Mehmi I, Atkinson V, Klein O, Stonesifer CJ, Zaman F, Haydon A, Carvajal RD, Hamid O, Dummer R, Hauschild A, Carlino MS, Mandala M, Robert C, Lebbe C, Guo J, Johnson DB, Ascierto PA, Shoushtari AN, Sullivan RJ, Cybulska-Stopa B, Rutkowski P, Zimmer L, Sandhu S, Blank CU, Lo SN, Menzies AM, Long GV. Single-agent anti-PD-1 or combined with ipilimumab in patients with mucosal melanoma: an international, retrospective, cohort study. Ann Oncol 2022; 33:968-980. [PMID: 35716907 DOI: 10.1016/j.annonc.2022.06.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/15/2022] [Accepted: 06/07/2022] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Mucosal melanoma (MM) is a rare melanoma subtype with distinct biology and poor prognosis. Data on the efficacy of immune checkpoint inhibitors (ICIs) is limited. We determined the efficacy of ICIs in MM, analysed by primary site and ethnicity/race. PATIENTS AND METHODS Retrospective cohort study from 25 cancer centres in Australia, Europe, USA and Asia. Patients with histologically confirmed MM were treated with anti-PD1+/-ipilimumab. Primary endpoints were response rate (RR), progression-free survival (PFS), overall survival (OS) by primary site (naso-oral, urogenital, anorectal, other), ethnicity/race (Caucasian, Asian, Other) and treatment. Univariate and multivariate Cox proportional hazard model analyses were conducted. RESULTS In total, 545 patients were included: 331 (63%) Caucasian, 176 (33%) Asian and 20 (4%) Other. Primary sites included 113 (21%) anorectal, 178 (32%) urogenital, 206 (38%) naso-oral and 45 (8%) other. 348 (64%) received anti-PD1 and 197 (36%) anti-PD1/ipilimumab. RR, PFS and OS did not differ by primary site, ethnicity/race or treatment. RR for naso-oral was numerically higher for anti-PD1/ipilimumab (40%, 95% CI 29-54%) compared with anti-PD1 (29%, 95% CI 21-37%). 35% of patients that initially responded progressed. Median duration of response (mDOR) was 26 months (95% CI 18-NR [Not Reached]). Factors associated with short PFS were ECOG PS ≥3 (p<0.01), LDH >ULN (p=0.01), lung metastases (p<0.01) and ≥1 previous treatments (p<0.01). Factors associated with short OS were ECOG PS ≥1 (p<0.01), LDH >ULN (p=0.03), lung metastases (p<0.01) and ≥1 previous treatments (p<0.01). CONCLUSIONS MM has poor prognosis. Treatment efficacy of anti-PD1+/-ipilimumab was similar and did not differ by ethnicity/race. Naso-oral primaries had numerically higher response to anti-PD1/ipilimumab, without difference in survival. The addition of ipilimumab did not show greater benefit over anti-PD1 for other primary sites. In responders, mDOR was short and acquired resistance was common. Other factors, including site and number of metastases were associated with survival.
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Affiliation(s)
- F Dimitriou
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia; Department of Dermatology, University Hospital Zurich (USZ) and University of Zurich (UZH), Zurich, Switzerland; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - K Namikawa
- Department of Dermatologic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - I L M Reijers
- Department of Medical Oncology and Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - E I Buchbinder
- Melanoma Disease Center, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02481, USA
| | - J A Soon
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - A Zaremba
- Department of Dermatology, University Hospital Essen, Essen, Germany
| | - P Teterycz
- Department of Soft Tissue/Bone Sarcoma and Melanoma, 49585Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - M J Mooradian
- Division of Oncology and Hematology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA
| | - E Armstrong
- Department of Medicine, Melanoma Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Y Nakamura
- Department of Skin Oncology/Dermatology, Saitama Medical University International Medical Center, Saitama, Japan
| | - M G Vitale
- Istituto Nazionale Tumori IRCCS Fondazione 'G. Pascale', Napoli, Italy
| | - L E Tran
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - X Bai
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Melanoma and Sarcoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - C Allayous
- APHP Hôpital Saint-Louis, Dermatology Department, DMU ICARE, Paris, France
| | - S Provent-Roy
- Dermatology Service, Department of Medicine, Gustave Roussy and Paris-Saclay University, Villejuif, France
| | - A Indini
- Unit of Medical Oncology, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi, Varese, Italy
| | - P Bhave
- Westmead and Blacktown Hospitals, Sydney, New South Wales, Australia
| | - M Farid
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - K C Kähler
- Department of Dermatology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - I Mehmi
- Department of Hematology/Oncology, The Angeles Clinic and Research Institute, a Cedars-Sinai Affiliate, 11800 Wilshire Blvd Suite 300, Los Angeles, CA, 90025, USA
| | - V Atkinson
- Princess Alexandra Hospital, Greenslopes Private Hospital, University of Queensland, Queensland, Australia
| | - O Klein
- Department of Medical Oncology, Austin Health, Melbourne, Australia; Olivia Newton-John Cancer Research Institute, Melbourne, Victoria
| | - C J Stonesifer
- Columbia University Irving Medical Center, New York City, New York, USA
| | - F Zaman
- Alfred Hospital, Melbourne, Victoria, Australia
| | - A Haydon
- Alfred Hospital, Melbourne, Victoria, Australia
| | - R D Carvajal
- Columbia University Irving Medical Center, New York City, New York, USA
| | - O Hamid
- Department of Hematology/Oncology, The Angeles Clinic and Research Institute, a Cedars-Sinai Affiliate, 11800 Wilshire Blvd Suite 300, Los Angeles, CA, 90025, USA
| | - R Dummer
- Department of Dermatology, University Hospital Zurich (USZ) and University of Zurich (UZH), Zurich, Switzerland
| | - A Hauschild
- Department of Dermatology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - M S Carlino
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia; Westmead and Blacktown Hospitals, Sydney, New South Wales, Australia
| | - M Mandala
- Unit of Medical Oncology, University of Perugia, Perugia, Italy
| | - C Robert
- Dermatology Service, Department of Medicine, Gustave Roussy and Paris-Saclay University, Villejuif, France
| | - C Lebbe
- Université de Paris, APHP Hôpital Saint-Louis, Dermatology Department, DMU ICARE, INSERM U-976, Paris, France
| | - J Guo
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Melanoma and Sarcoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - D B Johnson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - P A Ascierto
- Istituto Nazionale Tumori IRCCS Fondazione 'G. Pascale', Napoli, Italy
| | - A N Shoushtari
- Department of Medicine, Melanoma Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - R J Sullivan
- Division of Oncology and Hematology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA
| | - B Cybulska-Stopa
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Cracow Branch, Poland
| | - P Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, 49585Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - L Zimmer
- Department of Dermatology, University Hospital Essen, Essen, Germany
| | - S Sandhu
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - C U Blank
- Department of Medical Oncology and Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - S N Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - A M Menzies
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Department of Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, NSW, Australia
| | - G V Long
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Department of Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, NSW, Australia.
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Dummer R, Flaherty K, Robert C, Arance A, de Groot J, Garbe C, Gogas H, Gutzmer R, Krajsová I, Liszkay G, Loquai C, Mandala M, Schadendorf D, Yamazaki N, Zohren F, Edwards M, Ascierto P. 1041MO 5-year update on COLUMBUS: A randomized phase III trial of encorafenib (enco) + binimetinib (bini) versus enco or vemurafenib (vem) in patients (pts) with BRAF V600-mutant melanoma. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Luke J, Rutkowski P, Queirolo P, Del Vecchio M, Mackiewicz J, Chiarion Sileni V, de la Cruz Merino L, Khattak M, Schadendorf D, Long G, Ascierto P, Mandala M, De Galitiis F, Sondak V, Scolyer R, Kirkwood J, Chen K, Ibrahim N, Ahsan S, Eggermont A. LBA3 Pembrolizumab versus placebo after complete resection of high-risk stage II melanoma: Efficacy and safety results from the KEYNOTE-716 double-blind phase III trial. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.2116] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Dimitriou F, Namikawa K, Teterycz P, Reijers I, Buchbinder E, Soon J, Zimmer L, Mooradian M, Vitale M, Armstrong E, Johnson D, Guo J, Lebbe C, Robert C, Mandala M, Bhave P, Farid M, Kähler K, Lo S, Long G. 1049P Clinical models to predict response in mucosal melanoma (MM) patients (pts) treated with anti-PD-1 (PD1) or combined with ipilimumab (PD1+IPI). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Mandala M, Becattini C, Roila F, Agnelli G, Giustozzi M. 1684P Cardiovascular events with immune checkpoint inhibitors in melanoma or NSCLC: A systematic review and meta-analysis. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1656] [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: 10/20/2022] Open
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14
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Ascierto P, Mandala M, Ferrucci P, Rutkowski P, Guidoboni M, Arance Fernandez A, Ferraresi V, Maiello E, Guida M, Del Vecchio M, Fierro M, Queirolo P, Lebbe C, Helgadottir H, Melero I, Palmieri G, Giannarelli D, Grimaldi A, Dummer R, Chiarion Sileni V. LBA40 SECOMBIT: The best sequential approach with combo immunotherapy [ipilimumab (I) /nivolumab (N)] and combo target therapy [encorafenib (E)/binimetinib (B)] in patients with BRAF mutated metastatic melanoma: A phase II randomized study. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.2118] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Owen CN, Bai X, Quah T, Lo SN, Allayous C, Callaghan S, Martínez-Vila C, Wallace R, Bhave P, Reijers ILM, Thompson N, Vanella V, Gerard CL, Aspeslagh S, Labianca A, Khattak A, Mandala M, Xu W, Neyns B, Michielin O, Blank CU, Welsh SJ, Haydon A, Sandhu S, Mangana J, McQuade JL, Ascierto PA, Zimmer L, Johnson DB, Arance A, Lorigan P, Lebbé C, Carlino MS, Sullivan RJ, Long GV, Menzies AM. Delayed immune-related adverse events with anti-PD-1-based immunotherapy in melanoma. Ann Oncol 2021; 32:917-925. [PMID: 33798657 DOI: 10.1016/j.annonc.2021.03.204] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 03/09/2021] [Accepted: 03/28/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Immune-related adverse events (irAEs) typically occur within 4 months of starting anti-programmed cell death protein 1 (PD-1)-based therapy [anti-PD-1 ± anti-cytotoxic T-lymphocyte-associated protein 4 (CTLA4)], but delayed irAEs (onset >12 months after commencement) can also occur. This study describes the incidence, nature and management of delayed irAEs in patients receiving anti-PD-1-based immunotherapy. PATIENTS AND METHODS Patients with delayed irAEs from 20 centres were studied. The incidence of delayed irAEs was estimated as a proportion of melanoma patients treated with anti-PD-1-based therapy and surviving >1 year. Onset, clinical features, management and outcomes of irAEs were examined. RESULTS One hundred and eighteen patients developed a total of 140 delayed irAEs (20 after initial combination with anti-CTLA4), with an estimated incidence of 5.3% (95% confidence interval 4.0-6.9, 53/999 patients at sites with available data). The median onset of delayed irAE was 16 months (range 12-53 months). Eighty-seven patients (74%) were on anti-PD-1 at irAE onset, 15 patients (12%) were <3 months from the last dose and 16 patients (14%) were >3 months from the last dose of anti-PD-1. The most common delayed irAEs were colitis, rash and pneumonitis; 55 of all irAEs (39%) were ≥grade 3. Steroids were required in 80 patients (68%), as well as an additional immunosuppressive agent in 27 patients (23%). There were two irAE-related deaths: encephalitis with onset during anti-PD-1 and a multiple-organ irAE with onset 11 months after ceasing anti-PD-1. Early irAEs (<12 months) had also occurred in 69 patients (58%), affecting a different organ from the delayed irAE in 59 patients (86%). CONCLUSIONS Delayed irAEs occur in a small but relevant subset of patients. Delayed irAEs are often different from previous irAEs, may be high grade and can lead to death. They mostly occur in patients still receiving anti-PD-1. The risk of delayed irAE should be considered when deciding the duration of treatment in responding patients. However, patients who stop treatment may also rarely develop delayed irAE.
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Affiliation(s)
- C N Owen
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - X Bai
- Massachusetts General Hospital, Boston, USA; Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Melanoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - T Quah
- Westmead and Blacktown Hospitals, Sydney, Australia
| | - S N Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - C Allayous
- Dermatology Department, Université de Paris, AP-HP Saint-Louis Hospital, INSERM, Paris, France
| | - S Callaghan
- The Christie NHS Foundation Trust, Manchester, UK
| | | | - R Wallace
- Peter MacCallum Cancer Centre and the University of Melbourne, Melbourne, Australia
| | - P Bhave
- The Alfred Hospital, Melbourne, Australia
| | - I L M Reijers
- Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - N Thompson
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - V Vanella
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - C L Gerard
- Lausanne University Hospital, Lausanne, Switzerland
| | - S Aspeslagh
- University Hospital Brussels, Brussels, Belgium
| | - A Labianca
- Papa Giovanni XXIII Cancer Center Hospital, Bergamo, Italy
| | - A Khattak
- Fiona Stanley Hospital and Edith Cowan University, Perth, Australia
| | - M Mandala
- University of Perugia, Unit of Medical Oncology, Santa Maria misericordia hospital, Perugia, Italy
| | - W Xu
- Princess Alexandra Hospital and The University of Queensland, Brisbane, Australia
| | - B Neyns
- University Hospital Brussels, Brussels, Belgium
| | - O Michielin
- Lausanne University Hospital, Lausanne, Switzerland
| | - C U Blank
- Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - S J Welsh
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - A Haydon
- The Alfred Hospital, Melbourne, Australia
| | - S Sandhu
- Peter MacCallum Cancer Centre and the University of Melbourne, Melbourne, Australia
| | - J Mangana
- Dermatology, Department of Dermato-Oncology, University Hospital Zurich, Zürich, Switzerland
| | - J L McQuade
- The University of Texas MD Anderson Cancer Center, Houston, USA
| | - P A Ascierto
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - L Zimmer
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - D B Johnson
- Vanderbilt University Medical Center, Nashville, USA
| | - A Arance
- Hospital Clinic Barcelona, Barcelona, Spain
| | - P Lorigan
- The Christie NHS Foundation Trust, Manchester, UK; The University of Manchester, Manchester, UK
| | - C Lebbé
- Dermatology Department, Université de Paris, AP-HP Saint-Louis Hospital, INSERM, Paris, France
| | - M S Carlino
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Westmead and Blacktown Hospitals, Sydney, Australia
| | | | - G V Long
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Royal North Shore Hospital, Sydney, Australia; Mater Hospital, Sydney, Australia.
| | - A M Menzies
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Royal North Shore Hospital, Sydney, Australia; Mater Hospital, Sydney, Australia
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Ascierto P, Mandala M, Ferrucci P, Rutkowski P, Guidoboni M, Fernandez AA, Ferraresi V, Maiello E, Guida M, Del Vecchio M, Fierro M, Queirolo P, Lebbé C, Helgadottir H, Melero I, Palmieri G, Giannarelli D, Grimaldi A, Dummer R, Chiarion Sileni V. LBA45 First report of efficacy and safety from the phase II study SECOMBIT (SEquential COMBo Immuno and Targeted therapy study). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.2275] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Weber J, Del Vecchio M, Mandala M, Gogas H, Fernandez AA, Dalle S, Cowey C, Schenker M, Grob JJ, Sileni VC, Márquez-Rodas I, Butler M, Maio M, Middleton M, Merino LDLC, Lobo M, de Pril V, Larkin J, Ascierto P. 1076O Adjuvant nivolumab (NIVO) vs ipilimumab (IPI) in resected stage III/IV melanoma: 4-y recurrence-free and overall survival (OS) results from CheckMate 238. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1200] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Robert C, Flaherty K, Gogas H, Fernandez AA, Mandala M, Liszkay G, Garbe C, Schadendorf D, Krajsova I, Gutzmer R, de Groot J, Dutriaux C, Loquai C, Harney A, Kiprilov E, Pickard M, Cantey-Kiser J, Dummer R, Ascierto P. 1127P Correlation of BRAF mutation status in circulating tumour DNA (ctDNA) with tumour biopsy and clinical outcomes in COLUMBUS. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1250] [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] Open
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Yoon H, Fuchs C, Özgüroğlu M, Bang Y, Bartolomeo MD, Mandala M, Ryu M, Fornaro L, Olesinski T, Caglevic C, Chung H, Muro K, Cutsem EV, Elme A, Thuss-Patience P, Chau I, Ohtsu A, Wang A, Bhagia P, Lin J, Shih C, Shitara K. O-12 KEYNOTE-061: Response to subsequent therapy following second-line pembrolizumab or paclitaxel in patients with advanced gastric or gastroesophageal junction adenocarcinoma. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.065] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Grob JJ, Weber J, Del Vecchio M, Mandala M, Gogas H, Arance A, Dalle S, Lance Cowey C, Schenker M, Chiarion Sileni V, Marquez-Rodas I, Butler M, Maio M, Middleton M, Tang H, Saci A, de Pril V, Lobo M, Larkin J, Ascierto P. Nivolumab (NIVO) versus ipilimumab (IPI) dans le traitement adjuvant du mélanome réséqué de stade III/IV: résultats d’efficacité à 3 ans et analyse de biomarqueurs issus de l’essai de phase 3 CheckMate 238. Ann Dermatol Venereol 2019. [DOI: 10.1016/j.annder.2019.09.108] [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: 10/25/2022]
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de Oliveira AL, Madore J, O’donnell J, Johnston R, Eastgate M, Mallardo D, Ascierto P, Massi D, Merelli B, Mandala M, Wilmott J, Bald T, Stagg J, Routy B, Long G, Scolyer R, Waddell N, Dougall W, Teng M, Smyth M. Resistance to immunotherapy is associated with high parenchymal PD1+CD8+/CD8+ T cells (PD1tR) driven by tumour CD155. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz452] [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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Weber J, Del Vecchio M, Mandala M, Gogas H, Arance A, Dalle S, Cowey C, Schenker M, Grob J, Chiarion-Sileni V, Marquez-Rodas I, Butler M, Maio M, Middleton M, Tang T, Saci A, De Pril V, Lobo M, Larkin J, Ascierto P. Adjuvant nivolumab (NIVO) versus ipilimumab (IPI) in resected stage III/IV melanoma: 3-year efficacy and biomarker results from the phase III CheckMate 238 trial. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz255] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Mandala M, Legramandi L, Salvati L, Rulli E. The impact of targeted therapies and immunotherapy in melanoma brain metastases: A systematic review and meta-analysis. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz255.047] [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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Robert C, Dummer R, Ascierto P, Gogas H, Arance A, Mandala M, Liszkay G, Garbe C, Schadendorf D, Krajsova I, Gutzmer R, Chiarion Sileni V, Dutriaux C, de Groot J, Yamazaki N, Loquai C, Moutouh-de Parseval L, Pickard M, Sandor V, Flaherty K. Données de survie globale de l’étude COLUMBUS, étude de phase III avec encorafénib (ENCO) plus binimétinib (BINI) versus vémurafénib (VEM) ou encorafénib (ENCO) dans le mélanome métastatique BRAF muté. Ann Dermatol Venereol 2018. [DOI: 10.1016/j.annder.2018.09.103] [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: 10/27/2022]
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Dummer R, Schadendorf D, Hauschild A, Santinami M, Atkinson V, Mandala M, Chiarion Sileni V, Larkin J, Nyakas M, Dutriaux C, Haydon A, Mortier L, Robert C, Schachter J, Feng X, de Jong E, Mookerjee B, Kefford R, Kirkwood J, Long G. Estimate of long-term relapse-free survival (RFS) and analysis of baseline factors associated with RFS in the COMBI-AD trial. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy289.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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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Atkinson V, Hauschild A, Santinami M, Mandala M, Chiarion Sileni V, Larkin J, Nyakas M, Dutriaux C, Haydon A, Mortier L, Robert C, Schachter J, Schadendorf D, Feng X, de Jong E, Mookerjee B, Kefford R, Dummer R, Kirkwood J, Long G. Adverse events (AEs) over time in patients (pts) treated with adjuvant dabrafenib plus trametinib (D + T) or placebo (Pbo) in the COMBI-AD trial. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy289.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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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Long G, Hauschild A, Santinami M, Atkinson V, Mandala M, Chiarion-Sileni V, Larkin J, Robert C, Schadendorf D, Dasgupta K, Shilkrut M, Garrett J, Brase J, Kefford R, Kirkwood J, Dummer R. Updated relapse-free survival (RFS) and biomarker analysis in the COMBI-AD trial of adjuvant dabrafenib + trametinib (D + T) in patients (pts) with resected BRAF V600–mutant stage III melanoma. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy424.053] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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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Coens C, Bottomley A, Blank C, Mandala M, Long G, Atkinson V, Dalle S, Haydon A, Lichinitser M, Khattak A, Carlino M, Sandhu S, Larkin J, Puig Sarda S, Ascierto P, Schadendorf D, Ibrahim N, Suciu S, Robert C, Eggermont A. Health-related quality-of-life results for pembrolizumab versus placebo after complete resection of high-risk stage III melanoma from the EORTC 1325-MG/Keynote 054 trial: An international randomized double-blind phase III trial. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy289.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Lissoni P, Rovelli F, Giani L, Mandala M, Meregalli S, Barni S, Confalonieri G, Bonfanti A. Dehydroepiandrosterone Sulfate (DHEAS) Secretion in Early and Advanced Solid Neoplasms: Selective Deficiency in Metastatic Disease. Int J Biol Markers 2018; 13:154-7. [PMID: 10079390 DOI: 10.1177/172460089801300306] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 11/17/2022]
Abstract
Several endogenous hormones have been proven to stimulate cancer growth, whereas at present very few hormones are known to display oncostatic activity. The most widely investigated antitumor hormone is the pineal indole melatonin (MLT), and cancer progression has been shown to be associated with a decline in MLT secretion. Recently, another hormone, the adrenal steroid dehydroepiandrosterone-sulfate (DHEAS), has appeared to exert antitumor effects similar to those previously described for MLT In addition, experimental studies suggest a diminished DHEAS production with neoplastic progression. This preliminary study was performed to evaluate the daily secretion of DHEAS in a group of early and advanced cancer patients. The study included 70 patients with solid tumors (gastrointestinal tract tumors: 28; breast cancer: 24; non-small cell lung cancer: 18), 28 without and 42 with distant metastases. The serum levels of DHEAS were measured by RIA in blood samples collected in the morning. The control group consisted of 100 age- and sex-matched healthy subjects. No significant difference in mean serum levels of DHEAS was observed between controls and non-metastatic patients. In contrast, metastatic patients, irrespectively of tumor histotype, showed significantly lower mean levels of DHEAS with respect to either controls or non-metastatic patients. Moreover, metastatic patients with visceral locations showed significantly lower values of DHEAS than those with bone or soft-tissue metastases. This preliminary study would suggest there to be a deficiency in the daily DHEA secretion in patients with disseminated cancer. Further studies evaluating circadian DHEAS secretion in relation to that of the pineal hormone MLT will be required to better define the biological significance of the advanced cancer-related decline in endogenous DHEAS production.
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Affiliation(s)
- P Lissoni
- Division of Radiotherapy, S. Gerardo Hospital, Monza, Milano, Italy
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Lewis K, Maio M, Demidov L, Mandala M, Ascierto P, Herbert C, Mackiewicz A, Rutkowski P, Guminski A, Goodman G, Simmons B, Ye C, Yan Y, Schadendorf D. BRIM8: a randomized, double-blind, placebo-controlled study of adjuvant vemurafenib in patients (pts) with completely resected, BRAFV600+ melanoma at high risk for recurrence. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx440.047] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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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Weber J, Mandala M, Del Vecchio M, Gogas H, Arance A, Cowey L, Dalle S, Schenker M, Chiarion-Sileni V, Márquez-Rodas I, Grob JJ, Butler M, Middleton M, Maio M, Atkinson V, Queirolo P, de Pril V, Qureshi A, Larkin J, Ascierto P. Adjuvant therapy with nivolumab (NIVO) versus ipilimumab (IPI) after complete resection of stage III/IV melanoma: A randomized, double-blind, phase 3 trial (CheckMate 238). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx440.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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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Arance A, Dummer R, Ascierto P, Gogas H, Mandala M, Liszkay G, Garbe C, Schadendorf D, Krajsová I, Gutzmer R, Chiarion Sileni V, Dutriaux C, de Groot J, Yamazaki N, Loquai C, de Parseval L, Pickard M, Sandor V, Robert C, Flaherty K. Hospitalization Rates in COLUMBUS Part 1: A Phase 3 Trial of Encorafenib (ENCO) Plus Binimetinib (BINI) Versus Vemurafenib (VEM) or ENCO in BRAF-Mutant Melanoma. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx377.030] [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: 11/14/2022] Open
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Dummer R, Ascierto P, Gogas H, Arance A, Mandala M, Liszkay G, Garbe C, Schadendorf D, Krajsová I, Gutzmer R, Chiarion Sileni V, Dutriaux C, de Groot J, Yamazaki N, Loquai C, de Parseval L, Pickard M, Sandor V, Robert C, Flaherty K. Results of COLUMBUS Part 2: A phase 3 trial of encorafenib (ENCO) plus binimetinib (BINI) versus ENCO in BRAF-mutant melanoma. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx377.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [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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Hauschild A, Santinami M, Long G, Atkinson V, Mandala M, Chiarion Sileni V, Nyakas M, Dutriaux C, Haydon A, Robert C, Mortier L, Schachter J, Ji R, Zhang P, Mookerjee B, Legos J, Kefford R, Dummer R, Kirkwood J. COMBI-AD: Adjuvant dabrafenib (D) plus trametinib (T) for resected stage III BRAF V600E/K–mutant melanoma. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx440.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Gogas H, Dummer R, Ascierto P, Arance A, Mandala M, Liszkay G, Garbe C, Schadendorf D, Krajsová I, Gutzmer R, Chiarion Sileni V, Dutriaux C, de Groot J, Yamazaki N, Loquai C, de Parseval L, Pickard M, Sandor V, Robert C, Flaherty K. Quality-of-life (QoL) in COLUMBUS part 1: A phase 3 trial of encorafenib (ENCO) plus binimetinib (BINI) versus vemurafenib (VEM) or ENCO in braf-mutant melanoma. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx377.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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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Xue G, Zippelius A, Wicki A, Mandala M, Tang F, Massi D, Hemmings BA. Integrated Akt/PKB Signaling in Immunomodulation and Its Potential Role in Cancer Immunotherapy. J Natl Cancer Inst 2015; 107:djv171. [DOI: 10.1093/jnci/djv171] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 05/22/2015] [Indexed: 12/17/2022] Open
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Debourdeau P, Farge D, Beckers M, Baglin C, Bauersachs RM, Brenner B, Brilhante D, Falanga A, Gerotzafias GT, Haim N, Kakkar AK, Khorana AA, Lecumberri R, Mandala M, Marty M, Monreal M, Mousa SA, Noble S, Pabinger I, Prandoni P, Prins MH, Qari MH, Streiff MB, Syrigos K, Büller HR, Bounameaux H. International clinical practice guidelines for the treatment and prophylaxis of thrombosis associated with central venous catheters in patients with cancer. J Thromb Haemost 2013; 11:71-80. [PMID: 23217208 DOI: 10.1111/jth.12071] [Citation(s) in RCA: 201] [Impact Index Per Article: 18.3] [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: 12/12/2022]
Abstract
BACKGROUND Although long-term indwelling central venous catheters (CVCs) may lead to pulmonary embolism (PE) and loss of the CVC, there is lack of consensus on management of CVC-related thrombosis (CRT) in cancer patients and heterogeneity in clinical practices worldwide. OBJECTIVES To establish common international Good Clinical Practices Guidelines (GCPG) for the management of CRT in cancer patients. METHODS An international working group of experts was set up to develop GCPG according to an evidence-based medicine approach, using the GRADE system. RESULTS For the treatment of established CRT in cancer patients, we found no prospective randomized studies, two non-randomized prospective studies and one retrospective study examining the efficacy and safety of low-molecular-weight heparin (LMWH) plus vitamin K antagonists (VKAs). One retrospective study evaluated the benefit of CVC removal and two small retrospective studies were on thrombolytic drugs. For the treatment of symptomatic CRT, anticoagulant treatment (AC) is recommended for a minimum of 3 months; in this setting, LMWHs are suggested. VKAs can also be used, in the absence of direct comparisons of these two types of anticoagulants in this setting [Guidance]. The CVC can be kept in place if it is functional, well-positioned and non-infected and there is good resolution under close surveillance; whether the CVC is kept or removed, no standard approach in terms of AC duration has been established [Guidance]. For the prophylaxis of CRT in cancer patients, we found six randomized studies investigating the efficacy and safety of VKA vs. placebo or no treatment, one on the efficacy and safety of unfractionnated heparin, six on the value of LMWH, one double-blind randomized and one non randomized study on thrombolytic drugs and six meta-analyses of AC and CVC thromboprophylaxis. Type of catheter (open-ended like the Hickman(®) catheter vs. closed-ended catheter with a valve like the Groshong(®) catheter), its position (above, below or at the junction of the superior vena cava and the right atrium) and method of placement may influence the onset of CRT on the basis of six retrospective trials, four prospective non-randomized trials, three randomized trials and one meta-analysis. In light of these data: use of AC for routine prophylaxis of CRT is not recommended [1A]; a CVC should be inserted on the right side, in the jugular vein, and distal extremity of the CVC should be located at the junction of the superior vena cava and the right atrium [1A]. CONCLUSION Dissemination and implementation of these international GCPG for the prevention and treatment of CRT in cancer patients at each national level is a major public health priority, needing worldwide collaboration.
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Farge D, Debourdeau P, Beckers M, Baglin C, Bauersachs RM, Brenner B, Brilhante D, Falanga A, Gerotzafias GT, Haim N, Kakkar AK, Khorana AA, Lecumberri R, Mandala M, Marty M, Monreal M, Mousa SA, Noble S, Pabinger I, Prandoni P, Prins MH, Qari MH, Streiff MB, Syrigos K, Bounameaux H, Büller HR. International clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer. J Thromb Haemost 2013; 11:56-70. [PMID: 23217107 DOI: 10.1111/jth.12070] [Citation(s) in RCA: 383] [Impact Index Per Article: 34.8] [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: 01/14/2023]
Abstract
BACKGROUND Guidelines addressing the management of venous thromboembolism (VTE) in cancer patients are heterogeneous and their implementation has been suboptimal worldwide. OBJECTIVES To establish a common international consensus addressing practical, clinically relevant questions in this setting. METHODS An international consensus working group of experts was set up to develop guidelines according to an evidence-based medicine approach, using the GRADE system. RESULTS For the initial treatment of established VTE: low-molecular-weight heparin (LMWH) is recommended [1B]; fondaparinux and unfractionated heparin (UFH) can be also used [2D]; thrombolysis may only be considered on a case-by-case basis [Best clinical practice (Guidance)]; vena cava filters (VCF) may be considered if contraindication to anticoagulation or pulmonary embolism recurrence under optimal anticoagulation; periodic reassessment of contraindications to anticoagulation is recommended and anticoagulation should be resumed when safe; VCF are not recommended for primary VTE prophylaxis in cancer patients [Guidance]. For the early maintenance (10 days to 3 months) and long-term (beyond 3 months) treatment of established VTE, LMWH for a minimum of 3 months is preferred over vitamin K antagonists (VKA) [1A]; idraparinux is not recommended [2C]; after 3-6 months, LMWH or VKA continuation should be based on individual evaluation of the benefit-risk ratio, tolerability, patient preference and cancer activity [Guidance]. For the treatment of VTE recurrence in cancer patients under anticoagulation, three options can be considered: (i) switch from VKA to LMWH when treated with VKA; (ii) increase in LMWH dose when treated with LMWH, and (iii) VCF insertion [Guidance]. For the prophylaxis of postoperative VTE in surgical cancer patients, use of LMWH o.d. or low dose of UFH t.i.d. is recommended; pharmacological prophylaxis should be started 12-2 h preoperatively and continued for at least 7-10 days; there are no data allowing conclusion that one type of LMWH is superior to another [1A]; there is no evidence to support fondaparinux as an alternative to LMWH [2C]; use of the highest prophylactic dose of LMWH is recommended [1A]; extended prophylaxis (4 weeks) after major laparotomy may be indicated in cancer patients with a high risk of VTE and low risk of bleeding [2B]; the use of LMWH for VTE prevention in cancer patients undergoing laparoscopic surgery may be recommended as for laparotomy [Guidance]; mechanical methods are not recommended as monotherapy except when pharmacological methods are contraindicated [2C]. For the prophylaxis of VTE in hospitalized medical patients with cancer and reduced mobility, we recommend prophylaxis with LMWH, UFH or fondaparinux [1B]; for children and adults with acute lymphocytic leukemia treated with l-asparaginase, depending on local policy and patient characteristics, prophylaxis may be considered in some patients [Guidance]; in patients receiving chemotherapy, prophylaxis is not recommended routinely [1B]; primary pharmacological prophylaxis of VTE may be indicated in patients with locally advanced or metastatic pancreatic [1B] or lung [2B] cancer treated with chemotherapy and having a low risk of bleeding; in patients treated with thalidomide or lenalidomide combined with steroids and/or chemotherapy, VTE prophylaxis is recommended; in this setting, VKA at low or therapeutic doses, LMWH at prophylactic doses and low-dose aspirin have shown similar effects; however, the efficacy of these regimens remains unclear [2C]. Special situations include brain tumors, severe renal failure (CrCl<30 mL min(-1) ), thrombocytopenia and pregnancy. Guidances are provided in these contexts. CONCLUSIONS Dissemination and implementation of good clinical practice for the management of VTE, the second cause of death in cancer patients, is a major public health priority.
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Affiliation(s)
- D Farge
- Assistance Publique-Hôpitaux de Paris, Internal Medicine and Vascular Disease Unit, Saint-Louis Hospital, Paris, France
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Maio M, Sileni VC, Pilla L, Nicoletti S, Di Guardo L, Queirolo P, De Galitiis F, Mandala M, Guida M, Ascierto P. Efficacy and Safety of Ipilimumab in Patients with Pretreated, Ocular Melanoma: Experience from Italian Clinics Participating in the European Expanded Access Programme (EAP). Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)33688-7] [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: 11/29/2022] Open
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Mandala M, Clerici M, Corradino I, Vitalini C, Colombini S, Torri V, De Pascale A, Marsoni S. Incidence, risk factors and clinical implications of venous thromboembolism in cancer patients treated within the context of phase I studies: the 'SENDO experience'. Ann Oncol 2011; 23:1416-21. [PMID: 22052988 DOI: 10.1093/annonc/mdr524] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND To investigate the incidence, risk factors and clinical implications of venous thromboembolism (VTE) in advanced cancer patients treated in phase I studies. PATIENTS AND METHODS Patients enrolled and treated in phase I studies conducted by SENDO (Southern Europe New Drugs Organization) Foundation between 2000 and 2010 in 15 experimental centers were considered for the study. Clinical data, including adverse events, were prospectively collected during the studies and retrospectively pooled for VTE analysis. RESULTS Data of 1415 patients were considered for analysis. Five hundred and twenty-six (37.2%) patients were males, and median age was 57.3 years (range: 13-85). Eighty-five percent of patients had metastatic disease, while the remaining had locally advanced irresectable disease. For 706 (49.9%) of the patients, the study treatment was with cytotoxic agent(s) only, for 314 with target therapy(ies) only, while the remaining patients received a target therapy in combination with a cytotoxic drug. Fifty-six (3.96%) patients who developed a VTE, almost all (89.3%) during the course of treatment, the remaining during the follow-up. At univariate analysis, the Khorana score, the combination of an antiangiogenic agent with a cytotoxic drug, and the time from first cancer diagnosis to study entry (as continuous variable) were associated with a statistically significant increase of VTE occurrence. The multivariate analysis confirmed only a statistically significant association for the Khorana score. The hazard ratio of VTE occurrence was 7.88 [95% confidence interval (CI) 2.86-21.70) and 2.74 (95% CI 1.27-5.92) times higher for the highest (≥3) and intermediate (1-2) scores as compared with score = 0. CONCLUSIONS VTE is a relatively common complication among patients treated in the context of phase I studies. The Khorana score predicts VTE development and can be used to identify patients at high of VTE.
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Affiliation(s)
- M Mandala
- Unit of Medical Oncology, Ospedali Riuniti, Bergamo.
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Keller J, Mandala M, Casson P, Osol G. Evidence of endothelial dysfunction in a rat model of PCOS: increased constrictor prostaglandin activity, reversible through cox inhibition. Fertil Steril 2011. [DOI: 10.1016/j.fertnstert.2011.07.515] [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: 11/17/2022]
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Labianca R, Gasparini G, Barni S, Verso M, Bonizzoni E, Brighenti M, Mandala M, Petrelli F, Bianchini C, Perrone T, Agnelli G. Prediction of venous thromboembolism in ambulatory patients with cancer receiving chemotherapy: An expanded thromboembolic risk score model. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e19551] [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: 11/20/2022] Open
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43
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Mandala M, Labianca R, Agnelli G, Crino L, Maiello E, Santoro A, Fagnani D. Multicenter, prospective, case-control, observational study on the influence of venous thromboembolism on patient outcome. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.1554] [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: 11/20/2022] Open
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Chiarion-Sileni V, Guida M, Romanini A, Ridolfi R, Mandala M, Del Bianco P, Silvestri B, Medici M, Michiara M, Dalla Palma M, Puccetti O, Pigozzo J, Laveder F, De Salvo GL. Intensified high-dose intravenous interferon alpha 2b (IFNa2b) for adjuvant treatment of stage III melanoma: A randomized phase III Italian Melanoma Intergroup (IMI) trial [ISRCTN75125874]. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.8506] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
The vestibulo-ocular reflex (VOR) uses head angular acceleration information transduced by the semicircular canals in the inner ear in order to drive eye movements that compensate for head rotations, and thus stabilize the visual scene on the retina. Peripheral and central vestibular pathologies may impair the function of the VOR, so that compensation becomes incomplete, making clear vision during head movement impossible. Powerful adaptive mechanisms quickly allow the central nervous system to use residual vestibular information or information provided through other senses to supplement the deficient VOR. Such recovery makes the clinical diagnosis difficult to classical testing techniques, yet the head impulse test allows to reveal vestibular deficits even in adapted patients. A compensatory saccade at the end of the head movement is the clinical sign of a vestibular deficit, and may be spotted by the experienced clinician. Here we describe the rationale and the software program driving a new computerized technique for reliably assessing vestibular function at different head angular accelerations, based on evaluating the ability of the patient in reading a character on the screen while the head is being rotated.
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Affiliation(s)
- A Bohler
- Upper Austria University for Applied Sciences, Linz, Austria.
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Mandala M, Imberti G, Piazzalunga D, Belfiglio M, Milesi L, Merelli B, di Biagio K, Labianca R, Milesi A, Tondini C. Relationship between socio-economic status and education grade on Breslow thickness and ulceration in clinical stage I-II AJCC skin melanoma: Analysis from a single institution prospectively collected data base. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e19004] [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: 11/20/2022] Open
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Mandala M, Falanga A, Labianca R. Video meliora proboque sed deteriora sequor: the case of thromboprophylaxis in hospitalized cancer patients. Ann Oncol 2010; 21:911-3. [DOI: 10.1093/annonc/mdp500] [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: 11/13/2022] Open
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48
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Mandala M, Barni S, Isa L, Floriani I, Fornarini G, Torri V, Mosconi S, Marangolo M, Corsi D, Labianca R. Incidence and clinical implications of venous thromboembolism in advanced colorectal cancer patients: Findings from the ‘GISCAD-Alternating schedule‘ study. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.20502] [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: 11/20/2022] Open
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49
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Johnson FE, Rosati G, Ambrosini G, Mandala M, Pinna N, Daniele B, Pavia G, Virgo KS, Longo WE, Grossmann EM, Fossati R. Colorectal cancer patient follow-up after surgery with curative intent. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.3695] [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)
- F. E. Johnson
- Saint Louis Univ, St. Louis, MO; Mario Negri Inst, Milan, Italy; Yale Univ, New Haven, CT
| | - G. Rosati
- Saint Louis Univ, St. Louis, MO; Mario Negri Inst, Milan, Italy; Yale Univ, New Haven, CT
| | - G. Ambrosini
- Saint Louis Univ, St. Louis, MO; Mario Negri Inst, Milan, Italy; Yale Univ, New Haven, CT
| | - M. Mandala
- Saint Louis Univ, St. Louis, MO; Mario Negri Inst, Milan, Italy; Yale Univ, New Haven, CT
| | - N. Pinna
- Saint Louis Univ, St. Louis, MO; Mario Negri Inst, Milan, Italy; Yale Univ, New Haven, CT
| | - B. Daniele
- Saint Louis Univ, St. Louis, MO; Mario Negri Inst, Milan, Italy; Yale Univ, New Haven, CT
| | - G. Pavia
- Saint Louis Univ, St. Louis, MO; Mario Negri Inst, Milan, Italy; Yale Univ, New Haven, CT
| | - K. S. Virgo
- Saint Louis Univ, St. Louis, MO; Mario Negri Inst, Milan, Italy; Yale Univ, New Haven, CT
| | - W. E. Longo
- Saint Louis Univ, St. Louis, MO; Mario Negri Inst, Milan, Italy; Yale Univ, New Haven, CT
| | - E. M. Grossmann
- Saint Louis Univ, St. Louis, MO; Mario Negri Inst, Milan, Italy; Yale Univ, New Haven, CT
| | - R. Fossati
- Saint Louis Univ, St. Louis, MO; Mario Negri Inst, Milan, Italy; Yale Univ, New Haven, CT
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Mandala M, Ciano C, Ghilardi M, Cremonesi M, Cazzaniga M, Barni S. Acute dyspnea due to right phrenic palsy during infusional chemotherapy. Ann Oncol 2004; 15:691-2. [PMID: 15033684 DOI: 10.1093/annonc/mdh154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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