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Schettini F, De Bonis MV, Strina C, Milani M, Ziglioli N, Aguggini S, Ciliberto I, Azzini C, Barbieri G, Cervoni V, Cappelletti MR, Ferrero G, Ungari M, Locci M, Paris I, Scambia G, Ruocco G, Generali D. Computational reactive-diffusive modeling for stratification and prognosis determination of patients with breast cancer receiving Olaparib. Sci Rep 2023; 13:11951. [PMID: 37488154 PMCID: PMC10366144 DOI: 10.1038/s41598-023-38760-z] [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] [Received: 02/22/2023] [Accepted: 07/14/2023] [Indexed: 07/26/2023] Open
Abstract
Mathematical models based on partial differential equations (PDEs) can be exploited to handle clinical data with space/time dimensions, e.g. tumor growth challenged by neoadjuvant therapy. A model based on simplified assessment of tumor malignancy and pharmacodynamics efficiency was exercised to discover new metrics of patient prognosis in the OLTRE trial. We tested in a 17-patients cohort affected by early-stage triple negative breast cancer (TNBC) treated with 3 weeks of olaparib, the capability of a PDEs-based reactive-diffusive model of tumor growth to efficiently predict the response to olaparib in terms of SUVmax detected at 18FDG-PET/CT scan, by using specific terms to characterize tumor diffusion and proliferation. Computations were performed with COMSOL Multiphysics. Driving parameters governing the mathematical model were selected with Pearson's correlations. Discrepancies between actual and computed SUVmax values were assessed with Student's t test and Wilcoxon rank sum test. The correlation between post-olaparib true and computed SUVmax was assessed with Pearson's r and Spearman's rho. After defining the proper mathematical assumptions, the nominal drug efficiency (εPD) and tumor malignancy (rc) were computationally evaluated. The former parameter reflected the activity of olaparib on the tumor, while the latter represented the growth rate of metabolic activity as detected by SUVmax. εPD was found to be directly dependent on basal tumor-infiltrating lymphocytes (TILs) and Ki67% and was detectable through proper linear regression functions according to TILs values, while rc was represented by the baseline Ki67-to-TILs ratio. Predicted post-olaparib SUV*max did not significantly differ from original post-olaparib SUVmax in the overall, gBRCA-mutant and gBRCA-wild-type subpopulations (p > 0.05 in all cases), showing strong positive correlation (r = 0.9 and rho = 0.9, p < 0.0001 both). A model of simplified tumor dynamics was exercised to effectively produce an upfront prediction of efficacy of 3-week neoadjuvant olaparib in terms of SUVmax. Prospective evaluation in independent cohorts and correlation of these outcomes with more recognized efficacy endpoints is now warranted for model confirmation and tailoring of escalated/de-escalated therapeutic strategies for early-TNBC patients.
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Affiliation(s)
- Francesco Schettini
- Medical Oncology Department, Hospital Clinic of Barcelona, C. Villaroel 170, 08036, Barcelona, Spain.
- Translational Genomics and Targeted Therapies in Solid Tumors, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.
- Faculty of Medicine, University of Barcelona, Barcelona, Spain.
| | - Maria Valeria De Bonis
- Department for Sustainable Food Process, Università Cattolica del Sacro Cuore, Piacenza, Italy
| | - Carla Strina
- Department of Medicine, Surgery and Health Sciences, Cattinara Hospital, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy
| | - Manuela Milani
- Department of Medicine, Surgery and Health Sciences, Cattinara Hospital, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy
| | - Nicoletta Ziglioli
- Department of Medicine, Surgery and Health Sciences, Cattinara Hospital, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy
| | - Sergio Aguggini
- Department of Medicine, Surgery and Health Sciences, Cattinara Hospital, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy
| | - Ignazio Ciliberto
- Department of Medicine, Surgery and Health Sciences, Cattinara Hospital, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy
| | - Carlo Azzini
- Department of Medicine, Surgery and Health Sciences, Cattinara Hospital, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy
| | - Giuseppina Barbieri
- Department of Medicine, Surgery and Health Sciences, Cattinara Hospital, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy
| | - Valeria Cervoni
- Department of Medicine, Surgery and Health Sciences, Cattinara Hospital, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy
| | - Maria Rosa Cappelletti
- Department of Medicine, Surgery and Health Sciences, Cattinara Hospital, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy
| | | | - Marco Ungari
- UO Anatomia Patologica ASST di Cremona, Cremona, Italy
| | - Mariavittoria Locci
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Ida Paris
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giovanni Scambia
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gianpaolo Ruocco
- Modeling and Prototyping Laboratory, College of Engineering, University of Basilicata, Potenza, Italy
| | - Daniele Generali
- Department of Medicine, Surgery and Health Sciences, Cattinara Hospital, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy.
- Multidisciplinary Unit of Breast Pathology and Translational Research, Cremona Hospital, Cremona, Italy.
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Fiorino E, Giudici F, Aguggini S, Strina C, Milani M, Ziglioli N, Dester M, Barbieri G, Alberio M, Azzini C, Ferrero G, Ungari M, Dreezen C, Pronin D, Generali D. P157 MammaPrint 8-year follow up results in patients with early breast cancer from a single-center Italian cohort study. Breast 2023. [DOI: 10.1016/s0960-9776(23)00274-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
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Schettini F, Corona SP, Giudici F, Strina C, Sirico M, Bernocchi O, Milani M, Ziglioli N, Aguggini S, Azzini C, Barbieri G, Cervoni V, Cappelletti MR, Molteni A, Lazzari MC, Ferrero G, Ungari M, Marasco E, Bruson A, Xumerle L, Zago E, Cerra D, Loddo M, Williams GH, Paris I, Scambia G, Generali D. Clinical, Radiometabolic and Immunologic Effects of Olaparib in Locally Advanced Triple Negative Breast Cancer: The OLTRE Window of Opportunity Trial. Front Oncol 2021; 11:686776. [PMID: 34262869 PMCID: PMC8273330 DOI: 10.3389/fonc.2021.686776] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 06/11/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Olaparib is effective in metastatic triple negative breast cancer (TNBC) carrying germline mutations in DNA damage repair (DDR) genes BRCA1/2 (gBRCA-mut). The OLTRE window-of-opportunity trial preliminarily investigated potential pathologic, radiometabolic and immune biomarkers of early-response to olaparib in gBRCA-wild-type (wt) TNBC and, as proof-of-concept in gBRCA-mut HER2-negative BC. METHODS Patients received olaparib for 3 weeks (3w) before standard neoadjuvant chemotherapy and underwent multiple FDG18-PET/CT scan (basal, after olaparib), clinical assessments (basal, every 3w), tumor biopsies and blood samplings (baseline, after olaparib). Clinical and radiometabolic responses were evaluated according to RECIST1.1 and PERCIST criteria. RESULTS 27 patients with gBRCA-wt TNBC and 8 with gBRCA-mut BC (6 TNBC, 2 HR+/HER2-negative) were enrolled. Three (11.1%) patients showed mutations in non-BRCA1/2 DDR genes and 4 (14.8%) in other genes. 3w olaparib induced 16/35 and 15/27 partial clinical and radiometabolic responses, including in 40.7% and 50.0% gBRCA-wt patients. gBRCA-mut tumors presented numerically higher tumor-infiltrating lymphocytes (TILs) levels and PD-L1 positive tumors. Clinical responders experienced a reduction in T-regs/T-eff ratio (p=0.05), B and NK lymphocytes (p=0.003 both), with an average increase in T-helpers rate (p<0.001) and CD4/CD8 ratio (p=0.02). Ki67% and TILs did not vary significantly (p=0.67 and p=0.77). A numerical increase in PD-L1 positive cases after olaparib was observed, though non-significant (p=0.134). No differences were observed according to gBRCA status and type of response. CONCLUSIONS Early-stage TNBC might be a target population for olaparib, irrespective of gBRCA mutations. Future trials should combine TILs, PD-L1 and gBRCA status to better identify candidates for escalated/de-escalated treatment strategies including olaparib.
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Affiliation(s)
- Francesco Schettini
- Translational genomics and targeted therapies in solid tumors, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Silvia Paola Corona
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Cattinara Hospital, Trieste, Italy
- Multidisciplinary Unit of Breast Pathology and Translational Research, Cremona Hospital, Cremona, Italy
| | - Fabiola Giudici
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Cattinara Hospital, Trieste, Italy
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Carla Strina
- Multidisciplinary Unit of Breast Pathology and Translational Research, Cremona Hospital, Cremona, Italy
| | - Marianna Sirico
- Multidisciplinary Unit of Breast Pathology and Translational Research, Cremona Hospital, Cremona, Italy
| | - Ottavia Bernocchi
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Cattinara Hospital, Trieste, Italy
- Multidisciplinary Unit of Breast Pathology and Translational Research, Cremona Hospital, Cremona, Italy
| | - Manuela Milani
- Multidisciplinary Unit of Breast Pathology and Translational Research, Cremona Hospital, Cremona, Italy
| | - Nicoletta Ziglioli
- Multidisciplinary Unit of Breast Pathology and Translational Research, Cremona Hospital, Cremona, Italy
| | - Sergio Aguggini
- Multidisciplinary Unit of Breast Pathology and Translational Research, Cremona Hospital, Cremona, Italy
| | - Carlo Azzini
- Multidisciplinary Unit of Breast Pathology and Translational Research, Cremona Hospital, Cremona, Italy
| | - Giuseppina Barbieri
- Multidisciplinary Unit of Breast Pathology and Translational Research, Cremona Hospital, Cremona, Italy
| | - Valeria Cervoni
- Multidisciplinary Unit of Breast Pathology and Translational Research, Cremona Hospital, Cremona, Italy
| | - Maria Rosa Cappelletti
- Multidisciplinary Unit of Breast Pathology and Translational Research, Cremona Hospital, Cremona, Italy
| | - Alfredo Molteni
- Unitá Operativa Ematologia e CTMO, Azienda Socio-Sanitaria Territoriale di Cremona, Cremona, Italy
| | - Maria Chiara Lazzari
- Unitá Operativa Ematologia e CTMO, Azienda Socio-Sanitaria Territoriale di Cremona, Cremona, Italy
| | | | - Marco Ungari
- UO Anatomia Patologica ASST di Cremona, Cremona, Italy
| | | | | | | | | | | | - Marco Loddo
- Oncologica UK Ltd, Cambridge, United Kingdom
| | | | - Ida Paris
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Roma, Italy
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Giovanni Scambia
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Roma, Italy
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Daniele Generali
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Cattinara Hospital, Trieste, Italy
- Multidisciplinary Unit of Breast Pathology and Translational Research, Cremona Hospital, Cremona, Italy
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Sirico M, Bernocchi O, Sobhani N, Giudici F, Corona SP, Vernieri C, Nichetti F, Cappelletti MR, Milani M, Strina C, Cervoni V, Barbieri G, Ziglioli N, Dester M, Bianchi GV, De Braud F, Generali D. Early Changes of the Standardized Uptake Values (SUV max) Predict the Efficacy of Everolimus-Exemestane in Patients with Hormone Receptor-Positive Metastatic Breast Cancer. Cancers (Basel) 2020; 12:cancers12113314. [PMID: 33182575 PMCID: PMC7697290 DOI: 10.3390/cancers12113314] [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: 09/23/2020] [Revised: 11/05/2020] [Accepted: 11/07/2020] [Indexed: 12/17/2022] Open
Abstract
Background: The mTORC1 inhibitor everolimus has been approved in combination with the aromatase inhibitor exemestane for the treatment of hormone receptor-positive (HR+) human epidermal growth factor receptor 2-negative (HER2-) metastatic breast cancer (HR+ mBC) progressing on prior therapy with a non-steroidal aromatase inhibitor. To date, no predictive biomarkers of tumor sensitivity/resistance for everolimus-based treatments have been identified. We hypothesized that precocious changes in the Standardized Uptake Volume (∆SUV%), as assessed by 18F-Fluorodeoxyglucosepositron-emission tomography (18F-FDG PET/CT), may be a marker of everolimus efficacy. Methods: This was a retrospective study including 31 HR+ HER2- patients treated with everolimus and exemestane in two Italian centers between 2013 and 2018. The objective of the study was to investigate ∆SUV% as a predictive marker of everolimus antitumor efficacy. 18F-FDG PET/CT scans were performed at baseline and after three months of treatment. Patients were defined as long responders (LRs) if disease progression occurred at least 10 months after treatment initiation and long survivors (LSs) if death occurred later than 36 months after starting therapy. ROC analysis was used to determine the optimal cut-off values of ∆SUV% to distinguish LRs from non-LRs and LSs from non-LSs. Progression-free survival (PFS) and overall survival (OS) were estimated by Kaplan-Meier method. Results: The SUVmax values decreased significantly from baseline to 3 months after therapy (p = 0.003). Dynamic changes of SUVmax (Delta SUV) had a higher accuracy in discriminating long-responders from non-long-responders (AUC = 0.67, Delta SUV cut-off = 28.8%) respects to its ability to identify long survivors from no-long survivors (AUC = 0.60, Delta SUV cut-off = 53.8%). Patients were divided into groups according to the Delta SUV cut-offs and survival outcomes were evaluated: patients with a decrease of ∆SUV% ≥ 28.8% had significantly better PFS (10 months-PFS: 63.2%, 95% CI: 37.9-80.4% and 16.7%, 95% CI: 2.7-41.3% respectively, p = 0.005). As regard as OS, patients with ∆SUV% ≥ 53.8% had longer OS when compared to patients with ∆SUV% < 53.8% (36 month-OS: 82.5% vs. 45.9% vs. p = 0.048). Conclusion: We found two precocious ∆SUV% thresholds capable of identifying HR+ HER2-mBC patients, which would achieve long-term benefit or long-term survival during everolimus-exemestane therapy. These results warrant further validation in prospective studies and should be integrated with molecular biomarkers related to tumor metabolism and mTORC1 signaling.
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Affiliation(s)
- Marianna Sirico
- Department of Surgery and Cancer, Imperial College London, London W12 0NN, UK; (S.P.C.); (M.R.C.); (M.M.); (C.S.); (V.C.); (G.B.); (N.Z.); (M.D.); (D.G.)
- Azienda Socio-Sanitaria Territoriale Cremona, 26100 Cremona, Italy
- Correspondence: (M.S.); (N.S.)
| | - Ottavia Bernocchi
- Department of Medical, Surgery and Health Sciences, University of Trieste, 34147 Trieste, Italy; (O.B.); (F.G.)
| | - Navid Sobhani
- Section of Epidemiology and Population Science, Department of Medicine, Baylor College of Medicine, Baylor Plaza, Houston, TX 77030, USA
- Correspondence: (M.S.); (N.S.)
| | - Fabiola Giudici
- Department of Medical, Surgery and Health Sciences, University of Trieste, 34147 Trieste, Italy; (O.B.); (F.G.)
| | - Silvia P. Corona
- Department of Surgery and Cancer, Imperial College London, London W12 0NN, UK; (S.P.C.); (M.R.C.); (M.M.); (C.S.); (V.C.); (G.B.); (N.Z.); (M.D.); (D.G.)
- Azienda Socio-Sanitaria Territoriale Cremona, 26100 Cremona, Italy
- Department of Medical, Surgery and Health Sciences, University of Trieste, 34147 Trieste, Italy; (O.B.); (F.G.)
| | - Claudio Vernieri
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (C.V.); (F.N.); (G.V.B.); (F.D.B.)
- Fondazione Istituto FIRC di Oncologia Molecolare (IFOM), 20129 Milan, Italy
| | - Federico Nichetti
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (C.V.); (F.N.); (G.V.B.); (F.D.B.)
| | - Maria Rosa Cappelletti
- Department of Surgery and Cancer, Imperial College London, London W12 0NN, UK; (S.P.C.); (M.R.C.); (M.M.); (C.S.); (V.C.); (G.B.); (N.Z.); (M.D.); (D.G.)
- Azienda Socio-Sanitaria Territoriale Cremona, 26100 Cremona, Italy
| | - Manuela Milani
- Department of Surgery and Cancer, Imperial College London, London W12 0NN, UK; (S.P.C.); (M.R.C.); (M.M.); (C.S.); (V.C.); (G.B.); (N.Z.); (M.D.); (D.G.)
- Azienda Socio-Sanitaria Territoriale Cremona, 26100 Cremona, Italy
| | - Carla Strina
- Department of Surgery and Cancer, Imperial College London, London W12 0NN, UK; (S.P.C.); (M.R.C.); (M.M.); (C.S.); (V.C.); (G.B.); (N.Z.); (M.D.); (D.G.)
- Azienda Socio-Sanitaria Territoriale Cremona, 26100 Cremona, Italy
| | - Valeria Cervoni
- Department of Surgery and Cancer, Imperial College London, London W12 0NN, UK; (S.P.C.); (M.R.C.); (M.M.); (C.S.); (V.C.); (G.B.); (N.Z.); (M.D.); (D.G.)
- Azienda Socio-Sanitaria Territoriale Cremona, 26100 Cremona, Italy
| | - Giuseppina Barbieri
- Department of Surgery and Cancer, Imperial College London, London W12 0NN, UK; (S.P.C.); (M.R.C.); (M.M.); (C.S.); (V.C.); (G.B.); (N.Z.); (M.D.); (D.G.)
- Azienda Socio-Sanitaria Territoriale Cremona, 26100 Cremona, Italy
| | - Nicoletta Ziglioli
- Department of Surgery and Cancer, Imperial College London, London W12 0NN, UK; (S.P.C.); (M.R.C.); (M.M.); (C.S.); (V.C.); (G.B.); (N.Z.); (M.D.); (D.G.)
- Azienda Socio-Sanitaria Territoriale Cremona, 26100 Cremona, Italy
| | - Martina Dester
- Department of Surgery and Cancer, Imperial College London, London W12 0NN, UK; (S.P.C.); (M.R.C.); (M.M.); (C.S.); (V.C.); (G.B.); (N.Z.); (M.D.); (D.G.)
- Azienda Socio-Sanitaria Territoriale Cremona, 26100 Cremona, Italy
| | - Giulia Valeria Bianchi
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (C.V.); (F.N.); (G.V.B.); (F.D.B.)
| | - Filippo De Braud
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (C.V.); (F.N.); (G.V.B.); (F.D.B.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Daniele Generali
- Department of Surgery and Cancer, Imperial College London, London W12 0NN, UK; (S.P.C.); (M.R.C.); (M.M.); (C.S.); (V.C.); (G.B.); (N.Z.); (M.D.); (D.G.)
- Azienda Socio-Sanitaria Territoriale Cremona, 26100 Cremona, Italy
- Department of Medical, Surgery and Health Sciences, University of Trieste, 34147 Trieste, Italy; (O.B.); (F.G.)
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Corona SP, Giudici F, Jerusalem G, Ciruelos E, Strina C, Sirico M, Bernocchi O, Milani M, Dester M, Ziglioli N, Barbieri G, Cervoni V, Montemurro F, Generali D. Impact of BMI on the outcome of metastatic breast cancer patients treated with everolimus: a retrospective exploratory analysis of the BALLET study. Oncotarget 2020; 11:2172-2181. [PMID: 32577163 PMCID: PMC7289535 DOI: 10.18632/oncotarget.27612] [Citation(s) in RCA: 2] [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: 01/08/2020] [Accepted: 05/01/2020] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Reliable biomarkers of response to mTOR inhibition are yet to be identified. As mTOR is heavily implicated in cell-metabolism, we investigated the relation between BMI variation and outcomes in metastatic breast cancer (mBC) patients treated with everolimus. RESULTS we found a linear correlation between everolimus exposure duration and BMI/weight decrease. Patients exhibiting >2 kg weight loss or >3% BMI decrease from baseline at the end of treatment (EOT) had a statistically significant improvement in PFS. Interestingly, a similar BMI/weight decrease within the first 8 weeks of therapy identified patients at higher risk of progression. PATIENTS AND METHODS we performed a retrospective analysis of patients enrolled in the BALLET trial who progressed during the study. Primary end-point was progression-free survival (PFS). Secondary end-point was the identification of other predictors of response. CONCLUSION A >3% weight loss at EOT is associated with better outcome in mBC patients treated with everolimus. On the contrary, a significant early weight loss represents a predictor of poor survival and could therefore be used as an early negative prognostic marker. As PI3K-inhibition also converges onto mTOR, these findings might extend to patients treated with selective PI3K inhibitors and warrant further investigation.
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Affiliation(s)
- Silvia P Corona
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Cattinara Hospital, Trieste, Italy
| | - Fabiola Giudici
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Cattinara Hospital, Trieste, Italy.,Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Guy Jerusalem
- CHU Sart Tilman Liège and Liège University, Liège, Belgium
| | - Eva Ciruelos
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Carla Strina
- Multidisciplinary Unit of Breast Pathology and Translational Research, Cremona Hospital, Cremona, Italy
| | | | - Ottavia Bernocchi
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Cattinara Hospital, Trieste, Italy
| | - Manuela Milani
- Multidisciplinary Unit of Breast Pathology and Translational Research, Cremona Hospital, Cremona, Italy
| | - Martina Dester
- Multidisciplinary Unit of Breast Pathology and Translational Research, Cremona Hospital, Cremona, Italy
| | - Nicoletta Ziglioli
- Multidisciplinary Unit of Breast Pathology and Translational Research, Cremona Hospital, Cremona, Italy
| | - Giuseppina Barbieri
- Multidisciplinary Unit of Breast Pathology and Translational Research, Cremona Hospital, Cremona, Italy
| | - Valeria Cervoni
- Multidisciplinary Unit of Breast Pathology and Translational Research, Cremona Hospital, Cremona, Italy
| | - Filippo Montemurro
- Multidisciplinary Outpatient Oncology Clinic, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | - Daniele Generali
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Cattinara Hospital, Trieste, Italy.,Multidisciplinary Unit of Breast Pathology and Translational Research, Cremona Hospital, Cremona, Italy
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