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Celio L, Cortinovis D, Cogoni AA, Cavanna L, Martelli O, Carnio S, Collovà E, Bertolini F, Petrelli F, Cassano A, Chiari R, Zanelli F, Pisconti S, Vittimberga I, Letizia A, Misino A, Gernone A, Bonizzoni E, Pilotto S, De Placido S, Bria E. Exploratory analysis of the effect of a dexamethasone-sparing regimen for prophylaxis of cisplatin-induced emesis on food intake (LUNG-NEPA study). Sci Rep 2023; 13:1257. [PMID: 36690734 PMCID: PMC9870907 DOI: 10.1038/s41598-023-28464-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/18/2023] [Indexed: 01/24/2023] Open
Abstract
We demonstrated the non-inferiority of a dexamethasone (DEX)-sparing (single-dose) regimen with NEPA, a netupitant/palonosetron fixed combination, for preventing chemotherapy-induced nausea and vomiting (CINV) caused by cisplatin. This pre-planned exploratory analysis assessed the effect of the DEX-sparing regimen on a patient's food intake. Chemotherapy-naïve patients undergoing cisplatin (≥ 70 mg/m2) were given NEPA and DEX (12 mg) on day 1 and randomized to receive either no further DEX (DEX1), or oral DEX (4 mg BID) on days 2-4 (DEX4). Patient-reported endpoint maintenance of usual daily food intake was assessed during the 5-days post-chemotherapy. The relationship between usual daily food intake and CINV control, pre-chemotherapy self-rated food intake and BMI-adjusted weight loss (WL) were evaluated. One-hundred fifty-two patients (76/group) were assessable. The proportion of patients reporting maintenance of usual daily food intake was similar in both groups: 69.7% (95% CI, 58.6-78.9) for DEX1 vs. 72.4% (95% CI, 61.4-81.2) for DEX4. Only CINV control was significantly associated with maintenance of usual daily food intake (P ≤ 0.001) during the overall phase. The DEX-sparing regimen does not adversely affect patient-reported daily food intake post-chemotherapy. The current analysis adds further insights into antiemetic efficacy of DEX sparing beyond day 1 in the challenging setting of cisplatin.Trial registration: The parent study was registered on ClinicalTrials.gov (NCT04201769).
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Affiliation(s)
- Luigi Celio
- Medical Oncology Unit, ASST del Garda, Località Montecroce 1, 25015, Desenzano del Garda, BS, Italy.
| | - Diego Cortinovis
- Medical Oncology Department, ASST Monza San Gerardo Hospital, Monza, Italy
| | - Alessio Aligi Cogoni
- Medical Oncology Department, Azienda Ospedaliero-Universitaria di Sassari, Sassari, Italy
| | - Luigi Cavanna
- Oncology Department, Azienda Ospedaliera di Piacenza, Piacenza, Italy
| | | | - Simona Carnio
- Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Elena Collovà
- Cancer Centre Department - Oncology Unit, ASST Ovest Milanese - Legnano Hospital, Legnano, Milan, Italy
| | - Federica Bertolini
- Department of Oncology and Hematology, AOU Policlinico di Modena, Modena, Italy
| | - Fausto Petrelli
- Medical Oncology Unit, ASST Bergamo Ovest, Treviglio, Bergamo, Italy
| | - Alessandra Cassano
- Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
- Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rita Chiari
- Oncology Unit, AULSS6 Euganea, Padova, Italy
| | - Francesca Zanelli
- Medical Oncology Unit, IRCCS Santa Maria Nuova, Reggio Emilia, Italy
| | - Salvatore Pisconti
- Medical Oncology Department, San Giuseppe Moscati Hospital, Statte, Taranto, Italy
| | | | - Antonietta Letizia
- Department of Pneumology and Oncology, AORN dei Colli-Ospedale Monaldi, Naples, Italy
| | - Andrea Misino
- Medical Oncology, Clinical Cancer Center, "Giovanni Paolo II" - IRCCS, Bari, Italy
| | - Angela Gernone
- Medical Oncology Unit, University of Bari, Policlinico di Bari, Bari, Italy
| | - Erminio Bonizzoni
- Department of Clinical Science and Community, Section of Medical Statistics, Biometry and Epidemiology "G.A. Maccacaro", Faculty of Medicine and Surgery, University of Milan, Milan, Italy
| | - Sara Pilotto
- Section of Oncology, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy
| | - Sabino De Placido
- Clinical Medicine and Surgery Department, University of Naples "Federico II", Naples, Italy
| | - Emilio Bria
- Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
- Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy
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Celio L, Cortinovis D, Cogoni AA, Cavanna L, Martelli O, Carnio S, Collovà E, Bertolini F, Petrelli F, Cassano A, Chiari R, Zanelli F, Pisconti S, Vittimberga I, Letizia A, Misino A, Gernone A, Bonizzoni E, Pilotto S, De Placido S, Bria E. Evaluating the impact of chemotherapy-induced nausea and vomiting on daily functioning in patients receiving dexamethasone-sparing antiemetic regimens with NEPA (netupitant/palonosetron) in the cisplatin setting: results from a randomized phase 3 study. BMC Cancer 2022; 22:915. [PMID: 35999527 PMCID: PMC9400287 DOI: 10.1186/s12885-022-10018-3] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 08/18/2022] [Indexed: 11/11/2022] Open
Abstract
Background The non-inferiority of dexamethasone (DEX) on day 1, with or without low-dose DEX on days 2 and 3, combined with oral NEPA (netupitant/palonosetron), compared with the guideline-consistent use of DEX was demonstrated in cisplatin. Here, we complete the analysis by assessing the impact of emesis on daily lives of patients receiving DEX-sparing regimens using the Functional Living Index-Emesis (FLIE). Methods Chemotherapy-naïve patients undergoing cisplatin (≥70 mg/m2), were given NEPA and DEX (12 mg) on day 1 and randomized to receive either 1) no further DEX (DEX1), 2) oral DEX (4 mg daily) on days 2–3 (DEX3), or 3) DEX (4 mg twice daily) on days 2–4 (DEX4; control). Patients completed the FLIE questionnaire on day 6 of cycle 1. Endpoints included the FLIE nausea domain, vomiting domain, and overall combined domain scores, as well as the proportion of patients with no impact on daily life (NIDL; overall score > 108). This was a protocol-planned analysis. Results In the DEX1 group, no significant differences were observed in the FLIE nausea score (48.9 [±1.8; SE] vs. 53.7 [±1.5]), vomiting score (56.6 [±1.4] vs. 58.7 [±0.8]) and overall score (105.6 [±2.8] vs.112.4 [±1.9]) versus DEX4 control; similar results were observed in the DEX3 group for nausea score (49.6 [±1.7]), vomiting score (58.2 [±1]) and overall score (107.8 [±2.4]) versus control. There were no significant between-group differences in the proportion of patients reporting NIDL. Conclusion Reducing DEX, when administered with NEPA, does not seem to adversely impact the daily functioning in patients undergoing cisplatin. Trial registration ClinicalTrials.govNCT04201769. Registration date: 17/12/2019 - Retrospectively registered.
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Affiliation(s)
- Luigi Celio
- Medical Oncology Unit, ASST del Garda, Desenzano del Garda Hospital, Località Montecroce 1, 25015, Desenzano del Garda, BS, Italy.
| | - Diego Cortinovis
- Medical Oncology Department, ASST Monza San Gerardo Hospital, Monza, Italy
| | - Alessio Aligi Cogoni
- Medical Oncology Department, Azienda Ospedaliero-Universitaria di Sassari, Sassari, Italy
| | - Luigi Cavanna
- Oncology Department, Azienda Ospedaliera di Piacenza, Piacenza, Italy
| | | | - Simona Carnio
- Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Elena Collovà
- Cancer Centre Department - Oncology Unit, ASST Ovest Milanese - Legnano Hospital, Legnano, Milan, Italy
| | - Federica Bertolini
- Department of Oncology and Hematology, AOU Policlinico di Modena, Modena, Italy
| | - Fausto Petrelli
- Medical Oncology Unit, ASST Bergamo Ovest, Treviglio, Bergamo, Italy
| | - Alessandra Cassano
- Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy.,Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rita Chiari
- Oncology Unit, AULSS6 Euganea, Padova, Italy
| | - Francesca Zanelli
- Medical Oncology Unit, IRCCS Santa Maria Nuova, Reggio Emilia, Italy
| | - Salvatore Pisconti
- Medical Oncology Department, San Giuseppe Moscati Hospital, Statte, Taranto, Italy
| | | | - Antonietta Letizia
- Department of Pneumology and Oncology, AORN dei Colli-Ospedale Monaldi, Naples, Italy
| | - Andrea Misino
- Medical Oncology, Clinical Cancer Center "Giovanni Paolo II" - IRCCS, Bari, Italy
| | - Angela Gernone
- Medical Oncology Unit, University of Bari, Policlinico di Bari, Bari, Italy
| | - Erminio Bonizzoni
- Department of Clinical Science and Community, Section of Medical Statistics, Biometry and Epidemiology "G.A. Maccacaro", Faculty of Medicine and Surgery, University of Milan, Milan, Italy
| | - Sara Pilotto
- Section of Oncology, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy
| | - Sabino De Placido
- Clinical Medicine and Surgery Department, University of Naples "Federico II", Naples, Italy
| | - Emilio Bria
- Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy.,Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy
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Minuti G, Stefani A, Carpano S, D'Argento E, Giusti R, Martelli O, Metro G, Gelibter AJ, Antonini Cappellini GC, Carta A, Fadda GM, Nelli F, Ricciardi S, Russano M, Bria E, Cappuzzo F. [Management of small cell lung cancer patient in the regions of Lazio, Umbria and Sardinia.]. Recenti Prog Med 2021; 112:639-646. [PMID: 34647533 DOI: 10.1701/3679.36653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Small cell lung cancer (SCLC) is an aggressive disease, difficult to treat. There have been no significant therapeutic advances over platinum and etoposide chemotherapy in the last 20 years until the introduction of immunotherapy. In 2020 atezolizumab, an immune checkpoint inhibitor against PD-L1 was approved in Italy in combination with carboplatin and etoposide for the first-line treatment of patients with extensive stage disease (ES-SCLC), becoming the new standard treatment. On May 20, 2021, a virtual meeting, directed by profs. Federico Cappuzzo and Emilio Bria, was held in which 14 clinicians from different oncology centers in Lazio, Umbria and Sardinia discussed the issues of ES-SCLC patients treatment, after the advent of immunotherapy. The aim of the meeting was to share their clinical experience and to provide a series of practical indications that can support clinicians in the management of ES-SCLC patients in first-line with chemo-immunotherapy.
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Affiliation(s)
- Gabriele Minuti
- Unità di Oncologia Medica 2, Istituto Nazionale Tumori Regina Elena, Roma
| | - Alessio Stefani
- Comprehensive Cancer Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Roma; Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Roma
| | - Silvia Carpano
- Unità di Oncologia Medica 2, Istituto Nazionale Tumori Regina Elena, Roma
| | - Ettore D'Argento
- Comprehensive Cancer Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Roma; Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Roma
| | | | | | - Giulio Metro
- Dipartimento di Oncologia Medica, Ospedale Santa Maria Della Misericordia, AO Perugia
| | - Alain J Gelibter
- UOC Oncologia Medica "B", Policlinico Umberto I, Sapienza Università di Roma
| | | | - Annamaria Carta
- SC Oncologia Medica, Ospedale Businco - ARNAS G. Brotzu, Cagliari
| | | | | | | | - Marco Russano
- UOC Oncologia Medica, Policlinico Universitario Campus Bio-Medico, Roma
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Celio L, Cortinovis D, Cogoni AA, Cavanna L, Martelli O, Carnio S, Collovà E, Bertolini F, Petrelli F, Cassano A, Chiari R, Zanelli F, Pisconti S, Vittimberga I, Letizia A, Misino A, Gernone A, Bonizzoni E, Pilotto S, De Placido S, Bria E. Dexamethasone-Sparing Regimens with Oral Netupitant and Palonosetron for the Prevention of Emesis Caused by High-Dose Cisplatin: A Randomized Noninferiority Study. Oncologist 2021; 26:e1854-e1861. [PMID: 34101934 PMCID: PMC8488764 DOI: 10.1002/onco.13851] [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: 02/25/2021] [Accepted: 05/25/2021] [Indexed: 11/19/2022] Open
Abstract
Background To reduce the overall exposure to dexamethasone (DEX) in patients receiving cisplatin‐based chemotherapy, we evaluated the noninferiority of DEX on day 1, with or without low‐dose DEX on days 2 and 3, combined with an oral fixed‐dose combination of netupitant and palonosetron (NEPA), compared with the guideline‐consistent use of 4‐day DEX. Patients and Methods In this open‐label, multicenter study, chemotherapy‐naïve patients undergoing high‐dose cisplatin (≥70 mg/m2), were given NEPA and DEX (12 mg) on day 1 and randomized (1:1:1 ratio) to receive either (a) no further DEX (DEX1), (b) oral DEX (4 mg daily) on days 2–3 (DEX3), or (c) DEX (4 mg twice daily) on days 2–4 (DEX4). The primary efficacy endpoint was complete response (CR: no emesis and no rescue medication) during the 5‐day overall phase. The noninferiority margin was set at −15% difference (DEX1 or DEX3 minus DEX4). Secondary efficacy endpoints included complete protection (CP: CR and none or mild nausea). Results Two‐hundred twenty‐eight patients, 76 in each arm, were assessable. Noninferiority was met for both DEX‐sparing regimens and the reference arm, with overall phase CR rates of 76.3% in each of the DEX1 and DEX3 arms and 75.0% in the DEX4 arm (95% confidence interval, −12.3% to 15% for each comparison). During the overall phase, CP rates were similar between groups. Conclusion A simplified regimen of NEPA plus single‐dose DEX offers comparable chemotherapy‐induced nausea and vomiting prevention throughout 5 days post‐chemotherapy with the advantage of sparing patients additional doses of DEX in the high–emetic‐risk setting of cisplatin‐based chemotherapy. Implications for Practice Dexamethasone (DEX) has traditionally played an integral role in the management of chemotherapy‐induced emesis. Although generally considered safe, even short‐term DEX use is associated with various side effects, and some evidence suggests that concurrent steroids may reduce the efficacy of immunotherapies. This study demonstrates comparable antiemetic control during the 5 days post‐chemotherapy with a simplified regimen of netupitant/palonosetron plus single‐dose DEX versus the standard 4‐day DEX reference treatment in high‐dose cisplatin. This represents a clinically relevant achievement as it not only simplifies antiemetic prophylaxis but also offers an opportunity to appropriately use in patients where caution with corticosteroid use is advised. This study was designed to test whether two different dexamethasone‐sparing regimens, when administered with NEPA, might provide the opportunity to reduce the total corticosteroid dose while maintaining the same degree of chemotherapy‐induced nausea and vomiting control in patients undergoing cisplatin‐based chemotherapy.
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Affiliation(s)
- Luigi Celio
- Oncology Unit, Azienda Socio Sanitaria Territoriale del Garda, Desenzano del Garda Hospital, Brescia, Italy
| | - Diego Cortinovis
- Medical Oncology Department, Azienda Socio Sanitaria Territoriale Monza San Gerardo Hospital, Monza, Italy
| | - Alessio Aligi Cogoni
- Medical Oncology Department, Azienda Ospedaliero-Universitaria di Sassari, Sassari, Italy
| | - Luigi Cavanna
- Oncology Department, Azienda Ospedaliera di Piacenza, Piacenza, Italy
| | - Olga Martelli
- Medical Oncology, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Simona Carnio
- Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Elena Collovà
- Cancer Centre Department, Oncology Unit, Azienda Socio Sanitaria Territoriale Ovest Milanese, Legnano Hospital, Legnano, Milan, Italy
| | - Federica Bertolini
- Department of Oncology and Hematology, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Fausto Petrelli
- Medical Oncology Unit, Azienda Socio Sanitaria Territoriale Bergamo Ovest, Treviglio, Bergamo, Italy
| | - Alessandra Cassano
- Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy.,Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Rita Chiari
- Oncology Unit, AULSS6 Euganea, Padova, Italy
| | - Francesca Zanelli
- Medical Oncology Unit, Istituto di Ricovero e Cura a Carattere Scientifico Santa Maria Nuova, Reggio Emilia, Italy
| | - Salvatore Pisconti
- Medical Oncology Department, San Giuseppe Moscati Hospital, Statte, Taranto, Italy
| | - Isabella Vittimberga
- Department of Oncology, Azienda Socio Sanitaria Territoriale Lecco, Lecco, Italy
| | - Antonietta Letizia
- Department of Pneumology and Oncology, Azienda Ospedaliera di Rilievo Nazionale dei Colli-Ospedale Monaldi, Naples, Italy
| | - Andrea Misino
- Medical Oncology, Clinical Cancer Center "Giovanni Paolo II," Istituto di Ricovero e Cura a Carattere Scientifico, Bari, Italy
| | - Angela Gernone
- Medical Oncology Unit, University of Bari, Policlinico di Bari, Bari, Italy
| | - Erminio Bonizzoni
- Department of Clinical Science and Community. Section of Medical Statistics, Biometry and Epidemiology "G.A. Maccacaro," Faculty of Medicine and Surgery, University of Milan, Milan, Italy
| | - Sara Pilotto
- Section of Oncology, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy
| | - Sabino De Placido
- Clinical Medicine and Surgery Department, University of Naples "Federico II," Naples, Italy
| | - Emilio Bria
- Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy.,Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
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Nelli F, Fabbri MA, Moscetti L, Sperduti I, Gamucci T, Mansueto G, Signorelli C, Cortesi E, Martelli O, Natoli C, Angelini F, Ruggeri EM. Long-term outcome of pemetrexed maintenance for advanced nonsquamous non-small-cell lung cancer: a real-world observational cohort study. Recenti Prog Med 2020; 111:761-768. [PMID: 33362173 DOI: 10.1701/3509.34967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Pemetrexed maintenance significantly improved progression-free survival (PFS) and overall survival (OS) in advanced nonsquamous non-small-cell lung cancer (NSCLC) patients not progressing after induction chemotherapy. OBJECTIVES This study is aimed at examine the association of various clinical factor and survival in a real-world cohort analysis. MATERIALS AND METHODS One hundred ninety-four patients were included and classified as "PM" cohort ("Pemetrexed Maintenance", including patients given with pemetrexed maintenance after induction chemotherapy, n=112), and "noPM" cohort ("no Pemetrexed Maintenance" including those discontinuing pemetrexed, n=82). RESULTS The median PFS was 8.8 and 5.4 months in the PM and noPM cohorts, respectively (p=0.001). The median OS was 19.6 months in the "PM" cohort and 13.2 months in the "noPM" cohort (p<0.02). In the multivariate analysis, ECOG Performance Status (PS) 0 and maintenance therapy were independently associated with improved PFS and OS. A longer median PFS was reported in patients given ≥5 cycles of pemetrexed maintenance (p<0.01). DISCUSSION These results further confirm the survival benefit of pemetrexed maintenance in a real-word population. All eligible advanced NSCLC patients should be strongly considered for at least 5 of pemetrexed maintenance.
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Affiliation(s)
- Fabrizio Nelli
- Department of Medical Oncology, Central Hospital of Belcolle, Viterbo, Italy - Outcome Research Network for Evaluation of Treatment Results in Oncology
| | - Maria Agnese Fabbri
- Department of Medical Oncology, Central Hospital of Belcolle, Viterbo, Italy
| | - Luca Moscetti
- Department of Medical Oncology, Central Hospital of Belcolle, Viterbo, Italy
| | | | - Teresa Gamucci
- Department of Medical Oncology, SS. Trinità Hospital of Sora, Frosinone, Italy
| | - Giovanni Mansueto
- Department of Medical Oncology, SS. Trinità Hospital of Sora, Frosinone, Italy
| | - Carlo Signorelli
- Department of Medical Oncology, Central Hospital of Belcolle, Viterbo, Italy
| | - Enrico Cortesi
- Department of Medical Oncology B, Sapienza University of Rome, Italy
| | - Olga Martelli
- Department of Medical Oncology, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Clara Natoli
- Department of Medical Oncology, University of Chieti, Italy
| | - Francesco Angelini
- Department of Medical Oncology, Regina Apostolorum Hospital, Albano (Rome), Italy
| | - Enzo Maria Ruggeri
- Department of Medical Oncology, Central Hospital of Belcolle, Viterbo, Italy
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6
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Filippi L, Nervi C, Proietti I, Pirisino R, Potenza C, Martelli O, Equitani F, Bagni O. Molecular imaging in immuno-oncology: current status and translational perspectives. Expert Rev Mol Diagn 2020; 20:1199-1211. [PMID: 33215963 DOI: 10.1080/14737159.2020.1854090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Introduction: Only 20-40% of patients respond to therapy with immune checkpoint inhibitors (ICIs). Therefore, the early identification of subjects that can benefit from such therapeutic regimen is mandatory. Areas covered: The immunobiological mechanisms of ICIs are briefly illustrated. Furthermore, the limitations of traditional radiological approaches are covered. Then, the pros and cons of molecular imaging through positron emission computed tomography (PET/CT) are reviewed, with a particular focus on 18f-fluorodeoxyglucose (18F-FDG) and PET-derived metabolic parameters. Lastly, translational perspective of radiopharmaceuticals others than 18F-FDG such as 89zirconium (89Zr) or fluorine-18 (18F) labeled monoclonal antibodies (e.g.89Zr-atezolizumab, 89Zr-nivolumab) binding to specific biomarkers are discussed. Expert opinion: Molecular imaging presents a prominent role for the management of oncological patients treated with ICIs. Preliminary clinical data indicate that PET/CT with 18F-FDG is useful for assessing the response to treatment and for the imaging of immune-related adverse effects. Nevertheless, the methodological approach (iPERCIST, PERCIMT, or others) to be used for an optimal diagnostic accuracy and patients' evaluation is still a debated issue. PET/CT with radioligands directed toward ICIs biomarkers, although is still in a translational phase, holds the promise of accurately predicting the response to treatment and revealing the acquired resistance to immunotherapy.
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Affiliation(s)
- Luca Filippi
- Department of Nuclear Medicine, Santa Maria Goretti Hospital, AUSL , Latina, Italy
| | - Clara Nervi
- Department of Medical and Surgical Sciences and Biotechnology, University of Rome "La Sapienza" , Latina, Italy
| | - Ilaria Proietti
- Dermatology Unit Daniele Innocenzi, A. Fiorini Hospital, Polo Pontino , Terracina, Italy
| | - Riccardo Pirisino
- Department of Nuclear Medicine, Santa Maria Goretti Hospital, AUSL , Latina, Italy
| | - Concetta Potenza
- Dermatology Unit Daniele Innocenzi, A. Fiorini Hospital, Polo Pontino , Terracina, Italy
| | | | - Francesco Equitani
- Department of Transfusion Medicine, Santa Maria Goretti Hospital, AUSL , Latina, Italy
| | - Oreste Bagni
- Department of Nuclear Medicine, Santa Maria Goretti Hospital, AUSL , Latina, Italy
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7
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Celio L, Cortinovis D, Cogoni A, Cavanna L, Martelli O, Carnio S, Collovà E, Bertolini F, Petrelli F, Cassano A, Chiari R, Zanelli F, Vittimberga I, Letizia A, Misino A, Silvestris F, Bonizzoni E, Pilotto S, De Placido S, Bria E. 1815MO Two simplified dexamethasone (DEX)-sparing regimens with NEPA for the prevention of emesis caused by cisplatin (DDP): A phase III, controlled, non-inferiority trial. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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8
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Pantano F, Russano M, Berruti A, Mansueto G, Migliorino MR, Adamo V, Aprile G, Gelibter A, Ficorella C, Falcone A, Russo A, Aieta M, Maio M, Martelli O, Barni S, Napolitano A, Roca E, Quadrini S, Iacono D, Russo A, Calvetti L, Occhipinti MA, Cortellini A, Vasile E, Passiglia F, Imperatori M, Calabrò L, Di Giacomo AM, Petrelli F, Pasquini G, Franchina T, Venditti O, Intagliata S, Galvano A, Fioroni I, Vincenzi B, Tonini G, Santini D. Prognostic clinical factors in patients affected by non-small-cell lung cancer receiving Nivolumab. Expert Opin Biol Ther 2020; 20:319-326. [PMID: 32011207 DOI: 10.1080/14712598.2020.1724953] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background: Immune-checkpoint inhibitors have radically changed the treatment landscape of Non-Small-Cell Lung Cancer (NSCLC). It is still unclear whether specific clinical characteristics might identify those patients benefiting from immunotherapy more than others. The aim of this study was to identify clinical characteristics associated with disease-specific survival (DSS), time-to-treatment failure (TTF), objective responses (OR) and progressive disease (PD) in NSCLC patients treated with Nivolumab.Methods: This was a multicenter retrospective study conducted on 294 patients treated with Nivolumab for advanced NSCLC.Results: Of the more than 50 variables analyzed, five showed a significant correlation with DSS: ECOG PS, size of the biggest brain metastasis, number of metastatic sites, toxicity, and malignant pleural effusion. Three variables significantly correlated with TTF: malignant pleural effusion, number of metastatic sites, number of liver metastases. Malignant pleural effusion was the only variable showing a significant correlation with OR, as well as the only one correlating with all the endpoints of the study.Conclusions: This study identified clinical characteristics associated with survival and response during treatment with Nivolumab in NSCLC patients. The unfavorable association between malignant pleural effusion and objective response is a novel finding with important translational implications.
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Affiliation(s)
- Francesco Pantano
- Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
| | - Marco Russano
- Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
| | - Alfredo Berruti
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Medical Oncology, ASST Spedali Civili, Brescia, Italy
| | | | | | - Vincenzo Adamo
- Medical Oncology Unit A.O. Papardo & Department of Human Pathology, University of Messina, Messina, Italy
| | - Giuseppe Aprile
- Department of Oncology, University and General Hospital, Udine, Italy.,Department of Oncology, San Bortolo General Hospital, ULSS8 Berica, Vicenza, Italy
| | - Alain Gelibter
- Medical Oncology Unit, Policlinico Umberto I, Rome, Italy
| | - Corrado Ficorella
- Medical Oncology Unit, St. Salvatore Hospital, L'Aquila, Italy.,Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Alfredo Falcone
- Unit of Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Antonio Russo
- Section of Medical Oncology, Department of Surgical and Oncological Sciences, University of Palermo, Palermo, Italy
| | - Michele Aieta
- Division of Medical Oncology, Department of Onco-Hematology, IRCCS-CROB, Referral Cancer Center of Basilicata, Rionero, Vulture, Italy
| | - Michele Maio
- Department of Oncology, Center for Immuno-Oncology, Medical Oncology and Immunotherapy, University Hospital of Siena, Siena, Italy
| | - Olga Martelli
- Medical Oncology Unit, Azienda Ospedale San Giovanni Addolorata, Roma, Italy
| | - Sandro Barni
- Division of Oncology, Azienda Ospedaliera Treviglio, Treviglio, Italy
| | - Andrea Napolitano
- Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
| | - Elisa Roca
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Medical Oncology, ASST Spedali Civili, Brescia, Italy
| | | | - Daniela Iacono
- Pulmonary Oncology Unit, St. Camillo Forlanini Hospital, Rome, Italy
| | - Alessandro Russo
- Medical Oncology Unit A.O. Papardo & Department of Human Pathology, University of Messina, Messina, Italy
| | - Lorenzo Calvetti
- Department of Oncology, University and General Hospital, Udine, Italy.,Department of Oncology, San Bortolo General Hospital, ULSS8 Berica, Vicenza, Italy
| | | | - Alessio Cortellini
- Medical Oncology Unit, St. Salvatore Hospital, L'Aquila, Italy.,Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Enrico Vasile
- Unit of Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Francesco Passiglia
- Section of Medical Oncology, Department of Surgical and Oncological Sciences, University of Palermo, Palermo, Italy
| | - Marco Imperatori
- Division of Medical Oncology, Department of Onco-Hematology, IRCCS-CROB, Referral Cancer Center of Basilicata, Rionero, Vulture, Italy
| | - Luana Calabrò
- Department of Oncology, Center for Immuno-Oncology, Medical Oncology and Immunotherapy, University Hospital of Siena, Siena, Italy
| | - Anna M Di Giacomo
- Department of Oncology, Center for Immuno-Oncology, Medical Oncology and Immunotherapy, University Hospital of Siena, Siena, Italy
| | - Fausto Petrelli
- Division of Oncology, Azienda Ospedaliera Treviglio, Treviglio, Italy
| | - Giulia Pasquini
- Unit of Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Tindara Franchina
- Medical Oncology Unit A.O. Papardo & Department of Human Pathology, University of Messina, Messina, Italy
| | - Olga Venditti
- Medical Oncology Unit, St. Salvatore Hospital, L'Aquila, Italy.,Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Salvatore Intagliata
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Medical Oncology, ASST Spedali Civili, Brescia, Italy
| | - Antonio Galvano
- Section of Medical Oncology, Department of Surgical and Oncological Sciences, University of Palermo, Palermo, Italy
| | - Iacopo Fioroni
- Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
| | - Bruno Vincenzi
- Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
| | - Giuseppe Tonini
- Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
| | - Daniele Santini
- Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
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9
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Reale ML, Chiari R, Tiseo M, Vitiello F, Barbieri F, Cortinovis D, Ceresoli GL, Finocchiaro G, Romano GD, Piovano PL, Del Conte A, Borra G, Verderame F, Scotti V, Nonnis D, Galetta D, Sergi C, Migliorino MR, Tonini G, Cecere F, Berardi R, Pino MS, Martelli O, Gelibter A, Carta A, Vattemi E, Pagano M, Zullo A, Ferrari S, Rossi A, Novello S. Be-TeaM: An Italian real-world observational study on second-line therapy for EGFR-mutated NSCLC patients. Lung Cancer 2019; 140:71-79. [PMID: 31884129 DOI: 10.1016/j.lungcan.2019.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 09/16/2019] [Revised: 11/21/2019] [Accepted: 12/13/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Molecular diagnostics and care of non-small cell lung cancer (NSCLC) are continuously evolving. Few data document the current strategies to manage advanced NSCLC patients beyond progression in clinical practice. PATIENTS AND METHODS Be-TeaM is an Italian multi-center observational study conducted on consecutive EGFR-mutated stage IV NSCLC patients, progressed during/after a first-line EGFR-TKI. It consists of a retrospective phase, from first-line EGFR-TKI therapy start until study entry (i.e. beginning of the diagnostic process), and a prospective phase, until treatment choice or for 3 months if no therapy was prescribed. Primary objective was to describe the diagnostic and therapeutic approaches adopted after progression in a real-world setting. RESULTS Of 308 patients enrolled in 63 centers from July 2017 to June 2018, 289 were included in the analysis. In first line, 53.3 % received gefitinib, 32.5 % afatinib and 14.2 % erlotinib. The testing rate (i.e. rate of all patients undergone any biopsy -liquid and/or tissue- for the T790 M detection) was 90.7 %, with liquid biopsy being the most frequently executed. Of 262 biopsied patients, 64.5 % underwent only 1 liquid biopsy, 10.7 % only 1 tissue biopsy and 18.3 % >1 biopsy, both liquid and solid in 85.4 %. The T790M positivity rate was 45.3 %; of 166 patients undergone only a liquid biopsy and tested for the mutation, 39.8 % were T790M+ and 60.2 % T790M-/undetermined. By the observation end, 87.9 % patients had a post-progression treatment chosen, osimertinib being the most frequent among the T790M+. CONCLUSION Be-TeaM provides the first snapshot of current practices for the management of NSCLC patients beyond progression in Italy; in clinical practice, assessing the T790M status is not always feasible.
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Affiliation(s)
- Maria Lucia Reale
- Department of Oncology, University of Turin, AOU San Luigi Gonzaga, Regione Gonzole, 10, 10043, Orbassano, TO, Italy.
| | - Rita Chiari
- UOC Oncology, Ospedali Riuniti Padova Sud-AULSS6 Euganea, Via Albere, 30, Monselice, PD, Italy(1).
| | - Marcello Tiseo
- Department of Medicine and Surgery, University of Parma and Medical Oncology Unit, Azienda Ospedaliero-Universitaria, Viale Antonio Gramsci, 14, 43126, Parma, Italy.
| | - Fabiana Vitiello
- U.O.S.D. DH Pneumoncologico A.O. dei Colli - Monaldi, Via Leonardo Bianchi, 80131, Napoli, Italy.
| | - Fausto Barbieri
- Dipartimento Oncologia ed Ematologia, AOU Policlinico, Largo del Pozzo, 71, 41125, Modena, Italy.
| | - Diego Cortinovis
- UO Oncologia Medica, ASST Ospedale San Gerardo, Via G. B. Pergolesi, 33, 20900, Monza, MB, Italy.
| | - Giovanni Luca Ceresoli
- Unità di Oncologia Toracica e Urologica, Humanitas Gavazzeni, Via Mauro Gavazzeni, 21, 24125, Bergamo, Italy.
| | - Giovanna Finocchiaro
- U.O Oncologia Medica ed Ematologia, Humanitas Cancer Center, Istituto Clinico Humanitas-IRCCS, Via Alessandro Manzoni, 56, 20089, Rozzano, MI, Italy.
| | | | - Pier Luigi Piovano
- SC Oncologia, ASO SS Antonio e Biagio e C Arrigo, Via Venezia, 16, 15121, Alessandria, Italy.
| | - Alessandro Del Conte
- S.C. Oncologia Medica e dei Tumori Immunocorrelati (OMTI), Centro di Riferimento Oncologico (CRO) - IRCCS, Via Franco Gallini, 2, 33081, Aviano, PN, Italy.
| | - Gloria Borra
- Dipartimento Medico Specialistico ed Oncologico, AOU Maggiore della Carità, corso Mazzini 18, Novara, Italy.
| | - Francesco Verderame
- U.O Oncologia Medica, AO Riuniti Villa Sofia - Cervello, Via Trabucco 180, 90146, Palermo, Italy.
| | - Vieri Scotti
- Unità di Radioterapia Oncologica - Dipartimento di Oncologia, Azienda Ospedaliero-universitaria Careggi, Largo G. Alessandro Brambilla, 3, 50134, Florence, Italy.
| | - Daniela Nonnis
- Oncologia Medica, ASST Spedali Civili, Piazzale Spedali Civili, 1, 25123, Brescia, Italy.
| | - Domenico Galetta
- SSD Oncologia Medica Patologia Toracica IRCCS Oncologico Giovanni Paolo II, Viale Orazio Flacco, 65, 70124, Bari, Italy.
| | - Concetta Sergi
- U.O.C Oncologia Medica, AO di rilievo Nazionale, ARNAS Garibaldi-Nesima, Via Palermo, 636, Catania, Italy.
| | - Maria Rita Migliorino
- U.O.C Pneumologia Oncologica, AO S. Camillo Forlanini, Circonvallazione Gianicolense, 87, 00152, Roma, Italy.
| | - Giuseppe Tonini
- Dipartimento di Oncologia, Università Campus Bio-Medico, Via Alvaro del Portillo 200, 00128, Roma, Italy.
| | - Fabiana Cecere
- U.O. Oncologia Medica, Istituto Tumori Regina Elena, Via Elio Chianesi, 53, 00128, Roma, Italy.
| | - Rossana Berardi
- SOD Clinica Oncologica, AOU Ospedali Riuniti, Via Conca, 71, 60126, Ancona, Italy.
| | - Maria Simona Pino
- U.O. Oncologia Medica, Ospedale S. Maria Annunziata, Via Antella, 58, 50012, Ponte a Niccheri, Bagno a Ripoli, FI, Italy.
| | - Olga Martelli
- U.O Oncologia Medica, Azienda Ospedaliera S Giovanni-Addolorata, Via dell'Amba Aradam 8, 00184, Roma, Italy.
| | - Alain Gelibter
- U.O Oncologia Medica, Policlinico Umberto I, Via del Policlinico 155, Roma, Italy.
| | - Annamaria Carta
- U.O Oncologia Medica, Ospedale A. Businco, Via Edward Jenner, 1, 09121, Cagliari, Italy.
| | - Emanuela Vattemi
- U.O Oncologia Medica, Ospedale Regionale, Via Lorenz Böhler, 5, 39100, Bolzano, Italy.
| | - Maria Pagano
- Azienda Unità Sanitaria Locale-IRCCS, Via Giovanni Amendola, 2, 42122, Reggio Emilia, Italy.
| | | | - Silvia Ferrari
- AstraZeneca S.p.A., Via Ludovico il Moro, 6/C, 20080, Basiglio, MI, Italy.
| | - Antonio Rossi
- Oncology Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, Viale Cappuccini, 1, 71013, San Giovanni Rotondo, FG, Italy.
| | - Silvia Novello
- Department of Oncology, University of Turin, AOU San Luigi Gonzaga, Regione Gonzole, 10, 10043, Orbassano, TO, Italy.
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10
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Gobbini E, Chiari R, Pizzutillo P, Bordi P, Ghilardi L, Pilotto S, Osman G, Cappuzzo F, Cecere F, Riccardi F, Scotti V, Martelli O, Borra G, Maiello E, Rossi A, Graziano P, Gregorc V, Casartelli C, Sergi C, Del Conte A, Delmonte A, Bareggi C, Cortinovis D, Rizzo P, Tabbò F, Rossi G, Bria E, Galetta D, Tiseo M, Di Maio M, Novello S. Real-world outcomes according to treatment strategies in ALK-rearranged non-small-cell lung cancer (NSCLC) patients: an Italian retrospective study. Clin Transl Oncol 2019; 22:294-301. [PMID: 31630357 DOI: 10.1007/s12094-019-02222-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 08/09/2019] [Accepted: 09/27/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE Anaplastic lymphoma kinase (ALK) rearrangement confers sensitivity to ALK inhibitors (ALKis) in non-small-cell lung cancer (NSCLC). Although several drugs provided an impressive outcome benefit, the most effective sequential strategy is still unknown. We describe outcomes of real-life patients according to the treatment strategy received. PATIENTS We retrospectively collected 290 ALK rearranged advanced NSCLC diagnosed between 2011 and 2017 in 23 Italian institutions. RESULTS After a median follow-up of 26 months, PFS for crizotinib and a new generation ALKis were 9.4 [CI 95% 7.9-11.2] and 11.1 months [CI 95% 9.2-13.8], respectively, while TTF were 10.2 [CI 95% 8.5-12.6] and 11.9 months [CI 95% 9.7-17.4], respectively, being consistent across the different settings. The composed outcomes (the sum of PFS or TTF) in patients treated with crizotinib followed by a new generation ALKis were 27.8 months [CI 95% 24.3-33.7] in PFS and 30.4 months [CI 95% 24.7-34.9] in TTF. The median OS from the diagnosis of advanced disease was 39 months [CI 95% 31.8-54.5]. Patients receiving crizotinib followed by a new generation ALKis showed a higher median OS [57 months (CI 95% 42.0-73.8)] compared to those that did not receive crizotinib [38 months (CI 95% 18.6-NR)] and those who performed only crizotinib as target agent [15 months (CI 95% 11.3-34.0)] (P < 0.0001). CONCLUSION The sequential administration of crizotinib and a new generation ALKis provided a remarkable clinical benefit in this real-life population, being an interesting option to consider in selected patients.
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Affiliation(s)
- E Gobbini
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Regione Gonzole 10, 10043, Orbassano, Italy. .,Cancer Research Center Lyon, Centre Léon Bérard, 28 Rue Laennec, 69008, Lyon Cedex 08, France.
| | - R Chiari
- Oncology Unit, Santa Maria della Misericordia Hospital, Sant'Andrea delle Fratte, 6156, Perugia, Italy
| | - P Pizzutillo
- Medical Thoracic Unit, IRCCS Istituto Oncologico "Giovanni Paolo II", Viale Orazio Flacco 65, 70124, Bari, Italy
| | - P Bordi
- Medical Oncology Unit, University Hospital, Via Gramsci 14, 43123, Parma, Italy
| | - L Ghilardi
- Oncology Department, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - S Pilotto
- Oncology Unit, Department of Medicine, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - G Osman
- UOSD Pneumologia Oncologica, San Camillo Forlanini Hospital, Circonvallazione Gianicolense 87, 00152, Roma, Italy
| | - F Cappuzzo
- Oncology and Hematology Department, AUSL Romagna-Ravenna, Viale Randi 5, 48100, Ravenna, Italy
| | - F Cecere
- Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Roma, Italy
| | - F Riccardi
- Oncology Unit, Antonio Cardarelli Hospital, Via Antonio Cardarelli 9, 80131, Napoli, Italy
| | - V Scotti
- Radiotherapy Unit, University Hospital Careggi, Largo Brambilla 3, 50134, Firenze, Italy
| | - O Martelli
- Medical Oncology Unit, San Giovanni Addolorata Hospital, Via dell'Amba Aradam 9, 00184, Rome, Italy
| | - G Borra
- Oncology Unit, East Piedmont University, Maggiore della Carità Hospital, Corso Mazzini 18, 28100, Novara, Italy
| | - E Maiello
- Department of Oncology and Hematology, Foundation IRCCS 'Casa Sollievo della Sofferenza', Viale Cappuccini 1, 71013, San Giovanni Rotondo, Italy
| | - A Rossi
- Department of Oncology and Hematology, Foundation IRCCS 'Casa Sollievo della Sofferenza', Viale Cappuccini 1, 71013, San Giovanni Rotondo, Italy
| | - P Graziano
- Department of Oncology and Hematology, Foundation IRCCS 'Casa Sollievo della Sofferenza', Viale Cappuccini 1, 71013, San Giovanni Rotondo, Italy
| | - V Gregorc
- Department of Medical Oncology, Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele Hospital, Via Olgettina Milano 60, 20132, Milano, Italy
| | - C Casartelli
- Oncology Unit, Valduce Hospital, Via Dante Alighieri 11, 22100, Como, Italy
| | - C Sergi
- Oncology Unit, A.O.R.N.A.S Garibaldi Nesima, Via Palermo 636, 95100, Catania, Italy
| | - A Del Conte
- S.O.C. Oncologia Medica e dei Tumori Immunocorrelati, Centro di Riferimento Oncologico (CRO), IRCCS, Via Gallini 2, Aviano, Italy
| | - A Delmonte
- Thoracic Oncology Group, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Via Maroncelli 40, 47014, Meldola, Italy
| | - C Bareggi
- Oncology Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 28, 20122, Milan, Italy
| | - D Cortinovis
- Oncology Unit, ASST San Gerardo Hospital, Via G. B. Pergolesi 33, 20052, Monza, Italy
| | - P Rizzo
- Medical Oncology Division and Breast Unit, Antonio Perrino Hospital, Strada Statale 7 per Mesagne, 72100, Brindisi, Italy
| | - F Tabbò
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Regione Gonzole 10, 10043, Orbassano, Italy
| | - G Rossi
- Operative Unit of Pathologic Anatomy, Azienda Unità Sanitaria Locale della Romagna, Hospital St. Maria delle Croci, Viale Vincenzo Randi 5, 48121, Ravenna, Italy
| | - E Bria
- U.O.C. Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Roma, Italy
| | - D Galetta
- Medical Thoracic Unit, IRCCS Istituto Oncologico "Giovanni Paolo II", Viale Orazio Flacco 65, 70124, Bari, Italy
| | - M Tiseo
- Medical Oncology Unit, University Hospital, Via Gramsci 14, 43123, Parma, Italy
| | - M Di Maio
- Department of Oncology, University of Turin, Mauriziano Umberto I, Via Magellano 1, 10128, Turin, Italy
| | - S Novello
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Regione Gonzole 10, 10043, Orbassano, Italy
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11
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Passiglia F, Cappuzzo F, Alabiso O, Bettini AC, Bidoli P, Chiari R, Defferrari C, Delmonte A, Finocchiaro G, Francini G, Gelsomino F, Giannarelli D, Giordano M, Illiano A, Livi L, Martelli O, Natoli C, Puppo G, Ricevuto E, Roca E, Turci D, Galetta D. Efficacy of nivolumab in pre-treated non-small-cell lung cancer patients harbouring KRAS mutations. Br J Cancer 2019; 120:57-62. [PMID: 30377342 PMCID: PMC6325128 DOI: 10.1038/s41416-018-0234-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 07/12/2018] [Accepted: 07/26/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The present study investigated the efficacy and safety of nivolumab in pre-treated patients with advanced NSCLC harbouring KRAS mutations. METHODS Clinical data and KRAS mutational status were analysed in patients treated with nivolumab within the Italian Expanded Access Program. Objective response rate, progression-free survival and overall survival were evaluated. Patients were monitored for adverse events using the National Cancer Institute Common Terminology Criteria for Adverse Events. RESULTS Among 530 patients evaluated for KRAS mutations, 206 (39%) were positive while 324 (61%) were KRAS wild-type mutations. KRAS status did not influence nivolumab efficacy in terms of ORR (20% vs 17%, P = 0.39) and DCR (47% vs 41%, P = 0.23). The median PFS and OS were 4 vs 3 months (P = 0.5) and 11.2 vs 10 months (P = 0.8) in the KRAS-positive vs the KRAS-negative group. The 3-months PFS rate was significantly higher in the KRAS-positive group as compared to the KRAS-negative group (53% vs 42%, P = 0.01). The percentage of any grade and grade 3-4 AEs were 45% vs 33% (P = 0.003) and 11% vs 6% (P = 0.03) in KRAS-positive and KRAS-negative groups, respectively. CONCLUSIONS Nivolumab is an effective and safe treatment option for patients with previously treated, advanced non-squamous NSCLC regardless of KRAS mutations.
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Affiliation(s)
- Francesco Passiglia
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - Federico Cappuzzo
- Department of Oncology and Hematology, AUSL Romagna, Ravenna, Italy.
| | - Oscar Alabiso
- University Hospital "Maggiore della Carità", Novara, Italy
| | | | | | - Rita Chiari
- Department of Medical Oncology, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | | | - Angelo Delmonte
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumouri (IRST), Meldola, Italy
| | | | | | | | - Diana Giannarelli
- Biostatistics Unit, Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | | | | | | | - Clara Natoli
- Department of Medical, Oral and Biotechnological Sciencesl, CeSI-MeT University G. D'Annunzio, Chieti-Pescara, Italy
| | | | - Enrico Ricevuto
- Assistenza Oncologica Territoriale, Ospedale San Salvatore, Rete Oncologica ASL1 Abruzzo, Università di L'Aquila, Aquila, Italy
| | - Elisa Roca
- ASST Spedali Civili di Brescia, Brescia, Italy
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12
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Gobbini E, Pizzutilo P, Chiari R, Pilotto S, Dazzi C, Osman G, Bordi P, Ghilardi L, Cecere F, Graziano P, Maiello E, Borra G, Martelli O, Gregorc V, Scotti V, Casartelli C, Riccardi F, Rizzo P, Del Conte A, Delmonte A, Bareggi C, Cortinovis D, Sergi C, Rossi A, Rossi G, Bria E, Di Maio M, Novello S. MA26.02 Upfront or Sequential Strategy for New Generation Anaplastic Lymphoma Kinase (ALK) Inhibitors: An Italian Retrospective Study. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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13
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Barbieri E, Frezza G, Martelli O, Neri S, Mercuri M, Gherlinzoni F, Bacci G, Mancini A, Putti C, Babini L. Non Conventional Fractionation in Radiotherapy of the Musculo-Skeletal Sarcomas. Tumori 2018; 84:167-70. [PMID: 9620241 DOI: 10.1177/030089169808400213] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In 1989 we started an accelerated hyperfractionated schedule of radiotherapy (two 1.6 Gy daily fractions) in standard risk localized Ewing's sarcoma of bone, with the aim at reducing late effects in young patients and at improving disease control through a better integration of treatment modalities. From 1991, the same schedule was used in preoperative radiotherapy of adult soft tissue sarcomas of the extremities: the main purpose was to reduce the time to surgery and to evaluate surgical complications in comparison with a previous experience of hypofractionated radiotherapy (one 3 Gy daily fraction). From 1991 to 1997, 76 patients with Ewing's sarcoma and 24 patients with soft tissue sarcoma were treated at our Institution. Results and complication rates are analyzed in comparison with historical data. In Ewing's sarcoma, a correct evaluation of improvement in local control was difficult because of changing treatment policy (bulky disease was not included in the present series). Late effects, as evaluated in patients with a minimum follow-up of 3 years, occurred with similar incidence, but at higher total dose levels in patients treated with accelerated hyperfractionation. In patients with soft tissue sarcomas, incidence of surgical complications is reduced as compared to historical experience. Major problems of wound healing were seen in association with intraoperative brachitherapy boost.
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Affiliation(s)
- E Barbieri
- Clinical Department of Radiological and Hystopathological Sciences, University of Bologna, Italy
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14
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Martelli O, Coppola L, De Quarto AL, Palma M, Sarmiento R, Foggi CM. Fulminant Hepatic Failure Caused by Diffuse Intrasinusoidal Metastatic Liver Disease: A Case Report. Tumori 2018; 86:424-7. [PMID: 11130575 DOI: 10.1177/030089160008600512] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 53-year-old woman experienced rapidly progressing liver failure four years after a quadrantectomy for a breast carcinoma. She had received adjuvant chemotherapy and radiotherapy, and second-line chemotherapy for bone metastasis one year earlier. The hepatic failure manifested with ascites, jaundice, elevation of serum bilirubin and hepatic enzyme levels and hypoalbuminemia. Imaging studies showed an enlarged liver without metastatic lesions. The patient died of hepatic decompensation within two weeks. Liver examination at autopsy revealed massive neoplastic infiltration consistent with a primary breast carcinoma. It is important to realize that this unusual pattern of liver metastasis cannot be demonstrated even with the most advanced techniques of instrumental diagnosis (CT scan, ultrasonography and magnetic resonance imaging), and should be taken into account in the differential diagnosis of rapidly progressing liver failure.
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Affiliation(s)
- O Martelli
- Divisione Oncologia, Azienda Complesso Ospedaliero S. Filippo Neri, Rome, Italy
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15
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Metro G, Passaro A, Lo Russo G, Bonanno L, Giusti R, Gregorc V, Capelletto E, Martelli O, Cecere FL, Giannarelli D, Luciani A, Bearz A, Tuzi A, Scotti V, Tonini G, Galetta D, Carta A, Soto Parra H, Rebonato A, Morabito A, Chiari R. Ceritinib compassionate use for patients with crizotinib-refractory, anaplastic lymphoma kinase-positive advanced non-small-cell lung cancer. Future Oncol 2018; 14:353-361. [DOI: 10.2217/fon-2017-0441] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Ceritinib was evaluated within a compassionate use program of Italian patients. Patients & methods: 70 patients with anaplastic lymphoma kinase-positive crizotinib-refractory advanced non-small-cell lung cancer received ceritinib. Results: Overall response was 40.6%, median progression-free survival was 8.2 months and median survival was 15.5 months. Dose reduction due to treatment-related adverse events occurred in 50.8% of patients starting at 750 mg/day. No significantly different progression-free survival was observed between patients who underwent any time dose reduction (n = 38) versus those who remained on the recommended dose of 750 mg/day (n = 32; p = 0.07). Conclusion: The efficacy of ceritinib compassionate use program resembled that of clinical trials. Dose reductions and adjustments did not appear to negatively affect clinical outcome.
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Affiliation(s)
- Giulio Metro
- Medical Oncology, Santa Maria della Misericordia Hospital, AOU di Perugia, Perugia, Italy
| | - Antonio Passaro
- Division of Thoracic Oncology, European Institute of Oncology, Milano, Italy
| | - Giuseppe Lo Russo
- Division of Thoracic Oncology, Fondazione IRCCS, Istituto Nazionale Tumori, Milano, Italy
| | - Laura Bonanno
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova (PD), Italy
| | | | - Vanesa Gregorc
- Department of Medical Oncology, IRCCS, San Raffaele Hospital, Milano, Italy
| | - Enrica Capelletto
- Department of Oncology, University of Torino, AOU San Luigi Orbassano, Torino, Italy
| | - Olga Martelli
- Medical Oncology, AO San Giovanni Addolorata, Roma, Italy
| | - Fabiana L Cecere
- Medical Oncology 1, Regina Elena National Cancer Institute, Roma, Italy
| | - Diana Giannarelli
- Medical Oncology 1, Regina Elena National Cancer Institute, Roma, Italy
| | | | | | | | - Vieri Scotti
- Department of Oncology, Division of Radiotherapy, AOU Careggi, Firenze, Italy
| | - Giuseppe Tonini
- Oncologia Medica, Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Domenico Galetta
- Division of Thoracic Oncology, IRCCS Oncologico Giovanni Paolo II, Bari, Italy
| | | | | | - Alberto Rebonato
- Department of Diagnostic Imaging, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Alessandro Morabito
- Division of Thoracic Oncology, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Napoli, Italy
| | - Rita Chiari
- Medical Oncology, Santa Maria della Misericordia Hospital, AOU di Perugia, Perugia, Italy
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Tiseo M, Martelli O, Mancuso A, Sormani MP, Bruzzi P, Di Salvia R, De Marinis F, Ardizzoni A. Short Hydration Regimen and Nephrotoxicity of Intermediate to High-Dose Cisplatin-Based Chemotherapy for Outpatient Treatment in Lung Cancer and Mesothelioma. Tumori 2018; 93:138-44. [PMID: 17557559 DOI: 10.1177/030089160709300205] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and Background Cisplatin, a standard component of combination chemotherapy for several tumors, presents important anti-tumor properties but also several toxic effects. In particular, the major dose-limiting effect appears to be renal toxicity. In several countries, to reduce nephrotoxicity after cisplatin administration, a 24-h hydration is recommended following a chemotherapy treatment in a hospital regimen. In our Institutions, cisplatin chemotherapy is an outpatient treatment that provides adequate hydration with an NaCl solution plus furosemide and diuresis monitoring during treatment. Methods and Study Design To assess incidence of cisplatin nephrotoxicity using a short hydration regimen, which included 2000 ml of fluids with control of diuresis, individual outpatient data was pooled retrospectively from patients enrolled in large randomized studies regarding cisplatin-based chemotherapy in lung cancer and mesothelioma. From February 1999 to November 2002, 107 patients treated with cisplatin (≥75 mg/m2/cycle) were examined, monitoring serum creatinine and creatinine clearance levels. Results Five patients out of 107 (4.6%) were withdrawn from chemotherapy because of renal toxicity. For the other 102 patients, serum creatinine and creatinine clearance measurements were stable around the normal values during treatment. No time trends relating to serum creatinine levels or creatinine clearance and cycle numbers or cisplatin-cumulative doses were detected (P = 0.36 and P = 0.64, for the relationship with cycle number, and P = 0.39 and P = 0.65 for the relationship with cumulative dose, respectively, random effect model) after adjusting for the total number of cycles administered. Conclusions These observations indicate that intermediate to high-dose cisplatin administration is feasible in outpatient management with a short hydration regimen without high risk of nephrotoxicity.
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Affiliation(s)
- Marcello Tiseo
- Division of Medical Oncology, University Hospital of Parma, Via Gramsci 14, 43100 Parma, Italy.
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Roila F, Ballatori E, Labianca R, De Braud F, Borgonovo K, Martelli O, Gallo C, Tinazzi A, Perrone F. Off-Label Prescription of Antineoplastic Drugs: An Italian Prospective, Observational, Multicenter Survey. Tumori 2018; 95:647-51. [DOI: 10.1177/030089160909500601] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims and Background An appropriate use of drugs should follow the registered indications. Different reasons can induce oncologists to prescribe drugs off-label. The aim of this study was to describe incidence and characteristics of these prescriptions in Italy. Methods Patients submitted to chemotherapy in 15 Italian oncology centers were evaluated for two randomized non-consecutive days of two weeks in May 2006. Results The study enrolled 644 patients receiving 1,053 drugs. Overall, 199 of 1053 (18.9%) prescriptions were off-label. In 92 of 199 cases (46.2%), the drugs were used for a neoplasm for which they were not approved, but there was scientific evidence (one or more randomized clinical trials or more phase II studies published in a major oncology journal) justifying the prescription. In 27 cases (13.6%), the drugs were prescribed for a rare neoplasm (cisplatin and gemcitabine in mesothelioma). In 20/21 cases (10.1%/10.5%), drugs were used in association/alone in contrast with the approved use (capecitabine in association in colorectal cancer). In 28/11 cases (14.0%/5.6%), the drugs were used in lines of chemotherapy subsequent/previous to that approved. Conclusions Off-label use of antineoplastic drugs, in this observational survey, represents less than 20% of the prescriptions, and most of them are based on scientific evidence of efficacy.
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Affiliation(s)
- Fausto Roila
- Medical Oncology Division, S. Maria Hospital, Terni
| | - Enzo Ballatori
- Dept of Internal Medicine and Public Health, University of L'Aquila, L'Aquila
| | | | | | | | | | - Ciro Gallo
- Dept of Medicine and Public Health, 2nd University of Naples, Naples
| | - Angelo Tinazzi
- Medical Informatics and Biometry Unit, Sendo Tech, Milan
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Ballatori E, Roila F, Ruggeri B, De Angelis V, Porzio G, Marchetti P, Basurto C, Ciccarese G, Palladino M, Porrozzi S, Fava S, Grimi E, Calcagno A, De Paoli A, Luoni M, Tocci A, Nuzzo A, Laudadio L, Di Blasio A, Sacco M, Contu A, Olmeo N, Pazzola A, Baldino G, Picece V, Nicodemo M, Cirillo M, Recaldin E, Dazzi C, Cariello A, Giovanis P, Zumaglini F, Rosati G, Manzione L, Bilancia D, Rossi A, Donati D, Maccaferri R, Malacarne P, Labianca R, Quadri A, Pessi M, Cortesi E, Martelli O, Giuliodori L, Silva R, Mari D, Massidda B, Ionta M, Alessandroni P, Baldelli A, Antimi M, Minelli M, Gridelli C, Rossi A, Passalacqua R, Quarta M, Sassi M, Pinaglia D, De Marino E, Giampaolo M, Ciancola S, Lalli A, Di Felice S, Casartelli C. Inappropriate Doses of Chemotherapy in Italian Breast Cancer Patients Enrolled in Clinical Trials. Tumori 2018; 93:540-3. [DOI: 10.1177/030089160709300604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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
Aims and background The dose of delivered chemotherapy is important to evaluate the appropriateness of the anticancer treatment. This aspect has been scarcely studied in Italy. About 7 years ago, the Italian Group for Antiemetic Research (IGAR) published a large controlled study on the effectiveness of different antiemetic prophylaxis in patients submitted to moderately emetogenic chemotherapy, where the prescribed chemotherapy was recorded. The aim of our study was to evaluate the incidence of undertreatment and to detect clinical and nonclinical factors able to explain its variability. Methods An observational study on the IGAR databank was performed to evaluate the incidence of undertreatment in the prescription in conditions of clinical trial, where the doses belonged to the eligibility criteria, and to analyze the importance of clinical and nonclinical factors using multifactorial logistic models. Results 317 patients receiving cyclophosphamide, methotrexate, and fluorouracil (CMF) and 224 anthracycline-based chemotherapy were considered. In the CMF-treated patients, 22.4% received full doses, whereas in 53.6% all three drugs of the schedule were down-dosed. In the anthracycline-treated group, 38.6% and 3.4% of patients submitted to chemotherapy containing epirubicin and doxorubicin, respectively, were undertreated. Logistic models showed that undertreatment in CMF-treated patients depended significantly on the geographic area and setting of chemotherapy administration. Although not significant, differences between age class and Karnofsky performance status were also detected. In the epirubicin-treated group, all these factors were significant. Conclusions The undertreatment of cancer patients is a relevant problem, because it could give, in daily clinical practice, worse results than those reported in clinical studies. Considering the setting of a clinical trial where our study was carried out, the incidence of undertreatment is surprisingly high. We do not know whether today, about 8 years after the IGAR study was carried out, the inappropriate dose of chemotherapy is still as frequent as we reported, but surely the topic deserves more attention.
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Affiliation(s)
- Enzo Ballatori
- Department of Internal Medicine and Public Health, University of L'Aquila
| | - Fausto Roila
- Medical Oncology Division, Policlinico Hospital, Perugia
| | | | | | | | | | | | | | | | | | - S. Fava
- Medical Oncology Service, Legnano Hospital, Legnano (Milano)
| | - E. Grimi
- Medical Oncology Service, Legnano Hospital, Legnano (Milano)
| | - A. Calcagno
- Medical Oncology Service, Legnano Hospital, Legnano (Milano)
| | - A. De Paoli
- Medical Oncology Service, Legnano Hospital, Legnano (Milano)
| | - M. Luoni
- Medical Oncology Service, Legnano Hospital, Legnano (Milano)
| | - A. Tocci
- Medical Oncology Service, Legnano Hospital, Legnano (Milano)
| | - A. Nuzzo
- Medical Oncology Division, Hospital Renzetti, Lanciano (Chieti)
| | - L. Laudadio
- Medical Oncology Division, Hospital Renzetti, Lanciano (Chieti)
| | - A. Di Blasio
- Medical Oncology Division, Hospital Renzetti, Lanciano (Chieti)
| | - M. Sacco
- Medical Oncology Division, Hospital Renzetti, Lanciano (Chieti)
| | - A. Contu
- Medical Oncology Service, Sassari
| | - N. Olmeo
- Medical Oncology Service, Sassari
| | | | | | - V. Picece
- Medical Oncology Division, Negrar Hospital, Verona
| | - M. Nicodemo
- Medical Oncology Division, Negrar Hospital, Verona
| | - M. Cirillo
- Medical Oncology Division, Negrar Hospital, Verona
| | - E. Recaldin
- Medical Oncology Division, Negrar Hospital, Verona
| | - C. Dazzi
- Medical Oncology Division, Ravenna
| | | | | | | | | | | | | | - A. Rossi
- Medical Oncology Division, Potenza
| | - D. Donati
- Medical Oncology Division, Arcispedale S. Anna, Ferrara
| | - R. Maccaferri
- Medical Oncology Division, Arcispedale S. Anna, Ferrara
| | - P. Malacarne
- Medical Oncology Division, Arcispedale S. Anna, Ferrara
| | | | | | | | - E. Cortesi
- Medical Oncology Division, La Sapienza University, Rome
| | - O. Martelli
- Medical Oncology Division, La Sapienza University, Rome
| | | | - R.R. Silva
- Medical Oncology Service, Fabriano (Ancona)
| | - D. Mari
- Medical Oncology Service, Fabriano (Ancona)
| | - B. Massidda
- Medical Oncology Department, University of Cagliari, Cagliari
| | - M.T. Ionta
- Medical Oncology Department, University of Cagliari, Cagliari
| | | | | | - M. Antimi
- Medical Oncology Service, Hospital S. Eugenio, Rome
| | - M. Minelli
- Medical Oncology Service, Hospital S. Eugenio, Rome
| | - C. Gridelli
- Medical Oncology B Division, National Cancer Institute, Naples
| | - A. Rossi
- Medical Oncology B Division, National Cancer Institute, Naples
| | | | | | - M. Sassi
- Medical Oncology Service, Foligno (Perugia)
| | | | - E. De Marino
- Medical Oncology Department, Internal Medicine Division, V. Fazzi Hospital, Lecce
| | | | - S. Ciancola
- Medical Oncology Service, Anagni (Frosinone)
| | - A. Lalli
- Medical Oncology Service, Giulianova (Teramo)
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Pilotto S, Rossi A, Vavalà T, Follador A, Tiseo M, Galetta D, Morabito A, Di Maio M, Martelli O, Caffo O, Piovano PL, Cortinovis D, Zilembo N, Casartelli C, Banna GL, Ardizzoia A, Barzelloni ML, Bearz A, Genestreti G, Mucciarini C, Filipazzi V, Menis J, Rizzo E, Barbieri F, Rijavec E, Cecere F, Spitaleri G, Bria E, Novello S. Outcomes of First-Generation EGFR-TKIs Against Non-Small-Cell Lung Cancer Harboring Uncommon EGFR Mutations: A Post Hoc Analysis of the BE-POSITIVE Study. Clin Lung Cancer 2018. [DOI: 10.1016/j.cllc.2017.05.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Finocchiaro CY, Rota A, Barbieri V, Bettini A, Bianco R, Borra G, Buffoni L, Bulotta A, Carta A, Cortinovis D, Costanzo R, Cusmai A, Danesi R, D’Argento E, Del Conte A, Franchina T, Gilli M, Gregorc V, Irtelli L, Landi L, Malorgio F, Mancuso G, Martelli O, Mazzanti P, Melotti B, Migliorino MR, Minotti V, Montrone M, Morabito A, Roca E, Romano G, Rossi A, Savio G, Tiseo M, Boscardini I, Piccolo L, Pilotto S, Malapelle U. Listening understanding and acting (lung): focus on communicational issue in thoracic oncology. Transl Cancer Res 2018; 8:S16-S22. [PMID: 35117061 PMCID: PMC8798889 DOI: 10.21037/tcr.2018.12.32] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 12/21/2018] [Indexed: 12/03/2022]
Abstract
Background In the field of oncological assistance, nowadays we have to deal with a complex scenario where patients got used to obtain a huge amount of information through internet or social media and to apply them in performing their health-related decisions. This landscape requires that clinicians become able to handle therapeutical approaches and adequate skills in communication tools to satisfy the current needs. Our project aimed to build a communication model based on clinical oncologists’ real experiences in order to find a simple way to share with patients all the innovative therapeutical opportunities today available in lung cancer. The final goal is to design a flexible and personalized model adaptable to clinician’s personal characteristics and to the specific patient he is facing. We applied both traditional educational tools and innovative techniques in order to make the results effective and applicable to support peer learning. Methods The first step consisted in a Board synthesized the definition of the diagnostic process, the identification of treatment strategies and any potential communication barrier clinicians may face dealing with patients. The second step consisted in teamwork including a theoretical part and a training part. In the third step we produce five training videos and video interviews regarding communication praxis and a “Small communication manual”. The last step consisted in the publication of the produced material on website and its diffusion through the social media. Results In medicine, the universal application of a single model of communication does not represent the optimal solution. By contrary, the availability of simple and practical suggestions to improve the communicative style could allow clinicians to abandon stereotyped formulas identically repurposed to all patients. The “from bottom to top” training, starting from real-life to take advantage of the clinician’s experience, give the clinicians the possibility to meditate about their own communicative style and to train in the context of a protected environment. Applying these rules, we design an effective communication model, based on healthcare humanization, which could represent a fundamental support for the patient in order to be gently driven by the clinician to the most appropriate therapeutical choice, balancing efficacy and quality of life. The relational training may improve the quality of clinician-patient communication and could be widespread to other clinicians through the media. Conclusions Considering the innovative therapeutical options available, particularly for lung cancer patients, and the increasing access of health-related information through internet or social media the clinician-patient communication has become crucial to support the achievement of the most appropriate therapeutical choice for the patient, facing the intricate illness experience. Building a shareable and easy-to-apply communication model represents a challenge aimed to help clinicians and including technology not as a threat, but as a positive tool.
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Affiliation(s)
| | | | - Vito Barbieri
- UO Oncologia Medica, AOU “Mater Domini”, Germaneto, Catanzaro, Italy
| | - Anna Bettini
- ASST Papa Giovanni XXIII, UO Oncologia, Bergamo, Italy
| | | | - Gloria Borra
- AOU Maggiore della Carità di Novara, Novara, Italy
| | - Lucio Buffoni
- AOU San Luigi Orbassano, Oncologia Medica, Torino, Italy
| | - Alessandra Bulotta
- Dipartimento di Oncologia Medica, IRCCS Ospedale Scientifico San Raffaele, Milano, Italy
| | - Annamaria Carta
- AOB Cagliari, UO Oncologia Medica, Ospedale Businco, Cagliari, Italy
| | - Diego Cortinovis
- Struttura Semplice Lung Unit, Ospedale San Gerardo, ASST Monza, Monza, Italy
| | - Raffaele Costanzo
- UO Complessa di Oncologia medica Toraco-Polmonare, Istituto Nazionale Tumori, Napoli, Italy
| | | | - Romano Danesi
- Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa, Pisa, Italy
| | - Ettore D’Argento
- UOC di Oncologia Medica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Alessandro Del Conte
- IRCCS, Centro di Riferimento Oncologico, SOC Oncologia Medica e dei Tumori Immunocorrelati, Aviano (PN), Italy
| | - Tindara Franchina
- Dipartimento di Patologia Umana “G.Barresi”, Università degli studi di Messina, Messina, Italy
| | - Marina Gilli
- AORN dei Colli, UOSD DH PNL Oncologico, Napoli, Italy
| | - Vanesa Gregorc
- Dipartimento di Oncologia Medica, IRCCS Ospedale Scientifico San Raffaele, Milano, Italy
| | - Luciana Irtelli
- Clinica Oncologica, ASL Lanciano Vasto Chieti, Chieti, Italy
| | - Lorenza Landi
- Unità Operativa di Oncologia ed Ematologia, AUSL Romagna, Ravenna, Italy
| | | | | | - Olga Martelli
- AO Complesso Ospedaliero San Giovanni-Addolorata, Roma, Italy
| | - Paola Mazzanti
- UO Clinica Oncologica, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Barbara Melotti
- Oncologia Medica, Azienda Ospedaliera S.Orsola-Malpighi, Bologna, Italy
| | - Maria Rita Migliorino
- UOSD di Pneumologia Oncologica Azienda Ospedaliera San Camillo-Forlanini, Roma, Italy
| | - Vincenzo Minotti
- Divisione Struttura Complessa Oncologia Medica, Ospedale S. Maria della Misericordia Perugia, Perugia, Italy
| | - Michele Montrone
- SSD Oncologia Medica per la Patologia Toracica, IRCCS Istituto Tumori “Giovanni Paolo II” di Bari, Bari, Italy
| | - Alessandro Morabito
- Struttura Complessa Oncologia Medica Toraco-Polmonare, Divisione di Oncologia Medica, Istituto Nazionale Tumori Fondazione Pascale, Napoli, Italy
| | - Elisa Roca
- Oncologia Medica, Spedali Civili di Brescia, Brescia, Italy
| | | | - Antonio Rossi
- Divisione di Oncologia Medica, Fondazione IRCCS Casa Sollievo della Sofferenza, S. Giovanni Rotondo, Foggia, Italy
| | | | - Marcello Tiseo
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Parma, Parma, Italy
| | - Ivano Boscardini
- Docente di tecniche di comunicazione, CREMS Centro di Ricerca in Economia e Management in Sanità e nel Sociale, Università Cattaneo LIUC, Castellanza, VA, Italy
| | | | - Sara Pilotto
- Università degli Studi di Verona, UO Oncologia Medica, AOUI Verona, Verona, Italy
| | - Umberto Malapelle
- Anatomia Patologica, Dip.to di Sanità Pubblica, Università degli Studi di Napoli Federico II, Naples, Italy
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Carnio S, Galetta D, Scotti V, Cortinovis D, Antonuzzo A, Pisconti S, Rossi A, Martelli O, Cecere F, Lunghi A, Del Conte A, Montagna E, Topulli J, Pelizzoni D, Rapetti S, Gianetta M, Pacchiana M, Pegoraro V, Cataldo N, Bria E, Novello S. The close link between anxiety and cluster symptoms in lung cancer patients during first-line chemotherapy: further data from a dedicated WALCE (Women Against Lung Cancer in Europe) survey. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx426.010] [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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Metro G, Passaro A, Lo Russo G, Bonanno L, Giusti R, Gregorc V, Capelletto E, Martelli O, Cecere F, Giannarelli D, Luciani A, Bearz A, Tuzi A, Scotti V, Tonini G, Galetta D, Carta A, Soto Parra H, Morabito A, Chiari R. Efficacy of ceritinib administered to patients with crizotinib-refractory, ALK-positive, advanced NSCLC within the Italian compassionate use program. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx426.007] [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: 11/14/2022] Open
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Pacchiana MV, Capelletto E, Carnio S, Gridelli C, Rossi A, Galetta D, Montagna ES, Bordi P, Ceribelli A, Cortinovis D, Scotti V, Martelli O, Valmadre G, Del Conte A, Miccianza A, Morena R, Rosetti F, Di Maio M, Ostacoli L, Novello S. Patients' Attitudes and Physicians' Perceptions Toward Maintenance Therapy for Advanced Non–Small-cell Lung Cancer: A Multicenter Italian Survey. Clin Lung Cancer 2017; 18:381-387. [DOI: 10.1016/j.cllc.2016.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 10/17/2016] [Accepted: 10/18/2016] [Indexed: 12/01/2022]
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Baldissera A, Giaccherini L, Marinelli I, Parisi A, Siepe G, Martelli O, Salvi F, Balestrini D, Degli Esposti C, Ammendolia I, Tolento G, Panni V, Macchia G, Deodato F, Cilla S, Morganti A, Frezza G. EP-1152: Intraoperative radiotherapy for early breast cancer: a monocentric experience. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31588-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Metro G, Passaro A, Lo Russo G, Gregorc V, Giusti R, Capelletto E, Martelli O, Cecere F, Bonanno L, Chiari R. Efficacy of ceritinib in a "real-world" population of crizotinib-refractory ALK-positive NSCLCs: Results of the Italian compassionate use program. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx091.024] [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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Carnio S, Galetta D, Scotti V, Cortinovis DL, Antonuzzo A, Pisconti S, Rossi A, Martelli O, Lunghi A, Pilotto S, Del Conte A, Pegoraro V, Montagna ES, Topulli J, Pelizzoni D, Rapetti SG, Gianetta M, Pacchiana MV, Novello S. P2.03a-017 Chemotherapy-Induced Nausea and Vomiting (CINV) in Italian Lung Cancer Patients: Assessment by Physician, Nurse and Patient. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.1226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Gobbini E, Gregorc V, Galetta D, Riccardi F, Bordi P, Scotti V, Ceribelli A, Buffoni L, Maiello E, Delmonte A, Franchina T, Migliorino MR, Cortinovis D, Pisconti S, Di Maio M, Graziano P, Bria E, Rossi G, Rossi A, Pasello G, Sergi C, Martelli O, Cinieri S, Lunghi A, Novello S. P2.03b-063 Molecular Profiling in Advanced Non-Small-Cell Lung Cancer: Preliminary Data of an Italian Observational Prospective Study. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.1344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Carnio S, Galetta D, Scotti V, Cortinovis D, Antonuzzo A, Pisconti S, Rossi A, Martelli O, Cecere F, Bria E, Del Conte A, Pegoraro V, Montagna E, Topulli J, Pelizzoni D, Rapetti S, Gianetta M, Novello S. Chemotherapy-induced nausea and vomiting (CINV) in patients with stage III/IV lung cancer during the first-line treatment: assessment by physician, nurse and patient. Preliminary results from an Italian multicenter survey. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw332.21] [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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Vavalà T, Follador A, Tiseo M, Galetta D, Morabito A, Di Maio M, Martelli O, Caffo O, Piovano PL, Cortinovis D, Zilembo N, Casartelli C, Banna GL, Ardizzoia A, Barzelloni ML, Bearz A, Genestreti G, Mucciarini C, Filipazzi V, Menis J, Rizzo E, Barbieri F, Rijavec E, Cecere F, Bria E, Spitaleri G, Rossi A, Novello S. BE-POSITIVE: Beyond progression after tyrosine kinase inhibitor in EGFR- positive non small cell lung cancer patients: Results from a multicenter Italian observational study. Lung Cancer 2016; 95:73-81. [PMID: 27040855 DOI: 10.1016/j.lungcan.2016.02.011] [Citation(s) in RCA: 13] [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: 11/25/2015] [Revised: 02/22/2016] [Accepted: 02/24/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Non-small-cell-lung-cancer (NSCLC) patients harbouring epidermal growth factor receptor (EGFR) mutations develop drug resistance after 9-12 months of EGFR tyrosine kinase inhibitors (TKIs) therapy pointing out the issue of the second-line treatment choice. MATERIALS AND METHODS From June 2009 until May 2013 patients affected by advanced NSCLC harbouring EGFR mutations receiving first-line TKI were collected mainly retrospectively in 24 Italian Centers. Primary objective was to describe the percentage of EGFR mutated patients receiving second-line therapy after progression to first-line EGFR-TKIs assessing the type, the activity in terms of objective response rate (ORR), efficacy in terms of progression free survival (PFS) and overall survival (OS), and safety of second-line treatment. Secondary objective was to describe the efficacy of first-line EGFR-TKIs. RESULTS 312 patients were included. Most of them were females (203, 65.1%), never smokers (200, 64.1%), with adenocarcinoma histology (290, 92.9%). The most common mutations were EGFR exon 19 deletion and L858R, detected in 186 and 97 cases (59.6% and 31.1%), respectively. At data cut-off, 274 patients (95.1%) received any second-line treatment (including best supportive care or local treatments only). A total of 163 patients received second-line systemic therapy with an ORR of 20.9% (95% CI:14.62-27.10), a median PFS and OS of 4.7 (95% CI:3.81-5.26) and 24.5 (95% CI:21.65-27.37) months, respectively. Grade 3-4 hematological and non-hematological toxicities were reported in 9% and 6.3% of 144 patients treated with chemotherapy while non-hematological toxicity was reported in 4 cases of the 17 patients receiving second-line target agents. CONCLUSIONS BE-Positive is the first multicenter observational study reporting outcomes of therapies in a "real-life Caucasian EGFR-mutated population", highlighting the need of further researches about new treatment strategies in this setting.
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Affiliation(s)
- Tiziana Vavalà
- Department of Oncology, University of Torino AOU San Luigi, Regione Gonzole 10, 10043 Orbassano (TO), Italy
| | - Alessandro Follador
- Department of Oncology, University Hospital of Udine, Piazzale S. Maria della Misericordia 15, 33100 Udine, Italy
| | - Marcello Tiseo
- Medical Oncology Unit, University Hospital of Parma, via Gramsci, 14, 43126 Parma, Italy
| | - Domenico Galetta
- Medical Oncology Unit, Clinical Cancer Center Giovanni Paolo II, viale Orazio Flacco, 65, 70124 Bari, Italy
| | - Alessandro Morabito
- Thoracic Medical Oncology, National Cancer Institute, Fondazione "G.Pascale", via Mariano Semmola 80131, Napoli, Italy
| | - Massimo Di Maio
- Clinical Trials Unit, National Cancer Institute, Fondazione "G.Pascale", via Mariano Semmola, 80131 Napoli, Italy
| | - Olga Martelli
- Medical Oncology, S.Giovanni-Addolorata Hospital, via di S. Stefano Rotondo 5a, 00184 Roma, Italy
| | - Orazio Caffo
- Medical Oncology Unit, Santa Chiara Hospital, Largo Medaglie D'oro 9, 38122 Trento, Italy
| | - Pier Luigi Piovano
- Medical Oncology Unit, AO SS. Antonio Biagio e Cesare Arrigo, via S. Pio V 5, Alessandria, Italy
| | - Diego Cortinovis
- Medical Oncology Unit, AOU San Gerardo, via Giambattista Pergolesi 33, 20900 Monza, Italy
| | - Nicoletta Zilembo
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, via Giacomo Venezian 1, Milano, Italy
| | - Clelia Casartelli
- Medical Oncology Unit, Valduce Hospital, via Dante Alighieri 11, 22100 Como, Italy
| | - Giuseppe Luigi Banna
- Division of Medical Oncology, AO Cannizzaro Hospital, via Messina 829, 95126 Catania, Italy
| | - Antonio Ardizzoia
- Medical Oncology Unit, A.Manzoni Hospital via dell'Eremo 9/11, 23900 Lecco, Italy
| | - Maria Luisa Barzelloni
- AOU San Giovanni di Dio e Ruggi d' Aragona c/o P.O. G. da Procida, largo Città di Ippocrate, 84131 Salerno, Italy
| | - Alessandra Bearz
- Department of Medical Oncology, National Institute for Cancer Research, via Franco Gallini 2, Aviano (PN), Italy
| | - Giovenzio Genestreti
- Department of Medical Oncology, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), via Piero Maroncelli 40, 47014 Meldola, Italy
| | - Claudia Mucciarini
- Department of Oncological Medicine, Ramazzini Hospital, via Guido Molinari 2, 41012 Carpi (MO), Italy
| | - Virginio Filipazzi
- UOC Medical Oncology, AO Luigi Sacco, via Giovanni Battista Grassi 74, 20157 Milano,Italy
| | - Jessica Menis
- Department of Oncology, University Hospital of Udine, Piazzale S. Maria della Misericordia 15, 33100 Udine, Italy
| | - Elisa Rizzo
- EORTC Headquarters, Avenue E. Mounier 83, 1200 Bruxelles, Belgium
| | - Fausto Barbieri
- Department of Oncology and Hemathology, AOU of Modena, viale del pozzo 71, Modena, Italy
| | - Erika Rijavec
- Lung Cancer Unit, IRCCS AOU San Martino-IST Istituto Nazionale per la Ricerca sul Cancro, Largo R. Benzi 10, 16132 Genova, Italy
| | - Fabiana Cecere
- Medical Oncology Unit, University Hospital Careggi, Largo Brambilla 3, 50134 Firenze, Italy
| | - Emilio Bria
- Medical Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, P.zza L. A. Scuro 10, 37134 Verona, Italy
| | - Gianluca Spitaleri
- Division of Thoracic Oncology, European Institute of Oncology, via Ripamonti 435, 20141 Milano, Italy
| | - Antonio Rossi
- Division of Medical Oncology, S.G. Moscati Hospital, Contrada Amoretta Avellino, Italy
| | - Silvia Novello
- Department of Oncology, University of Torino AOU San Luigi, Regione Gonzole 10, 10043 Orbassano (TO), Italy.
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Pacchiana M, Capelletto E, Rossi A, Galetta D, Bordi P, Ceribelli A, Scotti V, Cortinovis D, Valmadre G, Martelli O, Miccianza A, Del Conte A, Morena R, Rosetti F, Ostacoli L, Novello S. Maintenance Therapy (MT) for non-squamous advanced NSCLC: a multicenter Italian survey about patients (pts)' perspectives and physicians' awareness. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv347.07] [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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Rulli E, Marabese M, Torri V, Farina G, Veronese S, Bettini A, Longo F, Moscetti L, Ganzinelli M, Lauricella C, Copreni E, Labianca R, Martelli O, Marsoni S, Broggini M, Garassino MC. Value of KRAS as prognostic or predictive marker in NSCLC: results from the TAILOR trial. Ann Oncol 2015. [PMID: 26209642 DOI: 10.1093/annonc/mdv318] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The prognostic and predictive role of KRAS mutations in advanced nonsmall-cell lung cancer (NSCLC) is still unclear. TAILOR prospectively assessed the prognostic and predictive value of KRAS mutations in NSCLC patients treated with erlotinib or docetaxel in second line. PATIENTS AND METHODS NSCLC patients from 52 Italian hospitals were genotyped for KRAS and EGFR mutational status in two independent laboratories. Wild-type EGFR patients (N = 218) received first-line platinum-based chemotherapy and were randomly allocated at progression to erlotinib or docetaxel. Overall survival (OS) according to KRAS mutational status was the primary end point. RESULTS KRAS mutations were present in 23% of TAILOR randomized cases. The presence of a KRAS mutation did not adversely affect progression-free (PFS) or overall (OS) survival [hazard ratio (HR) PFS = 1.01, 95% confidence interval (CI) 0.71-1.41, P = 0.977; OS = 1.24, 95% CI 0.87-1.77, P = 0.233], nor influenced treatment outcome (test for interaction: OS P = 0.965; PFS P = 0.417). Patients randomized to docetaxel treatment experienced longer survival independently from the KRAS mutational status of their tumors (HR: mutated KRAS 0.81, 95% CI 0.45-1.47; wild-type KRAS 0.79, 95% CI 0.57-1.10). CONCLUSION In TAILOR, KRAS was neither prognostic nor predictive of benefit for either docetaxel or erlotinib. Docetaxel remains superior independently from KRAS status for second-line treatment in EGFR wild-type advanced NSCLC patients. CLINICAL TRIAL REGISTRATION NCT00637910.
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Affiliation(s)
- E Rulli
- Department of Oncology, IRCCS-Istituto di Ricerche Farmacologiche 'Mario Negri', Milan
| | - M Marabese
- Department of Oncology, IRCCS-Istituto di Ricerche Farmacologiche 'Mario Negri', Milan
| | - V Torri
- Department of Oncology, IRCCS-Istituto di Ricerche Farmacologiche 'Mario Negri', Milan
| | - G Farina
- Department of Medical Oncology, Fatebenefratelli e Oftalmico Hospital, Milan
| | - S Veronese
- Department of Pathology, Niguarda Cancer Center, Ospedale Niguarda Cà Granda, Milan
| | - A Bettini
- Department of Medical Oncology, Papa Giovanni XXIII Hospital, Bergamo
| | - F Longo
- Department of Medical Oncology, Università La Sapienza, Policlinico Umberto I, Rome
| | - L Moscetti
- Department of Medical Oncology, Ospedale Belcolle, Viterbo
| | - M Ganzinelli
- Thoracic Oncology Unit, Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - C Lauricella
- Department of Pathology, Niguarda Cancer Center, Ospedale Niguarda Cà Granda, Milan
| | - E Copreni
- Department of Oncology, IRCCS-Istituto di Ricerche Farmacologiche 'Mario Negri', Milan
| | - R Labianca
- Department of Medical Oncology, Papa Giovanni XXIII Hospital, Bergamo
| | - O Martelli
- Department of Medical Oncology, Ospedale San Giovanni e Addolorata, Rome
| | - S Marsoni
- Clinical Trials Coordination Unit, Istituto di Candiolo-FPO, IRCCS, Candiolo, Italy
| | - M Broggini
- Department of Oncology, IRCCS-Istituto di Ricerche Farmacologiche 'Mario Negri', Milan
| | - M C Garassino
- Thoracic Oncology Unit, Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
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Vavala T, Follador A, Tiseo M, Galetta D, Montanino A, Martelli O, Caffo O, Piovano P, Cortinovis D, Zilembo N, Casartelli C, Banna G, Colombo D, Barzelloni M, Rijavec E, Cecere F, Bria E, Lazzari C, Rossi A, Novello S. Be-Positive: Beyond Progression After Tyrosine Kinase Inhibitor in Egfr-Positive Non-Small Cell Lung Cancer (Nsclc) Patients. Preliminary Results from a Multicenter Italian Observational Study. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu349.57] [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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La Verde N, Collovà E, Lonardi S, Generali D, Moretti A, Atzori F, Cazzaniga M, Saggia C, Tondulli L, Marcon I, Gentile AL, Rossello R, Martelli O, Aglione S, Farina G, Cinquini M, Garassino M. Male breast cancer: clinical features and multimodal treatment in a retrospective survey analysis at Italian centers. Tumori 2013. [PMID: 24362863 DOI: 10.1700/1377.15308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS AND BACKGROUND We report a collection of data about early breast cancer in male patients from 13 Italian institutions. METHODS AND STUDY DESIGN We obtained data from patient charts and performed statistical analysis. The primary end points were overall survival and disease-free survival. RESULTS A total of 205 men with invasive breast cancer was identified, with a median age of 66 years. Pathological characteristics were heterogeneous for T stage, N stage and HER2 status. Histological subtype was predominantly ductal infiltrating carcinoma. Most of them were hormone receptor positive. Mastectomy was the most common strategy. Postsurgical treatment was not standardized. Patients with large tumors were more likely to be treated with chemotherapy. Disease recurrence was associated with an ER+ and PR+ status. CONCLUSIONS We identified a correlation between relapse and hormone receptor expression, as is the case in female breast cancer.
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MESH Headings
- Adult
- Aged
- Antineoplastic Agents, Hormonal/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biomarkers, Tumor/analysis
- Breast Neoplasms, Male/chemistry
- Breast Neoplasms, Male/diagnosis
- Breast Neoplasms, Male/mortality
- Breast Neoplasms, Male/pathology
- Breast Neoplasms, Male/therapy
- Chemotherapy, Adjuvant
- Disease-Free Survival
- Humans
- Italy/epidemiology
- Kaplan-Meier Estimate
- Male
- Mastectomy
- Medical Records
- Middle Aged
- Neoplasm Staging
- Radiotherapy, Adjuvant
- Receptor, ErbB-2/analysis
- Receptors, Estrogen/analysis
- Receptors, Progesterone/analysis
- Recurrence
- Retrospective Studies
- Risk Assessment
- Risk Factors
- Treatment Outcome
- Triple Negative Breast Neoplasms/diagnosis
- Triple Negative Breast Neoplasms/mortality
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La Verde N, Collovà E, Lonardi S, Generali D, Moretti A, Atzori F, Cazzaniga M, Saggia C, Tondulli L, Marcon I, Gentile AL, Rossello R, Martelli O, Aglione S, Farina G, Cinquini M, Garassino M. Male Breast Cancer: Clinical Features and Multimodal Treatment in a Retrospective Survey Analysis at Italian Centers. Tumori 2013; 99:596-600. [DOI: 10.1177/030089161309900506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and background We report a collection of data about early breast cancer in male patients from 13 Italian institutions. Methods and study design We obtained data from patient charts and performed statistical analysis. The primary end points were overall survival and disease-free survival. Results A total of 205 men with invasive breast cancer was identified, with a median age of 66 years. Pathological characteristics were heterogeneous for T stage, N stage and HER2 status. Histological subtype was predominantly ductal infiltrating carcinoma. Most of them were hormone receptor positive. Mastectomy was the most common strategy. Postsurgical treatment was not standardized. Patients with large tumors were more likely to be treated with chemotherapy. Disease recurrence was associated with an ER+ and PR+ status. Conclusions We identified a correlation between relapse and hormone receptor expression, as is the case in female breast cancer.
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Affiliation(s)
- Nicla La Verde
- AO Fatebenefratelli e Oftalmico, Department of Oncology, Milan
| | - Elena Collovà
- Hospital of Legnano, Division of Medical Oncology, Legnano
| | - Sara Lonardi
- Veneto Oncology Institute IRCCS, Medical Oncology Unit 1, Padua
| | - Daniele Generali
- Azienda Istituti Ospitalieri di Cremona, UO Multidisciplinare di Patologia Mammaria, Cremona
| | - Anna Moretti
- AO Fatebenefratelli e Oftalmico, Department of Oncology, Milan
| | | | | | | | - Luca Tondulli
- AO Universitaria Integrata di Verona Borgo Trento Hospital, Department of Oncology, Verona
| | - Ilaria Marcon
- Ospedale di Circolo e Fondazione Macchi, Department of Oncology, Varese
| | | | - Rosalba Rossello
- Policlinico Universitario “G Martino”, Department of Human Pathology, Medical Oncology and Integrated Therapies Unit, Messina
| | - Olga Martelli
- AO S Giovanni-Addolorata, Medical Oncology Unit, Rome
| | | | | | - Michela Cinquini
- Mario Negri Institute for Pharmacological Research, Department of Oncology, Milan
| | - Marina Garassino
- Fondazione IRCCS Istituto Nazionale dei Tumori, Medical Oncology Unit 1, Milan, Italy
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Rossi A, Martelli O, Di Maio M. Treatment of patients with small-cell lung cancer: From meta-analyses to clinical practice. Cancer Treat Rev 2013; 39:498-506. [DOI: 10.1016/j.ctrv.2012.09.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2012] [Revised: 08/23/2012] [Accepted: 09/18/2012] [Indexed: 11/25/2022]
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Garassino MC, Martelli O, Broggini M, Farina G, Veronese S, Rulli E, Bianchi F, Bettini A, Longo F, Moscetti L, Tomirotti M, Marabese M, Ganzinelli M, Lauricella C, Labianca R, Floriani I, Giaccone G, Torri V, Scanni A, Marsoni S. Erlotinib versus docetaxel as second-line treatment of patients with advanced non-small-cell lung cancer and wild-type EGFR tumours (TAILOR): a randomised controlled trial. Lancet Oncol 2013; 14:981-8. [PMID: 23883922 DOI: 10.1016/s1470-2045(13)70310-3] [Citation(s) in RCA: 394] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Erlotinib is registered for treatment of all patients with advanced non-small-cell lung cancer (NSCLC). However, its efficacy for treatment of patients whose tumours are EGFR wild-type-which includes most patients-is still contentious. We assessed the efficacy of erlotinib compared with a standard second-line chemotherapy in such patients. METHODS We did this randomised controlled trial in 52 Italian hospitals. We enrolled patients who had metastatic NSCLC, had had platinum-based chemotherapy, and had wild-type EGFR as assessed by direct sequencing. Patients were randomly assigned centrally (1:1) to receive either erlotinib orally 150 mg/day or docetaxel intravenously 75 mg/m(2) every 21 days or 35 mg/m(2) on days 1, 8, and 15, every 28 days. Randomisation was stratified by centre, stage, type of first-line chemotherapy, and performance status. Patients and investigators who gave treatments or assessed outcomes were not masked to treatment allocation, investigators who analysed results were. The primary endpoint was overall survival in the intention-to-treat population. The study is registered at ClinicalTrials.gov, number NCT00637910. FINDINGS We screened 702 patients, of whom we genotyped 540. 222 patients were enrolled (110 assigned to docetaxel vs 112 assigned to erlotinib). Median overall survival was 8·2 months (95% CI 5·8-10·9) with docetaxel versus 5·4 months (4·5-6·8) with erlotinib (adjusted hazard ratio [HR] 0·73, 95% CI 0·53-1·00; p=0·05). Progression-free survival was significantly better with docetaxel than with erlotinib: median progression-free survival was 2·9 months (95% CI 2·4-3·8) with docetaxel versus 2·4 months (2·1-2·6) with erlotinib (adjusted HR 0·71, 95% CI 0·53-0·95; p=0·02). The most common grade 3-4 toxic effects were: low absolute neutrophil count (21 [20%] of 104 in the docetaxel group vs none of 107 in the erlotinib group), skin toxic effects (none vs 15 [14%]), and asthenia (ten [10%] vs six [6%]). INTERPRETATION Our results show that chemotherapy is more effective than erlotinib for second-line treatment for previously treated patients with NSCLC who have wild-type EGFR tumours.
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Garassino MC, Martelli O, Bettini A, Floriani I, Copreni E, Lauricella C, Ganzinelli M, Marabese M, Broggini M, Veronese S, Gherardi G, Longo F, Fabbri MA, Tomirotti M, Alabiso O, Sarobba MG, Labianca R, Marsoni S, Farina G, Scanni A. TAILOR: A phase III trial comparing erlotinib with docetaxel as the second-line treatment of NSCLC patients with wild-type (wt) EGFR. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.18_suppl.lba7501] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
LBA7501 Background: While the benefit of EGFR tyrosine kinase inhibitors in the treatment of patients with NSCLC harboring EGFR mutations has been widely established, their value in treating patients with wt EGFR is still debated. To assess the role of erlotinib in these patients, we performed an independent multicenter phase III trial (Tarceva Italian Lung Optimization Trial [TAILOR] NCT00637910), comparing erlotinib to docetaxel in second line treatment, having overall (OS) and progression free survival (PFS) as principal and secondary endpoints, respectively. Methods: EGFR and KRAS mutational status were assessed by direct sequencing in all eligible patients; only patients with wt EGFR NSCLC (exons 19 and 21) at progression, and previously treated with a first line platinum-based regimen, were randomized to receive either erlotinib 150 mg daily or docetaxel 75 mg/m2 (3-weekly) or 35 mg/m2 (weekly) until disease progression or unacceptable toxicity occurred. To detect an hazard ratio of 0.67 (2-sided 5% significance level for the log-rank test and a power of 80%), 199 events were required for both OS and PFS evaluation. Results: On the planned analysis date (March 30, 2012), 221 patients had been randomized and 218 were evaluable (docetaxel 110, erlotinib 108; three major violations excluded). At a median follow-up of 20 months, 199 relapses and 157 deaths were recorded. The Kaplan-Meier PFS curves showed a highly significant increase favoring docetaxel (HR 0.70 with 95% CI 0.53-0.94; p = 0.016) over erlotinib regimen. The HR translated into an estimated absolute difference in 6-months PFS of 12% (16% vs 28%). Data concerning toxicity were consistent with the literature. Conclusions: In terms of PFS, our results indicate a clear superiority of docetaxel over erlotinib as second line treatment for patients without EGFR mutations in exons 19 or 21. Analysis of OS will be conducted as far as the planned number of 199 deaths is reached.
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Affiliation(s)
| | - Olga Martelli
- Division of Medical Oncology, San Giovanni-Addolorata Hospital, Rome, Italy
| | | | - Irene Floriani
- Laboratory of Clinical Trials, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Elena Copreni
- Laboratory of Clinical Trials, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Calogero Lauricella
- Stuttura Complessa di Anatomia Patologica, Azienda Ospedaliera Niguarda-Cà Granda, Milan, Italy
| | - Monica Ganzinelli
- Pathology Department, Azienda Ospedaliera Fatebenefratelli e Oftalmico, Milano, Italy
| | - Mirko Marabese
- Laboratory of Molecular Pharmacology, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Massimo Broggini
- Laboratory of Molecular Pharmacology, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Silvio Veronese
- Pathology Department Ospedale Niguarda Ca' Granda, Milano, Italy
| | - Giorgio Gherardi
- Pathology Department Ospedale Fatebenefratelli e Oftalmico, Milano, Italy
| | - Flavia Longo
- Medical Oncology Department Policlinico Umberto I La Sapienza, Rome, Italy
| | | | - Maurizio Tomirotti
- UO Oncologia Medica Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milano, Italy
| | - Oscar Alabiso
- Oncologia Medica, Azienda Ospedaliera “Maggiore della Carita”, Novara, Italy
| | | | - Roberto Labianca
- Oncology Department, Ospedali Riuniti di Bergamo, Bergamo, Italy
| | | | - Gabriella Farina
- U.O. Oncologia Medica, A.O. Fatebenefratelli e Oftalmico, Milan, Italy
| | - Alberto Scanni
- Oncology Department, Ospedale Fatebenefratelli e Oftalmico, Milano, Italy
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Garassino M, de Braud F, Broggini M, Marabese M, Veronese S, Ganzinelli M, Martelli O. P1.25 Prospective Evaluation of the Role of Kras in Patients Treated with a Platinum Based Doublet. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)31316-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Einert TR, Schmidt G, Binnig G, Balacescu O, Balacescu L, Rus M, Buiga R, Tudoran O, Todor N, Nagy V, Irimie A, Neagoe I, Yacobi R, Ustaev E, Berger RR, Barshack I, Kaur K, Henderson S, Cutts A, Domingo E, Woods J, Motley C, Dougherty B, Middleton M, Hassan B, Wang Y, Beasley E, Naley M, Schuh A, Tomlinson I, Taylor J, Planchard D, Lueza B, Rahal A, Lacroix L, Ngocamus M, Auger N, Saulnier P, Dorfmuller P, Le Chevalier T, Celebic A, Pignon JP, Soria JC, Besse B, Sun YH, Wang R, Li CG, Pan YJ, Chen HQ, Chouchane L, Shan J, Kizhakayil D, Aigha I, Dsouza S, Noureddine B, Gabbouj S, Mathew R, Hassen E, Chouchane L, Shan S, al-Rumaihi K, al-Bozom I, al-Said S, Rabah D, Farhat K, Kizhakayil D, Aigha I, Jakobsen Falk IA, Green KHZ, Lotfi K, Fyrberg A, Pejovic T, Li H, Mhawech-Fauceglia P, Hoatlin M, Guo MG, Huang M, Ge Y, Hess K, Wei C, Zhang W, Bogush TA, Dudko EA, Nureev MV, Kamensky AA, Polotsky BE, Tjulandin SA, Davydov MI, Caballero M, Hasmats J, Green H, Quanz M, Buhler C, Sun JS, Dutreix M, Cebotaru CL, Buiga R, Placintar AN, Ghilezan N, Balogh ZB, Reiniger L, Rajnai H, Csomor J, Szepesi A, Balogh A, Deak L, Gagyi E, Bodor C, Matolcsy A, Bozhenko VK, Rozhkova NI, Kudinova EA, Bliznyukov OP, Vaskevich EN, Trotsenko ID, Bozhenko VK, Rozhkova NI, Kharchenko NV, Kudinova EA, Bliznyukov OP, Kiandarian IV, Trotsenko ID, Pulito C, Terrenato I, Sacconi A, Biagioni F, Mottolese M, Blandino G, Muti P, Falvo E, Strano S, Mori F, Sacconi A, Ganci F, Covello R, Zoccali C, Biagini R, Blandino G, Strano S, Palmer GA, Wegdam W, Meijer D, Kramer G, Langridge J, Moerland PD, de Jong SM, Vissers JP, Kenter GG, Buist MR, Aerts JMFG, Milione M, de Braud F, Buzzoni R, Pusceddu S, Mazzaferro V, Damato A, Pelosi G, Garassino M, de Braud F, Broggini M, Marabese M, Veronese S, Ganzinelli M, Martelli O, Ganci F, Bossel N, Sacconi A, Fontemaggi G, Manciocco V, Sperduti I, Falvo E, Strigari L, Covello R, Muti P, Strano S, Spriano G, Domany E, Blandino G, Donzelli S, Sacconi A, Bellissimo T, Alessandrini G, Strano S, Carosi MA, Pescarmona E, Facciolo F, Telera S, Pompili A, Blandino G, de Vriendt V, de Roock W, di Narzo AF, Tian S, Biesmans B, Jacobs B, de Schutter J, Budzinska E, Sagaert X, Delorenzi M, Simon I, Tejpar S, Zhu Y, Wang HK, Ye DW, Denisov E, Tsyganov M, Tashireva L, Zavyalova M, Perelmuter V, Cherdyntseva N, Kim YC, Jang T, Oh IJ, Kim KS, Ban H, Na KJ, Ahn SJ, Kang H, Kim WJ, Park C, Abousamra NK, El-Din MS, Azmy EA. Diagnostics. Ann Oncol 2012. [DOI: 10.1093/annonc/mds161] [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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Garassino MC, Martelli O, Bettini A, Floriani I, Copreni E, Lauricella C, Ganzinelli M, Marabese M, Broggini M, Veronese S, Gherardi G, Longo F, Fabbri MA, Tomirotti M, Alabiso O, Sarobba MG, Labianca R, Marsoni S, Farina G, Scanni A. TAILOR: Phase III trial comparing erlotinib with docetaxel in the second-line treatment of NSCLC patients with wild-type (wt) EGFR. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.lba7501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
LBA7501 The full, final text of this abstract will be available at abstract.asco.org at 12:01 AM (EDT) on Monday, June 4, 2012, and in the Annual Meeting Proceedings online supplement to the June 20, 2012, issue of Journal of Clinical Oncology. Onsite at the Meeting, this abstract will be printed in the Monday edition of ASCO Daily News.
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Affiliation(s)
| | - Olga Martelli
- Division of Medical Oncology, San Giovanni-Addolorata Hospital, Rome, Italy
| | | | - Irene Floriani
- Laboratory of Clinical Trials, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Elena Copreni
- Laboratory of Clinical Trials, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Calogero Lauricella
- Stuttura Complessa di Anatomia Patologica, Azienda Ospedaliera Niguarda-Cà Granda, Milan, Italy
| | - Monica Ganzinelli
- Pathology Department, Azienda Ospedaliera Fatebenefratelli e Oftalmico, Milano, Italy
| | - Mirko Marabese
- Laboratory of Molecular Pharmacology, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Massimo Broggini
- Laboratory of Molecular Pharmacology, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Silvio Veronese
- Pathology Department Ospedale Niguarda Ca' Granda, Milano, Italy
| | - Giorgio Gherardi
- Pathology Department Ospedale Fatebenefratelli e Oftalmico, Milano, Italy
| | - Flavia Longo
- Medical Oncology Department Policlinico Umberto I La Sapienza, Rome, Italy
| | | | - Maurizio Tomirotti
- UO Oncologia Medica Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milano, Italy
| | - Oscar Alabiso
- Oncologia Medica, Azienda Ospedaliera “Maggiore della Carita”, Novara, Italy
| | | | - Roberto Labianca
- Oncology Department, Ospedali Riuniti di Bergamo, Bergamo, Italy
| | | | - Gabriella Farina
- U.O. Oncologia Medica, A.O. Fatebenefratelli e Oftalmico, Milan, Italy
| | - Alberto Scanni
- Oncology Department, Ospedale Fatebenefratelli e Oftalmico, Milano, Italy
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Fabbri MA, Moscetti L, Nelli F, Gamucci T, Mansueto G, Narducci F, Quadrini S, Sperduti I, Passaro A, Campenni G, Cortesi E, Martelli O, Bianchetti S, Angelini F, Pellegrino A, Pavese I, Signorelli C, Ruggeri EM. The predictive value of clinical variables in patients affected with non-small-cell lung cancer (NSCLC) treated with pemetrexed (PEM) plus platinum-based regimen: A retrospective analysis. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.e18065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18065 Background: PEM plus platinum–based regimen is a standard of care in chemonaïve advanced non-squamous NSCLC pts. This retrospective multicenter analysis was performed to evaluate the predictive value of clinical variables for PFS in an unselected population. Methods: Data were obtained by reviewing the clinical data of pts affected with advanced NSCLC treated from 2009 to 2011. 193 pts were retrieved. Main characteristics were: median age: 63 years (range 33-79); male/female (M/F): 67%/33%; ECOG PS 0-1: 97%; weight loss >5%: 34%; current smoker 31%. Stage IV disease: 81% ; ≥ 1 site of metastasis: 79%. Brain metastasis: 28% of pts at diagnosis. Results: All 193 pts are evaluable for analysis. 158 pts (82%) received the cisplatin- and 35 pts (18%) the carboplatin-based regimen. Most pts received at least 2 cycles of therapy and 21% received PEM maintenance treatment. The overall disease control rate observed was 69%. (CR+PR = 44%, SD 25%). At a median follow-up of 6.7 months (range 1-22), the median PFS was 6 months (95%CI 5-7) with a 1 year-PFS rate of 16.8%. In the Cox multivariate analysis, factors found to be associated with a statistically significant longer PFS were: gender (M vs F, HR 1.68, C.I.95% 1.19-2.38; p=0.003); no. of metastatic site (>1 vs 1, HR 1.6, 95%CI 1.07-2.40; p=0.02); type of response (CR/PR vs no response, HR 2.74, 95%CI 1.95-3.86; p<0.0001); and maintenance treatment (no vs yes, HR 2.74, 95%CI 1.95-3.86; p=0.02). The Kaplan-Meyer analysis of 1-year PFS confirmed female gender (F vs M 24.4% vs 12.2%, log-rank p=0.01), objective response (CR/PR vs SD/PD 29.9% vs 5.2%, log-rank p<0.0001), and maintenance therapy (yes vs no 30% vs 17.3%, log-rank p=0.01) as the significant clinical variables predictive of longer survival. Conclusions: According to our data only female gender, responsive disease and subsequent maintenance therapy were independent predictive factors. No difference in term of PFS outcome were found for elderly pts, presence of brain metastases and weight loss at diagnosis. Overall survival data will be presented.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Enrico Cortesi
- Dipartimento di Oncologia Medica, Università di Roma La Sapienza, Rome, Italy
| | - Olga Martelli
- Division of Medical Oncology, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Sara Bianchetti
- Medical Oncology Unit Regina Apostolorum, Albano Laziale, Italy
| | | | | | - Ida Pavese
- UOC Oncologia Ospedale San Pietro Fatebenefratelli, Rome, Italy
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Rossi A, Di Maio M, Chiodini P, Rudd RM, Okamoto H, Skarlos DV, Früh M, Qian W, Tamura T, Samantas E, Shibata T, Perrone F, Gallo C, Gridelli C, Martelli O, Lee SM. Carboplatin- or cisplatin-based chemotherapy in first-line treatment of small-cell lung cancer: the COCIS meta-analysis of individual patient data. J Clin Oncol 2012; 30:1692-8. [PMID: 22473169 DOI: 10.1200/jco.2011.40.4905] [Citation(s) in RCA: 327] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Since treatment efficacy of cisplatin- or carboplatin-based chemotherapy in the first-line treatment of small-cell lung cancer (SCLC) remains contentious, a meta-analysis of individual patient data was performed to compare the two treatments. PATIENTS AND METHODS A systematic review identified randomized trials comparing cisplatin with carboplatin in the first-line treatment of SCLC. Individual patient data were obtained from coordinating centers of all eligible trials. The primary end point was overall survival (OS). All statistical analyses were stratified by trial. Secondary end points were progression-free survival (PFS), objective response rate (ORR), and treatment toxicity. OS and PFS curves were compared by using the log-rank test. ORR was compared by using the Mantel-Haenszel test. RESULTS Four eligible trials with 663 patients (328 assigned to cisplatin and 335 to carboplatin) were included in the analysis. Median OS was 9.6 months for cisplatin and 9.4 months for carboplatin (hazard ratio [HR], 1.08; 95% CI, 0.92 to 1.27; P = .37). There was no evidence of treatment difference between the cisplatin and carboplatin arms according to sex, stage, performance status, or age. Median PFS was 5.5 and 5.3 months for cisplatin and carboplatin, respectively (HR, 1.10; 95% CI, 0.94 to 1.29; P = .25). ORR was 67.1% and 66.0%, respectively (relative risk, 0.98; 95% CI, 0.84 to 1.16; P = .83). Toxicity profile was significantly different for each of the arms: hematologic toxicity was higher with carboplatin, and nonhematologic toxicity was higher with cisplatin. CONCLUSION Our meta-analysis of individual patient data suggests no differences in efficacy between cisplatin and carboplatin in the first-line treatment of SCLC, but there are differences in the toxicity profile.
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Affiliation(s)
- Antonio Rossi
- S.G. Moscati Hospital, Avellino, Città Ospedaliera, Contrada Amoretta, Avellino, Italy.
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Rossi A, Di Maio M, Chiodini P, Rudd R, Okamoto H, Skarlos D, Frueh M, Qian W, Tamura T, Samantas E, Shibata T, Perrone F, Gallo C, Gridelli C, Martelli O, Lee SM. COCIS individual patient data (IPD) meta-analysis: Carboplatin- or cisplatin-based chemotherapy (CT) as first-line treatment of small cell lung cancer (SCLC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.7022] [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: 11/20/2022] Open
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Novello S, Milella M, Tiseo M, Banna G, Cortinovis D, Di Maio M, Garassino M, Maione P, Martelli O, Vavalà T, Bria E. Maintenance therapy in NSCLC: why? To whom? Which agent? J Exp Clin Cancer Res 2011; 30:50. [PMID: 21548925 PMCID: PMC3113744 DOI: 10.1186/1756-9966-30-50] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Accepted: 05/06/2011] [Indexed: 11/25/2022]
Abstract
Maintenance therapy is emerging as a treatment strategy in the management of advanced non small cell lung cancer (NSCLC). Initial trials addressing the question of duration of combination chemotherapy failed to show any overall survival benefit for the prolonged administration over a fixed number of cycles with an increased risk for cumulative toxicity. Nowadays several agents with different ways of administration and a different pattern of toxicity have been formally investigated in the maintenance setting. Maintenance strategies include continuing with an agent already present in the induction regimen or switching to a different one. Taking into consideration that no comparative trials of maintenance with different chemotherapy drugs or targeted agents have been conducted, the choice and the duration of maintenance agents is largely empirical. Furthermore, it is still unknown and it remains an open question if this approach needs to be proposed to every patient in the case of partial/complete response or stable disease after the induction therapy. Here, we critically review available data on maintenance treatment, discussing the possibility to tailor the right treatment to the right patient, in an attempt to optimize costs and benefits of an ever-growing panel of different treatment options.
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Affiliation(s)
- Silvia Novello
- Thoracic Oncology Unit, University of Turin, AOU, San Luigi Orbassano, Italy.
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Garassino MC, Marabese M, Rusconi P, Rulli E, Martelli O, Farina G, Scanni A, Broggini M. Different types of K-Ras mutations could affect drug sensitivity and tumour behaviour in non-small-cell lung cancer. Ann Oncol 2011; 22:235-237. [PMID: 21169473 DOI: 10.1093/annonc/mdq680] [Citation(s) in RCA: 151] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M C Garassino
- Division of Medical Oncology, Fatebenefratelli and Oftalmico Hospital.
| | | | - P Rusconi
- Laboratory of Molecular Pharmacology
| | - E Rulli
- Laboratory of Clinical Trial, Department of Oncology, "Mario Negri" Institute, Milan
| | - O Martelli
- Division of Medical Oncology, San Giovanni Hospital, Rome
| | - G Farina
- Division of Medical Oncology, Fatebenefratelli and Oftalmico Hospital
| | - A Scanni
- General Direction, "Luigi Sacco" Hospital, Milan, Italy
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Mancuso A, Sacchetta S, Saletti PC, Tronconi C, Milesi L, Garassino M, Martelli O, Leone A, Zivi A, Cerbone L, Recine F, Sollami R, Labianca R, Cavalli F, Sternberg CN. Clinical and molecular determinants of survival in pancreatic cancer patients treated with second-line chemotherapy: results of an Italian/Swiss multicenter survey. Anticancer Res 2010; 30:4289-4295. [PMID: 21036754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Increased knowledge about the treatment of pancreatic cancer has influenced the management of locally advanced and metastatic disease. Nonetheless, prognosis remains dismal (24%, 1-year survival). The impact on overall survival (OS) of second-line therapy has not been clarified and the use of platinum salts and/or fluoropyrimidines is hotly debated. It is the hope that future treatment can be tailored to predict chemosensitivity in order to improve outcomes in patients with locally advanced and metastatic pancreatic cancer. Since DNA-damaging agents could be one therapeutic option, a retrospective multicenter study was performed to evaluate the efficacy of salvage treatment with the hypothesis that levels of the DNA repair gene excision repair cross complementing 1 (ERCC1) could influence OS. PATIENTS AND METHODS In a population of 160 patients treated with fluoropyrimidine-based second-line chemotherapy, expression levels of ERCC1 were determined by immunohistochemistry and reverse transcription-polymerase chain reaction (RT-PCR). In 108 patients with locally advanced and metastatic pancreatic cancer treated with either fluoropyrimidines and platinum salts (group A=58) or fluoropyrimidines alone (group B=50), ERCC1 levels were correlated with OS, time to progression and response to chemotherapy. RESULTS Median survival was significantly higher in group A with low ERCC1 levels [11.9 versus 9.9 months; p ≤ 0.05] (median follow-up 24 months). Moreover in the same group, a trend towards longer time to progression was observed. No differences in OS were observed when ERCC1 was studied (low versus high) in patients not treated with platinum salts. On multivariate analysis of pretreatment prognostic factors, ERCC1 emerged as an independent predictive factor for OS. CONCLUSION The results of this study indicate that ERCC1 may predict survival in pancreatic cancer patients treated by platinum and fluoropyrimidine as second-line chemotherapy.
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Affiliation(s)
- A Mancuso
- Department of Medical Oncology, San Camillo and Forlanini Hospitals, Rome, Italy.
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Garassino MC, Marabese M, Broggini M, Lauricella C, Floriani I, Martelli O, Marsoni S, Gherardi G, Farina G, Scanni A. Effect of tumor-specific KRAS mutational status on impact of anti-EGFR therapy in non-small cell lung cancer (NSCLC). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.7564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Laverde N, Torri V, Lo Dico M, Galetta D, Martelli O, Michetti G, Aglione S, Sburlati P, Fatigoni S, Farina G. 9085 A platinum based second line rechallenge chemotherapy improves survival in small cell lung cancer patients. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71798-7] [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: 11/16/2022] Open
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Garassino MC, Borgonovo K, Rossi A, Mancuso A, Martelli O, Tinazzi A, Di Cosimo S, La Verde N, Sburlati P, Bianchi C, Farina G, Torri V. Biological and clinical features in predicting efficacy of epidermal growth factor receptor tyrosine kinase inhibitors: a systematic review and meta-analysis. Anticancer Res 2009; 29:2691-2701. [PMID: 19596948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs), developed for patients with advanced non-small cell lung cancer (NSCLC), give modest results similar to those with chemotherapy. There is evidence of a greater survival benefit from TKIs in patients with certain molecular and clinical features, but results are conflicting. To assess the role of these factors in predicting TKI efficacy, a pooled analysis was performed on data from randomized trials in NSCLC. MATERIALS AND METHODS An electronic search of all randomized trials comparing the efficacy or activity of TKIs and a pooled analysis were performed. The hazard ratio (HR) with 95% confidence interval (CI) was calculated for each level of the factors and an interaction test was used to detect differences in treatment effect related to the different levels. RESULTS Of ten randomized trials identified, five were considered for analysis. Smoking was shown to be the only clinical factor to have a predictive effect (non smokers: overall survival (OS) HR 0.53, 95% CI 0.42-0.67; smokers: HR 0.91, 95% CI 0.81-1.02; p-value for interaction <0.001). A negative predictive value was suggested for K-ras mutations (K-ras(+): HR 1.97 95% CI 1.16-3.33; K-ras(-): HR 0.79, 95% CI 0.59-1.05; p-value for interaction 0.003). CONCLUSION At the present time, none of the biological features which have been evaluated in patients who have undergone therapy using TKIs is proven to be of predictive value; only K-ras mutations and smoking habits can be considered as a possible criteria for selection. Results of prospective randomized trials on biological markers are awaited.
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Garassino M, Califano R, Michetti G, Borgonovo K, Dico ML, Fatigoni S, Martelli O, Ghidini A, Bareggi C, Torri V. 148PD OUTCOMES OF SMALL CELL LUNG CANCER (SCLC) PATIENTS TREATED WITH SECOND-LINE CHEMOTHERAPY (SL): A RETROSPECTIVE ANALYSIS OF 166 PATIENTS. Lung Cancer 2009. [DOI: 10.1016/s0169-5002(09)70271-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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