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Valenza C, Trapani D, Gandini S, Sposetti C, Boscolo Bielo L, Marra A, Giarratano T, Favero D, Cortesi L, Moscetti L, Pistelli M, Berardi R, Zambelli A, Lambertini M, Del Mastro L, Guarneri V, Vernieri C, Curigliano G. Platinum-based chemotherapy and PARP inhibitors for patients with a germline BRCA pathogenic variant and advanced breast cancer (LATER-BC): retrospective multicentric analysis of post-progression treatments. Eur J Cancer 2023; 190:112944. [PMID: 37437366 DOI: 10.1016/j.ejca.2023.112944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 06/08/2023] [Accepted: 06/10/2023] [Indexed: 07/14/2023]
Abstract
INTRODUCTION Patients with breast cancer (BC) harbouring a germinal BRCA pathogenic variant (gBRCA-PV) may have an enhanced sensitivity to platinum-based chemotherapy (PBC) and PARP inhibitors (PARPi). As reported in ovarian cancer, however, sensitivity and resistance to these treatments could partially overlap. In patients with a gBRCA-PV and advanced BC (aBC), it remains unclear whether prior exposure to PARPi/PBC affects tumour response to subsequent PBC/PARPi, respectively. METHODS We conducted a retrospective, multicentric study to investigate the clinical benefit of post-PBC PARPi and vice versa in patients with a gBRCA-PV and aBC. Patients included had received (neo)adjuvant PBC and then PARPi in advanced setting (group 1), PBC followed by PARPi (group 2) or PARPi followed by PBC (group 3), both in advanced setting. We reported median progression-free survival (mPFS) and disease control rate (DCR) in each group. RESULTS A total of 67 patients from six centres were included. PARPi-mPFS in advanced setting was 6.1 months in patients in group 1 (N = 12), while PARPi-DCR was 67%. In group 2 (N = 36), PARPi-mPFS was 3.4 months and PARPi-DCR was 64%. Age < 65 years and platinum-free interval (PFI) > 6 months were associated with longer PARPi-PFS; previous PBC-PFS > 6 months and PBC in first to second line were associated with longer PARPi-DCR. Patients in group 3 (N = 21) reported a PBC-mPFS of 1.8 months and a PBC-DCR of 14%. PARPi-PFS ≥ 9 months and PARPi-FI ≥ 6 months were associated with better PBC-DCR. CONCLUSIONS Sensitivity and resistance to PARPi and PBC partially overlap in patients with a gBRCA-PV and aBC. Evidence of PARPi activity emerged in patients who progressed on previous PBC.
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Affiliation(s)
- Carmine Valenza
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan 20141, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Dario Trapani
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan 20141, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Sara Gandini
- Department of Experimental Oncology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Caterina Sposetti
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy; Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Luca Boscolo Bielo
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan 20141, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Antonio Marra
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan 20141, Italy
| | - Tommaso Giarratano
- Division of Oncology 2, Istituto Oncologico Veneto, IRCCS, Padova, Italy
| | - Diletta Favero
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa, Italy
| | - Laura Cortesi
- Department of Oncology and Hematology, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Luca Moscetti
- Department of Oncology and Hematology, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Mirco Pistelli
- Department of Oncology, Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy
| | - Rossana Berardi
- Department of Oncology, Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy; Department of Clinical and Molecular Science, Università Politecnica delle Marche, Ancona, Italy
| | - Alberto Zambelli
- IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Rozzano, MI, Italy; Department of Biomedical Sciences, Humanitas University, Rozzano, MI, Italy
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa, Italy; Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Lucia Del Mastro
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa, Italy; Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Valentina Guarneri
- Division of Oncology 2, Istituto Oncologico Veneto, IRCCS, Padova, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Claudio Vernieri
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy; IFOM ETS, the AIRC Institute of Molecular Oncology, Milan, Italy
| | - Giuseppe Curigliano
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan 20141, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.
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2
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Di Lisa FS, Krasniqi E, Pizzuti L, Barba M, Cannita K, De Giorgi U, Borella F, Foglietta J, Cariello A, Ferro A, Picardo E, Mitidieri M, Sini V, Stani S, Tonini G, Santini D, La Verde N, Gambaro AR, Grassadonia A, Tinari N, Garrone O, Sarobba G, Livi L, Meattini I, D’Auria G, Vergati M, Gamucci T, Pistelli M, Berardi R, Risi E, Giotta F, Lorusso V, Rinaldi L, Artale S, Cazzaniga ME, Zustovich F, Cappuzzo F, Landi L, Torrisi R, Scagnoli S, Botticelli A, Michelotti A, Fratini B, Saltarelli R, Paris I, Muratore M, Cassano A, Gianni L, Gaspari V, Veltri EM, Zoratto F, Fiorio E, Fabbri MA, Mazzotta M, Ruggeri EM, Pedersini R, Valerio MR, Filomeno L, Minelli M, Scavina P, Raffaele M, Astone A, De Vita R, Pozzi M, Riccardi F, Greco F, Moscetti L, Giordano M, Maugeri-Saccà M, Zennaro A, Botti C, Pelle F, Cappelli S, Cavicchi F, Vizza E, Sanguineti G, Tomao F, Cortesi E, Marchetti P, Tomao S, Speranza I, Sperduti I, Ciliberto G, Vici P. Adjuvant capecitabine in triple negative breast cancer patients with residual disease after neoadjuvant treatment: real-world evidence from CaRe, a multicentric, observational study. Front Oncol 2023; 13:1152123. [PMID: 37260975 PMCID: PMC10227592 DOI: 10.3389/fonc.2023.1152123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/26/2023] [Indexed: 06/02/2023] Open
Abstract
Background In triple negative breast cancer patients treated with neoadjuvant chemotherapy, residual disease at surgery is the most relevant unfavorable prognostic factor. Current guidelines consider the use of adjuvant capecitabine, based on the results of the randomized CREATE-X study, carried out in Asian patients and including a small subset of triple negative tumors. Thus far, evidence on Caucasian patients is limited, and no real-world data are available. Methods We carried out a multicenter, observational study, involving 44 oncologic centres. Triple negative breast cancer patients with residual disease, treated with adjuvant capecitabine from January 2017 through June 2021, were recruited. We primarily focused on treatment tolerability, with toxicity being reported as potential cause of treatment discontinuation. Secondarily, we assessed effectiveness in the overall study population and in a subset having a minimum follow-up of 2 years. Results Overall, 270 patients were retrospectively identified. The 50.4% of the patients had residual node positive disease, 7.8% and 81.9% had large or G3 residual tumor, respectively, and 80.4% a Ki-67 >20%. Toxicity-related treatment discontinuation was observed only in 10.4% of the patients. In the whole population, at a median follow-up of 15 months, 2-year disease-free survival was 62%, 2 and 3-year overall survival 84.0% and 76.2%, respectively. In 129 patients with a median follow-up of 25 months, 2-year disease-free survival was 43.4%, 2 and 3-year overall survival 78.0% and 70.8%, respectively. Six or more cycles of capecitabine were associated with more favourable outcomes compared with less than six cycles. Conclusion The CaRe study shows an unexpectedly good tolerance of adjuvant capecitabine in a real-world setting, although effectiveness appears to be lower than that observed in the CREATE-X study. Methodological differences between the two studies impose significant limits to comparability concerning effectiveness, and strongly invite further research.
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Affiliation(s)
| | - Eriseld Krasniqi
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Laura Pizzuti
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Maddalena Barba
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Katia Cannita
- Oncology Division, Mazzini Hospital, ASL Teramo, Teramo, Italy
| | - Ugo De Giorgi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
| | - Fulvio Borella
- Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, Sant' Anna Hospital, University of Turin, Turin, Italy
| | | | | | | | - Elisa Picardo
- Gynecology and Obstetrics 4, Department of Surgical Sciences, City of Health and Science, Sant' Anna Hospital, University of Turin, Turin, Italy
| | - Marco Mitidieri
- Gynecology and Obstetrics 4, Department of Surgical Sciences, City of Health and Science, Sant' Anna Hospital, University of Turin, Turin, Italy
| | | | | | - Giuseppe Tonini
- Department of Medical Oncology, Fondazione Policlinico Universitario Campus Biomedico, Rome, Italy
| | - Daniele Santini
- Medical Oncology A, Policlinico Umberto I, Department of Radiological, Oncological and Anatomo-Pathological Sciences, “Sapienza” University of Rome, Rome, Italy
| | - Nicla La Verde
- Department of Oncology, Ospedale Luigi Sacco, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Anna Rita Gambaro
- Department of Oncology, Ospedale Luigi Sacco, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Antonino Grassadonia
- Department of Innovative Technologies in Medicine and Dentistry and Centre for Advanced Studies and Technology (CAST), G. D’Annunzio University, Chieti, Italy
| | - Nicola Tinari
- Department of Medical, Oral and Biotechnological Sciences and Center for Advanced Studies and Technology (CAST), G. D’Annunzio University, Chieti, Italy
| | - Ornella Garrone
- Medical Oncology, Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico Milano, Milan, Italy
| | | | - Lorenzo Livi
- Department of Biomedical, Experimental and Clinical Sciences “M. Serio”, University of Florence, Florence, Italy
- Radiotherapy Unit, Oncology Department, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Icro Meattini
- Department of Biomedical, Experimental and Clinical Sciences “M. Serio”, University of Florence, Florence, Italy
- Radiotherapy Unit, Oncology Department, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | | | - Matteo Vergati
- UOC of Medical Oncology, Sandro Pertini Hospital, Rome, Italy
| | - Teresa Gamucci
- UOC of Medical Oncology, Sandro Pertini Hospital, Rome, Italy
| | - Mirco Pistelli
- Oncology Clinic, Università Politecnica delle Marche, Ospedali Riuniti Hospital, Ancona, Italy
| | - Rossana Berardi
- Oncology Clinic, Università Politecnica delle Marche, Ospedali Riuniti Hospital, Ancona, Italy
| | - Emanuela Risi
- Sandro Pitigliani Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - Francesco Giotta
- Department of Medical Oncology, IRCCS Giovanni Paolo II Institute, Bari, Italy
| | - Vito Lorusso
- Department of Medical Oncology, IRCCS Giovanni Paolo II Institute, Bari, Italy
| | - Lucia Rinaldi
- “Don Tonino Bello” Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari, Italy
| | - Salvatore Artale
- Oncology Department, Ospedale di Gallarate, ASST Valle Olona, Gallarate, Italy
| | - Marina Elena Cazzaniga
- Phase 1 Research Centre and Oncology Unit, Department of Medicine and Surgery, University of Milano-Bicocca, ASST Monza, Monza, Italy
- Oncology Unit, ASST Monza, Monza, Italy
| | - Fable Zustovich
- Oncology Division, AULSS 1 Dolomiti, San Martino Medical Hospital, Belluno, Italy
| | - Federico Cappuzzo
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Lorenza Landi
- Phase I Clinical Studies Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Rosalba Torrisi
- Department of Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Simone Scagnoli
- Department of Medical and Surgical Sciences and Translational Medicine, “Sapienza” University of Rome, Rome, Italy
| | - Andrea Botticelli
- Medical Oncology A, Policlinico Umberto I, Department of Radiological, Oncological and Anatomo-Pathological Sciences, “Sapienza” University of Rome, Rome, Italy
| | - Andrea Michelotti
- UO Medical Oncology I, S. Chiara Hospital, Pisa University Hospital, Pisa, Italy
| | - Beatrice Fratini
- UO Medical Oncology I, S. Chiara Hospital, Pisa University Hospital, Pisa, Italy
| | - Rosa Saltarelli
- Oncology Division, San Giovanni Evangelista Hospital, ASL RM5, Rome, Italy
| | - Ida Paris
- Division of Gynecologic Oncology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Margherita Muratore
- Division of Gynecologic Oncology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Alessandra Cassano
- Medical Oncology, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Lorenzo Gianni
- Oncology Unit Rimini, Azienda USL Romagna, Rimini, Italy
| | | | | | - Federica Zoratto
- Medical Oncology Unit, Santa Maria Goretti Hospital, Latina, Italy
| | - Elena Fiorio
- Pathology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Marco Mazzotta
- Medical Oncology Unit, Belcolle Hospital, Viterbo, Italy
| | | | | | - Maria Rosaria Valerio
- Medical Oncology, Azienda Ospedaliera Universitaria Policlinico Paolo Giaccone, Palermo, Italy
| | - Lorena Filomeno
- Phase IV Clinical Studies Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Mauro Minelli
- Division of Oncology, San Giovanni Hospital, Rome, Italy
| | - Paola Scavina
- Division of Oncology, San Giovanni Hospital, Rome, Italy
| | - Mimma Raffaele
- Presidio Oncologico Cassia – S. Andrea, ASL Roma 1, Rome, Italy
| | - Antonio Astone
- Oncology Division, San Pietro Fatebenefratelli Hospital, Rome, Italy
| | - Roy De Vita
- Department of Plastic and Reconstructive Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Marcello Pozzi
- Department of Plastic and Reconstructive Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | - Filippo Greco
- Medical Oncology Unit, AULSS 9 Regione Veneto, Scaligera - Ospedale Generale Mater Salutis, Legnago, Italy
| | - Luca Moscetti
- Division of Medical Oncology, Department of Oncology-Hematology, University Hospital of Modena, Modena, Italy
| | | | - Marcello Maugeri-Saccà
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
- Clinical Trial Center, Biostatistics and Bioinformatics, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Alessandro Zennaro
- Clinical Trial Center, Biostatistics and Bioinformatics, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Claudio Botti
- Department of Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Fabio Pelle
- Department of Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Sonia Cappelli
- Department of Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Flavia Cavicchi
- Department of Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Enrico Vizza
- Gynecologic Oncology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppe Sanguineti
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Federica Tomao
- Department of Maternal and Child Health and Urological Sciences, “Sapienza” University of Rome, Policlinico Umberto I, Rome, Italy
| | - Enrico Cortesi
- Medical Oncology B, Policlinico Umberto I, Department of Radiological, Oncological and Pathological Sciences, “Sapienza” University of Rome, Rome, Italy
| | - Paolo Marchetti
- Scientific Direction, IRCCS IDI, Istituto Dermopatico dell'Immacolata, Rome, Italy
| | - Silverio Tomao
- Department of Radiological, Oncological and Pathological Sciences, “Sapienza” University of Rome, Rome, Italy
| | - Iolanda Speranza
- Medical Oncology A, Policlinico Umberto I, Department of Radiological, Oncological and Anatomo-Pathological Sciences, “Sapienza” University of Rome, Rome, Italy
| | - Isabella Sperduti
- Clinical Trial Center, Biostatistics and Bioinformatics, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Gennaro Ciliberto
- Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Patrizia Vici
- Phase IV Clinical Studies Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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3
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Coltelli L, Allegrini G, Orlandi P, Finale C, Fontana A, Masini LC, Scalese M, Arrighi G, Barletta MT, De Maio E, Banchi M, Fini E, Guidi P, Frenzilli G, Donati S, Giovannelli S, Tanganelli L, Salvadori B, Livi L, Meattini I, Pazzagli I, Di Lieto M, Pistelli M, Casadei V, Ferro A, Cupini S, Orlandi F, Francesca D, Lorenzini G, Barellini L, Falcone A, Cosimi A, Bocci G. A pharmacogenetic interaction analysis of bevacizumab with paclitaxel in advanced breast cancer patients. NPJ Breast Cancer 2022; 8:33. [PMID: 35314692 PMCID: PMC8938486 DOI: 10.1038/s41523-022-00400-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 02/07/2022] [Indexed: 11/18/2022] Open
Abstract
To investigate pharmacogenetic interactions among VEGF-A, VEGFR-2, IL-8, HIF-1α, EPAS-1, and TSP-1 SNPs and their role on progression-free survival (PFS) in metastatic breast cancer (MBC) patients treated with bevacizumab plus first-line paclitaxel or with paclitaxel alone. Analyses were performed on germline DNA, and SNPs were investigated by real-time PCR technique. The multifactor dimensionality reduction (MDR) methodology was applied to investigate the interaction between SNPs. The present study was an explorative, ambidirectional cohort study: 307 patients from 11 Oncology Units were evaluated retrospectively from 2009 to 2016, then followed prospectively (NCT01935102). Two hundred and fifteen patients were treated with paclitaxel and bevacizumab, whereas 92 patients with paclitaxel alone. In the bevacizumab plus paclitaxel group, the MDR software provided two pharmacogenetic interaction profiles consisting of the combination between specific VEGF-A rs833061 and VEGFR-2 rs1870377 genotypes. Median PFS for favorable genetic profile was 16.8 vs. the 10.6 months of unfavorable genetic profile (p = 0.0011). Cox proportional hazards model showed an adjusted hazard ratio of 0.64 (95% CI, 0.5–0.9; p = 0.004). Median OS for the favorable genetic profile was 39.6 vs. 28 months of unfavorable genetic profile (p = 0.0103). Cox proportional hazards model revealed an adjusted hazard ratio of 0.71 (95% CI, 0.5–1.01; p = 0.058). In the 92 patients treated with paclitaxel alone, the results showed no effect of the favorable genetic profile, as compared to the unfavorable genetic profile, either on the PFS (p = 0.509) and on the OS (p = 0.732). The pharmacogenetic statistical interaction between VEGF-A rs833061 and VEGFR-2 rs1870377 genotypes may identify a population of bevacizumab-treated patients with a better PFS.
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4
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Pizzuti L, Krasniqi E, Sperduti I, Barba M, Gamucci T, Mauri M, Veltri EM, Meattini I, Berardi R, Di Lisa FS, Natoli C, Pistelli M, Iezzi L, Risi E, D’Ostilio N, Tomao S, Ficorella C, Cannita K, Riccardi F, Cassano A, Bria E, Fabbri MA, Mazzotta M, Barchiesi G, Botticelli A, D’Auria G, Ceribelli A, Michelotti A, Russo A, Salimbeni BT, Sarobba G, Giotta F, Paris I, Saltarelli R, Marinelli D, Corsi D, Capomolla EM, Sini V, Moscetti L, Mentuccia L, Tonini G, Raffaele M, Marchetti L, Minelli M, Ruggeri EM, Scavina P, Bacciu O, Salesi N, Livi L, Tinari N, Grassadonia A, Fedele Scinto A, Rossi R, Valerio MR, Landucci E, Stani S, Fratini B, Maugeri-Saccà M, De Tursi M, Maione A, Santini D, Orlandi A, Lorusso V, Cortesi E, Sanguineti G, Pinnarò P, Cappuzzo F, Landi L, Botti C, Tomao F, Cappelli S, Bon G, Pelle F, Cavicchi F, Fiorio E, Foglietta J, Scagnoli S, Marchetti P, Ciliberto G, Vici P. PANHER study: a 20-year treatment outcome analysis from a multicentre observational study of HER2-positive advanced breast cancer patients from the real-world setting. Ther Adv Med Oncol 2021; 13:17588359211059873. [PMID: 35173816 PMCID: PMC8842182 DOI: 10.1177/17588359211059873] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 10/27/2021] [Indexed: 12/16/2022] Open
Abstract
Background: The evolution of therapeutic landscape of human epidermal growth factor
receptor-2 (HER2)-positive breast cancer (BC) has led to an unprecedented
outcome improvement, even if the optimal sequence strategy is still debated.
To address this issue and to provide a picture of the advancement of
anti-HER2 treatments, we performed a large, multicenter, retrospective study
of HER2-positive BC patients. Methods: The observational PANHER study included 1,328 HER2-positive advanced BC
patients treated with HER2 blocking agents since June 2000 throughout July
2020. Endpoints of efficacy were progression-free survival (PFS) and overall
survival (OS). Results: Patients who received a first-line pertuzumab-based regimen showed better PFS
(p < 0.0001) and OS (p = 0.004)
than those receiving other treatments. Median PFS and mOS from second-line
starting were 8 and 28 months, without significant differences among various
regimens. Pertuzumab-pretreated patients showed a mPFS and a mOS from
second-line starting not significantly affected by type of second line, that
is, T-DM1 or lapatinib/capecitabine (p = 0.80 and
p = 0.45, respectively). Conversely, pertuzumab-naïve
patients receiving second-line T-DM1 showed a significantly higher mPFS
compared with that of patients treated with lapatinib/capecitabine
(p = 0.004). Median OS from metastatic disease
diagnosis was higher in patients treated with trastuzumab-based first line
followed by second-line T-DM1 in comparison to pertuzumab-based first-line
and second-line T-DM1 (p = 0.003), although these data
might be partially influenced by more favorable prognostic characteristics
of patients in the pre-pertuzumab era. No significant
differences emerged when comparing patients treated with ‘old’ or ‘new’
drugs (p = 0.43), even though differences in the length of
the follow-up between the two cohorts should be taken into account. Conclusion: Our results confirmed a relevant impact of first-line pertuzumab-based
treatment and showed lower efficacy of second-line T-DM1 in
trastuzumab/pertuzumab pretreated, as compared with pertuzumab-naïve
patients. Our findings may help delineate a more appropriate therapeutic
strategy in HER2-positive metastatic BC. Prospective randomized trials
addressing this topic are awaited.
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Affiliation(s)
- Laura Pizzuti
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Eriseld Krasniqi
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, via Elio Chianesi 53, 00144 Rome, Italy
| | - Isabella Sperduti
- Biostatistics Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Maddalena Barba
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, via Elio Chianesi 53, 00144 Rome, Italy
| | | | - Maria Mauri
- Division of Oncology, San Giovanni Hospital, Rome, Italy
| | | | - Icro Meattini
- Radiation Oncology Unit and Department of Clinical and Experimental Biomedical Sciences ‘Mario Serio’, Careggi University Hospital, University of Florence, Florence, Italy
| | - Rossana Berardi
- Oncology Clinic, ‘Ospedali iuniti di Ancona’ Hospital, Ancona, Italy
| | - Francesca Sofia Di Lisa
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
- Medical Oncology A, Policlinico Umberto I, Rome, Italy
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, ‘Sapienza’ University of Rome, Umberto I University Hospital, Rome, Italy
| | - Clara Natoli
- Department of Medical, Oral and Biotechnological Sciences and Center for Advanced Studies and Technology (CAST), G. D’Annunzio University, Chieti, Italy
| | - Mirco Pistelli
- Oncology Clinic, ‘Ospedali Riuniti di Ancona’ Hospital, Ancona, Italy
| | - Laura Iezzi
- Oncology Division, Hospital ‘Maria SS. dello Splendore’ ASL 4, Giulianova, Italy
| | - Emanuela Risi
- Sandro Pitigliani Medical Oncology Department, Hospital of Prato, Prato, Italy
| | | | - Silverio Tomao
- Medical Oncology A, Policlinico Umberto I, Rome, Italy
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, ‘Sapienza’ University of Rome, Umberto I University Hospital, Rome, Italy
| | - Corrado Ficorella
- Medical Oncology, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | | | | | - Alessandra Cassano
- U.O.C. Medical Oncology, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Emilio Bria
- U.O.C. Medical Oncology, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Marco Mazzotta
- Medical Oncology Unit, Belcolle Hospital, Viterbo, Italy
| | - Giacomo Barchiesi
- Medical Oncology A, Policlinico Umberto I, Rome, Italy
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, ‘Sapienza’ University of Rome, Umberto I University Hospital, Rome, Italy
- Medical Oncology Unit, Ospedale dell’Angelo, Mestre, Italy
| | - Andrea Botticelli
- Medical Oncology B, Policlinico Umberto I, Rome, Italy
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Giuliana D’Auria
- Medical Oncology, Sandro Pertini Hospital, Rome, Italy
- Paola ScavinaSan Giovanni Addolorata Hospital, 00184 Rome, Italy
| | - Anna Ceribelli
- Medical Oncology Unit, San Camillo de Lellis Hospital, ASL Rieti, Rieti, Italy
| | - Andrea Michelotti
- UO Medical Oncology I, S. Chiara Hospital, Pisa, Italy
- Oncology, Transplant and New Technologies Department, Pisa University Hospital, Pisa, Italy
| | - Antonio Russo
- Medical Oncology, AOU Policlinico Paolo Giaccone, Palermo, Italy
| | | | | | - Francesco Giotta
- Department of Medical Oncology, IRCCS Giovanni Paolo II Institute, Bari, Italy
| | - Ida Paris
- Gynaecology – Oncology Unit, IRCCS Catholic University of the Sacred Heart, Rome, Italy
| | - Rosa Saltarelli
- UOC Oncology, San Giovanni Evangelista Hospital, ASL RM5, Rome, Italy
| | - Daniele Marinelli
- Medical Oncology B, Policlinico Umberto I, Rome, Italy
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Domenico Corsi
- Medical Oncology Unit, Fatebenefratelli Hospital, Rome, Italy
| | | | | | - Luca Moscetti
- Division of Medical Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Lucia Mentuccia
- Medical Oncology, Ospedale ‘Parodi-Delfino’, Colleferro, Italy
| | - Giuseppe Tonini
- Department of Oncology, University Campus Biomedico of Rome, Rome, Italy
| | - Mimma Raffaele
- UOSD Presidio Oncologico Cassia – S. Andrea, ASL Roma 1, Rome, Italy
| | - Luca Marchetti
- UOC Oncology, San Pietro Fatebenefratelli Hospital, Rome, Italy
| | - Mauro Minelli
- Division of Oncology, San Giovanni Hospital, Rome, Italy
| | | | | | - Olivia Bacciu
- Division of Oncology, San Giovanni Hospital, Rome, Italy
| | - Nello Salesi
- Medical Oncology Unit, Santa Maria Goretti, Latina, Italy
| | - Lorenzo Livi
- Radiation Oncology Unit and Department of Clinical and Experimental Biomedical Sciences ‘Mario Serio’, Careggi University Hospital, University of Florence, Florence, Italy
| | - Nicola Tinari
- Department of Medical, Oral and Biotechnological Sciences and Center for Advanced Studies and Technology (CAST), G. D’Annunzio University, Chieti, Italy
| | - Antonino Grassadonia
- Department of Medical, Oral and Biotrechnological Sciences and Centre for Advanced Studues and Echnology (CAST), G. D’Annunzio University, Chieti, Italy
| | | | | | | | - Elisabetta Landucci
- UO Medical Oncology I, S. Chiara Hospital, Pisa, Italy
- Oncology, Transplant and New Technologies Department, Pisa University Hospital, Pisa, Italy
| | | | - Beatrice Fratini
- UO Medical Oncology I, S. Chiara Hospital, Pisa, Italy
- Oncology, Transplant and New Technologies Department, Pisa University Hospital, Pisa, Italy
| | - Marcello Maugeri-Saccà
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Michele De Tursi
- Department of Medical, Oral and Biotechnological Sciences and Center for Advanced Studies and Technology (CAST), G. D’Annunzio University, Chieti, Italy
| | - Angela Maione
- Oncology Unit, Antonio Cardarelli Hospital, Naples, Italy
| | - Daniele Santini
- Department of Oncology, University Campus Biomedico of Rome, Rome, Italy
| | - Armando Orlandi
- U.O.C. Medical Oncology, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vito Lorusso
- Department of Medical Oncology, IRCCS Giovanni Paolo II Institute, Bari, Italy
| | - Enrico Cortesi
- Medical Oncology B, Policlinico Umberto I, Rome, Italy
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Sanguineti
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Paola Pinnarò
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Federico Cappuzzo
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Lorenza Landi
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Claudio Botti
- Department of Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Federica Tomao
- Department of Gynecologic Oncology, European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | - Sonia Cappelli
- Department of Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giulia Bon
- Cellular Network and Molecular Therapeutic Target Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Fabio Pelle
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Flavia Cavicchi
- Department of Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Elena Fiorio
- U.O.C. Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Simone Scagnoli
- Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy
| | - Paolo Marchetti
- Medical Oncology B, Policlinico Umberto I, Rome, Italy
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Gennaro Ciliberto
- Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Patrizia Vici
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
- Sperimentazioni di Fase IV, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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5
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Pistelli M, Natalucci V, Scortichini L, Agostinelli V, Lenci E, Crocetti S, Merloni F, Bastianelli L, Taus M, Fumelli D, Giulietti G, Cola C, Capecci M, Serrani R, Ceravolo MG, Ricci M, Nicolai A, Barbieri E, Nicolai G, Ballatore Z, Savini A, Berardi R. The Impact of Lifestyle Interventions in High-Risk Early Breast Cancer Patients: A Modeling Approach from a Single Institution Experience. Cancers (Basel) 2021; 13:cancers13215539. [PMID: 34771702 PMCID: PMC8583345 DOI: 10.3390/cancers13215539] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/29/2021] [Accepted: 11/01/2021] [Indexed: 11/16/2022] Open
Abstract
A healthy lifestyle plays a strategic role in the prevention of BC. The aim of our prospective study is to evaluate the effects of a lifestyle interventions program based on special exercise and nutrition education on weight, psycho-physical well-being, blood lipid and hormonal profile among BC patients who underwent primary surgery. From January 2014 to March 2017, a multidisciplinary group of oncologists, dieticians, physiatrists and an exercise specialist evaluated 98 adult BC female patients at baseline and at different time points. The patients had at least one of the following risk factors: BMI ≥ 25 kg/m2, high testosterone levels, high serum insulin levels or diagnosis of MS. Statistically significant differences are shown in terms of BMI variation with the lifestyle interventions program, as well as in waist circumference and blood glucose, insulin and testosterone levels. Moreover, a statistically significant difference was reported in variations of total Hospital Anxiety and Depression Scale (HADS) score, in the anxiety HADS score and improvement in joint pain. Our results suggested that promoting a healthy lifestyle in clinical practice reduces risk factors involved in BC recurrence and ensures psycho-physical well-being.
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Affiliation(s)
- Mirco Pistelli
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (L.S.); (V.A.); (E.L.); (S.C.); (F.M.); (L.B.); (Z.B.); (A.S.)
- Correspondence: (M.P.); (R.B.); Tel.: +39-071-5964265 (M.P.); Fax: +39-071-5965053 (M.P.)
| | - Valentina Natalucci
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, 61029 Urbino, Italy; (V.N.); (E.B.)
| | - Laura Scortichini
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (L.S.); (V.A.); (E.L.); (S.C.); (F.M.); (L.B.); (Z.B.); (A.S.)
| | - Veronica Agostinelli
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (L.S.); (V.A.); (E.L.); (S.C.); (F.M.); (L.B.); (Z.B.); (A.S.)
| | - Edoardo Lenci
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (L.S.); (V.A.); (E.L.); (S.C.); (F.M.); (L.B.); (Z.B.); (A.S.)
| | - Sonia Crocetti
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (L.S.); (V.A.); (E.L.); (S.C.); (F.M.); (L.B.); (Z.B.); (A.S.)
| | - Filippo Merloni
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (L.S.); (V.A.); (E.L.); (S.C.); (F.M.); (L.B.); (Z.B.); (A.S.)
| | - Lucia Bastianelli
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (L.S.); (V.A.); (E.L.); (S.C.); (F.M.); (L.B.); (Z.B.); (A.S.)
| | - Marina Taus
- Dietology and Clinical Nutrition, AOU Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (M.T.); (D.F.); (G.G.); (C.C.); (A.N.)
| | - Daniele Fumelli
- Dietology and Clinical Nutrition, AOU Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (M.T.); (D.F.); (G.G.); (C.C.); (A.N.)
| | - Gloria Giulietti
- Dietology and Clinical Nutrition, AOU Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (M.T.); (D.F.); (G.G.); (C.C.); (A.N.)
| | - Claudia Cola
- Dietology and Clinical Nutrition, AOU Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (M.T.); (D.F.); (G.G.); (C.C.); (A.N.)
| | - Marianna Capecci
- Department of Experimental and Clinical Medicine, Neurorehabilitation Clinic, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (M.C.); (M.G.C.)
| | - Roberta Serrani
- Division of Rehabilitation Medicine, AOU Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (R.S.); (M.R.)
| | - Maria Gabriella Ceravolo
- Department of Experimental and Clinical Medicine, Neurorehabilitation Clinic, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (M.C.); (M.G.C.)
| | - Maurizio Ricci
- Division of Rehabilitation Medicine, AOU Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (R.S.); (M.R.)
| | - Albano Nicolai
- Dietology and Clinical Nutrition, AOU Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (M.T.); (D.F.); (G.G.); (C.C.); (A.N.)
| | - Elena Barbieri
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, 61029 Urbino, Italy; (V.N.); (E.B.)
| | - Giulia Nicolai
- Department of Medical Emergency, AOU Ospedali Riuniti Marche Nord, 61121 Pesaro, Italy;
| | - Zelmira Ballatore
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (L.S.); (V.A.); (E.L.); (S.C.); (F.M.); (L.B.); (Z.B.); (A.S.)
| | - Agnese Savini
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (L.S.); (V.A.); (E.L.); (S.C.); (F.M.); (L.B.); (Z.B.); (A.S.)
| | - Rossana Berardi
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (L.S.); (V.A.); (E.L.); (S.C.); (F.M.); (L.B.); (Z.B.); (A.S.)
- Correspondence: (M.P.); (R.B.); Tel.: +39-071-5964265 (M.P.); Fax: +39-071-5965053 (M.P.)
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Berardi R, Mentrasti G, Crocetti S, La Verde N, Chiari R, Cona M, Nicolardi L, De Filippis C, Oldani S, Pecci F, Venanzi F, Rocchi M, Savini A, Cantini L, Pistelli M. 1609P COVID-19 outbreak repercussions on breast cancer diagnoses and access to treatment: Preliminary data from the COVID-DELAY study. Ann Oncol 2021. [PMCID: PMC8454380 DOI: 10.1016/j.annonc.2021.08.1602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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7
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Pistelli M, Natalucci V, Bastianelli L, Scortichini L, Agostinelli V, Merloni F, Savini A, Capecci M, Ceravolo MG, Serrani R, Ricci M, Taus M, Nicolai A, Barbieri E, Berardi R. Abstract PD11-03: Assessing the impact of 12 months lifestyle interventions on breast cancer secondary prevention: A modeling approach. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-pd11-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background Healthy lifestyle, including caloric restriction, balanced diet and physical activity, is important in primary and secondary prevention of breast cancer (BC). It is known that Mediterranean diet reduces metabolic syndrome and insulin resistance that are associated with increased risk of BC onset and recurrence. Physical activity decreases BMI, blood concentrations of testosterone, estrogens, insulin, its resistance and strengthens anti-inflammatory pathways against tumor cells. Since January 2014, at our Institution we promoted a project named “Lifestyle Program” for high risk BC patients underwent to primary surgery. Here we presented the results of 12 months of “Lifestyle Program”. Patients and methods Since January 2014 we have prospectively enrolled all high risk patients between 18 and 70 years treated to our department for invasive early-stage breast cancer (stage I-III). High risk has been defined by one or more of the following inclusion criteria: body mass index (BMI) > 25, diagnosis of metabolic syndrome, increased level of blood testosterone and/or insulin. All high risk patients receive a periodical personalized educational intervention by a physiatrist for physical activity and by a nutritionist for a mediterranean diet low in animals fat and enriched of fibers, fruits and vegetables. All patients underwent to screening for anxiety and depression through HADS questionnaire scores. All data were analyzed by Chi-square test assuming statistical significance at p<0.05. Results 98 BC patients were included; 21.4% of them had a metabolic syndrome. Median age was 56 years old (range 27-75). Most of patients enrolled had ER+ (85.7%), Her2/neu negative (79.6%), stage I (48%) BC. We observed a statistically significant reduction of BMI (BMI>25 in 94.9% of pts at baseline vs 63.2% after 12 months of lifestyle; p=<0.0001), glycemic (>110 mg/dl in 23.5% of pts at baseline vs 10.2% at 12 months; p=<0.0001), insulin levels (>27 uU/ml in 20.6% of pts at baseline vs 2.9% after 12 months; p<0.0001), testosterone (>1,2 ng/ml in 17.6% of pts at baseline vs 4.1% at 12 months; p<0.0001), cholesterol (>200 mg/dl in 46.9% of pts at baseline vs 35.7% at 12 months; p<0.0001), triglycerides (>170 mg/dl in 13.3% of pts at baseline vs 10.2% at 12 months; p<0.0001) and arthralgia (37.7% at baseline vs 17.3% at 12 months; p=0.0008). We also noted a significantly reduction of anxiety and depression after 12 months of lifestyle program (25.4% and 12% respectively at diagnosis vs 13.4% and 4.5% at 12 months respectively; p=0,0064 and p<0.0001). Conclusions Promoting healthy lifestyle can reduce risk factors involved in BC recurrence and ensure psychological benefit and compliance to endocrine therapy. A multidisciplinary approach allows greater adherence to healthy attitudes in BC high risk patients.
Citation Format: Mirco Pistelli, Valentina Natalucci, Lucia Bastianelli, Laura Scortichini, Veronica Agostinelli, Filippo Merloni, Agnese Savini, Marianna Capecci, Maria Gabriella Ceravolo, Roberta Serrani, Maurizio Ricci, Marina Taus, Albano Nicolai, Elena Barbieri, Rossana Berardi. Assessing the impact of 12 months lifestyle interventions on breast cancer secondary prevention: A modeling approach [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PD11-03.
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Affiliation(s)
- Mirco Pistelli
- 1Clinica di Oncologia Medica e Centro Regionale di Genetica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti-Ancona, Ancona, Italy
| | - Valentina Natalucci
- 2Dipartimento di Scienze Biomolecolari, Università degli Studi di Urbino Carlo Bo, Urbino, Italy
| | - Lucia Bastianelli
- 1Clinica di Oncologia Medica e Centro Regionale di Genetica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti-Ancona, Ancona, Italy
| | - Laura Scortichini
- 1Clinica di Oncologia Medica e Centro Regionale di Genetica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti-Ancona, Ancona, Italy
| | - Veronica Agostinelli
- 1Clinica di Oncologia Medica e Centro Regionale di Genetica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti-Ancona, Ancona, Italy
| | - Filippo Merloni
- 1Clinica di Oncologia Medica e Centro Regionale di Genetica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti-Ancona, Ancona, Italy
| | - Agnese Savini
- 1Clinica di Oncologia Medica e Centro Regionale di Genetica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti-Ancona, Ancona, Italy
| | - Marianna Capecci
- 3Clinica di Neuroriabilitazione, Università Politecnica delle Marche, Ancona, AOU Ospedali Riuniti-Ancona, Ancona, Italy
| | - Maria Gabriella Ceravolo
- 3Clinica di Neuroriabilitazione, Università Politecnica delle Marche, Ancona, AOU Ospedali Riuniti-Ancona, Ancona, Italy
| | - Roberta Serrani
- 4Medicina Riabilitativa, AOU Ospedali Riuniti-Ancona, Ancona, Italy
| | - Maurizio Ricci
- 4Medicina Riabilitativa, AOU Ospedali Riuniti-Ancona, Ancona, Italy
| | - Marina Taus
- 5Dietetica e Nutrizione Clinica, AOU Ospedali Riuniti-Ancona, Ancona, Italy
| | - Albano Nicolai
- 5Dietetica e Nutrizione Clinica, AOU Ospedali Riuniti-Ancona, Ancona, Italy
| | - Elena Barbieri
- 6Dipartimento di Scienze Biomolecolari, Università degli Studi di Urbino Carlo Bo, Ancona, Italy
| | - Rossana Berardi
- 1Clinica di Oncologia Medica e Centro Regionale di Genetica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti-Ancona, Ancona, Italy
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De Lisa M, Ballatore Z, Marcantognini G, Pierantoni C, Antognoli S, Pistelli M, Pagliacci A, Berardi R. Irinotecan-Induced Transient Dysarthria: Case Series and Updated Literature Review. Oncol Ther 2020; 8:147-160. [PMID: 32700070 PMCID: PMC7359989 DOI: 10.1007/s40487-019-00106-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Indexed: 12/27/2022] Open
Abstract
Irinotecan-based regimens are used worldwide for the treatment of several recurrent or advanced gastrointestinal malignancies. In this paper we describe the cases of four patients treated in our institution who developed acute dysarthria while receiving intravenous infusion of irinotecan. In all our cases, dysarthria occurred during the infusion of the first course of irinotecan, and then resolved rapidly without any sequelae. Imaging of the brain was performed, but failed to show any evidence of an acute neurological event. We also reviewed the literature on this very uncommon adverse event. The pathogenesis of irinotecan-induced dysarthria is still unknown and is not completely elucidated by the current pharmacodynamic or kinetic explanations; therefore, we could only hypothesize some assumptions.
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Affiliation(s)
- Mariagrazia De Lisa
- Medical Oncology, Azienda Ospedaliero-Universitaria Ospedali Riuniti-Ancona, Università Politecnica delle Marche, Ancona, Italy
| | - Zelmira Ballatore
- Medical Oncology, Azienda Ospedaliero-Universitaria Ospedali Riuniti-Ancona, Università Politecnica delle Marche, Ancona, Italy
| | - Giulia Marcantognini
- Medical Oncology, Azienda Ospedaliero-Universitaria Ospedali Riuniti-Ancona, Università Politecnica delle Marche, Ancona, Italy
| | - Chiara Pierantoni
- Medical Oncology, Azienda Ospedaliero-Universitaria Ospedali Riuniti-Ancona, Università Politecnica delle Marche, Ancona, Italy
| | - Stefania Antognoli
- Medical Oncology, Azienda Ospedaliero-Universitaria Ospedali Riuniti-Ancona, Università Politecnica delle Marche, Ancona, Italy
| | - Mirco Pistelli
- Medical Oncology, Azienda Ospedaliero-Universitaria Ospedali Riuniti-Ancona, Università Politecnica delle Marche, Ancona, Italy
| | - Alessandra Pagliacci
- Medical Oncology, Azienda Ospedaliero-Universitaria Ospedali Riuniti-Ancona, Università Politecnica delle Marche, Ancona, Italy
| | - Rossana Berardi
- Medical Oncology, Azienda Ospedaliero-Universitaria Ospedali Riuniti-Ancona, Università Politecnica delle Marche, Ancona, Italy.
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Ballatore Z, Bracci R, Maccaroni E, Svarca L, Bianchi F, Belvederesi L, Brugiati C, Pagliaretta S, Murrone A, Bini F, Pistelli M, Ricci G, Berardi R. Correction to: Expectations and psychological issues before genetic counseling: analysis of distress determinant factors. Hered Cancer Clin Pract 2020; 18:11. [PMID: 32467738 PMCID: PMC7236283 DOI: 10.1186/s13053-020-00143-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Zelmira Ballatore
- 1Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Raffaella Bracci
- 2Oncologia, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Presidio Santa Croce, Fano, Italy
| | - Elena Maccaroni
- 1Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Lucia Svarca
- 3Neuropsichiatria Infantile, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Francesca Bianchi
- 1Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Laura Belvederesi
- 1Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Cristiana Brugiati
- 1Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Silvia Pagliaretta
- 1Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Alberto Murrone
- 1Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Federica Bini
- 1Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Mirco Pistelli
- 1Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Giulia Ricci
- 1Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Rossana Berardi
- 1Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
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10
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Ballatore Z, Bracci R, Maccaroni E, Svarca L, Bianchi F, Belvederesi L, Bruciati C, Pagliaretta S, Murrone A, Bini F, Pistelli M, Ricci G, Berardi R. Expectations and psychological issues before genetic counseling: analysis of distress determinant factors. Hered Cancer Clin Pract 2020; 18:10. [PMID: 32368313 PMCID: PMC7189592 DOI: 10.1186/s13053-020-00142-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 04/15/2020] [Indexed: 01/17/2023] Open
Abstract
Background Hereditary non-polyposis colorectal cancer (HNPCC) and Hereditary Breast and Ovarian Cancer Syndrome (HBOC) are the most common hereditary cancer syndromes in which a genetic test is available. Potential risks associated with testing include psychological harm, emotional distress and insurance problems. Methods The aim of the present study is to investigate determinants of distress in a sample of Italian subjects undergoing genetic counseling. Demographic information and psychological distress were assessed by using a self-reported questionnaire and the "Hospital Anxiety and Depression Scale" (HAD), before attending the first counseling session. Results Of the all subjects referred for the first time to our Center (January 2012-June 2013), a total of 227 were eligible (female/male = 174/53) for the survey, 134 (59%) were oncologic patients and of these, 116 received genetic test (36 for HNPCC and 80 for HBOC). The remaining 93 (41%) were healthy subjects referred for suspected familiar history and of this group, 65 subjects performed predictive test in a family with a known pathogenic mutation (53 for HBOC and 12 for HNPCC). Affected subjects had a significantly higher level of anxiety (p = 0.02) and HAD global score (p = 0.01) than healthy ones. There was no difference in HAD score between individuals testing for different syndromes (p = 0.3). In the affected subgroup, there was a significant linear correlation between the HAD anxiety score and how much subjects perceived their disease as hereditary (p = 0.01). Female and younger subjects had higher levels of anxiety (p = 0.05). Also healthy single subjects show more general distress (p = 0.02) than those with a partner. Conclusions Greater level of distress identified on females, single and younger subjects.
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Affiliation(s)
- Zelmira Ballatore
- 1Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Raffaella Bracci
- 2Oncologia, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Presidio Santa Croce, Fano, Italy
| | - Elena Maccaroni
- 1Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Lucia Svarca
- 3Neuropsichiatria Infantile, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Francesca Bianchi
- 1Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Laura Belvederesi
- 1Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Cristiana Bruciati
- 1Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Silvia Pagliaretta
- 1Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Alberto Murrone
- 1Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Federica Bini
- 1Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Mirco Pistelli
- 1Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Giulia Ricci
- 1Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Rossana Berardi
- 1Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
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11
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Cazzaniga ME, Verusio C, Ciccarese M, Fumagalli A, Sartori D, Valerio MR, Airoldi M, Moretti G, Ficorella C, Gianni L, Michelotti A, Zambelli A, Febbraro A, Generali D, Pistelli M, Garrone O, Musolino A, Vici P, Maur M, Mentuccia L, La Verde N, Bianchi GV, Artale S, Blasi L, De Laurentiis M, Atzori F, Turletti A, Porpiglia M, Santini D, Fabi A, Gebbia V, Schirone A, Palumbo R, Ferzi A, Frassoldati A, Scavelli C, Clivio L, Giordano M, Donadio M, Biganzoli L, Del Mastro L, Bisagni G, Livi L, Natoli C, Montemurro F, Riccardi F, Romagnoli E, Marchetti P, Torri V, Pronzato P, Mustacchi G. Is There Still a Role for Endocrine Therapy Alone in HR+/HER2- Advanced Breast Cancer Patients? Results from the Analysis of Two Data Sets of Patients Treated with High-Dose Fulvestrant as First-Line Therapy in the Real-World Setting: The EVA and GIM-13 AMBRA Studies. Breast Care (Basel) 2020; 15:30-37. [PMID: 32231495 DOI: 10.1159/000495469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 11/15/2018] [Indexed: 11/19/2022] Open
Abstract
Background Different studies suggest that fulvestrant 500 mg every 28 days (HD-FUL) could be an active treatment in HR+ advanced breast cancer (ABC) patients even treated with aromatase inhibitors in the adjuvant setting. The aim of this analysis is to describe the outcome of ABC patients treated with HD-FUL as first-line treatment in terms of median duration of treatment and the overall response rate in a real-world setting. Methods For the purpose of the present analysis, we considered two data sets of HR+ ABC patients collected in Italy between 2012 and 2015 (EVA and GIM-13 AMBRA studies). Results Eighty-one and 91 patients have been identified from the two data sets. The median age was 63 years (range 35-82) for the EVA and 57.8 years (range 35.0-82.3) for the AMBRA patients. ORRs were 23.5 and 24.3% in the whole population, 26.9% in the patients with bone only, and 21.8 and 21.4% in those with visceral metastases. The median duration of HD-FUL was 11.6 months (range 1-48) and 12.4 months (range 2.9-70.0) in the two data sets, respectively. Conclusion These data suggest that HD-FUL should still continue to play a significant role as first-line therapy in HR+ ABC patients.
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Affiliation(s)
- Marina Elena Cazzaniga
- Research Unit Phase I Trials, ASST Monza, Monza, Italy.,Oncology Unit, ASST Monza, Monza, Italy
| | - Claudio Verusio
- Oncology Unit, ASST della Valle Olona - Presidio Ospedaliero di Saronno, Saronno, Italy
| | | | | | | | | | - Mario Airoldi
- Oncology Unit 2 - Città della Salute e della Scienza di Torino, Turin, Italy
| | - Gabriella Moretti
- Oncology Unit, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | - Corrado Ficorella
- Dipartimento di Scienze Cliniche Applicate e Biotecnologiche (DISCAB) - Università Degli Studi Dell'Aquila, L'Aquila, Italy
| | - Lorenzo Gianni
- Oncology Unit Rimini, Azienda USL Romagna, Rimini, Italy
| | - Andrea Michelotti
- Oncology Unit 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | | | - Antonio Febbraro
- Oncology Unit, Ospedale Sacro Cuore di Gesù, Fatebenefratelli, Benevento, Italy
| | | | - Mirco Pistelli
- Oncology Unit, AOU Ospedali Riuniti Ancona, Ancona, Italy
| | - Ornella Garrone
- Oncology Unit, A.O.S. Croce e Carle Ospedale di Insegnamento, Cuneo, Italy
| | - Antonino Musolino
- Oncology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Patrizia Vici
- Oncology Unit 2, Istituto Nazionale Tumori Regina Elena - IFO, Rome, Italy
| | - Michela Maur
- Oncology Unit, Policlinico University Hospital of Modena, Modena, Italy
| | - Lucia Mentuccia
- Oncology Unit, ASL di Frosinone, Osp. "SS. Trinità", Sora, Italy
| | - Nicla La Verde
- Oncology Unit, ASST Fatebenefratelli Sacco Presidio Ospedaliero Fatebenefratelli, Milan, Italy
| | | | - Salvatore Artale
- Oncology Departement, Ospedale di Gallarate, ASST Valle Olona, Gallarate, Italy
| | - Livio Blasi
- Oncology Unit, ARNAS Civico Palermo, Palermo, Italy
| | | | | | | | - Mauro Porpiglia
- Oncology Unit, ASST della Valle Olona - Presidio Ospedaliero di Saronno, Saronno, Italy
| | | | - Alessandra Fabi
- Oncology Unit, Ospedale Moriggia Pelascini, Gravedona, Italy
| | | | - Alessio Schirone
- Oncology Department, Policlinico "Paolo Giaccone", Palermo, Italy
| | - Raffaella Palumbo
- Oncology Unit 2 - Città della Salute e della Scienza di Torino, Turin, Italy
| | - Antonella Ferzi
- Oncology Unit, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | - Antonio Frassoldati
- Dipartimento di Scienze Cliniche Applicate e Biotecnologiche (DISCAB) - Università Degli Studi Dell'Aquila, L'Aquila, Italy
| | | | - Luca Clivio
- Oncology Unit 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | | | - Michela Donadio
- Oncology Unit, Ospedale Sacro Cuore di Gesù, Fatebenefratelli, Benevento, Italy
| | | | | | - Giancarlo Bisagni
- Oncology Unit, A.O.S. Croce e Carle Ospedale di Insegnamento, Cuneo, Italy
| | - Lorenzo Livi
- Oncology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Clara Natoli
- Oncology Unit 2, Istituto Nazionale Tumori Regina Elena - IFO, Rome, Italy
| | | | | | - Emanuela Romagnoli
- Oncology Unit, ASST Fatebenefratelli Sacco Presidio Ospedaliero Fatebenefratelli, Milan, Italy
| | - Paolo Marchetti
- Oncology Unit 1, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Valter Torri
- Oncology Unit 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Paolo Pronzato
- Oncology Departement, Ospedale di Gallarate, ASST Valle Olona, Gallarate, Italy
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12
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Krasniqi E, Pizzuti L, Barchiesi G, Sergi D, Carpano S, Botti C, Kayal R, Sanguineti G, Marchetti P, Botticelli A, Marinelli D, Gamucci T, Natoli C, Grassadonia A, Tinari N, Tomao S, Tonini G, Santini D, Michelotti A, Mentuccia L, Vaccaro A, Magnolfi E, Gelibter A, Magri V, Cortesi E, D'Onofrio L, Cassano A, Cazzaniga M, Moscetti L, Fabbri A, Scinto AF, Corsi D, Carbognin L, Bria E, La Verde N, Garufi C, Di Stefano P, Mirabelli R, Veltri E, Paris I, Giotta F, Lorusso V, Landucci E, Ficorella C, Roselli M, Adamo V, Ricciardi G, Russo A, Valerio MR, Berardi R, Pistelli M, Cannita K, Zamagni C, Garrone O, Baldini E, Livi L, Meattini I, Del Medico P, Generali D, De Maria R, Risi E, Ciliberto G, Villa A, Sperduti I, Mazzotta M, Barba M, Giordano A, Vici P. Impact of BMI on HER2+ metastatic breast cancer patients treated with pertuzumab and/or trastuzumab emtansine. Real-world evidence. J Cell Physiol 2020; 235:7900-7910. [PMID: 31943171 DOI: 10.1002/jcp.29445] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 12/04/2019] [Indexed: 12/27/2022]
Abstract
Body mass index (BMI) is a main indicator of obesity and its association with breast cancer is well established. However, little is known in the metastatic setting, especially in HER2-positive patients. We assessed the influence of BMI on clinical outcomes of patients treated with pertuzumab and/or trastuzumab emtansine (T-DM1) for HER2+ metastatic breast cancer (mBC). BMI was addressed as a categorical variable, being classified on the basis of the following ranges, that is, 18.5-24.9, 25-29.9, and 30.0-34.9, namely, normal weight, overweight, and Class I obesity. The outcomes chosen were progression-free survival to first-line chemotherapy (PFS1) and overall survival (OS). Overall (N = 709), no impact of BMI was observed on PFS1 (p = .15), while BMI ≥ 30 was associated with worse OS (p = .003). In subjects who progressed to first line (N = 575), analyzing data across PFS1 quartiles and strata of disease burden, BMI predicted lower PFS1 in patients within the I PFS1 quartile and with the lowest disease burden (p = .001). Univariate analysis showed a detrimental effect of BMI ≥ 30 on OS for women within the I PFS1 quartile (p = .03). Results were confirmed in multivariate analysis. According to PFS1 quartiles a higher percentage of patients with high BMI and low disease burden progressed within 6 months of therapy. The effect of BMI on prognosis was also confirmed in multivariate analysis of OS for overall population. In our cohort, a BMI ≥ 30 correlated with worse OS in patients with HER2+ mBC who received pertuzumab and/or T-DM1 but had no impact on PFS to first line. BMI predicted worse I PFS1 quartile.
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Affiliation(s)
- Eriseld Krasniqi
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Laura Pizzuti
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giacomo Barchiesi
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Domenico Sergi
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Silvia Carpano
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Claudio Botti
- Department of Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Ramy Kayal
- Department of Radiology and Diagnostic Imaging, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppe Sanguineti
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Paolo Marchetti
- Medical Oncology Unit B, Policlinico Umberto I, Rome, Italy.,Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant'Andrea, "Sapienza" University of Rome, Rome, Italy
| | | | - Daniele Marinelli
- Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant'Andrea, "Sapienza" University of Rome, Rome, Italy
| | | | - Clara Natoli
- Department of Medical, Oral and Biotechnological Sciences and CeSI-MeT, G. D'Annunzio University, Chieti, Italy
| | - Antonino Grassadonia
- Department of Medical, Oral and Biotechnological Sciences and CeSI-MeT, G. D'Annunzio University, Chieti, Italy
| | - Nicola Tinari
- Department of Medical, Oral and Biotechnological Sciences and CeSI-MeT, G. D'Annunzio University, Chieti, Italy
| | - Silverio Tomao
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Policlinico Umberto I, 'Sapienza' University of Rome, Rome, Italy
| | - Giuseppe Tonini
- Department of Oncology, University Campus Biomedico of Rome, Rome, Italy
| | - Daniele Santini
- Department of Oncology, University Campus Biomedico of Rome, Rome, Italy
| | - Aandrea Michelotti
- Dipartimento di Oncologia, Dei Trapianti e Delle Nuove Tecnologie, UO Oncologia Medica I, S. Chiara Hospital, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | | | | | | | - Alain Gelibter
- Medical Oncology Unit B, Policlinico Umberto I, Rome, Italy
| | | | - Enrico Cortesi
- Medical Oncology Unit B, Policlinico Umberto I, Rome, Italy
| | - Loretta D'Onofrio
- Department of Oncology, University Campus Biomedico of Rome, Rome, Italy
| | - Alessandra Cassano
- Department of Medical Oncology, Policlinico Universitario "A. Gemelli", Rome, Italy
| | - Marina Cazzaniga
- Research Unit Phase I Trials and Oncology Unit, ASST Monza, Monza, Italy
| | - Luca Moscetti
- Division of Medical Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Agnese Fabbri
- Medical Oncology Unit, Belcolle Hospital, Viterbo, Italy
| | | | - Domenico Corsi
- Medical Oncology Unit, Fatebenefratelli Hospital, Rome, Italy
| | - Luisa Carbognin
- University of Verona, Verona, Italy.,Division of Gynecologic Oncology, Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Emilio Bria
- University of Verona, Verona, Italy.,Comprehensive Cancer Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Del Sacro Cuore, Roma, Italy
| | - Nicla La Verde
- Oncology Unit, ASST Fatebenefratelli Sacco Presidio Ospedaliero Fatebenefratelli, Milano, Italy
| | - Carlo Garufi
- Medical Oncology, "Santo Spirito" Hospital, Pescara, Italy
| | - Pia Di Stefano
- Medical Oncology, "Santo Spirito" Hospital, Pescara, Italy
| | - Rossana Mirabelli
- Department of Hematology & Oncology, Azienda Ospedaliera Pugliese-Ciaccio, Catanzaro, Italy
| | - Enzo Veltri
- Oncology Unit, S. Maria Goretti Hospital, Latina, Italy
| | - Ida Paris
- Division of Gynecologic Oncology, Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Francesco Giotta
- Department of Medical Oncology, "Giovanni Paolo II" Institute, Bari, Italy
| | - Vito Lorusso
- Department of Medical Oncology, "Giovanni Paolo II" Institute, Bari, Italy
| | - Elisa Landucci
- Dipartimento di Oncologia, Dei Trapianti e Delle Nuove Tecnologie, UO Oncologia Medica I, S. Chiara Hospital, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Corrado Ficorella
- Department of Biotechnological and Applied Clinical Sciences, Medical Oncology, University of L'Aquila, L'Aquila, Italy
| | - Mario Roselli
- Department of Systems Medicine, Medical Oncology, University of Rome "Tor Vergata", Rome, Italy
| | - Vincenzo Adamo
- Department of Human Pathology, Medical Oncology Unit A.O. Papardo, University of Messina, Messina, Italy
| | - Giuseppina Ricciardi
- Department of Human Pathology, Medical Oncology Unit A.O. Papardo, University of Messina, Messina, Italy
| | - Antonio Russo
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - Maria Rosaria Valerio
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - Rossana Berardi
- Oncology Clinic, Università Politecnica delle Marche, Ancona, Italy
| | - Mirco Pistelli
- Oncology Clinic, Università Politecnica delle Marche, Ancona, Italy
| | - Katia Cannita
- Medical Oncology, St. Salvatore Hospital, L'Aquila, Italy
| | - Claudio Zamagni
- Medical Oncology Unit, Addarii Institute of Oncology, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Ornella Garrone
- Medical Oncology, A.O. Ospedale di Insegnamento S. Croce e Carle, Cuneo, Italy
| | | | - Lorenzo Livi
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio," Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Icro Meattini
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio," Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Pietro Del Medico
- Division of Medical Oncology, Reggio Calabria General Hospital, Reggio Calabria, Italy
| | - Daniele Generali
- Breast Cancer Unit & Translational Research Unit, ASST Cremona, Cremona, Italy
| | - Ruggero De Maria
- Institute of General Pathology, Catholic University of the Sacred Heart, Rome, Italy
| | - Emanuela Risi
- Department of "Sandro Pitigliani" Medical Oncology, Santo Stefano Hospital, Prato, Italy
| | - Gennaro Ciliberto
- Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Alice Villa
- Endocrinology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Isabella Sperduti
- Department of Bio-Statistics, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Marco Mazzotta
- Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant'Andrea, "Sapienza" University of Rome, Rome, Italy
| | - Maddalena Barba
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Antonio Giordano
- Department of Biology, Sbarro Institute for Cancer Research and Molecular Medicine, Temple University, Philadelphia, Pennsylvania
| | - Patrizia Vici
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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13
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Biganzoli L, Cinieri S, Berardi R, Pedersini R, McCartney A, Minisini AM, Caremoli ER, Spazzapan S, Magnolfi E, Brunello A, Risi E, Palumbo R, Leo S, Colleoni M, Donati S, De Placido S, Orlando L, Pistelli M, Parolin V, Mislang A, Becheri D, Puglisi F, Sanna G, Zafarana E, Boni L, Mottino G. EFFECT: a randomized phase II study of efficacy and impact on function of two doses of nab-paclitaxel as first-line treatment in older women with advanced breast cancer. Breast Cancer Res 2020; 22:83. [PMID: 32758299 PMCID: PMC7405344 DOI: 10.1186/s13058-020-01319-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 07/22/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Limited data are available regarding the use of nab-paclitaxel in older patients with breast cancer. A weekly schedule is recommended, but there is a paucity of evidence regarding the optimal dose. We evaluated the efficacy of two different doses of weekly nab-paclitaxel, with a specific focus on their corresponding impact on patient function, in order to address the lack of data specifically relating to the older population. METHODS EFFECT is an open-label, phase II trial wherein 160 women with advanced breast cancer aged ≥ 65 years were enrolled from 15 institutions within Italy. Patients were randomly assigned 1:1 to receive nab-paclitaxel 100 mg/m2 (arm A) or 125 mg/m2 (arm B) on days 1, 8, and 15 on a 28-day cycle, as first-line treatment for advanced disease. The primary endpoint was event-free survival (EFS), wherein an event was defined as disease progression (PD), functional decline (FD), or death. In each arm, the null hypothesis that the median EFS would be ≤ 7 months was tested against a one-sided alternative according to the Brookmeyer Crowley test. Secondary endpoints included objective response rate (ORR), clinical benefit rate (CBR), progression-free survival (PFS), overall survival (OS), and safety. RESULTS After a median follow-up of 32.6 months, 140 events were observed in 158 evaluable patients. Median EFS was 8.2 months (90% CI, 5.9-8.9; p = 0.188) in arm A vs 8.3 months (90% CI, 6.2-9.7, p = 0.078) in arm B. Progression-free survival, overall survival, and response rates were similar in both groups. A higher percentage of dose reductions and discontinuations due to adverse events (AEs) was noted in arm B. The most frequently reported non-haematological AEs were fatigue (grade [G] 2-3 toxicity occurrence in arm A vs B, 43% and 51%, respectively) and peripheral neuropathy (G2-3 arm A vs B, 19% and 38%, respectively). CONCLUSION Pre-specified outcomes were similar in both treatment arms. However, 100 mg/m2 was significantly better tolerated with fewer neurotoxicity-related events, representing a more feasible dose to be recommended for older patients with advanced disease. TRIAL REGISTRATION EudraCT, 2012-002707-18 . Registered on June 4, 2012. NIH ClinicalTrials.gov, NCT02783222 . Retrospectively registered on May 26, 2016.
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Affiliation(s)
- Laura Biganzoli
- grid.430148.a“Sandro Pitigliani” Department of Medical Oncology, Hospital of Prato, ASL Toscana Centro, Prato, Italy
| | - Saverio Cinieri
- grid.417511.7Department of Medical Oncology, Perrino Hospital, ASL Brindisi, Brindisi, Italy
| | - Rossana Berardi
- grid.7010.60000 0001 1017 3210Department of Medical Oncology, Ospedali Riuniti di Ancona, Università Politecnica delle Marche, Ancona, Italy
| | | | - Amelia McCartney
- grid.430148.a“Sandro Pitigliani” Department of Medical Oncology, Hospital of Prato, ASL Toscana Centro, Prato, Italy
| | | | - Elena Rota Caremoli
- Cancer Centre, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Simon Spazzapan
- grid.417893.00000 0001 0807 2568Unit of Medical Oncology and Cancer Prevention, IRCCS CRO di Aviano, National Cancer Institute, Aviano, Italy
| | - Emanuela Magnolfi
- Department of Medical Oncology, Hospital Civile SS Trinità di Sora, Frosinone, Italy
| | - Antonella Brunello
- grid.419546.b0000 0004 1808 1697Department of Medical Oncology, Veneto Institute of Oncology IOV Padova, Padua, Italy
| | - Emanuela Risi
- grid.430148.a“Sandro Pitigliani” Department of Medical Oncology, Hospital of Prato, ASL Toscana Centro, Prato, Italy
| | | | - Silvana Leo
- grid.417011.20000 0004 1769 6825Department of Medical Oncology, Vito Fazzi Hospital, Lecce, Italy
| | - Marco Colleoni
- grid.15667.330000 0004 1757 0843Division of Medical Senology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Sara Donati
- grid.459640.a0000 0004 0625 0318Department of Oncology, Versilia Hospital (Camaiore-Lu), Viareggio, Italy
| | - Sabino De Placido
- grid.4691.a0000 0001 0790 385XDepartment of Endocrinology and Molecular and Clinical Oncology, AOU Federico II, Naples, Italy
| | - Laura Orlando
- grid.417511.7Department of Medical Oncology, Perrino Hospital, ASL Brindisi, Brindisi, Italy
| | - Mirco Pistelli
- grid.7010.60000 0001 1017 3210Department of Medical Oncology, Ospedali Riuniti di Ancona, Università Politecnica delle Marche, Ancona, Italy
| | - Veronica Parolin
- grid.411475.20000 0004 1756 948XDepartment of Medical Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Anna Mislang
- grid.430148.a“Sandro Pitigliani” Department of Medical Oncology, Hospital of Prato, ASL Toscana Centro, Prato, Italy ,grid.414925.f0000 0000 9685 0624Flinders Centre for Innovation in Cancer, Flinders Medical Centre, Bedford Park, South Australia Australia
| | | | - Fabio Puglisi
- Department of Oncology, Azienda Ospedaliero Universitaria Integrata di Udine, Udine, Italy ,grid.417893.00000 0001 0807 2568Unit of Medical Oncology and Cancer Prevention, IRCCS CRO di Aviano, National Cancer Institute, Aviano, Italy
| | - Giuseppina Sanna
- grid.430148.a“Sandro Pitigliani” Department of Medical Oncology, Hospital of Prato, ASL Toscana Centro, Prato, Italy
| | - Elena Zafarana
- grid.430148.a“Sandro Pitigliani” Department of Medical Oncology, Hospital of Prato, ASL Toscana Centro, Prato, Italy
| | - Luca Boni
- grid.24704.350000 0004 1759 9494Clinical Trials Centre, AOU University Hospital Careggi, Florence, Italy
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14
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Pizzuti L, Krasniqi E, Barchiesi G, Della Giulia M, Izzo F, Sanguineti G, Marchetti P, Mazzotta M, Giusti R, Botticelli A, Gamucci T, Natoli C, Grassadonia A, Tinari N, Iezzi L, Tomao S, Tomao F, Tonini G, Santini D, Astone A, Michelotti A, De Angelis C, Mentuccia L, Vaccaro A, Magnolfi E, Gelibter A, Magri V, Cortesi E, D'Onofrio L, Cassano A, Rossi E, Cazzaniga M, Moscetti L, Omarini C, Piacentini F, Fabbri MA, Scinto AF, Corsi D, Carbognin L, Bria E, La Verde N, Samaritani R, Garufi C, Barni S, Mirabelli R, Sarmiento R, Veltri EM, D'Auria G, Paris I, Giotta F, Lorusso V, Cardillo F, Landucci E, Mauri M, Ficorella C, Roselli M, Adamo V, Ricciardi GRR, Russo A, Berardi R, Pistelli M, Fiorio E, Cannita K, Sini V, D'Ostilio N, Foglietta J, Greco F, Zamagni C, Garrone O, Di Cocco B, Baldini E, Livi L, Desideri I, Meattini I, Sarobba G, Del Medico P, De Tursi M, Generali D, De Maria R, Risi E, Ciliberto G, Sperduti I, Villa A, Barba M, Di Leo A, Vici P. Distinct HR expression patterns significantly affect the clinical behavior of metastatic HER2+ breast cancer and degree of benefit from novel anti-HER2 agents in the real world setting. Int J Cancer 2019; 146:1917-1929. [PMID: 31330065 PMCID: PMC7027476 DOI: 10.1002/ijc.32583] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/07/2019] [Accepted: 07/03/2019] [Indexed: 12/02/2022]
Abstract
We analyzed data from 738 HER2‐positive metastatic breast cancer (mbc) patients treated with pertuzumab‐based regimens and/or T‐DM1 at 45 Italian centers. Outcomes were explored in relation to tumor subtype assessed by immunohistochemistry (IHC). The median progression‐free survival at first‐line (mPFS1) was 12 months. Pertuzumab as first‐line conferred longer mPFS1 compared to other first‐line treatments (16 vs. 9 months, p = 0.0001), regardless of IHC subtype. Median PFS in second‐line (mPFS2) was 7 months, with no difference by IHC subtype, but it was more favorable with T‐DM1 compared to other agents (7 vs. 6 months, p = 0.03). There was no PFS2 gain in patients with tumors expressing both hormonal receptors (HRs; p = 0.17), while a trend emerged for tumors with one HR (p = 0.05). Conversely, PFS2 gain was significant in HRs‐negative tumors (p = 0.04). Median overall survival (mOS) was 74 months, with no significant differences by IHC subtypes. Survival rates at 2 and 3 years in patients treated with T‐DM1 in second‐line after pertuzumab were significantly lower compared to pertuzumab‐naïve patients (p = 0.01). When analyzed by IHC subtype, the outcome was confirmed if both HRs or no HRs were expressed (p = 0.02 and p = 0.006, respectively). Our results confirm that HRs expression impacts the clinical behavior and novel treatment‐related outcomes of HER2‐positive tumors when treatment sequences are considered. Moreover, multivariate analysis showed that HRs expression had no effect on PFS and OS. Further studies are warranted to confirm our findings and clarify the interplay between HER2 and estrogen receptor pathways in HER2‐positive (mbc) patients. What's new? About half of breast cancers positive for human epidermal growth factor (HER2) also express hormone receptors but the impact of hormone receptor status on the success of HER2‐directed treatments is not fully explored. Here the authors retrospectively assessed tumor behavior and treatment outcomes in 738 women with HER2+ metastatic breast cancer treated with new generation anti‐HER2 agents. Distinct hormone receptor expression patterns significantly affected the progression free and overall survival, justifying further studies to define optimal treatment regimens and the interplay between hormone receptor and HER2 signaling.
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Affiliation(s)
- Laura Pizzuti
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Eriseld Krasniqi
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giacomo Barchiesi
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Marina Della Giulia
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Fiorentino Izzo
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppe Sanguineti
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Paolo Marchetti
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Sant'Andrea, Rome, Italy.,Medical Oncology Unit B, Policlinico Umberto I, Rome, Italy
| | - Marco Mazzotta
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Sant'Andrea, Rome, Italy
| | - Raffaele Giusti
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Sant'Andrea, Rome, Italy
| | | | | | - Clara Natoli
- Department of Medical, Oral and Biotechnological Sciences, Centro Scienze dell'Invecchiamento e Medicina Traslazionale -CeSI-MeT, Chieti, Italy
| | - Antonino Grassadonia
- Department of Medical, Oral and Biotechnological Sciences, Centro Scienze dell'Invecchiamento e Medicina Traslazionale -CeSI-MeT, Chieti, Italy
| | - Nicola Tinari
- Department of Medical, Oral and Biotechnological Sciences, Centro Scienze dell'Invecchiamento e Medicina Traslazionale -CeSI-MeT, Chieti, Italy
| | - Laura Iezzi
- Department of Medical, Oral and Biotechnological Sciences, Centro Scienze dell'Invecchiamento e Medicina Traslazionale -CeSI-MeT, Chieti, Italy
| | - Silverio Tomao
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, 'Sapienza' University of Rome, Policlinico Umberto I, Rome, Italy
| | - Federica Tomao
- Department of Gynecology-Obstetrics and Urology, "Sapienza" University of Rome, Rome, Italy
| | - Giuseppe Tonini
- Department of Oncology, University Campus Biomedico of Rome, Rome, Italy
| | - Daniele Santini
- Department of Oncology, University Campus Biomedico of Rome, Rome, Italy
| | - Antonio Astone
- Division of Medical Oncology, Villa San Pietro Hospital, Rome, Italy
| | - Andrea Michelotti
- UO Oncologia Medica I, S. Chiara Hospital, Dipartimentodi Oncologia, Dei Trapianti e Delle Nuove Tecnologie, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Claudia De Angelis
- UO Oncologia Medica I, S. Chiara Hospital, Dipartimentodi Oncologia, Dei Trapianti e Delle Nuove Tecnologie, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | | | | | | | - Alain Gelibter
- Medical Oncology Unit B, Policlinico Umberto I, Rome, Italy
| | | | - Enrico Cortesi
- Medical Oncology Unit B, Policlinico Umberto I, Rome, Italy
| | - Loretta D'Onofrio
- Department of Oncology, University Campus Biomedico of Rome, Rome, Italy
| | - Alessandra Cassano
- Department of Medical Oncology, Policlinico Universitario "A. Gemelli", Rome, Italy.,Universita Cattolica del Sacro Cuore, Roma
| | - Ernesto Rossi
- Department of Medical Oncology, Policlinico Universitario "A. Gemelli", Rome, Italy
| | - Marina Cazzaniga
- Research Unit Phase I trials and Oncology Unit, ASST Monza, Monza, Italy
| | - Luca Moscetti
- Division of Medical Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Claudia Omarini
- Division of Medical Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Federico Piacentini
- Division of Medical Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Maria A Fabbri
- Medical Oncology Unit, Belcolle Hospital, Viterbo, Italy
| | - Angelo F Scinto
- Medical Oncology Unit, Fatebenefratelli Hospital, Rome, Italy
| | - Domenico Corsi
- Medical Oncology Unit, Fatebenefratelli Hospital, Rome, Italy
| | - Luisa Carbognin
- Gynecology Oncology Unit, Catholic University of the Sacred Heart, Rome, Italy
| | - Emilio Bria
- Department of Medical Oncology, Policlinico Universitario "A. Gemelli", Rome, Italy.,Universita Cattolica del Sacro Cuore, Roma
| | - Nicla La Verde
- Oncology Unit, ASST Fatebenefratelli Sacco Presidio Ospedaliero Fatebenefratelli, Milano, Italy
| | | | - Carlo Garufi
- Division of Medical Oncology, Pescara Hospital, Pescara, Italy
| | - Sandro Barni
- Department of Oncology, Oncology Unit, ASST Bergamo Ovest, Treviglio, Italy
| | - Rosanna Mirabelli
- Department of Hematology & Oncology, Azienda Ospedaliera Pugliese-Ciaccio, Catanzaro, Italy
| | | | - Enzo M Veltri
- Oncology Unit, S. Maria Goretti Hospital, Latina, Italy
| | | | - Ida Paris
- Gynecology Oncology Unit, Catholic University of the Sacred Heart, Rome, Italy
| | - Francesco Giotta
- Department of Medical Oncology, "Giovanni PaoloII" Institute, Bari, Italy
| | - Vito Lorusso
- Department of Medical Oncology, "Giovanni PaoloII" Institute, Bari, Italy
| | | | - Elisabetta Landucci
- UO Oncologia Medica I, S. Chiara Hospital, Dipartimentodi Oncologia, Dei Trapianti e Delle Nuove Tecnologie, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Maria Mauri
- Division of Oncology, San Giovanni Hospital, Rome, Italy
| | - Corrado Ficorella
- Medical Oncology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Mario Roselli
- Department of Systems Medicine, Medical Oncology, University of Rome "Tor Vergata", Rome, Italy
| | - Vincenzo Adamo
- Medical Oncology Unit A.O. Papardo & Department Human Pathology University of Messina
| | | | - Antonio Russo
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - Rossana Berardi
- Oncology Clinic, Università Politecnica delle Marche, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Mirco Pistelli
- Oncology Clinic, Università Politecnica delle Marche, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Elena Fiorio
- U.O.C. Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Katia Cannita
- Medical Oncology, St. Salvatore Hospital, L'Aquila, Italy
| | - Valentina Sini
- Oncology Unit, ASL Roma 1, Santo Spirito Hospital, Rome, Italy
| | | | | | - Filippo Greco
- Department of Pathology, Surgery and Oncology, "Mater Salutis" Hospital, ULSS21, Verona, Italy
| | - Claudio Zamagni
- Medical Oncology Unit, Addarii Institute of Oncology, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Ornella Garrone
- Medical Oncology, A.O. Ospedale di Insegnamento S. Crocee Carle, Cuneo, Italy
| | | | | | - Lorenzo Livi
- Radiation Oncology Unit and Department of Clinical and Experimental Biomedical Sciences "Mario Serio", Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Isacco Desideri
- Radiation Oncology Unit and Department of Clinical and Experimental Biomedical Sciences "Mario Serio", Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Icro Meattini
- Radiation Oncology Unit and Department of Clinical and Experimental Biomedical Sciences "Mario Serio", Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | | | - Pietro Del Medico
- Division of Medical Oncology, Reggio Calabria General Hospital, Reggio Calabria, Italy
| | - Michele De Tursi
- Department of Medical, Oral and Biotechnological Sciences, Centro Scienze dell'Invecchiamento e Medicina Traslazionale -CeSI-MeT, Chieti, Italy
| | - Daniele Generali
- Breast Cancer Unit & Translational Research Unit, ASST Cremona, Cremona, Italy
| | - Ruggero De Maria
- Department of Medical Oncology, Policlinico Universitario "A. Gemelli", Rome, Italy.,Universita Cattolica del Sacro Cuore, Roma
| | - Emanuela Risi
- Sandro Pitigliani Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - Gennaro Ciliberto
- Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Isabella Sperduti
- Bio-Statistics Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Alice Villa
- Department of Medical Oncology, Policlinico Universitario "A. Gemelli", Rome, Italy.,Universita Cattolica del Sacro Cuore, Roma
| | - Maddalena Barba
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Angelo Di Leo
- Sandro Pitigliani Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - Patrizia Vici
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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15
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Cantini L, Pistelli M, Merloni F, Fontana A, Bertolini I, De Angelis C, Bastianelli L, Della Mora A, Santinelli A, Savini A, Maccaroni E, Diodati L, Falcone A, Berardi R. Body Mass Index and Hormone Receptor Status Influence Recurrence Risk in HER2-Positive Early Breast Cancer Patients. Clin Breast Cancer 2019; 20:e89-e98. [PMID: 31378534 DOI: 10.1016/j.clbc.2019.06.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 01/27/2019] [Revised: 06/06/2019] [Accepted: 06/20/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION A reliable risk stratification on the basis of tumor biology and host factors of HER2-positive (HER2+) early breast cancer (eBC) patients is needed. The aim of our study was to assess the prognostic role of body mass index (BMI) and hormone receptor (HR) expression in this setting. PATIENTS AND METHODS We retrospectively evaluated 238 women with stage I to III HER2+ breast cancer who completed adjuvant chemotherapy (CHT) and 1 year of treatment with trastuzumab. The end point was 3-year distant disease-free survival (3yDDFS). Survival analysis was evaluated using the Kaplan-Meier method. Multivariate analysis was performed using Cox proportional-hazards model adjusting for HR status, BMI, tumor staging, size, nodal status, and type of adjuvant CHT. Association among categorical variables was assessed using χ2 test. RESULTS The early recurrence rate after 3 years resulted as 4.2% (40% HR+ patients and 60% HR- patients). Neither HR status nor BMI alone showed an association with 3yDDFS in multivariate analysis. However, the hazard ratios for patients with HR- tumors who had also BMI ≥25 (3yDDFS 86.9%; 95% confidence interval [CI], 75.0%-97.7%) were amplified compared with patients with HR+ tumors and with BMI <25 (3yDDFS 98%; 95% CI, 94.8%-100.0%) and other subgroups (P = .003). This observation was confirmed in multivariate analysis (hazard ratio, 1.79; 95% CI, 1.04-3.07; P = .03). CONCLUSION Our real-life data highlight a different risk of eBC recurrence after grouping patients according to HR status and BMI. These results might help clinicians to identify correct treatment strategies. Patients who are HR- and have BMI ≥25 might benefit from escalation approaches, whereas those who are HR+ and have BMI <25 might be eligible for a shorter duration of adjuvant treatment with anti-HER2 agents.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biomarkers, Tumor/analysis
- Biomarkers, Tumor/metabolism
- Body Mass Index
- Breast/pathology
- Breast/surgery
- Breast Neoplasms/mortality
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Chemotherapy, Adjuvant/statistics & numerical data
- Disease-Free Survival
- Female
- Follow-Up Studies
- Humans
- Mastectomy
- Middle Aged
- Neoplasm Recurrence, Local/epidemiology
- Neoplasm Recurrence, Local/prevention & control
- Neoplasm Staging
- Prognosis
- Receptor, ErbB-2/analysis
- Receptor, ErbB-2/antagonists & inhibitors
- Receptor, ErbB-2/metabolism
- Receptors, Estrogen/analysis
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/analysis
- Receptors, Progesterone/metabolism
- Retrospective Studies
- Risk Assessment/methods
- Time Factors
- Trastuzumab/therapeutic use
- Young Adult
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Affiliation(s)
- Luca Cantini
- Clinica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti, Ancona, Italy
| | - Mirco Pistelli
- Clinica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti, Ancona, Italy
| | - Filippo Merloni
- Clinica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti, Ancona, Italy
| | - Andrea Fontana
- Oncology Unit II, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Ilaria Bertolini
- Oncology Unit II, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | | | - Lucia Bastianelli
- Clinica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti, Ancona, Italy
| | - Arianna Della Mora
- Clinica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti, Ancona, Italy
| | - Alfredo Santinelli
- Anatomia Patologica e Citologia, AO Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Agnese Savini
- Clinica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti, Ancona, Italy
| | - Elena Maccaroni
- Clinica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti, Ancona, Italy
| | - Lucrezia Diodati
- Oncology Unit II, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Alfredo Falcone
- Oncology Unit II, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Rossana Berardi
- Clinica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti, Ancona, Italy.
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16
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Pizzuti L, Giordano A, Michelotti A, Mazzotta M, Natoli C, Gamucci T, De Angelis C, Landucci E, Diodati L, Iezzi L, Mentuccia L, Fabbri A, Barba M, Sanguineti G, Marchetti P, Tomao S, Mariani L, Paris I, Lorusso V, Vallarelli S, Cassano A, Aroldi F, Orlandi A, Moscetti L, Sergi D, Sarobba MG, Tonini G, Santini D, Sini V, Veltri E, Vaccaro A, Ferrari L, De Tursi M, Tinari N, Grassadonia A, Greco F, Botticelli A, La Verde N, Zamagni C, Rubino D, Cortesi E, Magri V, Pomati G, Scagnoli S, Capomolla E, Kayal R, Scinto AF, Corsi D, Cazzaniga M, Laudadio L, Forciniti S, Mancini M, Carbognin L, Seminara P, Barni S, Samaritani R, Roselli M, Portarena I, Russo A, Ficorella C, Cannita K, Carpano S, Pistelli M, Berardi R, De Maria R, Sperduti I, Ciliberto G, Vici P. Palbociclib plus endocrine therapy in HER2 negative, hormonal receptor-positive, advanced breast cancer: A real-world experience. J Cell Physiol 2018; 234:7708-7717. [PMID: 30536609 DOI: 10.1002/jcp.27832] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 11/06/2018] [Indexed: 12/11/2022]
Abstract
Data from 423 human epidermal growth factor receptor 2-negative (HER2-), hormone receptor-positive (HR+) advanced breast cancer (aBC) patients treated with palbociclib and endocrine therapy (ET) were provided by 35 Italian cancer centers and analyzed for treatment outcomes. Overall, 158 patients were treated in first line and 265 in second/later lines. We observed 19 complete responses and 112 partial responses. The overall response rate (ORR) was 31% (95% confidence interval [CI], 26.6-35.4) and clinical benefit was 52.7% (95% CI, 48-57.5). ORR was negatively affected by prior exposure to everolimus/exemestane ( p = 0.002) and favorably influenced by early line-treatment ( p < 0.0001). At 6 months, median progression-free survival was 12 months (95% CI, 8-16) and median overall survival was 24 months (95% CI, 17-30). More favorable outcomes were associated with palbociclib in early lines, no visceral metastases and no prior everolimus/exemestane. The main toxicity reported was neutropenia. Our results provide further support to the use of palbociclib with ET in HER2-, HR+ aBC. Differences in outcomes across patients subsets remain largely unexplained.
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Affiliation(s)
- Laura Pizzuti
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Antonio Giordano
- Department of Clinical and Molecular Medicine, "Sapienza" University of Rome, Azienda Ospedaliera Sant'Andrea, Rome, Italy
| | - Andrea Michelotti
- UO Oncologia Medica I, Ospedale S. Chiara, Dipartimento di Oncologia, Dei Trapianti e Delle Nuove Tecnologie, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Marco Mazzotta
- Department of Medical, Oral and Biotechnological Sciences, Centro Scienze Dell'Invecchiamento e Medicina Traslazionale-CeSI-MeT, Chieti, Italy
| | - Clara Natoli
- Medical Oncology Unit, SS Trinità Hospital, Loc. San MarcianoHospital, Sora, Frosinone, Italy
| | - Teresa Gamucci
- Medical Oncology Unit, SS Trinità Hospital, Sora, Italy.,Medical Oncology, Sandro Pertini Hospital, Rome, Italy
| | - Claudia De Angelis
- UO Oncologia Medica I, Ospedale S. Chiara, Dipartimento di Oncologia, Dei Trapianti e Delle Nuove Tecnologie, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Elisabetta Landucci
- UO Oncologia Medica I, Ospedale S. Chiara, Dipartimento di Oncologia, Dei Trapianti e Delle Nuove Tecnologie, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Lucrezia Diodati
- UO Oncologia Medica I, Ospedale S. Chiara, Dipartimento di Oncologia, Dei Trapianti e Delle Nuove Tecnologie, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Laura Iezzi
- Medical Oncology Unit, SS Trinità Hospital, Loc. San MarcianoHospital, Sora, Frosinone, Italy
| | | | - Agnese Fabbri
- Medical Oncology Unit, Belcolle Hospital, Viterbo, Italy
| | - Maddalena Barba
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppe Sanguineti
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Paolo Marchetti
- Department of Medical, Oral and Biotechnological Sciences, Centro Scienze Dell'Invecchiamento e Medicina Traslazionale-CeSI-MeT, Chieti, Italy.,Department of Clinical and Molecular Medicine, A Oncology Division, "Sapienza" University of Rome, Rome, Italy
| | - Silverio Tomao
- Department of Clinical and Molecular Medicine, A Oncology Division, La "Sapienza" University of Rome, Rome, Italy
| | - Luciano Mariani
- HPV Unit, Department of Gynaecologic Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Ida Paris
- Gynecology Oncology Unit, Catholic University of the Sacred Heart, Rome, Italy
| | - Vito Lorusso
- Division of Medical Oncology, IRCCS, Giovanni Paolo II Hospital, Bari, Italy
| | - Simona Vallarelli
- Division of Medical Oncology, IRCCS, Giovanni Paolo II Hospital, Bari, Italy
| | - Alessandra Cassano
- Department of Medical Oncology, Catholic University of Sacred Heart, Rome, Italy
| | - Francesca Aroldi
- Department of Medical Oncology, Catholic University of Sacred Heart, Rome, Italy
| | - Armando Orlandi
- Department of Medical Oncology, Catholic University of Sacred Heart, Rome, Italy
| | - Luca Moscetti
- Division of Medical Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Domenico Sergi
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | - Giuseppe Tonini
- Department of Oncology, University Campus Biomedico of Rome, Rome, Italy
| | - Daniele Santini
- Department of Oncology, University Campus Biomedico of Rome, Rome, Italy
| | - Valentina Sini
- Oncology Unit, ASL Roma 1, Santo Spirito Hospital, Rome, Italy
| | - Enzo Veltri
- Division of Medical Oncology, Ospedale S. Maria Goretti, Latina, Italy
| | - Angela Vaccaro
- Medical Oncology Unit, SS Trinità Hospital, Loc. San MarcianoHospital, Sora, Frosinone, Italy
| | - Laura Ferrari
- Medical Oncology Unit, SS Trinità Hospital, Loc. San MarcianoHospital, Sora, Frosinone, Italy
| | - Michele De Tursi
- Department of Medical, Oral and Biotechnological Sciences, Centro Scienze Dell'Invecchiamento e Medicina Traslazionale-CeSI-MeT, Chieti, Italy
| | - Nicola Tinari
- Department of Medical, Oral and Biotechnological Sciences, Centro Scienze Dell'Invecchiamento e Medicina Traslazionale-CeSI-MeT, Chieti, Italy
| | - Antonino Grassadonia
- Department of Medical, Oral and Biotechnological Sciences, Centro Scienze Dell'Invecchiamento e Medicina Traslazionale-CeSI-MeT, Chieti, Italy
| | - Filippo Greco
- ASST Fatebenefratelli Sacco PO Fatebenefratelli, Department of Oncology, Milan, Italy
| | - Andrea Botticelli
- Department of Clinical and Molecular Medicine, "Sapienza" University of Rome, Azienda Ospedaliera Sant'Andrea, Rome, Italy
| | - Nicla La Verde
- Department of Oncology, ASST Fatebenefratelli Sacco PO Fatebenefratelli, Milan, Italy
| | - Claudio Zamagni
- SSD Oncologia Medica "Addarii", S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Daniela Rubino
- SSD Oncologia Medica "Addarii", S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Enrico Cortesi
- Medical Oncology, Policlinico Umberto I, Sapienza, University of Rome, Rome, Italy
| | - Valentina Magri
- Medical Oncology, Policlinico Umberto I, Sapienza, University of Rome, Rome, Italy
| | - Giulia Pomati
- Medical Oncology, Policlinico Umberto I, Sapienza, University of Rome, Rome, Italy
| | - Simone Scagnoli
- Medical Oncology, Policlinico Umberto I, Sapienza, University of Rome, Rome, Italy
| | | | - Ramy Kayal
- Department of Radiology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | - Domenico Corsi
- Medical Oncology Unit, Ospedale San Pietro Fatebenefratelli, Rome, Italy
| | | | | | | | - Maria Mancini
- Medical Oncology, Ospedale F. Renzetti, Lanciano, Italy
| | - Luisa Carbognin
- Department of Pathology, Surgery and Oncology, "Mater Salutis" Hospital, ULSS21, Verona, Italy
| | - Patrizia Seminara
- Department of Clinical and Molecular Medicine, A Oncology Division, "Sapienza" University of Rome, Rome, Italy
| | - Sandro Barni
- Department of Oncology, Oncology Unit, ASST Bergamo Ovest, Treviglio, Italy
| | | | - Mario Roselli
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata Clinical Center University Hospital, Tor Vergata University Hospital, Rome, Italy
| | - Ilaria Portarena
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata Clinical Center University Hospital, Tor Vergata University Hospital, Rome, Italy
| | - Antonio Russo
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - Corrado Ficorella
- Medical Oncology Department, S. Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | - Katia Cannita
- Medical Oncology Department, S. Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | - Silvia Carpano
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Mirco Pistelli
- Azienda Ospedaliero Universitaria Ospedali Riuniti Clinica di Oncologia, Università Politecnica delle Marche, Ancona, Italy
| | - Rossana Berardi
- Azienda Ospedaliero Universitaria Ospedali Riuniti Clinica di Oncologia, Università Politecnica delle Marche, Ancona, Italy
| | - Ruggero De Maria
- Institute of General Pathology, Catholic University of the Sacred Heart, Rome, Italy
| | - Isabella Sperduti
- Bio-statistics Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Gennaro Ciliberto
- Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Patrizia Vici
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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Cazzaniga M, Verusio C, Ciccarese M, Fumagalli A, Sartori D, Valerio MR, Airoldi M, Moretti G, Ficorella C, Arcangeli V, Diodati L, Zambelli A, Febbraro A, Generali D, Pistelli M, Garrone O, Musolino A, Vici P, Maur M, Mentuccia L, La Verde N, Bianchi G, Artale S, Blasi L, Piezzo M, Atzori F, Turletti A, Benedetto C, Cursano MC, Fabi A, Gebbia V, Schirone A, Palumbo R, Ferzi A, Frassoldati A, Scavelli C, Clivio L, Torri V. Correction 2: Everolimus (EVE) and exemestane (EXE) in patients with advanced breast cancer aged ≥ 65 years: new lessons for clinical practice from the EVA study. Oncotarget 2018; 9:36720-36721. [PMID: 30613355 PMCID: PMC6291174 DOI: 10.18632/oncotarget.26431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Marina Cazzaniga
- Research Unit Phase I trials, ASST Monza, Monza, Italy.,Oncology Unit, ASST Monza, Monza, Italy
| | - Claudio Verusio
- Oncology Unit, ASST della Valle Olona-Presidio Ospedaliero di Saronno, Saronno, Italy
| | | | | | | | | | - Mario Airoldi
- Oncology Unit 2-Città della Salute e della Scienza di Torino, Torino, Italy
| | - Gabriella Moretti
- Oncology Unit, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | - Corrado Ficorella
- Dipartimento di Scienze Cliniche Applicate e Biotecnologiche (DISCAB)-Università Degli Studi Dell'Aquila, L'Aquila, Italy
| | | | - Lucrezia Diodati
- Oncology Unit 2, Azienda Osp edaliera Universitaria Pisa via Roma 67, Pisa, Italy
| | | | - Antonio Febbraro
- Oncology Unit, Ospedale Sacro Cuore di Gesù, Fatebenefratelli, Benevento, Italy
| | | | - Mirco Pistelli
- Oncology Unit, AOU Ospedali Riuniti Umberto I-GM Lancisi-G Salesi, Ancona, Italy
| | - Ornella Garrone
- Oncology Unit, AOS Croce e Carle Ospedale di Insegnamento, Cuneo, Italy
| | - Antonino Musolino
- Oncology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Patrizia Vici
- Oncology Unit 2, Istituto Nazionale Tumori Regina Elena-IFO, Roma, Italy
| | - Michela Maur
- Oncology Unit, Policlinico University Hospital of Modena, Modena, Italy
| | - Lucia Mentuccia
- Oncology Unit, ASL di Frosinone Osp. "SS. Trinità", Sora, Italy
| | - Nicla La Verde
- Oncology Unit, ASST Fatebenefratelli Sacco Presidio Ospedaliero Fatebenefratelli, Milano, Italy
| | - Giulia Bianchi
- Oncology Unit 1, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Salvatore Artale
- Oncology Departement, Ospedale di Gallarate ASST Valle Olona, Gallarate, Italy
| | - Livio Blasi
- Oncology Unit, ARNAS Civico Palermo, Palermo, Italy
| | - Michela Piezzo
- National Cancer Institute "Fondazione Giovanni Pascale", Napoli, Italy
| | - Francesco Atzori
- Struttura Complessa di Oncologia Medica Azienda Ospedaliero-Universitaria Cagliari, Cagliari, Italy
| | - Anna Turletti
- Oncology Unit, Ospedale Martini della ASL Città di Torino, Torino, Italy
| | - Chiara Benedetto
- Dipartimento Universitario Ginecologia e Ostetricia 1, Ospedale S. Anna Torino, Turin, Italy
| | | | | | | | - Alessio Schirone
- Oncolgy Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | | | - Antonella Ferzi
- Oncology Unit, ASST OVEST Milanese, Presidio di Legnano, Legnano, Italy
| | | | | | - Luca Clivio
- IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milano, Italy
| | - Valter Torri
- IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milano, Italy
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Cazzaniga M, Verusio C, Ciccarese M, Fumagalli A, Sartori D, Valerio MR, Ancona C, Airoldi M, Moretti G, Ficorella C, Arcangeli V, Diodati L, Zambelli A, Febbraro A, Generali D, Pistelli M, Garrone O, Musolino A, Vici P, Maur M, Mentuccia L, La Verde N, Bianchi G, Artale S, Blasi L, Piezzo M, Atzori F, Turletti A, Benedetto C, Cursano MC, Fabi A, Gebbia V, Schirone A, Palumbo R, Ferzi A, Frassoldati A, Scavelli C, Clivio L, Torri On Behalf Of The Eva Study Group V. Everolimus (EVE) and exemestane (EXE) in patients with advanced breast cancer aged ≥ 65 years: new lessons for clinical practice from the EVA study. Oncotarget 2018; 9:31877-31887. [PMID: 30159129 PMCID: PMC6112755 DOI: 10.18632/oncotarget.25874] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 07/12/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The present analysis focuses on real-world data of Everolimus-Exemestane in advanced HR+ve, HER2-ve elderly breast cancer patients (aged 65 years) included in the EVA study, with unique findings in those aged 70 years. METHODS Data are collected from clinical records and analysed according to age cut-off (< 65 years; 65 - 69 years and {greater than or equal to} 70 years). Relationship of analyzed variables with response were tested by mean of a Mantel-Haenszel chi square test. Time to event analysis was described by Kaplan Meier approach and association with baseline characteristics was analysed by stratified log-rank test and proportional hazard model. RESULTS From July 2013 to December 2015, the EVA study enrolled overall 404 pts. 154 patients out of 404 (38,1%) were aged {greater than or equal to} 65 years, of whom 87 were {greater than or equal to} 70 years. Median duration of EVE treatment was 28.5 weeks (95% CI 19.0 - 33.8) in patients aged 65-69 years and 24,4 weeks (95% CI 19,2 - 33,2) in those aged {greater than or equal to} 70 years. Fewer patients aged 65 years received the highest EVE Dose-Intensity (>7.5 mg/day) in comparison to younger patients (49,6% vs. 66,8%). Grade 3–4 toxicities occurred to 55 patients (35,7%), mainly stomatitis (10,9%), rash (5,8%) and non-infectious pneumonitis (NIP) (3,6%). Some toxicities, such as weight loss and anaemia were peculiarly observed in patients aged {greater than or equal to} 70 years. Five treatment-related deaths were collected (3,2%). CONCLUSIONS EVE-EXE combination remains one of the potential treatments in HR+ patients also for elderly ones.
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Affiliation(s)
- Marina Cazzaniga
- Research Unit Phase I trials, ASST Monza, Monza, Italy.,Oncology Unit, ASST Monza, Monza, Italy
| | - Claudio Verusio
- Oncology Unit, ASST della Valle Olona-Presidio Ospedaliero di Saronno, Saronno, Italy
| | | | | | | | | | - Cristina Ancona
- Oncology Department, Policlinico di Palermo Paolo Giaccone, Palermo, Italy
| | - Mario Airoldi
- Oncology Unit 2-Città della Salute e della Scienza di Torino, Torino, Italy
| | - Gabriella Moretti
- Oncology Unit, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | - Corrado Ficorella
- Dipartimento di Scienze Cliniche Applicate e Biotecnologiche (DISCAB)-Università Degli Studi Dell'Aquila, L'Aquila, Italy
| | | | - Lucrezia Diodati
- Oncology Unit 2, Azienda Osp edaliera Universitaria Pisa via Roma 67, Pisa, Italy
| | | | - Antonio Febbraro
- Oncology Unit, Ospedale Sacro Cuore di Gesù, Fatebenefratelli, Benevento, Italy
| | | | - Mirco Pistelli
- Oncology Unit, AOU Ospedali Riuniti Umberto I-GM Lancisi-G Salesi, Ancona, Italy
| | - Ornella Garrone
- Oncology Unit, AOS Croce e Carle Ospedale di Insegnamento, Cuneo, Italy
| | - Antonino Musolino
- Oncology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Patrizia Vici
- Oncology Unit 2, Istituto Nazionale Tumori Regina Elena-IFO, Roma, Italy
| | - Michela Maur
- Oncology Unit, Policlinico University Hospital of Modena, Modena, Italy
| | - Lucia Mentuccia
- Oncology Unit, ASL di Frosinone Osp. "SS. Trinità", Sora, Italy
| | - Nicla La Verde
- Oncology Unit, ASST Fatebenefratelli Sacco Presidio Ospedaliero Fatebenefratelli, Milano, Italy
| | - Giulia Bianchi
- Oncology Unit 1, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Salvatore Artale
- Oncology Departement, Ospedale di Gallarate ASST Valle Olona, Gallarate, Italy
| | - Livio Blasi
- Oncology Unit, ARNAS Civico Palermo, Palermo, Italy
| | - Matilde Piezzo
- National Cancer Institute "Fondazione Giovanni Pascale", Napoli, Italy
| | - Francesco Atzori
- Struttura Complessa di Oncologia Medica Azienda Ospedaliero-Universitaria Cagliari, Italy
| | - Anna Turletti
- Oncology Unit, Ospedale Martini della ASL Città di Torino, Torino, Italy
| | - Chiara Benedetto
- Dipartimento Universitario Ginecologia e Ostetricia 1, Ospedale S. Anna Torino, Turin, Italy
| | | | | | | | - Antonio Schirone
- Oncolgy Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | | | - Antonella Ferzi
- Oncology Unit, ASST OVEST Milanese, Presidio di Legnano, Legnano, Italy
| | | | | | - Luca Clivio
- IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milano, Italy
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Macchini M, Ponziani M, Iamurri AP, Pistelli M, De Lisa M, Berardi R, Giuseppetti GM. Role of DCE-MR in predicting breast cancer subtypes. Radiol Med 2018; 123:753-764. [PMID: 29869226 DOI: 10.1007/s11547-018-0908-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 05/24/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The purpose of this retrospective study is to find a correlation between dynamic contrast-enhanced MR features with histological, immunohistochemical and loco-regional characteristics of breast cancer. MATERIALS AND METHODS A total of 149 patients with histopathologically confirmed invasive breast carcinoma underwent MR imaging. Histological analysis included: histological features (histological type, necrosis, vascular invasion and Mib-1), immunohistochemical characterization (immunophenotype, receptor status, HER2-neu and grading) and loco-regional characteristics (T and N). The kinetic MR features analyzed were: curve type, maximum enhancement, time to peak, wash-in and wash-out rate, brevity of enhancement and area under curve. RESULTS MRI kinetic parameters and immunohistological features were compared using chi square test, two-tailed student t test and Anova test, with p = 0.05 level of significance. Vascular invasion was shown to be significantly related to time to peak (p = 0.02). The immunohistotype was shown to be significantly related with maximum enhancement (p = 0.05), time to peak (p = 0.04) and wash-in rate (p = 0.01). ER status correlates with maximum and relative enhancement (p = 0.004 and p = 0.028), wash-in rate (p = 0.0018) and area under curve (p = 0.006). PR status was significantly related to time to peak (p = 0.048) and wash-in rate (p = 0.05). CONCLUSION Maximum enhancement absolute and relative, time to peak, wash-in rate and area under the curve significantly correlate with several prognostic factors, like ER status, immune profile and tumoral vascular invasion, and may predict the aggressiveness of the tumor.
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Affiliation(s)
- Marco Macchini
- Sc. Spec. Radiologia, Università Politecnica delle Marche, Ancona, Italy.
| | - Martina Ponziani
- Sc. Spec. Radiologia, Università Politecnica delle Marche, Ancona, Italy
| | | | - Mirco Pistelli
- Azienda Ospedaliero Universitaria Ospedali Riuniti Clinica di Oncologia, Università Politecnica delle Marche, Ancona, Italy
| | - Mariagrazia De Lisa
- Azienda Ospedaliero Universitaria Ospedali Riuniti Clinica di Oncologia, Università Politecnica delle Marche, Ancona, Italy
| | - Rossana Berardi
- Azienda Ospedaliero Universitaria Ospedali Riuniti Clinica di Oncologia, Università Politecnica delle Marche, Ancona, Italy
| | - Gian Marco Giuseppetti
- Azienda Ospedaliero Universitaria Ospedali Riuniti Clinica di Radiologia, Università Politecnica delle Marche, Ancona, Italy.,Dipartimento Radiologia Clinica, Ospedali Riuniti Azienda Ospedaliero Universitaria Ospedali Riuniti, Via Tronto 10, 60126, Ancona, AN, Italy
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20
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Pistelli M, Mora AD, Ballatore Z, Berardi R. Aromatase inhibitors in premenopausal women with breast cancer: the state of the art and future prospects. ACTA ACUST UNITED AC 2018; 25:e168-e175. [PMID: 29719441 DOI: 10.3747/co.25.3735] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Approximately 11% of patients with breast cancer (bca) are diagnosed before menopause, and because in most of those patients the tumour expresses a hormone receptor, treatment with endocrine interventions can be applied in any setting of disease (early or advanced). In the past, hormonal treatment consisted only of the estrogen receptor modulator tamoxifen, associated with luteinizing hormone-releasing hormone (lhrh); more recently, aromatase inhibitors (ais) have come into widespread use. The ais interfere with the last enzymatic step of estrogen synthesis in which androgens are converted into estrogens. Initially, the ais were used alone in postmenopausal patients to prevent disease recurrence, but together with lhrh analogs, they can be used in premenopausal patients to produce better estrogen suppression than can be achieved with tamoxifen plus a lhrh analog. Using a systematic review of the scientific literature (prospective and retrospective studies), we set out to assess the efficacy of ais compared with other endocrine therapy in various disease settings (neoadjuvant, adjuvant, metastatic).
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Affiliation(s)
- M Pistelli
- Clinica di Oncologia Medica e Centro Regionale di Genetica Oncologica, Università Politecnica delle Marche, Ancona, Italy
| | - A Della Mora
- Clinica di Oncologia Medica e Centro Regionale di Genetica Oncologica, Università Politecnica delle Marche, Ancona, Italy
| | - Z Ballatore
- Clinica di Oncologia Medica e Centro Regionale di Genetica Oncologica, Università Politecnica delle Marche, Ancona, Italy
| | - R Berardi
- Clinica di Oncologia Medica e Centro Regionale di Genetica Oncologica, Università Politecnica delle Marche, Ancona, Italy
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21
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Prochowski Iamurri A, Ponziani M, Macchini M, Fogante M, Pistelli M, De Lisa M, Berardi R, Giuseppetti GM. Evaluation of Multifocality and Multicentricity With Breast Magnetic Resonance Imaging in Each Breast Cancer Subtype. Clin Breast Cancer 2018; 18:e231-e235. [DOI: 10.1016/j.clbc.2017.10.012] [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] [Received: 03/22/2017] [Revised: 09/21/2017] [Accepted: 10/16/2017] [Indexed: 01/05/2023]
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22
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Biganzoli L, Berardi R, Pedersini R, Minisini AM, Caremoli ER, Spazzapan S, Lima JS, Baldari D, Orlando L, Magnolfi E, Pistelli M, Brunello A, Zafarana E, Bernardo A, Leo S, Colleoni M, Donati S, De Placido S, Parolin V, Vitale S, Di Leo A, Puglisi F, Boni L, Cinieri S. Abstract P6-14-01: The effect trial: A randomized phase II trial evaluating two different doses of weekly (W) NAB-paclitaxel (NP) as first-line chemotherapy in older breast cancer (BC) patients (pts). Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p6-14-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: W taxanes (T) are commonly used in the treatment of older BC pts, with neurotoxicity (NTX) and fatigue being dose-limiting toxicities with a possible negative impact on function. No prospective data exists on the safety and efficacy of W NP in this population. NP might be of particular value in older pts, due to no need for premedication with steroids and shorter time to recovery from neurotoxicity than conventional T, resulting in a reduced risk of exacerbation of comorbidities such as hypertension and diabetes, and possibly of functional decline (FD). Methods: Pts aged ≥ 65 years (y) with Her-2 negative or Her-2 positive (+), but contraindicated to anti-Her-2 therapy, advanced BC were randomized to receive NP as first-line chemotherapy at either 100 (Arm A) or 125 mg/m2 (Arm B), days 1, 8, 15 q 28. The primary end-point was event-free survival (EFS). An event was either disease progression (PD), death, or FD - defined as a decrease of at least 1 point from baseline values of activities of daily living (ADL) or instrumental ADL (IADL), deemed by the investigator as treatment-related and confirmed at the subsequent cycle. Secondary endpoints included progression-free survival (PFS), response rate (RR) in pts with measurable disease, and incidence of adverse events (AEs). Results: From January 2013 to September 2016, 160 pts were randomized in 15 Italian centres; all but 2 who never started NP were eligible for final analysis. Pts median age was 72y (range 65-84) in Arm A and 73y (range 65-88) in Arm B. Median ECOG performance status was 0 (range 0-2). Baseline IADL impairment was reported in 20 pts (25%) in both arms. >80% pts had ER+ tumors; 2 pts had HER2+ disease. Visceral disease was present in 71% (Arm A) and 70% (Arm B) of pts. Prior exposure to T in the neo/adjuvant setting was 14% (Arm A) and 13% (Arm B). Median number of delivered cycles of NP was 6 (range 1-28 in Arm A, and 1-22 in Arm B), with 3 pts still on treatment. Dose reductions were similarly reported (72% of pts Arm A, 78% of pts Arm B). At a median follow-up of 21 months (mos) (Interquartile range 14-28.4) 140 events were observed. Arm A/Arm B: PD n=53(67%)/n=52(66%); FD n=13(15%)/n=14(18%), death n=3(4%)n=5(6%). Outcomes data are reported in the following table:
Outcomes Arm AArm BMedian EFS, mos (90% CI)6.2 (5.5-8.4)6.4 (5.8-7.7)Median PFS, mos (95% CI)8.3 (5.9-10.5)8.8 (7.4-10.3)RR (95% CI)37% (25-50)42% (30-54)
Fatigue (Arm A: grade (G)2 29%, G3 11%; Arm B: G2 46%, G3 5%) and NTX (Arm A: G2 15%, G3 4%; Arm B: G2 28%, G3 8%) were the most frequently reported AEs. No G4 AEs were reported with the exception of neutropenia (1 pt in arm A) and leucopenia (3 pts in Arm A, 1 pt in arm B). 1 G5 (sepsis) was recorded in Arm B. NTX was reported as the reason for treatment discontinuation in 21 pts (13%) of whom 16 (21%) in arm B. Conclusion: Looking at classical study endpoints (PFS, RR), both doses of NP are active in older pts. However, 17% of pts had to stop treatment due to FD, assessed according to predefined criteria. Due to similar efficacy and reduced NTX, W NP 100 is the suggested dose to be used in older pts with advanced BC.
Citation Format: Biganzoli L, Berardi R, Pedersini R, Minisini AM, Caremoli ER, Spazzapan S, Lima JS, Baldari D, Orlando L, Magnolfi E, Pistelli M, Brunello A, Zafarana E, Bernardo A, Leo S, Colleoni M, Donati S, De Placido S, Parolin V, Vitale S, Di Leo A, Puglisi F, Boni L, Cinieri S. The effect trial: A randomized phase II trial evaluating two different doses of weekly (W) NAB-paclitaxel (NP) as first-line chemotherapy in older breast cancer (BC) patients (pts) [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-14-01.
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Affiliation(s)
- L Biganzoli
- Sandro Pitigliani Medical Oncology Unit, Instituto Toscano Tumori, Prato, Italy; Clinica Oncologica – Università Politecnica delle Marche – Ospedali Riuniti di Ancona, Ancona, Italy; Oncologia-Breast Unit Spedali Civili di Brescia, Brescia, Italy; Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Udine, Italy; Oncologia Medica A.O.Papa Giovanni XXIII, Bergamo, Italy; Oncologia Medica B, Centro di Riferimento Oncologico, Istituto Nazionale Tumori, Aviano, Aviano, Italy; Clinical Trials Coordinating Centre, AOU Careggi Instituto Toscano Tumori, Firenze, Italy; Oncologia Medica, Ospedale Perrino, ASL Brindisi Sora, Brindisi, Italy; Oncologia Medica Ospedale Civile SS Trinità di SoraOV Padova, Frosinone, Italy; Oncologia Medica 1 Istituto Oncologico Veneto- IOV Padova, Padova, Italy; Unita Operativa Complessa di Oncologia, Fondazione Maugeri, IRCCS di Pavia, Pavia, Italy; Oncologia Geriatrica, U.O. Oncologia Medica, Ospedale V. Fazzi, Lecce, Italy; Istituto Europeo di Oncologia di Milano, Mila
| | - R Berardi
- Sandro Pitigliani Medical Oncology Unit, Instituto Toscano Tumori, Prato, Italy; Clinica Oncologica – Università Politecnica delle Marche – Ospedali Riuniti di Ancona, Ancona, Italy; Oncologia-Breast Unit Spedali Civili di Brescia, Brescia, Italy; Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Udine, Italy; Oncologia Medica A.O.Papa Giovanni XXIII, Bergamo, Italy; Oncologia Medica B, Centro di Riferimento Oncologico, Istituto Nazionale Tumori, Aviano, Aviano, Italy; Clinical Trials Coordinating Centre, AOU Careggi Instituto Toscano Tumori, Firenze, Italy; Oncologia Medica, Ospedale Perrino, ASL Brindisi Sora, Brindisi, Italy; Oncologia Medica Ospedale Civile SS Trinità di SoraOV Padova, Frosinone, Italy; Oncologia Medica 1 Istituto Oncologico Veneto- IOV Padova, Padova, Italy; Unita Operativa Complessa di Oncologia, Fondazione Maugeri, IRCCS di Pavia, Pavia, Italy; Oncologia Geriatrica, U.O. Oncologia Medica, Ospedale V. Fazzi, Lecce, Italy; Istituto Europeo di Oncologia di Milano, Mila
| | - R Pedersini
- Sandro Pitigliani Medical Oncology Unit, Instituto Toscano Tumori, Prato, Italy; Clinica Oncologica – Università Politecnica delle Marche – Ospedali Riuniti di Ancona, Ancona, Italy; Oncologia-Breast Unit Spedali Civili di Brescia, Brescia, Italy; Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Udine, Italy; Oncologia Medica A.O.Papa Giovanni XXIII, Bergamo, Italy; Oncologia Medica B, Centro di Riferimento Oncologico, Istituto Nazionale Tumori, Aviano, Aviano, Italy; Clinical Trials Coordinating Centre, AOU Careggi Instituto Toscano Tumori, Firenze, Italy; Oncologia Medica, Ospedale Perrino, ASL Brindisi Sora, Brindisi, Italy; Oncologia Medica Ospedale Civile SS Trinità di SoraOV Padova, Frosinone, Italy; Oncologia Medica 1 Istituto Oncologico Veneto- IOV Padova, Padova, Italy; Unita Operativa Complessa di Oncologia, Fondazione Maugeri, IRCCS di Pavia, Pavia, Italy; Oncologia Geriatrica, U.O. Oncologia Medica, Ospedale V. Fazzi, Lecce, Italy; Istituto Europeo di Oncologia di Milano, Mila
| | - AM Minisini
- Sandro Pitigliani Medical Oncology Unit, Instituto Toscano Tumori, Prato, Italy; Clinica Oncologica – Università Politecnica delle Marche – Ospedali Riuniti di Ancona, Ancona, Italy; Oncologia-Breast Unit Spedali Civili di Brescia, Brescia, Italy; Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Udine, Italy; Oncologia Medica A.O.Papa Giovanni XXIII, Bergamo, Italy; Oncologia Medica B, Centro di Riferimento Oncologico, Istituto Nazionale Tumori, Aviano, Aviano, Italy; Clinical Trials Coordinating Centre, AOU Careggi Instituto Toscano Tumori, Firenze, Italy; Oncologia Medica, Ospedale Perrino, ASL Brindisi Sora, Brindisi, Italy; Oncologia Medica Ospedale Civile SS Trinità di SoraOV Padova, Frosinone, Italy; Oncologia Medica 1 Istituto Oncologico Veneto- IOV Padova, Padova, Italy; Unita Operativa Complessa di Oncologia, Fondazione Maugeri, IRCCS di Pavia, Pavia, Italy; Oncologia Geriatrica, U.O. Oncologia Medica, Ospedale V. Fazzi, Lecce, Italy; Istituto Europeo di Oncologia di Milano, Mila
| | - ER Caremoli
- Sandro Pitigliani Medical Oncology Unit, Instituto Toscano Tumori, Prato, Italy; Clinica Oncologica – Università Politecnica delle Marche – Ospedali Riuniti di Ancona, Ancona, Italy; Oncologia-Breast Unit Spedali Civili di Brescia, Brescia, Italy; Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Udine, Italy; Oncologia Medica A.O.Papa Giovanni XXIII, Bergamo, Italy; Oncologia Medica B, Centro di Riferimento Oncologico, Istituto Nazionale Tumori, Aviano, Aviano, Italy; Clinical Trials Coordinating Centre, AOU Careggi Instituto Toscano Tumori, Firenze, Italy; Oncologia Medica, Ospedale Perrino, ASL Brindisi Sora, Brindisi, Italy; Oncologia Medica Ospedale Civile SS Trinità di SoraOV Padova, Frosinone, Italy; Oncologia Medica 1 Istituto Oncologico Veneto- IOV Padova, Padova, Italy; Unita Operativa Complessa di Oncologia, Fondazione Maugeri, IRCCS di Pavia, Pavia, Italy; Oncologia Geriatrica, U.O. Oncologia Medica, Ospedale V. Fazzi, Lecce, Italy; Istituto Europeo di Oncologia di Milano, Mila
| | - S Spazzapan
- Sandro Pitigliani Medical Oncology Unit, Instituto Toscano Tumori, Prato, Italy; Clinica Oncologica – Università Politecnica delle Marche – Ospedali Riuniti di Ancona, Ancona, Italy; Oncologia-Breast Unit Spedali Civili di Brescia, Brescia, Italy; Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Udine, Italy; Oncologia Medica A.O.Papa Giovanni XXIII, Bergamo, Italy; Oncologia Medica B, Centro di Riferimento Oncologico, Istituto Nazionale Tumori, Aviano, Aviano, Italy; Clinical Trials Coordinating Centre, AOU Careggi Instituto Toscano Tumori, Firenze, Italy; Oncologia Medica, Ospedale Perrino, ASL Brindisi Sora, Brindisi, Italy; Oncologia Medica Ospedale Civile SS Trinità di SoraOV Padova, Frosinone, Italy; Oncologia Medica 1 Istituto Oncologico Veneto- IOV Padova, Padova, Italy; Unita Operativa Complessa di Oncologia, Fondazione Maugeri, IRCCS di Pavia, Pavia, Italy; Oncologia Geriatrica, U.O. Oncologia Medica, Ospedale V. Fazzi, Lecce, Italy; Istituto Europeo di Oncologia di Milano, Mila
| | - JS Lima
- Sandro Pitigliani Medical Oncology Unit, Instituto Toscano Tumori, Prato, Italy; Clinica Oncologica – Università Politecnica delle Marche – Ospedali Riuniti di Ancona, Ancona, Italy; Oncologia-Breast Unit Spedali Civili di Brescia, Brescia, Italy; Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Udine, Italy; Oncologia Medica A.O.Papa Giovanni XXIII, Bergamo, Italy; Oncologia Medica B, Centro di Riferimento Oncologico, Istituto Nazionale Tumori, Aviano, Aviano, Italy; Clinical Trials Coordinating Centre, AOU Careggi Instituto Toscano Tumori, Firenze, Italy; Oncologia Medica, Ospedale Perrino, ASL Brindisi Sora, Brindisi, Italy; Oncologia Medica Ospedale Civile SS Trinità di SoraOV Padova, Frosinone, Italy; Oncologia Medica 1 Istituto Oncologico Veneto- IOV Padova, Padova, Italy; Unita Operativa Complessa di Oncologia, Fondazione Maugeri, IRCCS di Pavia, Pavia, Italy; Oncologia Geriatrica, U.O. Oncologia Medica, Ospedale V. Fazzi, Lecce, Italy; Istituto Europeo di Oncologia di Milano, Mila
| | - D Baldari
- Sandro Pitigliani Medical Oncology Unit, Instituto Toscano Tumori, Prato, Italy; Clinica Oncologica – Università Politecnica delle Marche – Ospedali Riuniti di Ancona, Ancona, Italy; Oncologia-Breast Unit Spedali Civili di Brescia, Brescia, Italy; Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Udine, Italy; Oncologia Medica A.O.Papa Giovanni XXIII, Bergamo, Italy; Oncologia Medica B, Centro di Riferimento Oncologico, Istituto Nazionale Tumori, Aviano, Aviano, Italy; Clinical Trials Coordinating Centre, AOU Careggi Instituto Toscano Tumori, Firenze, Italy; Oncologia Medica, Ospedale Perrino, ASL Brindisi Sora, Brindisi, Italy; Oncologia Medica Ospedale Civile SS Trinità di SoraOV Padova, Frosinone, Italy; Oncologia Medica 1 Istituto Oncologico Veneto- IOV Padova, Padova, Italy; Unita Operativa Complessa di Oncologia, Fondazione Maugeri, IRCCS di Pavia, Pavia, Italy; Oncologia Geriatrica, U.O. Oncologia Medica, Ospedale V. Fazzi, Lecce, Italy; Istituto Europeo di Oncologia di Milano, Mila
| | - L Orlando
- Sandro Pitigliani Medical Oncology Unit, Instituto Toscano Tumori, Prato, Italy; Clinica Oncologica – Università Politecnica delle Marche – Ospedali Riuniti di Ancona, Ancona, Italy; Oncologia-Breast Unit Spedali Civili di Brescia, Brescia, Italy; Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Udine, Italy; Oncologia Medica A.O.Papa Giovanni XXIII, Bergamo, Italy; Oncologia Medica B, Centro di Riferimento Oncologico, Istituto Nazionale Tumori, Aviano, Aviano, Italy; Clinical Trials Coordinating Centre, AOU Careggi Instituto Toscano Tumori, Firenze, Italy; Oncologia Medica, Ospedale Perrino, ASL Brindisi Sora, Brindisi, Italy; Oncologia Medica Ospedale Civile SS Trinità di SoraOV Padova, Frosinone, Italy; Oncologia Medica 1 Istituto Oncologico Veneto- IOV Padova, Padova, Italy; Unita Operativa Complessa di Oncologia, Fondazione Maugeri, IRCCS di Pavia, Pavia, Italy; Oncologia Geriatrica, U.O. Oncologia Medica, Ospedale V. Fazzi, Lecce, Italy; Istituto Europeo di Oncologia di Milano, Mila
| | - E Magnolfi
- Sandro Pitigliani Medical Oncology Unit, Instituto Toscano Tumori, Prato, Italy; Clinica Oncologica – Università Politecnica delle Marche – Ospedali Riuniti di Ancona, Ancona, Italy; Oncologia-Breast Unit Spedali Civili di Brescia, Brescia, Italy; Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Udine, Italy; Oncologia Medica A.O.Papa Giovanni XXIII, Bergamo, Italy; Oncologia Medica B, Centro di Riferimento Oncologico, Istituto Nazionale Tumori, Aviano, Aviano, Italy; Clinical Trials Coordinating Centre, AOU Careggi Instituto Toscano Tumori, Firenze, Italy; Oncologia Medica, Ospedale Perrino, ASL Brindisi Sora, Brindisi, Italy; Oncologia Medica Ospedale Civile SS Trinità di SoraOV Padova, Frosinone, Italy; Oncologia Medica 1 Istituto Oncologico Veneto- IOV Padova, Padova, Italy; Unita Operativa Complessa di Oncologia, Fondazione Maugeri, IRCCS di Pavia, Pavia, Italy; Oncologia Geriatrica, U.O. Oncologia Medica, Ospedale V. Fazzi, Lecce, Italy; Istituto Europeo di Oncologia di Milano, Mila
| | - M Pistelli
- Sandro Pitigliani Medical Oncology Unit, Instituto Toscano Tumori, Prato, Italy; Clinica Oncologica – Università Politecnica delle Marche – Ospedali Riuniti di Ancona, Ancona, Italy; Oncologia-Breast Unit Spedali Civili di Brescia, Brescia, Italy; Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Udine, Italy; Oncologia Medica A.O.Papa Giovanni XXIII, Bergamo, Italy; Oncologia Medica B, Centro di Riferimento Oncologico, Istituto Nazionale Tumori, Aviano, Aviano, Italy; Clinical Trials Coordinating Centre, AOU Careggi Instituto Toscano Tumori, Firenze, Italy; Oncologia Medica, Ospedale Perrino, ASL Brindisi Sora, Brindisi, Italy; Oncologia Medica Ospedale Civile SS Trinità di SoraOV Padova, Frosinone, Italy; Oncologia Medica 1 Istituto Oncologico Veneto- IOV Padova, Padova, Italy; Unita Operativa Complessa di Oncologia, Fondazione Maugeri, IRCCS di Pavia, Pavia, Italy; Oncologia Geriatrica, U.O. Oncologia Medica, Ospedale V. Fazzi, Lecce, Italy; Istituto Europeo di Oncologia di Milano, Mila
| | - A Brunello
- Sandro Pitigliani Medical Oncology Unit, Instituto Toscano Tumori, Prato, Italy; Clinica Oncologica – Università Politecnica delle Marche – Ospedali Riuniti di Ancona, Ancona, Italy; Oncologia-Breast Unit Spedali Civili di Brescia, Brescia, Italy; Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Udine, Italy; Oncologia Medica A.O.Papa Giovanni XXIII, Bergamo, Italy; Oncologia Medica B, Centro di Riferimento Oncologico, Istituto Nazionale Tumori, Aviano, Aviano, Italy; Clinical Trials Coordinating Centre, AOU Careggi Instituto Toscano Tumori, Firenze, Italy; Oncologia Medica, Ospedale Perrino, ASL Brindisi Sora, Brindisi, Italy; Oncologia Medica Ospedale Civile SS Trinità di SoraOV Padova, Frosinone, Italy; Oncologia Medica 1 Istituto Oncologico Veneto- IOV Padova, Padova, Italy; Unita Operativa Complessa di Oncologia, Fondazione Maugeri, IRCCS di Pavia, Pavia, Italy; Oncologia Geriatrica, U.O. Oncologia Medica, Ospedale V. Fazzi, Lecce, Italy; Istituto Europeo di Oncologia di Milano, Mila
| | - E Zafarana
- Sandro Pitigliani Medical Oncology Unit, Instituto Toscano Tumori, Prato, Italy; Clinica Oncologica – Università Politecnica delle Marche – Ospedali Riuniti di Ancona, Ancona, Italy; Oncologia-Breast Unit Spedali Civili di Brescia, Brescia, Italy; Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Udine, Italy; Oncologia Medica A.O.Papa Giovanni XXIII, Bergamo, Italy; Oncologia Medica B, Centro di Riferimento Oncologico, Istituto Nazionale Tumori, Aviano, Aviano, Italy; Clinical Trials Coordinating Centre, AOU Careggi Instituto Toscano Tumori, Firenze, Italy; Oncologia Medica, Ospedale Perrino, ASL Brindisi Sora, Brindisi, Italy; Oncologia Medica Ospedale Civile SS Trinità di SoraOV Padova, Frosinone, Italy; Oncologia Medica 1 Istituto Oncologico Veneto- IOV Padova, Padova, Italy; Unita Operativa Complessa di Oncologia, Fondazione Maugeri, IRCCS di Pavia, Pavia, Italy; Oncologia Geriatrica, U.O. Oncologia Medica, Ospedale V. Fazzi, Lecce, Italy; Istituto Europeo di Oncologia di Milano, Mila
| | - A Bernardo
- Sandro Pitigliani Medical Oncology Unit, Instituto Toscano Tumori, Prato, Italy; Clinica Oncologica – Università Politecnica delle Marche – Ospedali Riuniti di Ancona, Ancona, Italy; Oncologia-Breast Unit Spedali Civili di Brescia, Brescia, Italy; Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Udine, Italy; Oncologia Medica A.O.Papa Giovanni XXIII, Bergamo, Italy; Oncologia Medica B, Centro di Riferimento Oncologico, Istituto Nazionale Tumori, Aviano, Aviano, Italy; Clinical Trials Coordinating Centre, AOU Careggi Instituto Toscano Tumori, Firenze, Italy; Oncologia Medica, Ospedale Perrino, ASL Brindisi Sora, Brindisi, Italy; Oncologia Medica Ospedale Civile SS Trinità di SoraOV Padova, Frosinone, Italy; Oncologia Medica 1 Istituto Oncologico Veneto- IOV Padova, Padova, Italy; Unita Operativa Complessa di Oncologia, Fondazione Maugeri, IRCCS di Pavia, Pavia, Italy; Oncologia Geriatrica, U.O. Oncologia Medica, Ospedale V. Fazzi, Lecce, Italy; Istituto Europeo di Oncologia di Milano, Mila
| | - S Leo
- Sandro Pitigliani Medical Oncology Unit, Instituto Toscano Tumori, Prato, Italy; Clinica Oncologica – Università Politecnica delle Marche – Ospedali Riuniti di Ancona, Ancona, Italy; Oncologia-Breast Unit Spedali Civili di Brescia, Brescia, Italy; Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Udine, Italy; Oncologia Medica A.O.Papa Giovanni XXIII, Bergamo, Italy; Oncologia Medica B, Centro di Riferimento Oncologico, Istituto Nazionale Tumori, Aviano, Aviano, Italy; Clinical Trials Coordinating Centre, AOU Careggi Instituto Toscano Tumori, Firenze, Italy; Oncologia Medica, Ospedale Perrino, ASL Brindisi Sora, Brindisi, Italy; Oncologia Medica Ospedale Civile SS Trinità di SoraOV Padova, Frosinone, Italy; Oncologia Medica 1 Istituto Oncologico Veneto- IOV Padova, Padova, Italy; Unita Operativa Complessa di Oncologia, Fondazione Maugeri, IRCCS di Pavia, Pavia, Italy; Oncologia Geriatrica, U.O. Oncologia Medica, Ospedale V. Fazzi, Lecce, Italy; Istituto Europeo di Oncologia di Milano, Mila
| | - M Colleoni
- Sandro Pitigliani Medical Oncology Unit, Instituto Toscano Tumori, Prato, Italy; Clinica Oncologica – Università Politecnica delle Marche – Ospedali Riuniti di Ancona, Ancona, Italy; Oncologia-Breast Unit Spedali Civili di Brescia, Brescia, Italy; Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Udine, Italy; Oncologia Medica A.O.Papa Giovanni XXIII, Bergamo, Italy; Oncologia Medica B, Centro di Riferimento Oncologico, Istituto Nazionale Tumori, Aviano, Aviano, Italy; Clinical Trials Coordinating Centre, AOU Careggi Instituto Toscano Tumori, Firenze, Italy; Oncologia Medica, Ospedale Perrino, ASL Brindisi Sora, Brindisi, Italy; Oncologia Medica Ospedale Civile SS Trinità di SoraOV Padova, Frosinone, Italy; Oncologia Medica 1 Istituto Oncologico Veneto- IOV Padova, Padova, Italy; Unita Operativa Complessa di Oncologia, Fondazione Maugeri, IRCCS di Pavia, Pavia, Italy; Oncologia Geriatrica, U.O. Oncologia Medica, Ospedale V. Fazzi, Lecce, Italy; Istituto Europeo di Oncologia di Milano, Mila
| | - S Donati
- Sandro Pitigliani Medical Oncology Unit, Instituto Toscano Tumori, Prato, Italy; Clinica Oncologica – Università Politecnica delle Marche – Ospedali Riuniti di Ancona, Ancona, Italy; Oncologia-Breast Unit Spedali Civili di Brescia, Brescia, Italy; Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Udine, Italy; Oncologia Medica A.O.Papa Giovanni XXIII, Bergamo, Italy; Oncologia Medica B, Centro di Riferimento Oncologico, Istituto Nazionale Tumori, Aviano, Aviano, Italy; Clinical Trials Coordinating Centre, AOU Careggi Instituto Toscano Tumori, Firenze, Italy; Oncologia Medica, Ospedale Perrino, ASL Brindisi Sora, Brindisi, Italy; Oncologia Medica Ospedale Civile SS Trinità di SoraOV Padova, Frosinone, Italy; Oncologia Medica 1 Istituto Oncologico Veneto- IOV Padova, Padova, Italy; Unita Operativa Complessa di Oncologia, Fondazione Maugeri, IRCCS di Pavia, Pavia, Italy; Oncologia Geriatrica, U.O. Oncologia Medica, Ospedale V. Fazzi, Lecce, Italy; Istituto Europeo di Oncologia di Milano, Mila
| | - S De Placido
- Sandro Pitigliani Medical Oncology Unit, Instituto Toscano Tumori, Prato, Italy; Clinica Oncologica – Università Politecnica delle Marche – Ospedali Riuniti di Ancona, Ancona, Italy; Oncologia-Breast Unit Spedali Civili di Brescia, Brescia, Italy; Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Udine, Italy; Oncologia Medica A.O.Papa Giovanni XXIII, Bergamo, Italy; Oncologia Medica B, Centro di Riferimento Oncologico, Istituto Nazionale Tumori, Aviano, Aviano, Italy; Clinical Trials Coordinating Centre, AOU Careggi Instituto Toscano Tumori, Firenze, Italy; Oncologia Medica, Ospedale Perrino, ASL Brindisi Sora, Brindisi, Italy; Oncologia Medica Ospedale Civile SS Trinità di SoraOV Padova, Frosinone, Italy; Oncologia Medica 1 Istituto Oncologico Veneto- IOV Padova, Padova, Italy; Unita Operativa Complessa di Oncologia, Fondazione Maugeri, IRCCS di Pavia, Pavia, Italy; Oncologia Geriatrica, U.O. Oncologia Medica, Ospedale V. Fazzi, Lecce, Italy; Istituto Europeo di Oncologia di Milano, Mila
| | - V Parolin
- Sandro Pitigliani Medical Oncology Unit, Instituto Toscano Tumori, Prato, Italy; Clinica Oncologica – Università Politecnica delle Marche – Ospedali Riuniti di Ancona, Ancona, Italy; Oncologia-Breast Unit Spedali Civili di Brescia, Brescia, Italy; Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Udine, Italy; Oncologia Medica A.O.Papa Giovanni XXIII, Bergamo, Italy; Oncologia Medica B, Centro di Riferimento Oncologico, Istituto Nazionale Tumori, Aviano, Aviano, Italy; Clinical Trials Coordinating Centre, AOU Careggi Instituto Toscano Tumori, Firenze, Italy; Oncologia Medica, Ospedale Perrino, ASL Brindisi Sora, Brindisi, Italy; Oncologia Medica Ospedale Civile SS Trinità di SoraOV Padova, Frosinone, Italy; Oncologia Medica 1 Istituto Oncologico Veneto- IOV Padova, Padova, Italy; Unita Operativa Complessa di Oncologia, Fondazione Maugeri, IRCCS di Pavia, Pavia, Italy; Oncologia Geriatrica, U.O. Oncologia Medica, Ospedale V. Fazzi, Lecce, Italy; Istituto Europeo di Oncologia di Milano, Mila
| | - S Vitale
- Sandro Pitigliani Medical Oncology Unit, Instituto Toscano Tumori, Prato, Italy; Clinica Oncologica – Università Politecnica delle Marche – Ospedali Riuniti di Ancona, Ancona, Italy; Oncologia-Breast Unit Spedali Civili di Brescia, Brescia, Italy; Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Udine, Italy; Oncologia Medica A.O.Papa Giovanni XXIII, Bergamo, Italy; Oncologia Medica B, Centro di Riferimento Oncologico, Istituto Nazionale Tumori, Aviano, Aviano, Italy; Clinical Trials Coordinating Centre, AOU Careggi Instituto Toscano Tumori, Firenze, Italy; Oncologia Medica, Ospedale Perrino, ASL Brindisi Sora, Brindisi, Italy; Oncologia Medica Ospedale Civile SS Trinità di SoraOV Padova, Frosinone, Italy; Oncologia Medica 1 Istituto Oncologico Veneto- IOV Padova, Padova, Italy; Unita Operativa Complessa di Oncologia, Fondazione Maugeri, IRCCS di Pavia, Pavia, Italy; Oncologia Geriatrica, U.O. Oncologia Medica, Ospedale V. Fazzi, Lecce, Italy; Istituto Europeo di Oncologia di Milano, Mila
| | - A Di Leo
- Sandro Pitigliani Medical Oncology Unit, Instituto Toscano Tumori, Prato, Italy; Clinica Oncologica – Università Politecnica delle Marche – Ospedali Riuniti di Ancona, Ancona, Italy; Oncologia-Breast Unit Spedali Civili di Brescia, Brescia, Italy; Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Udine, Italy; Oncologia Medica A.O.Papa Giovanni XXIII, Bergamo, Italy; Oncologia Medica B, Centro di Riferimento Oncologico, Istituto Nazionale Tumori, Aviano, Aviano, Italy; Clinical Trials Coordinating Centre, AOU Careggi Instituto Toscano Tumori, Firenze, Italy; Oncologia Medica, Ospedale Perrino, ASL Brindisi Sora, Brindisi, Italy; Oncologia Medica Ospedale Civile SS Trinità di SoraOV Padova, Frosinone, Italy; Oncologia Medica 1 Istituto Oncologico Veneto- IOV Padova, Padova, Italy; Unita Operativa Complessa di Oncologia, Fondazione Maugeri, IRCCS di Pavia, Pavia, Italy; Oncologia Geriatrica, U.O. Oncologia Medica, Ospedale V. Fazzi, Lecce, Italy; Istituto Europeo di Oncologia di Milano, Mila
| | - F Puglisi
- Sandro Pitigliani Medical Oncology Unit, Instituto Toscano Tumori, Prato, Italy; Clinica Oncologica – Università Politecnica delle Marche – Ospedali Riuniti di Ancona, Ancona, Italy; Oncologia-Breast Unit Spedali Civili di Brescia, Brescia, Italy; Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Udine, Italy; Oncologia Medica A.O.Papa Giovanni XXIII, Bergamo, Italy; Oncologia Medica B, Centro di Riferimento Oncologico, Istituto Nazionale Tumori, Aviano, Aviano, Italy; Clinical Trials Coordinating Centre, AOU Careggi Instituto Toscano Tumori, Firenze, Italy; Oncologia Medica, Ospedale Perrino, ASL Brindisi Sora, Brindisi, Italy; Oncologia Medica Ospedale Civile SS Trinità di SoraOV Padova, Frosinone, Italy; Oncologia Medica 1 Istituto Oncologico Veneto- IOV Padova, Padova, Italy; Unita Operativa Complessa di Oncologia, Fondazione Maugeri, IRCCS di Pavia, Pavia, Italy; Oncologia Geriatrica, U.O. Oncologia Medica, Ospedale V. Fazzi, Lecce, Italy; Istituto Europeo di Oncologia di Milano, Mila
| | - L Boni
- Sandro Pitigliani Medical Oncology Unit, Instituto Toscano Tumori, Prato, Italy; Clinica Oncologica – Università Politecnica delle Marche – Ospedali Riuniti di Ancona, Ancona, Italy; Oncologia-Breast Unit Spedali Civili di Brescia, Brescia, Italy; Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Udine, Italy; Oncologia Medica A.O.Papa Giovanni XXIII, Bergamo, Italy; Oncologia Medica B, Centro di Riferimento Oncologico, Istituto Nazionale Tumori, Aviano, Aviano, Italy; Clinical Trials Coordinating Centre, AOU Careggi Instituto Toscano Tumori, Firenze, Italy; Oncologia Medica, Ospedale Perrino, ASL Brindisi Sora, Brindisi, Italy; Oncologia Medica Ospedale Civile SS Trinità di SoraOV Padova, Frosinone, Italy; Oncologia Medica 1 Istituto Oncologico Veneto- IOV Padova, Padova, Italy; Unita Operativa Complessa di Oncologia, Fondazione Maugeri, IRCCS di Pavia, Pavia, Italy; Oncologia Geriatrica, U.O. Oncologia Medica, Ospedale V. Fazzi, Lecce, Italy; Istituto Europeo di Oncologia di Milano, Mila
| | - S Cinieri
- Sandro Pitigliani Medical Oncology Unit, Instituto Toscano Tumori, Prato, Italy; Clinica Oncologica – Università Politecnica delle Marche – Ospedali Riuniti di Ancona, Ancona, Italy; Oncologia-Breast Unit Spedali Civili di Brescia, Brescia, Italy; Dipartimento di Area Medica, Università degli Studi di Udine, Udine, Udine, Italy; Oncologia Medica A.O.Papa Giovanni XXIII, Bergamo, Italy; Oncologia Medica B, Centro di Riferimento Oncologico, Istituto Nazionale Tumori, Aviano, Aviano, Italy; Clinical Trials Coordinating Centre, AOU Careggi Instituto Toscano Tumori, Firenze, Italy; Oncologia Medica, Ospedale Perrino, ASL Brindisi Sora, Brindisi, Italy; Oncologia Medica Ospedale Civile SS Trinità di SoraOV Padova, Frosinone, Italy; Oncologia Medica 1 Istituto Oncologico Veneto- IOV Padova, Padova, Italy; Unita Operativa Complessa di Oncologia, Fondazione Maugeri, IRCCS di Pavia, Pavia, Italy; Oncologia Geriatrica, U.O. Oncologia Medica, Ospedale V. Fazzi, Lecce, Italy; Istituto Europeo di Oncologia di Milano, Mila
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Cantini L, Pistelli M, Savini A, Bastianelli L, Della Mora A, Merloni F, Burattini M, Berardi R. Long-responders to anti-HER2 therapies: A case report and review of the literature. Mol Clin Oncol 2018; 8:147-152. [PMID: 29387408 DOI: 10.3892/mco.2017.1495] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 11/07/2017] [Indexed: 11/05/2022] Open
Abstract
Since the introduction of targeted therapies, prognosis in human epidermal growth factor receptor (HER) 2-positive metastatic breast cancer (MBC) has radically changed. The addition of Pertuzumab to Trastuzumab and standard chemotherapy has further increased patients' overall survival (OS). However, there is no agreement regarding the optimal duration of trastuzumab therapy in selected patients achieving long-term complete remission. In addition, no potential factors of long-term benefit have been identified yet. In the present study, we report the case of a MBC woman who was successfully treated with trastuzumab for over 10 years. At the time of diagnosis (February 2005), she revealed lung, nodal and bone metastases. Therefore, a first-line chemotherapy with Epirubicine and Docetaxel was administered for 6 cycles and then the patient started Trastuzumab plus hormonal therapy until reaching a sensible reduction of mammary lump and disappearance of distant metastases. Following a multidisciplinary evaluation, in November 2006, the patient underwent radical mastectomy and axillary dissection, achieving a complete remission. She continued Trastuzumab until September 2015 (for a total of 156 cycles) when a pleural diffusion was demonstrated. Long-term survival during anti-HER2 treatment remains a rare and optimal situation. Currently, no data exist to support trastuzumab interruption in this setting and collaborative efforts to better analyze the characteristics of long-responder patients are needed. Data regarding prognostic factors in this setting are relatively confusing. Our review reveals that hormonal receptor (HR)-positive disease is associated with a better prognosis, whereas the role of visceral spread differs by single or dual target anti HER2-inhibition. The introduction of Pertuzumab is raising concerns in terms of toxicity and its cost effectiveness. While waiting for novel molecular data and randomized trials, available evidence advocates continuous use of anti-HER2 therapies until disease progression or development of side effects.
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Affiliation(s)
- Luca Cantini
- Medical Oncology, Marche Polytechnic University, University Hospital Ospedali Riuniti Ancona, I-60126 Ancona, Italy
| | - Mirco Pistelli
- Medical Oncology, Marche Polytechnic University, University Hospital Ospedali Riuniti Ancona, I-60126 Ancona, Italy
| | - Agnese Savini
- Medical Oncology, Marche Polytechnic University, University Hospital Ospedali Riuniti Ancona, I-60126 Ancona, Italy
| | - Lucia Bastianelli
- Medical Oncology, Marche Polytechnic University, University Hospital Ospedali Riuniti Ancona, I-60126 Ancona, Italy
| | - Arianna Della Mora
- Medical Oncology, Marche Polytechnic University, University Hospital Ospedali Riuniti Ancona, I-60126 Ancona, Italy
| | - Filippo Merloni
- Medical Oncology, Marche Polytechnic University, University Hospital Ospedali Riuniti Ancona, I-60126 Ancona, Italy
| | - Michela Burattini
- Medical Oncology, Marche Polytechnic University, University Hospital Ospedali Riuniti Ancona, I-60126 Ancona, Italy
| | - Rossana Berardi
- Medical Oncology, Marche Polytechnic University, University Hospital Ospedali Riuniti Ancona, I-60126 Ancona, Italy
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Tartari F, Santoni M, Pistelli M, Berardi R. Healthcare cost of HER2-positive and negative breast tumors in the United States (2012–2035). Cancer Treat Rev 2017; 60:12-17. [DOI: 10.1016/j.ctrv.2017.08.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 08/10/2017] [Accepted: 08/13/2017] [Indexed: 12/21/2022]
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Bini F, Ballatore Z, Bianchi F, Maccaroni E, Belvederesi L, Brugiati C, Pagliaretta S, Murrone A, Savini A, Pistelli M, Bracci R, Berardi R. Pathogenetic mutations in BRCA related triple negative breast cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx424.034] [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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26
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De Lisa M, Pistelli M, Giampieri R, Macchini M, Ponzani M, Giuseppetti G, Santinelli A, Bastianelli L, Ballatore Z, Battelli N, Berardi R. Evaluation of stromal tumour-infiltrating lymphocytes (TILs) in breast cancer by Dynamic contrast–enhanced magnetic resonance (DCE-MR) imaging. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx424.006] [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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27
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Cazzaniga M, Orlando L, Melegari E, Arcangeli V, Butera A, Pinotti G, Vallini I, Mocerino C, Giovanardi F, Cretella E, Gambaro A, Pistelli M, Donati S, Pizzuti L, Spagnuolo A, Putzu C, Leonardi V, De Angelis C, Pedroli S, Torri V. Metronomic chemotherapy (mCHT) in HER2-ve advanced breast cancer (ABC) patients (pts): old drugs, new results. The multicenter VICTOR-6 study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx424.015] [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: 11/12/2022] Open
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Maccaroni E, Giampieri R, Del Prete M, Principi G, Bracci R, Calcinari A, Della Mora A, Bianchi F, Belvederesi L, Brugiati C, Pagliaretta S, Pistelli M, Savini A, Pagliacci A, Ballatore Z, Bini F, Baleani M, Cantini L, Murrone A, Berardi R. Prognostic impact of CA15-3 pre-treatment levels in ovarian cancer patients. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx429.007] [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: 11/12/2022] Open
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Della Mora A, Bastianelli L, Pistelli M, Santinelli A, Cantini L, Doria A, Merloni F, Lucarelli A, Savini A, Maccaroni E, Ballatore Z, Pagliacci A, Berardi R. Stromal peritumoral and intratumoral infiltrating lymphocytes: how immunity influences prognosis in triple negative breast cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx424.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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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30
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Ballatore Z, Bracci R, Bianchi F, Maccaroni E, Belvederesi L, Brugiati C, Murrone A, Pagliaretta S, Pistelli M, Berardi R. BRCA related breast cancer and sporadic tumors: same prognosis or survivorship bias? Ann Oncol 2017. [DOI: 10.1093/annonc/mdx424.011] [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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31
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Tonnini C, De Papa A, Loiacono F, Ricci G, Romeo M, Giampieri R, Pistelli M, Savini A, Francoletti M, Berardi R. “Feel beautiful to feel alive”. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx438.028] [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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Pistelli M, Bastianelli L, Della Mora A, Romeo M, Ballatore Z, Natalucci V, Capecci M, Ceravolo M, Serrani R, Ricci M, Fumelli D, Taus M, Nicolai A, Berardi R. Breast cancer secondary prevention: get fit to feel healthy. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx433.007] [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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Merloni F, Pistelli M, Cantini L, Della Mora A, Bastianelli L, De Lisa M, Burattini M, Maccaroni E, Ballatore Z, Savini A, Pagliacci A, Berardi R. Role of inflammation parameters in locally advanced breast cancer: the debate is still open. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx424.043] [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: 11/12/2022] Open
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Bertolini I, Diodati L, Fontana A, De Angelis C, Cantini L, Cecconi S, Montagnani I, Salvadori B, Ferrarini I, Ferrari P, Michelotti A, Landucci E, Fanelli G, Scatena C, Naccarato A, Berardi R, Pistelli M, Falcone A. Are anti-HER2 agents the best choice in metastatic breast cancer with an HER2 positive switch from primary tumour? A retrospective multi institution analysis of clinical-pathological characteristics and outcomes. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx424.064] [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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35
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Bastianelli L, Pistelli M, Giuseppetti G, De Lisa M, Macchini M, Ponziani M, Della Mora A, Cantini L, Merloni F, Savini A, Berardi R. Role of DCE-MR imaging of the breast in predicting breast cancer subtypes: where are we going? Ann Oncol 2017. [DOI: 10.1093/annonc/mdx424.027] [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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36
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Guerra F, Flori M, Contadini D, Menditto A, Baiocco E, Mancini G, Pistelli M, Olivieri A, Leoni P, Berardi R, Capucci A. P4357Left ventricular torsion and rigid body rotation pattern in patients treated with anthracycline. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4357] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Cazzaniga ME, Airoldi M, Arcangeli V, Artale S, Atzori F, Ballerio A, Bianchi GV, Blasi L, Campidoglio S, Ciccarese M, Cursano MC, Piezzo M, Fabi A, Ferrari L, Ferzi A, Ficorella C, Frassoldati A, Fumagalli A, Garrone O, Gebbia V, Generali D, La Verde N, Maur M, Michelotti A, Moretti G, Musolino A, Palumbo R, Pistelli M, Porpiglia M, Sartori D, Scavelli C, Schirone A, Turletti A, Valerio MR, Vici P, Zambelli A, Clivio L, Torri V. Efficacy and safety of Everolimus and Exemestane in hormone-receptor positive (HR+) human-epidermal-growth-factor negative (HER2-) advanced breast cancer patients: New insights beyond clinical trials. The EVA study. Breast 2017; 35:115-121. [PMID: 28711793 DOI: 10.1016/j.breast.2017.06.043] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 06/12/2017] [Accepted: 06/29/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The BOLERO-2 trial reported efficacy and safety of Everolimus (EVE) and Exemestane (EXE) combination in HR+ advanced breast cancer (ABC) patients. The BALLET trial further evaluated the safety of EVE-EXE in HR+ ABC patients, without reporting efficacy data. Aim of the EVA real-life study was to collect data of efficacy and safety of EVE-EXE combination in the clinical setting, as well as exploring efficacy according to EVE Dose-Intensity (DI) and to previous treatment with Fulvestrant. PATIENTS AND METHODS This study aimed to describe the outcome of ABC pts treated with EVE-EXE combination in terms of median duration of EVE treatment and ORR in a real-life setting. RESULTS From July 2013 to December 2015, the EVA study enrolled 404 pts. Median age was 61 years (33-83). Main metastatic sites were: bone (69.1%), soft tissue (34.7%) and viscera (33.2%). Median number of previous treatments was 2 (1-7). 43.3% of the pts had received Fulvestrant. Median exposure to EVE was 31.0 weeks (15.4-58.3) in the whole population. No difference was observed in terms of EVE exposure duration according to DI (p for trend = 0.27) or type of previous treatments (p = 0.33). ORR and Disease Control Rate (DCR) were observed in 31.6% and 60.7% of the patients, respectively, with the lowest ORRs confined in CHT pre-treated patients or in those who received the lowest DI of EVE. Grade 3-4 adverse events (AEs) were reported in 37.9% of the patients. Main AEs were: stomatitis (11.2%), non-infectious pneumonitis - NIP (3.8%), anaemia (3.8%) and fatigue (3.2%). CONCLUSIONS The EVA study provided new insights in the use of EVE-EVE combination in HR+ ABC pts many years after the publication of the pivotal trial. The combination is safe and the best response could be obtained in patients receiving the full dose of EVE and/or after hormone-therapy as Fulvestrant in ABC.
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Affiliation(s)
- M E Cazzaniga
- Research Unit Phase I Trials, ASST Monza, Monza, Italy; Oncology Unit, ASST Monza, Monza, Italy.
| | - M Airoldi
- Oncology Unit 2 - Città della Salute e della Scienza di Torino, Torino, Italy
| | - V Arcangeli
- Oncology Unit Rimini Azienda USL Romagna, Rimini, Italy
| | - S Artale
- Oncology Department, Ospedale di Gallarate ASST Valle Olona, Gallarate, Italy
| | - F Atzori
- Oncology Unit, Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - A Ballerio
- Oncology Unit, ASST della Valle Olona - Presidio Ospedaliero di Saronno, Saronno, Italy
| | - G V Bianchi
- Oncology Unit 1, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - L Blasi
- Oncology Unit, ARNAS Civico Palermo, Palermo, Italy
| | - S Campidoglio
- Oncology Unit, Ospedale Sacro Cuore di Gesù, Fatebenefratelli, Benevento, Italy
| | - M Ciccarese
- Oncology Unit, Ospedale "Vito Fazzi" di Lecce, Lecce, Italy
| | - M C Cursano
- Oncology Unit, Università Campus Bio-Medico, Roma, Italy
| | - M Piezzo
- National Cancer Institute "Fondazione Giovanni Pascale", Napoli, Italy
| | - A Fabi
- Oncology Unit 1, Istituto Regina Elena - IFO, Roma, Italy
| | - L Ferrari
- Oncology Unit, ASL di Frosinone Osp. "SS. Trinità", Italy
| | - A Ferzi
- Oncology Unit, ASST OVEST Milanese - Presidio di Legnano, Legnano, Italy
| | - C Ficorella
- Dipartimento di Scienze Cliniche Applicate e Biotecnologiche (DISCAB) - Università Degli Studi Dell'Aquila, L'Aquila, Italy
| | - A Frassoldati
- Oncology Unit, Az Ospedaliero Universitaria di Ferrara, Ferrara, Italy
| | - A Fumagalli
- Oncology Unit, Ospedale Moriggia Pelascini, Gravedona, Italy
| | - O Garrone
- Oncology Unit, A.O. S. Croce e Carle Ospedale di Insegnamento, Cuneo, Italy
| | - V Gebbia
- Oncology Unit, Osp. La Maddalena, Palermo, Italy
| | | | - N La Verde
- Oncology Unit, ASST Fatebenefratelli Sacco, Milano, Italy
| | - M Maur
- Oncology and Haematology Department, A.O.U Policlinico di Modena, Modena, Italy
| | - A Michelotti
- Oncology Unit I, Ospedale S. Chiara, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - G Moretti
- Oncology Unit, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | - A Musolino
- Oncology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - R Palumbo
- Oncology Unit, IRCCS ICS Maugeri, Pavia, Italy
| | - M Pistelli
- Oncology Unit, AOU Ospedali Riuniti Umberto I-G.M. Lancisi-G. Salesi, Ancona, Italy
| | - M Porpiglia
- Oncology Unit, Presidio Ospedaliero S. Anna, Torino, Italy
| | - D Sartori
- Oncology Unit, AULSS 3, Mirano, Italy
| | - C Scavelli
- Oncology Unit, Ospedale "S. Cuore di Gesù", Gallipoli, Italy
| | - A Schirone
- Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - A Turletti
- Oncology Unit, Ospedale Martini della ASL "Città di Torino", Torino, Italy
| | - M R Valerio
- Oncology Department, Policlinico di Palermo Paolo Giaccone, Palermo, Italy
| | - P Vici
- Oncology Unit, Istituto Nazionale Tumori Regina Elena - IFO, Roma, Italy
| | - A Zambelli
- Oncology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - L Clivio
- IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milano, Italy
| | - V Torri
- IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milano, Italy
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Ballatore Z, Pistelli M, Battelli N, Pagliacci A, De Lisa M, Berardi R, Cascinu S. Everolimus and exemestane in long survival hormone receptor positive male breast cancer: case report. BMC Res Notes 2016; 9:497. [PMID: 27894335 PMCID: PMC5127048 DOI: 10.1186/s13104-016-2301-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 11/15/2016] [Indexed: 01/27/2023] Open
Abstract
Background Male breast cancer is a rare event, accounting for approximately 1% of all breast carcinomas. Although men with breast cancer had poorer survival when compared with women, data on prognosis principally derive from retrospective studies and from extrapolation of female breast cancer series. We reported the case of a very long survival patient. Case presentation A caucasian 42-year-old man underwent radical mastectomy with axillary dissection for breast cancer in 1993. Pathologic stage was pT4pN0M0 infiltrating ductal carcinoma of right breast without lymph nodes metastases. Biological characterization was not available. He received adjuvant treatment with chemotherapy, six cycles of cyclophosphamide, methotrexate and fluorouracil, then endocrine therapy with tamoxifen for 5 years and complementary radiotherapy. Then he began clinical-instrumental follow up. In May 1996, a computed tomography scan showed multiple lung metastases. Hereafter he received several oncologic treatment including seven chemotherapy and five endocrine therapy lines with two re-challenge of endocrine therapy. In October 2007 further lung progression was showed and a biopsy was performed to characterize the disease. Histological examination confirmed breast cancer metastases, immunohistochemistry showed positive staining for estrogen receptor, negative for progesterone receptor and human epithelial growth factor receptor 2, proliferative index was 21%. In April 2013, bone disease progression was evident and he received radiant treatment to sacral spine. In May 2014 an off-label treatment with exemestane and everolimus combination was approved by Ethics Committee of the Marche Region. The patient received treatment for 3 months with evident clinical benefit to subcutaneous lesions of the chest wall that were not visible nor palpable on physical examination after 1 month of treatment. Conclusion That is the case of long survival male breast cancer patient with luminal B subtype and no BRCA mutations. He achieved higher progression free survival with endocrine therapy creating the rationale for last line treatment with everolimus and exemestane combination. Attending conclusive results from ongoing studies, everolimus and exemestane should not be used routinely in male metastatic breast cancer patients, but taking into account for selected cases. At the best of our knowledge, this is the first case of male beast cancer treated with exemestane and everolimus combination.
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Affiliation(s)
- Z Ballatore
- Clinica di Oncologia Medica e Centro Regionale di Genetica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti-Ancona, Ancona, Italy.
| | - M Pistelli
- Clinica di Oncologia Medica e Centro Regionale di Genetica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti-Ancona, Ancona, Italy
| | - N Battelli
- Clinica di Oncologia Medica e Centro Regionale di Genetica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti-Ancona, Ancona, Italy
| | - A Pagliacci
- Clinica di Oncologia Medica e Centro Regionale di Genetica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti-Ancona, Ancona, Italy
| | - M De Lisa
- Clinica di Oncologia Medica e Centro Regionale di Genetica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti-Ancona, Ancona, Italy
| | - R Berardi
- Clinica di Oncologia Medica e Centro Regionale di Genetica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti-Ancona, Ancona, Italy
| | - S Cascinu
- Clinica di Oncologia Medica e Centro Regionale di Genetica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti-Ancona, Ancona, Italy
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Giotta F, Acito L, Candeloro G, Del Medico P, Gadaleta-Caldarola G, Giordano G, Gueli R, Lugini A, Magri V, Mandarà M, Masci G, Pisconti S, Pistelli M, Rizzi A, Salesi N, Schirone A, Scognamiglio G, Tedeschi M, Zucchinelli P. Eribulin in Male Patients With Breast Cancer: The First Report of Clinical Outcomes. Oncologist 2016; 21:1298-1305. [PMID: 27742906 PMCID: PMC5189626 DOI: 10.1634/theoncologist.2016-0022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 04/14/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Evidence on the management and treatment of male breast cancer is scant. We report the analysis of a multicenter Italian series of patients with male breast cancer treated with eribulin. To our knowledge, this is the first report on the use or eribulin in this setting. PATIENTS AND METHODS Patients were retrospectively identified in 19 reference centers. All patients received eribulin treatment, according to the standard practice of each center. Data on the identified patients were collected using a standardized form and were then centrally reviewed by two experienced oncologists. RESULTS A total of 23 patients (median age, 64 years; range, 42-80) were considered. The median age at the time of diagnosis of breast cancer was 57 years (range, 42-74). HER2 status was negative in 14 patients (61%), and 2 patients (9%) had triple-negative disease. The most common metastatic sites were the lung (n = 14; 61%) and bone (n = 13; 56%). Eribulin was administered for a median of 6 cycles (range, 3-15). All patients reported at least stable disease; two complete responses (9%) were documented. Eribulin was well-tolerated, with only four patients (17%) reporting grade 3 adverse events and two (9%) with treatment interruptions because of toxicity. Eight subjects (35%) did not report any adverse event during treatment. For patients with a reported fatal event, the median overall survival from the diagnosis of metastatic disease was 65 months (range, 22-228). CONCLUSION Although hampered by all the limitations of any retrospective case series, the results of the present study suggest, for the first time, the use of eribulin as therapy for male breast cancer. IMPLICATIONS FOR PRACTICE Evidence on the management and treatment of male breast cancer is eagerly awaited. Although hampered by all the limitations of any retrospective case series, the results of the present study suggest, for the first time, the use of eribulin as therapy for male breast cancer.
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Affiliation(s)
- Francesco Giotta
- Oncologia Medica, Istituti di Ricovero e Cura a Carattere Scientifico, Istituto Tumori "Giovanni Paolo II," Bari, Italy
| | - Luigi Acito
- Oncologia Medica, Ospedale A. Murri, Fermo, Italy
| | | | | | | | - Guido Giordano
- Ospedale Sacro Cuore di Gesú Fatebenefratelli, Benevento, Italy
| | - Rossana Gueli
- Ospedale di Circolo e Fondazione Macchi Varese, Varese, Italy
| | | | | | | | | | | | | | | | | | - Alessio Schirone
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Istituti di Ricovero e Cura a Carattere Scientifico, Meldola, Italy
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Maccaroni E, Bracci R, Giampieri R, Bianchi F, Belvederesi L, Brugiati C, Pagliaretta S, De Mora A, Tronconi F, Pistelli M, Pagliacci A, Battelli N, Ballatore Z, De Lisa M, Berardi R. Hypersensitivity reactions to antineoplastic agents in BRCA-mutated ovarian cancer (OC) patients: a single centre experience. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw374.12] [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: 11/12/2022] Open
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41
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Ballatore Z, Pistelli M, Bracci R, Bianchi F, Maccaroni E, Belvederesi L, Brugiati C, Pagliaretta S, De Lisa M, Della Mora A, Cantini L, Bastianelli L, Pagliacci A, Battelli N, Berardi R. Triple-negative breast cancer and BRCA mutation: looking at the future. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw364.24] [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: 11/14/2022] Open
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42
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Pistelli M, Santinelli A, Santoni M, Piva F, Bianchi F, Belvederesi L, Biscotti T, De Lisa M, Ballatore Z, Occhipinti G, Pagliacci A, Maccaroni E, Bracci R, Battelli N, Cantini L, Bastianelli L, Berardi R, Cascinu S. BRCA mutations and IGF-R1 expression in modulating sensitivity to trastuzumab in HER2-positive breast cancer. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw364.25] [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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43
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De Lisa M, Pistelli M, Ballatore Z, Lucia B, Pagliacci A, Matteo S, Luca C, Tahani H, Battelli N, Maccaroni E, Bracci R, Santinelli A, Berardi R. Potential role of PLR and NLR in clinical decision making in locally advanced breast cancer. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw337.33] [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: 11/13/2022] Open
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44
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Cantini L, Pistelli M, Paesani M, Ballatore Z, Bastianelli L, De Lisa M, Santoni M, Pagliacci A, Battelli N, Bracci R, Maccaroni E, Valeri I, Biscotti T, Santinelli A, Berardi R. Impact of hormonal receptor status on prognosis in HER2 positive breast cancer. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw337.25] [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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45
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Ballatore Z, Pistelli M, Bracci R, Bianchi F, Maccaroni E, Belvederesi L, Brugiati C, Pagliaretta S, De Lisa M, Della Mora A, Cantini L, Bastianelli L, Pagliacci A, Battelli N, Berardi R. Triple-negative breast cancer and BRCA mutation: looking at the future. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw337.24] [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: 11/12/2022] Open
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46
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Torniai M, Piva F, Rinaldi S, Santoni M, Pagliaretta S, Partelli S, Savini A, Morgese F, Caramanti M, Pistelli M, Bittoni A, Giampieri R, Onofri A, Pezzulla D, Principato G, Falconi M, Berardi R. Pathogenic and prognostic role of VEGF and VEGFR single nucleotide polymorphisms in gastroenteropancreatic neuroendocrine neoplasms. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw333.27] [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: 11/12/2022] Open
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47
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Bastianelli L, De Lisa M, Pistelli M, Ballatore Z, Santoni M, Cantini L, Pagliacci A, Battelli N, Maccaroni E, Bracci R, Santinelli A, Tahani H, Berardi R. The link between obesity and advanced breast cancer is a matter of much interest. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw337.42] [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: 11/12/2022] Open
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48
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Pistelli M, Santinelli A, Santoni M, Piva F, Bianchi F, Biscotti T, Belvederesi L, Ballatore Z, Occhipinti G, De Lisa M, Pagliacci A, Battelli N, Bracci R, Maccaroni E, Bastinelli L, Cantini L, Berardi R, Cascinu S. BRCA mutations and IGF-R1 expression in modulating sensitivity to Trastuzumab in patients with HER2-positive breast cancer. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw337.19] [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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49
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Pistelli M, Ballatore Z, Santinelli A, Biscotti T, Piva F, Occhipinti G, Della Mora A, Pagliacci A, Battelli N, Bastianelli L, De Lisa M, Bracci R, Maccaroni E, Berardi R, Cascinu S. Phosphorylated mTOR is associated to androgen receptor expression in early triple-negative breast cancer. Oncol Rep 2016; 36:755-62. [PMID: 27350136 DOI: 10.3892/or.2016.4903] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 02/24/2016] [Indexed: 11/06/2022] Open
Abstract
The significance of phosphorylated mTOR (p-mTOR) expression is unknown in triple-negative breast carcinoma (TNBC). The aims of the present study were to assess the expression of p-mTOR in early TNBC and to evaluate possible correlations between androgen receptor (AR) expression, clinicopathological parameters and disease outcome. Between January 2009 and December 2013, all consecutive patients who were diagnosed and completed the treatment of invasive TNBC at our institution were eligible for this analysis. Patients with stage IV disease were excluded. The evaluation of p-mTOR immunohistochemical staining was semi-quantitatively considering both the percentage of positive tumor cells (range, 0-100%) and staining intensity (range, 0-3+). Ninety-eight TNBC patients were included. Approximately 33% of cases were p-mTOR positive and there was no association between positive immunostaining for p-mTOR and DFS (p=0.74) and OS (p=0.81). p-mTOR positivity was associated with small tumor size (p=0.03) and AR expression (p=0.04). High expression of p-mTOR may drive tumor proliferation in almost one third of TNBC. The biological association between mTOR activation and AR pathway suggests that there may exist a subgroup of TNBC in which the combination of both AR antagonism and mTOR inhibition should have a synergistic effect on cell growth and tumor progression.
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Affiliation(s)
- M Pistelli
- Department of Medical Oncology, AOU Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Z Ballatore
- Department of Medical Oncology, AOU Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - A Santinelli
- Department of Pathology, AOU Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - T Biscotti
- Department of Pathology, AOU Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - F Piva
- Department of Specialistic Clinical and Odontostomatological Sciences, Polytechnic University of Marche, Ancona, Italy
| | - G Occhipinti
- Department of Medical Oncology, AOU Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - A Della Mora
- Department of Medical Oncology, AOU Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - A Pagliacci
- Department of Medical Oncology, AOU Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - N Battelli
- Department of Medical Oncology, AOU Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - L Bastianelli
- Department of Medical Oncology, AOU Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - M De Lisa
- Department of Medical Oncology, AOU Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - R Bracci
- Department of Medical Oncology, AOU Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - E Maccaroni
- Department of Medical Oncology, AOU Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - R Berardi
- Department of Medical Oncology, AOU Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - S Cascinu
- Department of Medical Oncology, AOU Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
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50
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Berardi R, Santoni M, Rinaldi S, Nunzi E, Smerilli A, Caramanti M, Morgese F, Torniai M, Savini A, Fiordoliva I, Onofri A, Pistelli M, Taccaliti A, Cascinu S. Risk of Hyponatraemia in Cancer Patients Treated with Targeted Therapies: A Systematic Review and Meta-Analysis of Clinical Trials. PLoS One 2016; 11:e0152079. [PMID: 27167519 PMCID: PMC4864354 DOI: 10.1371/journal.pone.0152079] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 03/08/2016] [Indexed: 12/21/2022] Open
Abstract
Background Hyponatraemia has been reported with targeted therapies in cancer patients. Aim of the study was to perform an up-to-date meta-analysis in order to determine the incidence and relative risk (RR) in cancer patients treated with these agents. Materials and Methods The scientific literature regarding hyponatraemia was extensively reviewed using MEDLINE, PubMed, Embase and Cochrane databases. Eligible studies were selected according to PRISMA statement. Summary incidence, RR, and 95% Confidence Intervals were calculated using random-effects or fixed-effects models based on the heterogeneity of selected studies. Results 4803 potentially relevant trials were identified: of them, 13 randomized phase III studies were included in this meta-analysis. 6670 patients treated with 8 targeted agents were included: 2574 patients had hepatocellular carcinoma, whilst 4096 had other malignancies. The highest incidences of all-grade hyponatraemia were observed with the combination of brivanib and cetuximab (63.4) and pazopanib (31.7), while the lowest incidence was reported by afatinib (1.7). The highest incidence of high-grade hyponatraemia was reported by cetuximab (34.8), while the lowest incidences were reported by gefitinib (1.0). Summary RR of developing all-grade and high-grade hyponatraemia with targeted agents was 1.36 and 1.52, respectively. The highest RRs of all-grade and high-grade hyponatraemia were associated with brivanib (6.5 and 5.2, respectively). Grouping by drug category, the RR of high-grade hyponatraemia with angiogenesis inhibitors was 2.69 compared to anti-Epidermal Growth Factor Receptors agents (1.12). Conclusion Treatment with biological therapy in cancer patients is associated with a significant increased risk of hyponatraemia, therefore frequent clinical monitoring should be emphasized when managing targeted agents.
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Affiliation(s)
- Rossana Berardi
- Clinica di Oncologia Medica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I–GM Lancisi–G Salesi, Ancona, Italy
- * E-mail:
| | - Matteo Santoni
- Clinica di Oncologia Medica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I–GM Lancisi–G Salesi, Ancona, Italy
| | - Silvia Rinaldi
- Clinica di Oncologia Medica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I–GM Lancisi–G Salesi, Ancona, Italy
| | - Emilia Nunzi
- Dipartimento Medicina Sperimentale, Università degli Studi di Perugia, Perugia, Italy
| | - Alessia Smerilli
- Division of Endocrinology, A—Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I–GM Lancisi–G Salesi, Ancona, Italy
| | - Miriam Caramanti
- Clinica di Oncologia Medica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I–GM Lancisi–G Salesi, Ancona, Italy
| | - Francesca Morgese
- Clinica di Oncologia Medica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I–GM Lancisi–G Salesi, Ancona, Italy
| | - Mariangela Torniai
- Clinica di Oncologia Medica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I–GM Lancisi–G Salesi, Ancona, Italy
| | - Agnese Savini
- Clinica di Oncologia Medica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I–GM Lancisi–G Salesi, Ancona, Italy
| | - Ilaria Fiordoliva
- Clinica di Oncologia Medica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I–GM Lancisi–G Salesi, Ancona, Italy
| | - Azzurra Onofri
- Clinica di Oncologia Medica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I–GM Lancisi–G Salesi, Ancona, Italy
| | - Mirco Pistelli
- Clinica di Oncologia Medica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I–GM Lancisi–G Salesi, Ancona, Italy
| | - Augusto Taccaliti
- Division of Endocrinology, A—Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I–GM Lancisi–G Salesi, Ancona, Italy
| | - Stefano Cascinu
- Clinica di Oncologia Medica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I–GM Lancisi–G Salesi, Ancona, Italy
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