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Iachettini S, Terrenato I, Porru M, Di Vito S, Rizzo A, D'Angelo C, Petti E, Dinami R, Maresca C, Di Benedetto A, Palange A, Mulè A, Santoro A, Palazzo A, Fuso P, Stoppacciaro A, Vici P, Filomeno L, Di Lisa FS, Arcuri T, Krasniqi E, Fabi A, Biroccio A, Zizza P. TRF2 as novel marker of tumor response to taxane-based therapy: from mechanistic insight to clinical implication. J Exp Clin Cancer Res 2024; 43:75. [PMID: 38459559 PMCID: PMC10924347 DOI: 10.1186/s13046-024-02998-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 02/27/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Breast Cancer (BC) can be classified, due to its heterogeneity, into multiple subtypes that differ for prognosis and clinical management. Notably, triple negative breast cancer (TNBC) - the most aggressive BC form - is refractory to endocrine and most of the target therapies. In this view, taxane-based therapy still represents the elective strategy for the treatment of this tumor. However, due variability in patients' response, management of TNBC still represents an unmet medical need. Telomeric Binding Factor 2 (TRF2), a key regulator of telomere integrity that is over-expressed in several tumors, including TNBC, has been recently found to plays a role in regulating autophagy, a degradative process that is involved in drug detoxification. Based on these considerations, we pointed, here, at investigating if TRF2, regulating autophagy, can affect tumor sensitivity to therapy. METHODS Human TNBC cell lines, over-expressing or not TRF2, were subjected to treatment with different taxanes and drug efficacy was tested in terms of autophagic response and cell proliferation. Autophagy was evaluated first biochemically, by measuring the levels of LC3, and then by immunofluorescence analysis of LC3-puncta positive cells. Concerning the proliferation, cells were subjected to colony formation assays associated with western blot and FACS analyses. The obtained results were then confirmed also in mouse models. Finally, the clinical relevance of our findings was established by retrospective analysis on a cohort of TNBC patients subjected to taxane-based neoadjuvant chemotherapy. RESULTS This study demonstrated that TRF2, inhibiting autophagy, is able to increase the sensitivity of TNBC cells to taxanes. The data, first obtained in in vitro models, were then recapitulated in preclinical mouse models and in a cohort of TNBC patients, definitively demonstrating that TRF2 over-expression enhances the efficacy of taxane-based neoadjuvant therapy in reducing tumor growth and its recurrence upon surgical intervention. CONCLUSIONS Based on our finding it is possible to conclude that TRF2, already known for its role in promoting tumor formation and progression, might represents an Achilles' heel for cancer. In this view, TRF2 might be exploited as a putative biomarker to predict the response of TNBC patients to taxane-based neoadjuvant chemotherapy.
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Affiliation(s)
- Sara Iachettini
- IRCCS - Regina Elena National Cancer Institute, Translational Oncology Research Unit, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Irene Terrenato
- IRCCS - Regina Elena National Cancer Institute, Clinical Trial Center, Biostatistics and Bioinformatics Unit, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Manuela Porru
- IRCCS - Regina Elena National Cancer Institute, Translational Oncology Research Unit, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Serena Di Vito
- IRCCS - Regina Elena National Cancer Institute, Translational Oncology Research Unit, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Angela Rizzo
- IRCCS - Regina Elena National Cancer Institute, Translational Oncology Research Unit, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Carmen D'Angelo
- IRCCS - Regina Elena National Cancer Institute, Translational Oncology Research Unit, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Eleonora Petti
- IRCCS - Regina Elena National Cancer Institute, Translational Oncology Research Unit, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Roberto Dinami
- IRCCS - Regina Elena National Cancer Institute, Translational Oncology Research Unit, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Carmen Maresca
- IRCCS - Regina Elena National Cancer Institute, Translational Oncology Research Unit, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Anna Di Benedetto
- IRCCS - Regina Elena National Cancer Institute, Pathology Unit, Via Elio Chianesi 53, Rome, Italy
| | - Aldo Palange
- IRCCS - Regina Elena National Cancer Institute, Pathology Unit, Via Elio Chianesi 53, Rome, Italy
| | - Antonino Mulè
- Pathology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Angela Santoro
- Pathology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonella Palazzo
- Medical Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Paola Fuso
- Department of Woman and Child Health and Public Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonella Stoppacciaro
- Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Patrizia Vici
- IRCCS - Regina Elena National Cancer Institute, Unit of Phase IV Trials, Via Elio Chianesi 53, Rome, Italy
| | - Lorena Filomeno
- IRCCS - Regina Elena National Cancer Institute, Unit of Phase IV Trials, Via Elio Chianesi 53, Rome, Italy
| | - Francesca Sofia Di Lisa
- IRCCS - Regina Elena National Cancer Institute, Unit of Phase IV Trials, Via Elio Chianesi 53, Rome, Italy
| | - Teresa Arcuri
- IRCCS - Regina Elena National Cancer Institute, Unit of Phase IV Trials, Via Elio Chianesi 53, Rome, Italy
| | - Eriseld Krasniqi
- IRCCS - Regina Elena National Cancer Institute, Unit of Phase IV Trials, Via Elio Chianesi 53, Rome, Italy
| | - Alessandra Fabi
- Precision Medicine Unit in Senology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Annamaria Biroccio
- IRCCS - Regina Elena National Cancer Institute, Translational Oncology Research Unit, Via Elio Chianesi 53, 00144, Rome, Italy.
| | - Pasquale Zizza
- IRCCS - Regina Elena National Cancer Institute, Translational Oncology Research Unit, Via Elio Chianesi 53, 00144, Rome, Italy.
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2
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Musicco F, Lasala R, Santoleri F, Costantini A, Abrate P, Carretta MT, Proli EM, Romagnoli A, Petragnani N, Vita FD, Zeuli M, Vici P, Sansone M, Pasquantonio M, La Malfa A, Fulgenzio C. A multicentre study with real-world data of the use of palbociclib in the treatment of breast cancer: Treatment duration correlates with dose reductions. J Oncol Pharm Pract 2023; 29:1806-1815. [PMID: 35903919 DOI: 10.1177/10781552221117135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Palbociclib, a highly selective reversible CDK4-6 kinase inhibitor, is indicated in combination with an aromatase inhibitor or in combination with fulvestrant in women who had received prior endocrine treatment. Studies have demonstrated the efficacy of palbociclib in combination with fulvestrant in increasing progression-free survival in patients who relapsed or progressed on previous endocrine therapy, or in combination with aromatase inhibitor in patients who had not received previous treatments. We analysed the prescribing patterns of palbociclib in real practice correlating it with the evidence of treatment-related toxicity management and to time-to-treatment discontinuation and treatment adherence. METHODS For the observational, retrospective study, data were collected from five Italian hospital centres that prescribed palbociclib between April 2017 and April 2020. Each centre provided data derived from an administrative database of adult patients treated with palbociclib for the two therapeutic indications.Treatment adherence was calculated using the proportion of days covered method while time-to-treatment discontinuation was defined as the difference between the first and last date treatment was administered plus the days ideally covered by the last date treatment was given. RESULTS There were 375 patients enrolled during the study period, of whom 159 were treated with palbociclib and aromatase inhibitor and 216 were treated with palbociclib and fulvestrant. The time-to-treatment discontinuation was 8.9 months in the case of P + f (95% CI: 7.1-12.7) and 13.7 months in the case of P + ia (95% CI: 8.9-17.5). In both cohorts, treatments that received at least one dose reduction had a statistically higher time-to-treatment discontinuation than those without dose reduction (17.7 months vs. 9.2 and 16.6 vs. 7.4).The mean adherence in our study was 0.9 and remained high in treatments with one dose reduction (0.83) and this with two dose reductions (0.87). CONCLUSION Based on these findings, it appears that the management of toxicities through reducing doses, as required by the Summary of Product Characteristics, results in a better outcome in terms of therapy duration, and therefore time to failure due to progression or toxicity.
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Affiliation(s)
- Felice Musicco
- Hospital Pharmacy, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Ruggero Lasala
- Hospital Pharmacy, "Umberto I" Hospital of Corato, Corato, Italy
| | | | | | | | | | | | - Alessia Romagnoli
- Pharmaceutical Service, Local Health Unit of Lanciano Vasto Chieti, Chieti, Italy
| | - Nicola Petragnani
- Hospital Pharmacy, "SS. Annunziata" Hospital of Chieti, Chieti, Italy
| | | | - Massimo Zeuli
- Medical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Patrizia Vici
- Phase IV Clinical Study Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Massimo Sansone
- Hospital Pharmacy, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | - Antonia La Malfa
- Hospital Pharmacy, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Chiara Fulgenzio
- Hospital Pharmacy, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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3
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Bon G, Krasniqi E, Porru M, D'Ambrosio L, Scalera S, Maugeri-Saccà M, Di Lisa FS, Filomeno L, Arcuri T, Botticelli A, Santini D, Fabbri MA, D'Auria G, Pulito C, Blandino G, Marchiò C, Barba M, Ciliberto G, Vici P, Pizzuti L. DARPP-32 and t-DARPP in the development of resistance to anti-HER2 agents. Pre-clinical evidence from the STEP study. Neoplasia 2023; 45:100937. [PMID: 37769528 PMCID: PMC10539861 DOI: 10.1016/j.neo.2023.100937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 09/20/2023] [Indexed: 10/02/2023]
Abstract
The therapeutic scenario of Human Epidermal Growth Factor Receptor 2 positive advanced breast cancer (ABC) has been recently enriched by a number of innovative agents, which are reshaping treatment sequence. While randomized trials have documented an advantage in terms of efficacy, for the newly available agents we lack effectiveness and tolerability evidence from the real-world setting. Similarly, the identification of predictive biomarkers might improve clinical decision. We herein describe the outline of a prospective/retrospective study which aims to explore the optimal sequence of treatment in HER2+, pertuzumab pre-treated ABC patients treated in II line with anti-HER2 agents in clinical practice. As part of the pre-clinical tasks envisioned by the STEP study, in vitro cell models of resistance were exploited to investigate molecular features associated with reduced efficacy of HER2 targeting agents at the transcript level. The aggressive behavior of resistant cell populations was measured by growth assessment in mouse models. This approach led to the identification of DARPP-32 and t-DARPP proteins as possible predictive biomarkers of efficacy of anti-HER2 agents. Biomarkers validation and the clinical goals will be reached through patients' inclusion into two independent cohorts, i.e., the prospective and retrospective cohorts, whose setup is currently ongoing.
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Affiliation(s)
- Giulia Bon
- Department of Research, Cellular Network and Molecular Therapeutic Target Unit, Diagnosis and Innovative Technologies, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Eriseld Krasniqi
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, via Elio Chianesi 53, Rome 00144, Italy
| | - Manuela Porru
- Department of Research, Diagnosis and Innovative Technologies, Translational Oncology Research Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Lorenzo D'Ambrosio
- Department of Research, Diagnosis and Innovative Technologies, Tumor Immunology and Immunotherapy Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Stefano Scalera
- SAFU Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy; Department of Biology, PhD Program in Cellular and Molecular Biology, University of Rome "Tor Vergata", Rome, Italy
| | - Marcello Maugeri-Saccà
- Clinical Trial Center, Biostatistics and Bioinformatics Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy; Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, via Elio Chianesi 53, Rome 00144, Italy
| | | | - Lorena Filomeno
- Phase IV Clinical Studies Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Teresa Arcuri
- Phase IV Clinical Studies Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy; Department of Radiological, Oncological and Anatomo-Pathological Sciences, Medical Oncology A, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Andrea Botticelli
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Medical Oncology A, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Daniele Santini
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Medical Oncology A, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | | | | | - Claudio Pulito
- Oncogenomic and Epigenetic Unit, IRCCS, Regina Elena National Cancer Institute, Rome, Italy
| | - Giovanni Blandino
- Oncogenomic and Epigenetic Unit, IRCCS, Regina Elena National Cancer Institute, Rome, Italy
| | - Caterina Marchiò
- Department of Medical Sciences, University of Turin, Turin, Italy; Pathology Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | - Maddalena Barba
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, via Elio Chianesi 53, Rome 00144, Italy.
| | - Gennaro Ciliberto
- Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Patrizia Vici
- Phase IV Clinical Studies Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Laura Pizzuti
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, via Elio Chianesi 53, Rome 00144, Italy
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4
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Giacomini P, Valenti F, Allegretti M, Pallocca M, De Nicola F, Ciuffreda L, Fanciulli M, Scalera S, Buglioni S, Melucci E, Casini B, Carosi M, Pescarmona E, Giordani E, Sperati F, Jannitti N, Betti M, Maugeri-Saccà M, Cecere FL, Villani V, Pace A, Appetecchia M, Vici P, Savarese A, Krasniqi E, Ferraresi V, Russillo M, Fabi A, Landi L, Minuti G, Cappuzzo F, Zeuli M, Ciliberto G. The Molecular Tumor Board of the Regina Elena National Cancer Institute: from accrual to treatment in real-world. J Transl Med 2023; 21:725. [PMID: 37845764 PMCID: PMC10577953 DOI: 10.1186/s12967-023-04595-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/05/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Molecular Tumor Boards (MTB) operating in real-world have generated limited consensus on good practices for accrual, actionable alteration mapping, and outcome metrics. These topics are addressed herein in 124 MTB patients, all real-world accrued at progression, and lacking approved therapy options. METHODS Actionable genomic alterations identified by tumor DNA (tDNA) and circulating tumor DNA (ctDNA) profiling were mapped by customized OncoKB criteria to reflect diagnostic/therapeutic indications as approved in Europe. Alterations were considered non-SoC when mapped at either OncoKB level 3, regardless of tDNA/ctDNA origin, or at OncoKB levels 1/2, provided they were undetectable in matched tDNA, and had not been exploited in previous therapy lines. RESULTS Altogether, actionable alterations were detected in 54/124 (43.5%) MTB patients, but only in 39 cases (31%) were these alterations (25 from tDNA, 14 from ctDNA) actionable/unexploited, e.g. they had not resulted in the assignment of pre-MTB treatments. Interestingly, actionable and actionable/unexploited alterations both decreased (37.5% and 22.7% respectively) in a subset of 88 MTB patients profiled by tDNA-only, but increased considerably (77.7% and 66.7%) in 18 distinct patients undergoing combined tDNA/ctDNA testing, approaching the potential treatment opportunities (76.9%) in 147 treatment-naïve patients undergoing routine tDNA profiling for the first time. Non-SoC therapy was MTB-recommended to all 39 patients with actionable/unexploited alterations, but only 22 (56%) accessed the applicable drug, mainly due to clinical deterioration, lengthy drug-gathering procedures, and geographical distance from recruiting clinical trials. Partial response and stable disease were recorded in 8 and 7 of 19 evaluable patients, respectively. The time to progression (TTP) ratio (MTB-recommended treatment vs last pre-MTB treatment) exceeded the conventional Von Hoff 1.3 cut-off in 9/19 cases, high absolute TTP and Von Hoff values coinciding in 3 cases. Retrospectively, 8 patients receiving post-MTB treatment(s) as per physician's choice were noted to have a much longer overall survival from MTB accrual than 11 patients who had received no further treatment (35.09 vs 6.67 months, p = 0.006). CONCLUSIONS MTB-recommended/non-SoC treatments are effective, including those assigned by ctDNA-only alterations. However, real-world MTBs may inadvertently recruit patients electively susceptible to diverse and/or multiple treatments.
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Affiliation(s)
- Patrizio Giacomini
- Clinical Trial Center, Biostatistics and Bioinformatics, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy.
| | - Fabio Valenti
- UOC Translational Oncology Research, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Matteo Allegretti
- UOC Translational Oncology Research, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Matteo Pallocca
- Clinical Trial Center, Biostatistics and Bioinformatics, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Francesca De Nicola
- SAFU, Department of Research, Advanced Diagnostics, and Technological Innovation, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Ludovica Ciuffreda
- SAFU, Department of Research, Advanced Diagnostics, and Technological Innovation, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Maurizio Fanciulli
- SAFU, Department of Research, Advanced Diagnostics, and Technological Innovation, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Stefano Scalera
- Clinical Trial Center, Biostatistics and Bioinformatics, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Simonetta Buglioni
- Department of Pathology, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Elisa Melucci
- Department of Pathology, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Beatrice Casini
- Department of Pathology, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Mariantonia Carosi
- Department of Pathology, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Edoardo Pescarmona
- Department of Pathology, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Elena Giordani
- UOC Translational Oncology Research, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Francesca Sperati
- Clinical Trial Center, Biostatistics and Bioinformatics, San Gallicano Dermatological Institute IRCCS, 00144, Rome, Italy
| | - Nicoletta Jannitti
- Pharmacy Unit, Medical Direction, IRCCS-Regina Elena National Cancer Institute and San Gallicano Institute, 00144, Rome, Italy
| | - Martina Betti
- Clinical Trial Center, Biostatistics and Bioinformatics, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Marcello Maugeri-Saccà
- Clinical Trial Center, Biostatistics and Bioinformatics, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
- Medical Oncology 2, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
| | | | - Veronica Villani
- Neuro-Oncology Unit, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Andrea Pace
- Neuro-Oncology Unit, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Marialuisa Appetecchia
- Oncological Endocrinology Unit, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Patrizia Vici
- Phase IV Studies, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Antonella Savarese
- Medical Oncology 1, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Eriseld Krasniqi
- Phase IV Studies, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Virginia Ferraresi
- Sarcomas and Rare Tumors Departmental Unit, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Michelangelo Russillo
- Sarcomas and Rare Tumors Departmental Unit, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Alessandra Fabi
- Precision Medicine Unit in Senology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Rome, Italy
| | - Lorenza Landi
- Clinical Trial Center: Phase 1 and Precision Medicine, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Gabriele Minuti
- Clinical Trial Center: Phase 1 and Precision Medicine, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Federico Cappuzzo
- Medical Oncology 2, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Massimo Zeuli
- Clinical Trial Center, Biostatistics and Bioinformatics, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
- Medical Oncology 1, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Gennaro Ciliberto
- Scientific Direction, IRCCS-Regina Elena National Cancer Institute, 00144, Rome, Italy
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5
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Gori S, Fabi A, Angiolini C, Turazza M, Salvini P, Ferretti G, Cretella E, Gianni L, Bighin C, Toss A, Zamagni C, Vici P, De Rossi C, Russo A, Bisagni G, Frassoldati A, Borgato L, Cariello A, Cappelletti C, Bordonaro R, Cinieri S, Modena A, Valerio M, Alvisi MF, De Simone I, Galli F, Rulli E, Santoni A, Nicolis F. Neoadjuvant Systemic Therapy in Early Breast Cancer: Results of a Prospective Observational Multicenter BRIDE Study. Cancers (Basel) 2023; 15:4852. [PMID: 37835546 PMCID: PMC10572070 DOI: 10.3390/cancers15194852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/26/2023] [Accepted: 09/28/2023] [Indexed: 10/15/2023] Open
Abstract
To evaluate the rate of early breast cancer (EBC) patients treated with neoadjuvant systemic therapy (NAT) in Italy, criteria of patient selection and types of therapies delivered, an analysis of 1276 patients with stage I-II-III was conducted out of 1633 patients enrolled in the multicenter prospective observational BRIDE study. A total of 177 patients (13.9%) were treated with NAT and 1099 (85.9%) with surgery; in multivariate analysis, menopausal status, cT, cN, grade, HER2-positive and Triple negative (TN) subgroups were significantly associated with the decision to administer NAT. The type of NAT delivered was influenced by EBC subtype. NAT was administered to 53.2% of HER2+/HR-negative, 27.9% of HER2+/HR+, 7.1% of HER2-negative/HR+ and 30.3% of TN EBC patients. The pCR rates were similar to the ones reported in the literature: 74.2% in HER2+/HR-negative, 52.3% in HER2+/HR+, 17.2% in HER2-negative/HR+ and 37.9% in TN. In clinical practice, patient and tumor characteristics influenced oncologists in the decision to administer NAT in EBC and in the choice of the type of systemic therapy, according to ESMO and AIOM Guidelines. Currently, it is recommended always to evaluate the use of NAT in EBC, mainly in HER2+ and TN patients, considering that pCR is associated with significantly better survival of the patient and that effective therapies are now available for residual disease.
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Affiliation(s)
- Stefania Gori
- Medical Oncology Unit, IRCCS Sacro Cuore Don Calabria, 37024 Negrar di Valpolicella, Italy
| | - Alessandra Fabi
- Precision Medicine Unit in Senology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Catia Angiolini
- Breast Unit and Multidisciplinary Oncology Group, Department of Breast Oncology, AOU Careggi, 50134 Florence, Italy;
| | - Monica Turazza
- Medical Oncology Unit, IRCCS Sacro Cuore Don Calabria, 37024 Negrar di Valpolicella, Italy
| | - Piermario Salvini
- Oncology, Humanitas Gavazzeni, 24125 Bergamo, Italy;
- Oncological Medicine—Policlinico Ponte S Pietro di Istituti Ospedalieri Bergamaschi, 24036 Ponte San Pietro, Italy
| | - Gianluigi Ferretti
- Division of Medical Oncology 1, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | | | | | | | - Angela Toss
- Department of Oncology and Hematology, Azienda Ospedaliero-Universitaria di Modena, 41125 Modena, Italy
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Claudio Zamagni
- Medical Oncology of Senology and Gynecology, IRCCS AOU Bologna, Policlinico Sant’Orsola, 40138 Bologna, Italy
| | - Patrizia Vici
- UOSD Sperimentazioni Fase IV, IRCCS Istituto Nazionale Tumori Regina Elena, 00144 Rome, Italy
| | - Costanza De Rossi
- Oncology—Ospedale dell’Angelo Azienda ULSS 3 Serenissima, 30174 Venice, Italy;
| | - Antonio Russo
- Medical Oncology, AOU Policlinico P. Giaccone, 90127 Palermo, Italy
| | - Giancarlo Bisagni
- Medical Oncology, Comprehensive Cancer Centre, AUSL-IRCCS di Reggio Emilia, 22100 Reggio Emilia, Italy;
| | | | - Lucia Borgato
- Department of Oncology, San Bortolo General Hospital, Azienda ULSS8 Berica, 36100 Vicenza, Italy
| | - Anna Cariello
- Medical Oncology, AUSL Ravenna, 48100 Ravenna, Italy;
| | | | | | - Saverio Cinieri
- Medical Oncology, Antonio Perrino Hospital, 72100 Brindisi, Italy
| | - Alessandra Modena
- Medical Oncology Unit, IRCCS Sacro Cuore Don Calabria, 37024 Negrar di Valpolicella, Italy
| | - Matteo Valerio
- Medical Oncology Unit, IRCCS Sacro Cuore Don Calabria, 37024 Negrar di Valpolicella, Italy
| | - Maria Francesca Alvisi
- Laboratory of Methodology for Clinical Research, Department of Clinical Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156 Milan, Italy (I.D.S.); (E.R.)
| | - Irene De Simone
- Laboratory of Methodology for Clinical Research, Department of Clinical Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156 Milan, Italy (I.D.S.); (E.R.)
| | - Francesca Galli
- Laboratory of Methodology for Clinical Research, Department of Clinical Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156 Milan, Italy (I.D.S.); (E.R.)
| | - Eliana Rulli
- Laboratory of Methodology for Clinical Research, Department of Clinical Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156 Milan, Italy (I.D.S.); (E.R.)
| | - Anna Santoni
- Laboratory of Methodology for Clinical Research, Department of Clinical Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156 Milan, Italy (I.D.S.); (E.R.)
| | - Fabrizio Nicolis
- Medical Direction, IRCCS Sacro Cuore Don Calabria, 37024 Negrar di Valpolicella, Italy
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6
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Pinnaro P, Takanen S, Marucci L, Giannarelli D, Vici P, Da Silva AB, Sanguineti G. 5-Year Results from a Prospective Phase II Trial of Ten-Fractions Hypofractionated Radiotherapy in Locally Advanced Breast Cancer. Int J Radiat Oncol Biol Phys 2023; 117:S136. [PMID: 37784349 DOI: 10.1016/j.ijrobp.2023.06.540] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) There is a growing interest for adjuvant loco-regional hypofractionated radiotherapy (Hypo-RT) regimens in patients (pts) undergoing surgery for locally advanced breast cancer (LABC). We report the 5-year results of a phase II study on Hypo-RT targeting the primary and regional lymph nodes in ten fractions (fxs). MATERIALS/METHODS A schedule of 34 Gy/10 fxs/2 wks to the whole breast/chest wall and to the draining lymph nodes was used; an optional single fraction 8 Gy boost was administered with electrons to the tumor bed in patients who had undergone conservative surgery. Both acute (CTCAE 4.0) and late (LENT/SOMA) toxicities were collected. All pts but those who underwent mastectomy without reconstruction or with temporary expander were also asked to rate their cosmetic outcome according to the Harvard scale. Toxicity was assessed weekly during RT and then at each follow-up (fup) examination (1, 3, 6 months and then yearly). Late toxicity was assessed starting from 3 months after the end of Hypo-RT and loco-regional toxicity was prospectively collected. Cancer related endpoints in terms of loco-regional (LR) recurrence, distant metastasis, specific disease- free survival and overall survival (OS) were evaluated from the date of RT start to the diagnosis of local relapse/distant metastases or the last fup respectively. RESULTS From February 2015 to March 2019, 59 women (median age 60 yrs, IQR: 48.3-68.8 yrs) with stage II to IIIA breast cancer who underwent axillary dissection and conservative surgery (83%) or mastectomy (17%) were accrued. One patient was lost to fup immediately after the end of RT. Of the 58 evaluable pts, 56 underwent neo-adjuvant (27.5%) or adjuvant (57%) chemotherapy and 15.5% exclusive hormone therapy as well. Trastuzumab was administered concomitant to RT in HER2 positive pts (25%). All pts completed treatment as planned. No grade 2+ acute toxicity was recorded. At the median fup of 63 months (range: 25-92 mths), the cumulative incidence of any grade locoregional late toxicity estimated with the Kaplan-Meier method is 43.4% (95% CI) (30.0% and 46.1% for patients undergone mastectomy and lumpectomy, respectively). Peak 2 events have been observed for fibrosis (1 pt, 1.7%), telangiectasia (1 pts, 1.7%) and lymphoedema (1 pt, 1.7%). One patient (1.7%) experienced grade 3 breast retraction. Of all eligible patients (N = 51), patient reported cosmetic outcome was excellent, good, fair and poor in 51.7%, 22.4%, 10.3% and 3.4%, respectively. No late lung toxicity was observed. The actuarial LR control rate at 5 years is 98%; for distant metastasis-free survival, specific disease-free survival and OS rates are 89.2%, 80.8% and 93.7% respectively. CONCLUSION Our results support the activity of a 10-fxs Hypo-RT schedule targeting the primary site as well as the draining lymph node stations after surgery for LABC.
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Affiliation(s)
- P Pinnaro
- IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - S Takanen
- IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - L Marucci
- IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - D Giannarelli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - P Vici
- IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | | | - G Sanguineti
- IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
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7
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Grassadonia A, Carletti E, De Luca A, Vici P, Di Lisa FS, Filomeno L, Cicero G, De Lellis L, Veschi S, Florio R, Brocco D, Di Marino P, Alberti S, Gamucci T, Borrelli P, Cama A, Tinari N. Prognostic value of gender and primary tumor location in metastatic colon cancer. J Cancer 2023; 14:2751-2758. [PMID: 37781086 PMCID: PMC10539565 DOI: 10.7150/jca.85748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 07/07/2023] [Indexed: 10/03/2023] Open
Abstract
Sex might influence prognosis in patients affected by colorectal cancer. We retrospectively studied a cohort of patients affected by metastatic colon cancer (mCC) stratified by sex and primary tumor location. RAS mutational status was also included in the analysis. Overall, 616 patients met the eligibility criteria, 261 women and 355 men. Neither gender, nor RAS mutational status influenced overall survival (OS) in the entire population. As expected, patients with right-sided colon cancer (RCC) had a significant shorter OS compared to those with left-sided colon cancer (LCC) (21.3 vs 33.1 months, p= 0.002). When the analysis was performed stratifying for gender, RCC retained worse prognosis among men (OS 20.5 vs 33.9 months, p= 0.008), but not among women (p= 0.132). Similarly, the presence of RAS mutations had no prognostic effect in women, but was significantly associate with shorter survival in men (OS 29.5 vs 33.7 months, p= 0.046). In addition, when comparing clinical outcome of women or men according to sidedness and RAS mutational status, RCC was associated with dismal prognosis only in men with RAS mutated tumor (OS 17.2 vs 32.3 months, p= 0.008). Our study highlights the importance of gender in the outcome of patients with mCC.
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Affiliation(s)
- Antonino Grassadonia
- Department of Innovative Technologies in Medicine and Dentistry, and Center for Advanced Studies and Technology (CAST), G. D'Annunzio University Chieti-Pescara, 66100 Chieti, Italy
| | - Erminia Carletti
- Department of Medical, Oral and Biotechnological Sciences, and Center for Advanced Studies and Technology (CAST), G. D'Annunzio University Chieti-Pescara, 66100 Chieti, Italy
| | - Antonella De Luca
- Department of Medical, Oral and Biotechnological Sciences, and Center for Advanced Studies and Technology (CAST), G. D'Annunzio University Chieti-Pescara, 66100 Chieti, Italy
| | - Patrizia Vici
- Unit of Phase IV Trials, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | | | - Lorena Filomeno
- Unit of Phase IV Trials, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Giuseppe Cicero
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, 90133 Palermo, Italy
| | - Laura De Lellis
- Department of Pharmacy, G. D'Annunzio University, Chieti-Pescara, 66100 Chieti, Italy
| | - Serena Veschi
- Department of Pharmacy, G. D'Annunzio University, Chieti-Pescara, 66100 Chieti, Italy
| | - Rosalba Florio
- Department of Pharmacy, G. D'Annunzio University, Chieti-Pescara, 66100 Chieti, Italy
| | - Davide Brocco
- Department of Pharmacy, G. D'Annunzio University, Chieti-Pescara, 66100 Chieti, Italy
| | - Pietro Di Marino
- Clinical Oncology, S.S. Annunziata Hospital, 66100 Chieti, Italy
| | - Saverio Alberti
- Unit of Medical Genetics, Department of Biomedical Sciences-BIOMORF, University of Messina, 98125 Messina, Italy
| | - Teresa Gamucci
- Medical Oncology, Sandro Pertini Hospital, 00159 Rome, Italy
| | - Paola Borrelli
- Laboratory of Biostatistics, Department of Medical, Oral and Biotechnological Sciences, G. D'Annunzio University Chieti-Pescara, 66100 Chieti, Italy
| | - Alessandro Cama
- Department of Pharmacy, G. D'Annunzio University, Chieti-Pescara, 66100 Chieti, Italy
| | - Nicola Tinari
- Department of Medical, Oral and Biotechnological Sciences, and Center for Advanced Studies and Technology (CAST), G. D'Annunzio University Chieti-Pescara, 66100 Chieti, Italy
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8
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Trevisan B, Pepe FF, Vallini I, Montagna E, Amoroso D, Berardi R, Butera A, Cagossi K, Cavanna L, Ciccarese M, Cinieri S, Cretella E, De Conciliis E, Febbraro A, Ferraù F, Ferzi A, Baldelli A, Fontana A, Gambaro AR, Garrone O, Gebbia V, Generali D, Gianni L, Giovanardi F, Grassadonia A, Leonardi V, Sarti S, Musolino A, Nicolini M, Putzu C, Riccardi F, Santini D, Sarobba MG, Schintu MG, Scognamiglio G, Spadaro P, Taverniti C, Toniolo D, Tralongo P, Turletti A, Valenza R, Valerio MR, Vici P, Clivio L, Torri V, Cazzaniga ME. Final results of the real-life observational VICTOR-6 study on metronomic chemotherapy in elderly metastatic breast cancer (MBC) patients. Sci Rep 2023; 13:12255. [PMID: 37507480 PMCID: PMC10382472 DOI: 10.1038/s41598-023-39386-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/25/2023] [Indexed: 07/30/2023] Open
Abstract
Nowadays, treatment of metastatic breast cancer (MBC) has been enriched with novel therapeutical strategies. Metronomic chemotherapy (mCHT) is a continuous and frequent administration of chemotherapy at a lower dose and so whit less toxicity. Thus, this strategy could be attractive for elderly MBC patients. Aim of this analysis is to provide insights into mCHT's activity in a real-life setting of elderly MBC patients. Data of patients ≥ 75 years old included in VICTOR-6 study were analyzed. VICTOR-6 is a multicentre, Italian, retrospective study, which collected data on mCHT in MBC patients treated between 2011 and 2016. A total of 112 patients were included. At the beginning of mCHT, median age was 81 years (75-98) and in 33% of the patients mCHT was the first line choice. Overall Response Rate (ORR) and Disease Control Rate (DCR) were 27.9% and 79.3%, respectively. Median PFS ranged between 7.6 and 9.1 months, OS between 14.1 and 18.5 months. The most relevant toxicity was the hematological one (24.1%); severe toxicity (grade 3-4) ranged from 0.9% for skin toxicity up to 8% for hematologic one. This is a large study about mCHT in elderly MBC patients, providing insights to be further investigated in this subgroup of frail patients.
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Affiliation(s)
- B Trevisan
- Azienda Ospedaliera San Gerardo, Monza, Italy
| | - F F Pepe
- Azienda Ospedaliera San Gerardo, Monza, Italy
| | - I Vallini
- Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - E Montagna
- European Institute of Oncology, Milan, Italy
| | | | - R Berardi
- Azienda Ospedaliera Universitaria Ospedali Riuniti, Torrette, Italy
| | - A Butera
- Nuovo Ospedale San Giovanni Di Dio, Florence, Italy
| | | | - L Cavanna
- Azienda Ospedaliera Piacenza, Piacenza, Italy
| | | | - S Cinieri
- Ospedale A. Perrino, Brindisi, Italy
| | | | | | - A Febbraro
- Ospedale S. Cuore di Gesù Fatebenefratelli, Benevento, Italy
| | - F Ferraù
- Ospedale San Vincenzo, Taormina, Italy
| | - A Ferzi
- Azienda Ospedaliera Ospedale Civile Di Legnano, Magenta, Italy
| | | | - A Fontana
- Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | | | - O Garrone
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - V Gebbia
- Ospedale La Maddalena, Palermo, Italy
| | - D Generali
- Istituti Ospitalieri Cremona, Cremona, Italy
| | | | | | | | | | - S Sarti
- IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Italy
| | | | | | - C Putzu
- Azienda Ospedaliera-Universitaria, Sassari, Italy
| | - F Riccardi
- Ospedale Antonio Cardarelli, Naples, Italy
| | - D Santini
- Università Campus Bio-Medico, RomE, Italy
| | | | | | | | - P Spadaro
- Casa di Cura Villa Salus-Messina, Messina, Italy
| | | | | | | | | | | | - M R Valerio
- A.O.U. Policlinico Paolo Giaccone, Palermo, Italy
| | - P Vici
- INT Regina Elena, Rome, Italy
| | - L Clivio
- IRCCS Mario Negri Institute of Pharmacological Research, Milan, Italy
| | - V Torri
- IRCCS Mario Negri Institute of Pharmacological Research, Milan, Italy
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9
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Annovazzi A, Rea S, Maccora D, Pizzuti L, Ferretti G, Vici P, Cappuzzo F, Sciuto R. Prognostic value of [18F]-FDG PET/CT in patients with meta-static breast cancer treated with cyclin-dependent inhibitors. Front Oncol 2023; 13:1193174. [PMID: 37519806 PMCID: PMC10376695 DOI: 10.3389/fonc.2023.1193174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 06/30/2023] [Indexed: 08/01/2023] Open
Abstract
Objective The addition of cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) to endocrine therapy impressively improved the outcome of patients with hormone receptor-positive metastatic breast cancer. Despite their great efficacy, not all patients respond to treatment and many of them develop acquired resistance. The aim of this retrospective study was to assess the role of [18F]-FDG PET/CT in predicting PFS and OS in breast cancer patients treated with CDK4/6i. Methods 114 patients who performed an [18F]-FDG PET/CT scan before (PET1) and 2-6 months (PET2) after starting treatment were retrospectively enrolled. Metabolic response was evaluated by EORTC, PERCIST and Deauville Score and correlated to PFS and OS. Results In patients who did not progress at PET2 (n = 90), PFS rates were not significantly different between classes of response by EORTC and PERCIST. Conversely, patients showing a Deauville score ≤3 had a longer PFS (median PFS 42 vs 21.0 months; p = 0.008). A higher total metabolic tumor volume at PET1 (TMTV1) was also associated with a shorter PFS (median 18 vs 42 months; p = 0.0026). TMTV1 and Deauville score were the only independent prognostic factors for PFS at multivariate analysis and their combination stratified the population in four definite classes of relapse risk. Conversely, the above parameters did not affect OS which was only influenced by a progressive metabolic disease at PET2 (3-years survival rate 29.8 vs 84.9%; p<0.0001). Conclusion TMTV and metabolic response by Deauville score were significant prognostic factors for PFS in patients with breast cancer treated with CDK4/6i. Their determination could help physicians to select patients who may need a closer follow up.
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Affiliation(s)
- Alessio Annovazzi
- Nuclear Medicine Unit – IRCCS, Regina Elena National Cancer Institute, Rome, Italy
| | - Sandra Rea
- Nuclear Medicine Unit – IRCCS, Regina Elena National Cancer Institute, Rome, Italy
| | - Daria Maccora
- Nuclear Medicine Unit – IRCCS, Regina Elena National Cancer Institute, Rome, Italy
| | - Laura Pizzuti
- Division of Medical Oncology 2 – IRCCS, Regina Elena National Cancer Institute, Rome, Italy
| | - Gianluigi Ferretti
- Division of Medical Oncology 1 – IRCCS, Regina Elena National Cancer Institute, Rome, Italy
| | - Patrizia Vici
- Phase IV Clinical Trial Unit – IRCCS, Regina Elena National Cancer Institute, Rome, Italy
| | - Federico Cappuzzo
- Division of Medical Oncology 2 – IRCCS, Regina Elena National Cancer Institute, Rome, Italy
| | - Rosa Sciuto
- Nuclear Medicine Unit – IRCCS, Regina Elena National Cancer Institute, Rome, Italy
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10
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Fabbri A, Nelli F, Botticelli A, Giannarelli D, Marrucci E, Fiore C, Virtuoso A, Scagnoli S, Pisegna S, Alesini D, Sini V, Orlandi A, Fabi A, Piacentini F, Moscetti L, D’Auria G, Gamucci T, Mazzotta M, Pizzuti L, Vici P, Cretella E, Scavina P, La Cesa A, Persano M, Atzori F, Ruggeri EM. Pathologic response and survival after neoadjuvant chemotherapy with or without pertuzumab in patients with HER2-positive breast cancer: the Neopearl nationwide collaborative study. Front Oncol 2023; 13:1177681. [PMID: 37441419 PMCID: PMC10335743 DOI: 10.3389/fonc.2023.1177681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/05/2023] [Indexed: 07/15/2023] Open
Abstract
Purpose Clinical trials have shown a significant increase in pathologic complete response (pCR) with the addition of pertuzumab to neoadjuvant chemotherapy for patients with early-stage HER-2 positive breast cancer. To date, limited studies have examined comparative outcomes of neoadjuvant pertuzumab in real-world setting. The Neopearl study aimed to assess comparative real-life efficacy and safety of neoadjuvant pertuzumab for these patients. Methods We conducted a nationwide retrospective analysis involving 17 oncology facilities with a certified multidisciplinary breast cancer treatment committee. We identified patients with HER-2 positive stage II-III breast cancer treated with neoadjuvant chemotherapy based on trastuzumab and taxanes with or without pertuzumab. All patients underwent breast surgery and received a comprehensive cardiologic evaluation at baseline and after neoadjuvant treatment. Patients who received the combination of pertuzumab, trastuzumab, and chemotherapy constituted case cohort (PTCT), whereas those treated with trastuzumab and chemotherapy accounted for control cohort (TCT). The pCR rate and 5-year event free survival (EFS) were the primary outcomes. Secondary end-points were rates of conversion from planned modified radical mastectomy (MRM) to breast conservation surgery (BCS) and cardiotoxicities. Results From March 2014 to April 2021, we included 271 patients, 134 (49%) and 137 (51%) in TCT and PTCT cohort, respectively. Positive axillary lymph nodes and stage III were more frequent in PTCT cohort. The pCR rate was significantly increased in patients who received pertuzumab (49% vs 62%; OR 1.74, 95%CI 1.04-2.89) and with HER-2 enriched subtypes (16% vs 85%; OR 2.94, 95%CI 1.60-5.41). After a median follow-up of 5 years, the 5-year EFS was significantly prolonged only in patients treated with pertuzumab (81% vs 93%; HR 2.22, 95%CI 1.03-4.79). The same analysis performed on propensity score matched population showed concordant results. On univariate analysis, only patients with positive lymph nodes were found to benefit from pertuzumab for both pCR and 5-year EFS. The rates of conversion from MRM to BCS and cardiologic toxicities did not differ between the cohorts. Conclusion Our findings support previous data on improved outcomes with the addition of pertuzumab to trastuzumab-based neoadjuvant chemotherapy. This benefit seems to be more significant in patients with clinically positive lymph nodes.
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Affiliation(s)
- Agnese Fabbri
- Department of Oncology and Hematology, Medical Oncology and Breast Unit, Central Hospital of Belcolle, Viterbo, Italy
| | - Fabrizio Nelli
- Department of Oncology and Hematology, Medical Oncology and Breast Unit, Central Hospital of Belcolle, Viterbo, Italy
| | - Andrea Botticelli
- Department of Radiological, Oncological and Pathological Science, Sapienza University of Rome, Rome, Italy
| | - Diana Giannarelli
- Biostatistics Unit, Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Eleonora Marrucci
- Department of Oncology and Hematology, Medical Oncology and Breast Unit, Central Hospital of Belcolle, Viterbo, Italy
| | - Cristina Fiore
- Department of Oncology and Hematology, Medical Oncology and Breast Unit, Central Hospital of Belcolle, Viterbo, Italy
| | - Antonella Virtuoso
- Department of Oncology and Hematology, Medical Oncology and Breast Unit, Central Hospital of Belcolle, Viterbo, Italy
| | - Simone Scagnoli
- Department of Radiological, Oncological and Pathological Science, Sapienza University of Rome, Rome, Italy
| | - Simona Pisegna
- Department of Radiological, Oncological and Pathological Science, Sapienza University of Rome, Rome, Italy
| | - Daniele Alesini
- UOSD Centro Oncologico S. Spirito e Nuovo Regina Margherita (SS-NRM), Ospedale Santo Spirito in Sassia, Rome, Italy
| | - Valentina Sini
- UOSD Centro Oncologico S. Spirito e Nuovo Regina Margherita (SS-NRM), Ospedale Santo Spirito in Sassia, Rome, Italy
| | - Armando Orlandi
- Department of Medical Oncology, Comprehensive Cancer Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessandra Fabi
- Precision Medicine Breast Unit, Scientific Directorate, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Federico Piacentini
- Department of Medical Oncology, University Hospital of Modena, Modena, Italy
| | - Luca Moscetti
- Department of Medical Oncology, University Hospital of Modena, Modena, Italy
| | - Giuliana D’Auria
- Department of Medical Oncology, Medical Oncology Unit, Sandro Pertini Hospital, Rome, Italy
| | - Teresa Gamucci
- Department of Medical Oncology, Medical Oncology Unit, Sandro Pertini Hospital, Rome, Italy
| | - Marco Mazzotta
- Department of Medical Oncology, Medical Oncology Unit, Sandro Pertini Hospital, Rome, Italy
| | - Laura Pizzuti
- UOSD Sperimentazioni di fase IV, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Patrizia Vici
- UOSD Sperimentazioni di fase IV, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Elisabetta Cretella
- Department of Medical Oncology, Medical Oncology Unit, Ospedale Di Bolzano, Azienda Sanitaria Alto Adige, Bolzano, Italy
| | - Paola Scavina
- Department of Medical Oncology, Medical Oncology Unit, San Giovanni Addolorata Hospital, Rome, Italy
| | - Annalisa La Cesa
- Department of Medical Oncology, Campus Bio-Medico University, Rome, Italy
| | - Mara Persano
- Department of Medical Oncology, University Hospital and University of Cagliari, Cagliari, Italy
| | - Francesco Atzori
- Department of Medical Oncology, University Hospital and University of Cagliari, Cagliari, Italy
| | - Enzo Maria Ruggeri
- Department of Oncology and Hematology, Medical Oncology and Breast Unit, Central Hospital of Belcolle, Viterbo, Italy
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11
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Di Lisa FS, Krasniqi E, Pizzuti L, Barba M, Cannita K, De Giorgi U, Borella F, Foglietta J, Cariello A, Ferro A, Picardo E, Mitidieri M, Sini V, Stani S, Tonini G, Santini D, La Verde N, Gambaro AR, Grassadonia A, Tinari N, Garrone O, Sarobba G, Livi L, Meattini I, D’Auria G, Vergati M, Gamucci T, Pistelli M, Berardi R, Risi E, Giotta F, Lorusso V, Rinaldi L, Artale S, Cazzaniga ME, Zustovich F, Cappuzzo F, Landi L, Torrisi R, Scagnoli S, Botticelli A, Michelotti A, Fratini B, Saltarelli R, Paris I, Muratore M, Cassano A, Gianni L, Gaspari V, Veltri EM, Zoratto F, Fiorio E, Fabbri MA, Mazzotta M, Ruggeri EM, Pedersini R, Valerio MR, Filomeno L, Minelli M, Scavina P, Raffaele M, Astone A, De Vita R, Pozzi M, Riccardi F, Greco F, Moscetti L, Giordano M, Maugeri-Saccà M, Zennaro A, Botti C, Pelle F, Cappelli S, Cavicchi F, Vizza E, Sanguineti G, Tomao F, Cortesi E, Marchetti P, Tomao S, Speranza I, Sperduti I, Ciliberto G, Vici P. Adjuvant capecitabine in triple negative breast cancer patients with residual disease after neoadjuvant treatment: real-world evidence from CaRe, a multicentric, observational study. Front Oncol 2023; 13:1152123. [PMID: 37260975 PMCID: PMC10227592 DOI: 10.3389/fonc.2023.1152123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/26/2023] [Indexed: 06/02/2023] Open
Abstract
Background In triple negative breast cancer patients treated with neoadjuvant chemotherapy, residual disease at surgery is the most relevant unfavorable prognostic factor. Current guidelines consider the use of adjuvant capecitabine, based on the results of the randomized CREATE-X study, carried out in Asian patients and including a small subset of triple negative tumors. Thus far, evidence on Caucasian patients is limited, and no real-world data are available. Methods We carried out a multicenter, observational study, involving 44 oncologic centres. Triple negative breast cancer patients with residual disease, treated with adjuvant capecitabine from January 2017 through June 2021, were recruited. We primarily focused on treatment tolerability, with toxicity being reported as potential cause of treatment discontinuation. Secondarily, we assessed effectiveness in the overall study population and in a subset having a minimum follow-up of 2 years. Results Overall, 270 patients were retrospectively identified. The 50.4% of the patients had residual node positive disease, 7.8% and 81.9% had large or G3 residual tumor, respectively, and 80.4% a Ki-67 >20%. Toxicity-related treatment discontinuation was observed only in 10.4% of the patients. In the whole population, at a median follow-up of 15 months, 2-year disease-free survival was 62%, 2 and 3-year overall survival 84.0% and 76.2%, respectively. In 129 patients with a median follow-up of 25 months, 2-year disease-free survival was 43.4%, 2 and 3-year overall survival 78.0% and 70.8%, respectively. Six or more cycles of capecitabine were associated with more favourable outcomes compared with less than six cycles. Conclusion The CaRe study shows an unexpectedly good tolerance of adjuvant capecitabine in a real-world setting, although effectiveness appears to be lower than that observed in the CREATE-X study. Methodological differences between the two studies impose significant limits to comparability concerning effectiveness, and strongly invite further research.
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Affiliation(s)
| | - Eriseld Krasniqi
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Laura Pizzuti
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Maddalena Barba
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Katia Cannita
- Oncology Division, Mazzini Hospital, ASL Teramo, Teramo, Italy
| | - Ugo De Giorgi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
| | - Fulvio Borella
- Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, Sant' Anna Hospital, University of Turin, Turin, Italy
| | | | | | | | - Elisa Picardo
- Gynecology and Obstetrics 4, Department of Surgical Sciences, City of Health and Science, Sant' Anna Hospital, University of Turin, Turin, Italy
| | - Marco Mitidieri
- Gynecology and Obstetrics 4, Department of Surgical Sciences, City of Health and Science, Sant' Anna Hospital, University of Turin, Turin, Italy
| | | | | | - Giuseppe Tonini
- Department of Medical Oncology, Fondazione Policlinico Universitario Campus Biomedico, Rome, Italy
| | - Daniele Santini
- Medical Oncology A, Policlinico Umberto I, Department of Radiological, Oncological and Anatomo-Pathological Sciences, “Sapienza” University of Rome, Rome, Italy
| | - Nicla La Verde
- Department of Oncology, Ospedale Luigi Sacco, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Anna Rita Gambaro
- Department of Oncology, Ospedale Luigi Sacco, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Antonino Grassadonia
- Department of Innovative Technologies in Medicine and Dentistry and Centre for Advanced Studies and Technology (CAST), G. D’Annunzio University, Chieti, Italy
| | - Nicola Tinari
- Department of Medical, Oral and Biotechnological Sciences and Center for Advanced Studies and Technology (CAST), G. D’Annunzio University, Chieti, Italy
| | - Ornella Garrone
- Medical Oncology, Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico Milano, Milan, Italy
| | | | - Lorenzo Livi
- Department of Biomedical, Experimental and Clinical Sciences “M. Serio”, University of Florence, Florence, Italy
- Radiotherapy Unit, Oncology Department, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Icro Meattini
- Department of Biomedical, Experimental and Clinical Sciences “M. Serio”, University of Florence, Florence, Italy
- Radiotherapy Unit, Oncology Department, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | | | - Matteo Vergati
- UOC of Medical Oncology, Sandro Pertini Hospital, Rome, Italy
| | - Teresa Gamucci
- UOC of Medical Oncology, Sandro Pertini Hospital, Rome, Italy
| | - Mirco Pistelli
- Oncology Clinic, Università Politecnica delle Marche, Ospedali Riuniti Hospital, Ancona, Italy
| | - Rossana Berardi
- Oncology Clinic, Università Politecnica delle Marche, Ospedali Riuniti Hospital, Ancona, Italy
| | - Emanuela Risi
- Sandro Pitigliani Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - Francesco Giotta
- Department of Medical Oncology, IRCCS Giovanni Paolo II Institute, Bari, Italy
| | - Vito Lorusso
- Department of Medical Oncology, IRCCS Giovanni Paolo II Institute, Bari, Italy
| | - Lucia Rinaldi
- “Don Tonino Bello” Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari, Italy
| | - Salvatore Artale
- Oncology Department, Ospedale di Gallarate, ASST Valle Olona, Gallarate, Italy
| | - Marina Elena Cazzaniga
- Phase 1 Research Centre and Oncology Unit, Department of Medicine and Surgery, University of Milano-Bicocca, ASST Monza, Monza, Italy
- Oncology Unit, ASST Monza, Monza, Italy
| | - Fable Zustovich
- Oncology Division, AULSS 1 Dolomiti, San Martino Medical Hospital, Belluno, Italy
| | - Federico Cappuzzo
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Lorenza Landi
- Phase I Clinical Studies Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Rosalba Torrisi
- Department of Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Simone Scagnoli
- Department of Medical and Surgical Sciences and Translational Medicine, “Sapienza” University of Rome, Rome, Italy
| | - Andrea Botticelli
- Medical Oncology A, Policlinico Umberto I, Department of Radiological, Oncological and Anatomo-Pathological Sciences, “Sapienza” University of Rome, Rome, Italy
| | - Andrea Michelotti
- UO Medical Oncology I, S. Chiara Hospital, Pisa University Hospital, Pisa, Italy
| | - Beatrice Fratini
- UO Medical Oncology I, S. Chiara Hospital, Pisa University Hospital, Pisa, Italy
| | - Rosa Saltarelli
- Oncology Division, San Giovanni Evangelista Hospital, ASL RM5, Rome, Italy
| | - Ida Paris
- Division of Gynecologic Oncology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Margherita Muratore
- Division of Gynecologic Oncology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Alessandra Cassano
- Medical Oncology, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Lorenzo Gianni
- Oncology Unit Rimini, Azienda USL Romagna, Rimini, Italy
| | | | | | - Federica Zoratto
- Medical Oncology Unit, Santa Maria Goretti Hospital, Latina, Italy
| | - Elena Fiorio
- Pathology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Marco Mazzotta
- Medical Oncology Unit, Belcolle Hospital, Viterbo, Italy
| | | | | | - Maria Rosaria Valerio
- Medical Oncology, Azienda Ospedaliera Universitaria Policlinico Paolo Giaccone, Palermo, Italy
| | - Lorena Filomeno
- Phase IV Clinical Studies Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Mauro Minelli
- Division of Oncology, San Giovanni Hospital, Rome, Italy
| | - Paola Scavina
- Division of Oncology, San Giovanni Hospital, Rome, Italy
| | - Mimma Raffaele
- Presidio Oncologico Cassia – S. Andrea, ASL Roma 1, Rome, Italy
| | - Antonio Astone
- Oncology Division, San Pietro Fatebenefratelli Hospital, Rome, Italy
| | - Roy De Vita
- Department of Plastic and Reconstructive Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Marcello Pozzi
- Department of Plastic and Reconstructive Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | - Filippo Greco
- Medical Oncology Unit, AULSS 9 Regione Veneto, Scaligera - Ospedale Generale Mater Salutis, Legnago, Italy
| | - Luca Moscetti
- Division of Medical Oncology, Department of Oncology-Hematology, University Hospital of Modena, Modena, Italy
| | | | - Marcello Maugeri-Saccà
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
- Clinical Trial Center, Biostatistics and Bioinformatics, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Alessandro Zennaro
- Clinical Trial Center, Biostatistics and Bioinformatics, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Claudio Botti
- Department of Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Fabio Pelle
- Department of Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Sonia Cappelli
- Department of Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Flavia Cavicchi
- Department of Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Enrico Vizza
- Gynecologic Oncology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppe Sanguineti
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Federica Tomao
- Department of Maternal and Child Health and Urological Sciences, “Sapienza” University of Rome, Policlinico Umberto I, Rome, Italy
| | - Enrico Cortesi
- Medical Oncology B, Policlinico Umberto I, Department of Radiological, Oncological and Pathological Sciences, “Sapienza” University of Rome, Rome, Italy
| | - Paolo Marchetti
- Scientific Direction, IRCCS IDI, Istituto Dermopatico dell'Immacolata, Rome, Italy
| | - Silverio Tomao
- Department of Radiological, Oncological and Pathological Sciences, “Sapienza” University of Rome, Rome, Italy
| | - Iolanda Speranza
- Medical Oncology A, Policlinico Umberto I, Department of Radiological, Oncological and Anatomo-Pathological Sciences, “Sapienza” University of Rome, Rome, Italy
| | - Isabella Sperduti
- Clinical Trial Center, Biostatistics and Bioinformatics, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Gennaro Ciliberto
- Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Patrizia Vici
- Phase IV Clinical Studies Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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12
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Vizza R, Capomolla EM, Tosetto L, Corrado G, Bruno V, Chiofalo B, Di Lisa FS, Filomeno L, Pizzuti L, Krasniqi E, Sanguineti G, Villa A, Giannini A, Kayal R, Stranges V, Tomao S, Botti C, Tomao F, Barba M, Vizza E, Ciliberto G, Vici P. Sexual dysfunctions in breast cancer patients: evidence in context. Sex Med Rev 2023:7128131. [PMID: 37076125 DOI: 10.1093/sxmrev/qead006] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 04/21/2023]
Abstract
INTRODUCTION In breast cancer patients, endocrine therapy may exert a negative impact on sexual functioning in both genders, with potentially relevant consequences concerning quality of life and treatment adherence. The availability of effective interventions to maintain and/or restore sexual health in breast cancer patients is a key issue to a research agenda. OBJECTIVES To summarize and critically discuss the most updated and qualitatively relevant literature on the therapeutic approach to sexual impairment in breast cancer patients, with a focus on patients treated with endocrine therapy. METHODS We searched PubMed from its inception to February 2022 for observational and intervention trials including participants with sexual dysfunctions. We were particularly interested in studies of breast cancer patients with sexual dysfunctions while undergoing endocrine therapy. We developed a search strategy with the aim of maximizing the number of articles considered for screening and potential inclusion. RESULTS Forty-five studies were selected: 3 observational and 42 intervention studies. Thirty-five studies were exclusively focused on female breast cancer populations. We could not identify studies exclusively focused on or also including male breast cancer patients. Overall, in female patients, the available armamentarium encompasses vaginal lubricants, moisturizers, estrogens, dehydroepiandrosterone, CO2 laser, ospemifene, and counseling. None of these interventions has been demonstrated to completely solve sexual dysfunctions when singularly considered. More favorable outcomes have come from the combination of different therapies. CONCLUSION In female breast cancer, future research is oriented toward the gain of evidence on combined therapies and long-term data on safety issues on the most promising interventions. The lack of evidence on sexual disturbances in male breast cancer patients remains a major concern.
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Affiliation(s)
| | | | - Livia Tosetto
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome 00144, Italy
| | - Giacomo Corrado
- Department of Woman and Child Health and Public Health, Woman Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
| | - Valentina Bruno
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome 00144, Italy
| | - Benito Chiofalo
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome 00144, Italy
| | - Francesca Sofia Di Lisa
- Phase IV Clinical Studies Unit, IRCCS Regina Elena National Cancer Institute, Rome 00144, Italy
| | - Lorena Filomeno
- Phase IV Clinical Studies Unit, IRCCS Regina Elena National Cancer Institute, Rome 00144, Italy
| | - Laura Pizzuti
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome 00144, Italy
| | - Eriseld Krasniqi
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome 00144, Italy
| | - Giuseppe Sanguineti
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome 00144, Italy
| | - Alice Villa
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome 00161, Italy
| | - Andrea Giannini
- Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea University Hospital, "Sapienza" University of Rome, Rome 00189, Italy
| | - Ramy Kayal
- Department of Radiology and Diagnostic Imaging, IRCCS Regina Elena National Cancer Institute, Rome 00144, Italy
| | | | - Silverio Tomao
- Department of Radiological, Oncological and Anatomo-pathological Sciences, "Sapienza" University of Rome, Rome 00161, Italy
| | - Claudio Botti
- Department of Surgery, IRCCS Regina Elena National Cancer Institute, Rome 00144, Italy
| | - Federica Tomao
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome, Rome 00161, Italy
| | - Maddalena Barba
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome 00144, Italy
| | - Enrico Vizza
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome 00144, Italy
| | - Gennaro Ciliberto
- Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome 00144, Italy
| | - Patrizia Vici
- Phase IV Clinical Studies Unit, IRCCS Regina Elena National Cancer Institute, Rome 00144, Italy
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13
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Bucchi L, Ravaioli A, Dal Maso L, Falcini F, Mangone L, Massarut S, Schirosi L, Crispo A, Vici P, Franceschi S. De-Implementation of Axillary Staging and Radiotherapy in Low-Risk Breast Cancer Patients Aged 70-79 Years from Six Italian Cancer Institutes. Curr Oncol 2023; 30:4177-4184. [PMID: 37185431 PMCID: PMC10137373 DOI: 10.3390/curroncol30040318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/05/2023] [Accepted: 04/07/2023] [Indexed: 05/17/2023] Open
Abstract
In women aged ≥70 with low-risk breast cancer (BrC), some major international guidelines recommend against sentinel lymph node biopsy (for example, those from the Society of Surgical Oncology, U.S.) and post-lumpectomy radiotherapy (for example, those from the National Comprehensive Cancer Network, U.S.). We assessed the frequency of both procedures in six National Cancer Institutes (IRCCSs) in the North, the Centre, and the South of Italy. Data on tumour characteristics and treatment were obtained from each centre. Patients aged 70-79 years diagnosed with a pT1-pT2, clinically axillary lymph node-negative, oestrogen and/or progesterone receptor-positive, and human epidermal growth factor receptor 2-negative BrC between 2015 and 2020 were eligible for the study. Factors associated with the omission of the two procedures were evaluated using binary penalised logistic regression models. Axillary staging was omitted in 33/1000 (3.3%) women. After simultaneous adjustment for the centre of treatment and all other key variables, axillary staging was omitted more often in 2015-2016 vs. 2017-2020 (odds ratio (OR): 2.7; 95% CI: 1.0-7.5), in women aged 75-79 vs. 70-74 years (OR: 2.3; 95% CI: 1.1-4.9), and in those who had mastectomy vs. breast-conserving surgery (OR: 3.3; 95% CI: 1.2-9.0). The higher the histological grade was, the less frequent were the omissions (OR for grade 3 vs. grade 1: 0.2; 95% CI: 0.0-0.7). Post-lumpectomy radiotherapy was omitted in 56/651 (8.6%) women with no significant association with age, period, tumour stage, and tumour grade. In conclusion, the omission of axillary staging and post-lumpectomy radiotherapy in low-risk older BrC patients was rare in the Italian IRCCSs. Although women included in the study cannot be considered a nationally representative sample of BrC patients in Italy, our findings can serve as a baseline to monitor the impact of future guidelines. To do that, the recording and storage of hospital-based information should be improved.
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Affiliation(s)
- Lauro Bucchi
- Emilia-Romagna Cancer Registry, Romagna Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, 47014 Meldola, Forlì, Italy
| | - Alessandra Ravaioli
- Emilia-Romagna Cancer Registry, Romagna Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, 47014 Meldola, Forlì, Italy
| | - Luigino Dal Maso
- SOC Epidemiologia Oncologica, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy
| | - Fabio Falcini
- Emilia-Romagna Cancer Registry, Romagna Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, 47014 Meldola, Forlì, Italy
| | - Lucia Mangone
- Epidemiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy
| | - Samuele Massarut
- SOC di Chirurgia Oncologica del Seno, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy
| | - Laura Schirosi
- U.O.C. Anatomia Patologica, IRCCS Istituto Tumori "Giovanni Paolo II", 70124 Bari, Italy
| | - Anna Crispo
- SOC Epidemiologia e Biostatistica, Istituto Nazionale dei Tumori-IRCCS Fondazione G. Pascale, 80131 Napoli, Italy
| | - Patrizia Vici
- UOSD Sperimentazioni di FASE IV, IRCCS Istituto Nazionale Tumori Regina Elena, 00128 Roma, Italy
| | - Silvia Franceschi
- Direzione Scientifica, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy
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14
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Scalera S, Ricciuti B, Mazzotta M, Calonaci N, Alessi JV, Cipriani L, Bon G, Messina B, Lamberti G, Di Federico A, Pecci F, Milite S, Krasniqi E, Barba M, Vici P, Vecchione A, De Nicola F, Ciuffreda L, Goeman F, Fanciulli M, Buglioni S, Pescarmona E, Sharma B, Felt KD, Lindsay J, Rodig SJ, De Maria R, Caravagna G, Cappuzzo F, Ciliberto G, Awad MM, Maugeri-Saccà M. Clonal KEAP1 mutations with loss of heterozygosity share reduced immunotherapy efficacy and low immune cell infiltration in lung adenocarcinoma. Ann Oncol 2023; 34:275-288. [PMID: 36526124 DOI: 10.1016/j.annonc.2022.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/26/2022] [Accepted: 12/06/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND KEAP1 mutations have been associated with reduced survival in lung adenocarcinoma (LUAD) patients treated with immune checkpoint inhibitors (ICIs), particularly in the presence of STK11/KRAS alterations. We hypothesized that, beyond co-occurring genomic events, clonality prediction may help identify deleterious KEAP1 mutations and their counterparts with retained sensitivity to ICIs. PATIENTS AND METHODS Beta-binomial modelling of sequencing read counts was used to infer KEAP1 clonal inactivation by combined somatic mutation and loss of heterozygosity (KEAP1 C-LOH) versus partial inactivation [KEAP1 clonal diploid-subclonal (KEAP1 CD-SC)] in the Memorial Sloan Kettering Cancer Center (MSK) MetTropism cohort (N = 2550). Clonality/LOH prediction was compared to a streamlined clinical classifier that relies on variant allele frequencies (VAFs) and tumor purity (TP) (VAF/TP ratio). The impact of this classification on survival outcomes was tested in two independent cohorts of LUAD patients treated with immunotherapy (MSK/Rome N = 237; DFCI N = 461). Immune-related features were studied by exploiting RNA-sequencing data (TCGA) and multiplexed immunofluorescence (DFCI mIF cohort). RESULTS Clonality/LOH inference in the MSK MetTropism cohort overlapped with a clinical classification model defined by the VAF/TP ratio. In the ICI-treated MSK/Rome discovery cohort, predicted KEAP1 C-LOH mutations were associated with shorter progression-free survival (PFS) and overall survival (OS) compared to KEAP1 wild-type cases (PFS log-rank P = 0.001; OS log-rank P < 0.001). Similar results were obtained in the DFCI validation cohort (PFS log-rank P = 0.006; OS log-rank P = 0.014). In both cohorts, we did not observe any significant difference in survival outcomes when comparing KEAP1 CD-SC and wild-type tumors. Immune deconvolution and multiplexed immunofluorescence revealed that KEAP1 C-LOH and KEAP1 CD-SC differed for immune-related features. CONCLUSIONS KEAP1 C-LOH mutations are associated with an immune-excluded phenotype and worse clinical outcomes among advanced LUAD patients treated with ICIs. By contrast, survival outcomes of patients whose tumors harbored KEAP1 CD-SC mutations were similar to those with KEAP1 wild-type LUADs.
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Affiliation(s)
- S Scalera
- SAFU Laboratory, Department of Research, Advanced Diagnostic, and Technological Innovation, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - B Ricciuti
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - M Mazzotta
- Medical Oncology Unit, Sandro Pertini Hospital, Rome, Italy
| | - N Calonaci
- Department of Mathematics and Geosciences, University of Trieste, Trieste, Italy
| | - J V Alessi
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - L Cipriani
- SAFU Laboratory, Department of Research, Advanced Diagnostic, and Technological Innovation, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - G Bon
- Cellular Network and Molecular Therapeutic Target Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - B Messina
- Clinical Trial Center, Biostatistics and Bioinformatics Division, IRCCS Regina Elena National Cancer Institute, Roma, Italy
| | - G Lamberti
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - A Di Federico
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - F Pecci
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - S Milite
- Department of Mathematics and Geosciences, University of Trieste, Trieste, Italy
| | - E Krasniqi
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - M Barba
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - P Vici
- UOSD Phase IV Studies, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - A Vecchione
- Department of Clinical and Molecular Medicine, Pathology Unit, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - F De Nicola
- SAFU Laboratory, Department of Research, Advanced Diagnostic, and Technological Innovation, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - L Ciuffreda
- SAFU Laboratory, Department of Research, Advanced Diagnostic, and Technological Innovation, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - F Goeman
- SAFU Laboratory, Department of Research, Advanced Diagnostic, and Technological Innovation, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - M Fanciulli
- SAFU Laboratory, Department of Research, Advanced Diagnostic, and Technological Innovation, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - S Buglioni
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - E Pescarmona
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - B Sharma
- ImmunoProfile, Brigham & Women's Hospital and Dana-Farber Cancer Institute, Boston, USA
| | - K D Felt
- ImmunoProfile, Brigham & Women's Hospital and Dana-Farber Cancer Institute, Boston, USA
| | - J Lindsay
- Knowledge Systems Group, Dana-Farber Cancer Institute, Boston, USA
| | - S J Rodig
- ImmunoProfile, Brigham & Women's Hospital and Dana-Farber Cancer Institute, Boston, USA; Department of Pathology, Brigham and Women's Hospital, Boston, USA
| | - R De Maria
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy; Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - G Caravagna
- Department of Mathematics and Geosciences, University of Trieste, Trieste, Italy
| | - F Cappuzzo
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - G Ciliberto
- Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - M M Awad
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - M Maugeri-Saccà
- Clinical Trial Center, Biostatistics and Bioinformatics Division, IRCCS Regina Elena National Cancer Institute, Roma, Italy; Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy.
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15
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Farneti A, Bottero M, Faiella A, Giannarelli D, Bertini L, Landoni V, Vici P, D’Urso P, Sanguineti G. The Prognostic Value of DCE-MRI Findings before Salvage Radiotherapy after Radical Prostatectomy. Cancers (Basel) 2023; 15:cancers15041246. [PMID: 36831588 PMCID: PMC9954112 DOI: 10.3390/cancers15041246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/06/2023] [Accepted: 02/09/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND To investigate the predictive role of dynamic contrast-enhanced-magnetic resonance imaging (DCE-MRI) findings before salvage radiotherapy after radical prostatectomy (RP). METHODS This retrospective study selected patients with biochemical failure (BF) after RP restaged with DCE-MRI. Patients underwent sRT in 30 fractions delivering 66-69 Gy and 73.5 Gy to the prostatic fossa and to the local failure as per DCE-MRI, respectively. Pelvic nodes were treated to 54 Gy in selected patients. The endpoint was BF after sRT. RESULTS In total, 236 patients were analyzed and 146 (61.9%) had presumed local failure at DCE-MRI: 54.8%, 23.8% and 21.4% were found at the vesico-urethral anastomosis (VUA), the bladder neck and the retro-vesical space, respectively. The presence of a local failure at DCE-MRI halved the risk of BF; VUA-only location and lesion volume were independently correlated with survival without evidence of biochemical failure (bNED) at multivariable analysis. For patients with VUA-only disease up to 0.4 cc, the 4-year-bNED was 94.6% (95%CI: 80.2-98.6%) as opposed to 80.9% (95%CI: 71.6-87.4%) and 73.7% (95%CI: 63.1-81.8%) for other lesions and no macrodisease, respectively. CONCLUSIONS DCE-MRI at restaging for BF after RP provides predictive and therapeutic information. Patients with small lesions at the VUA have an excellent prognosis after sRT.
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Affiliation(s)
- Alessia Farneti
- Radiation Oncology, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Marta Bottero
- Radiation Oncology, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Adriana Faiella
- Radiation Oncology, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Diana Giannarelli
- Biostatistics, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Luca Bertini
- Radiology, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Valeria Landoni
- Physics, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Patrizia Vici
- Phase IV Studies, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Pasqualina D’Urso
- Radiation Oncology, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Giuseppe Sanguineti
- Radiation Oncology, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
- Correspondence:
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16
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Loria R, Vici P, Di Lisa FS, Soddu S, Maugeri-Saccà M, Bon G. Corrigendum: Cross-resistance among sequential cancer therapeutics: An emerging issue. Front Oncol 2022; 12:1063651. [PMID: 36387137 PMCID: PMC9662166 DOI: 10.3389/fonc.2022.1063651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 10/21/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Rossella Loria
- Cellular Network and Molecular Therapeutic Target Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Patrizia Vici
- Unit of Phase IV Trials, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Francesca Sofia Di Lisa
- Unit of Phase IV Trials, IRCCS Regina Elena National Cancer Institute, Rome, Italy
- Medical Oncology A, Department of Radiological, Oncological, and Anatomo-Pathological Sciences, Umberto I University Hospital, University Sapienza, Rome, Italy
| | - Silvia Soddu
- Cellular Network and Molecular Therapeutic Target Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Marcello Maugeri-Saccà
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giulia Bon
- Cellular Network and Molecular Therapeutic Target Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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Takanen S, Pinnarò P, Farina I, Sperati F, Botti C, Vici P, Soriani A, Marucci L, Sanguineti G. Stereotactic partial breast irradiation in primary breast cancer: A comprehensive review of the current status and future directions. Front Oncol 2022; 12:953810. [PMID: 36313648 PMCID: PMC9606691 DOI: 10.3389/fonc.2022.953810] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022] Open
Abstract
In selected low-risk breast cancer patients, accelerated partial breast irradiation (APBI) may represent an alternative option to the whole breast irradiation to reduce the volume of irradiated breast and total treatment duration. In the last few years, preliminary data from clinical trials showed that stereotactic partial breast radiotherapy may have the advantage to be less invasive compared to other APBI techniques, with preliminary good results in terms of local toxicity and cosmesis: the use of magnetic resonance, fiducial markers in the tumor bed, and new breast devices support both a precise definition of the target and radiation planning.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021257856, identifier CRD42021257856.
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Affiliation(s)
- Silvia Takanen
- Radiation Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
- *Correspondence: Silvia Takanen, ; Ilaria Farina,
| | - Paola Pinnarò
- Radiation Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
| | - Ilaria Farina
- Radiation Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
- *Correspondence: Silvia Takanen, ; Ilaria Farina,
| | - Francesca Sperati
- Biostatistics, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
| | - Claudio Botti
- Surgery, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
| | - Patrizia Vici
- Phase IV Studies, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
| | - Antonella Soriani
- Physics, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
| | - Laura Marucci
- Radiation Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppe Sanguineti
- Radiation Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
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Krasniqi E, Di Lisa FS, Di Benedetto A, Barba M, Pizzuti L, Filomeno L, Ercolani C, Tinari N, Grassadonia A, Santini D, Minelli M, Montemurro F, Fabbri MA, Mazzotta M, Gamucci T, D’Auria G, Botti C, Pelle F, Cavicchi F, Cappelli S, Cappuzzo F, Sanguineti G, Tomao S, Botticelli A, Marchetti P, Maugeri-Saccà M, De Maria R, Ciliberto G, Sperati F, Vici P. The Impact of the Hippo Pathway and Cell Metabolism on Pathological Complete Response in Locally Advanced Her2+ Breast Cancer: The TRISKELE Multicenter Prospective Study. Cancers (Basel) 2022; 14:cancers14194835. [PMID: 36230758 PMCID: PMC9563553 DOI: 10.3390/cancers14194835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 09/28/2022] [Indexed: 12/02/2022] Open
Abstract
The Hippo pathway and its two key effectors, Yes-associated protein (YAP) and transcriptional coactivator with PDZ-binding motif (TAZ), are consistently altered in breast cancer. Pivotal regulators of cell metabolism such as the AMP-activated protein kinase (AMPK), Stearoyl-CoA-desaturase 1 (SCD1), and HMG-CoA reductase (HMGCR) are relevant modulators of TAZ/YAP activity. In this prospective study, we measured the tumor expression of TAZ, YAP, AMPK, SCD1, and HMGCR by immunohistochemistry in 65 Her2+ breast cancer patients who underwent trastuzumab-based neoadjuvant treatment. The aim of the study was to assess the impact of the immunohistochemical expression of the Hippo pathway transducers and cell metabolism regulators on pathological complete response. Low expression of cytoplasmic TAZ, both alone and in the context of a composite signature identified by machine learning including also low nuclear levels of YAP and HMGCR and high cytoplasmic levels of SCD1, was a predictor of residual disease in the univariate logistic regression. This finding was not confirmed in the multivariate model including estrogen receptor > 70% and body mass index > 20. However, our findings were concordant with overall survival data from the TCGA cohort. Our results, possibly affected by the relatively small sample size of this study population, deserve further investigation in adequately sized, ad hoc prospective studies.
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Affiliation(s)
- Eriseld Krasniqi
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Francesca Sofia Di Lisa
- Phase IV Clinical Studies Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Anna Di Benedetto
- Pathology Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Maddalena Barba
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
- Correspondence: or (M.B.); (C.E.); Tel.: +39-0652666762 (M.B.); +39-0652666134 (C.E.)
| | - Laura Pizzuti
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Lorena Filomeno
- Phase IV Clinical Studies Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Cristiana Ercolani
- Pathology Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
- Correspondence: or (M.B.); (C.E.); Tel.: +39-0652666762 (M.B.); +39-0652666134 (C.E.)
| | - Nicola Tinari
- Department of Medical, Oral and Biotechnological Sciences, Center for Advanced Studies and Technology (CAST), G. D’Annunzio University, 66100 Chieti, Italy
| | - Antonino Grassadonia
- Department of Innovative Technologies in Medicine and Dentistry, Centre for Advanced Studies and Technology (CAST), G. D’Annunzio University, 66100 Chieti, Italy
| | - Daniele Santini
- “Sapienza” University of Rome, Polo Pontino, 04011 Aprilia, Italy
| | - Mauro Minelli
- Division of Oncology, San Giovanni Hospital, 00184 Rome, Italy
| | - Filippo Montemurro
- Breast Unit, Candiolo Cancer Institute, Fondazione del Piemonte per l’Oncologia-IRCCS (Istituti di Ricovero e Cura a Carattere Scientifico), 10060 Candiolo, Italy
| | | | - Marco Mazzotta
- Medical Oncology Unit, Belcolle Hospital, 01100 Viterbo, Italy
| | - Teresa Gamucci
- Medical Oncology, Sandro Pertini Hospital, 00157 Rome, Italy
| | | | - Claudio Botti
- Department of Surgery, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Fabio Pelle
- Department of Surgery, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Flavia Cavicchi
- Department of Surgery, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Sonia Cappelli
- Department of Surgery, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Federico Cappuzzo
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Giuseppe Sanguineti
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Silverio Tomao
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, “Sapienza” University of Rome, 00185 Rome, Italy
| | - Andrea Botticelli
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, “Sapienza” University of Rome, 00185 Rome, Italy
| | - Paolo Marchetti
- Istituto Dermopatico dell’Immacolata, IDI-IRCCS, 00167 Rome, Italy
| | - Marcello Maugeri-Saccà
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
- Clinical Trial Center, Biostatistics and Bioinformatics, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Ruggero De Maria
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Fondazione Policlinico Universitario “A. Gemelli”, IRCCS (Istituti di Ricovero e Cura a Carattere Scientifico), 00168 Rome, Italy
| | - Gennaro Ciliberto
- Scientific Direction, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Francesca Sperati
- Clinical Trial Center, Biostatistics and Bioinformatics, San Gallicano Dermatological Institute IRCCS, 00144 Rome, Italy
| | - Patrizia Vici
- Phase IV Clinical Studies Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
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De Laurentiis M, Caputo R, Mazza M, Mansutti M, Masetti R, Ballatore Z, Torrisi R, Michelotti A, Zambelli A, Ferro A, Generali D, Vici P, Coltelli L, Fabi A, Marchetti P, Ballestrero A, Spazzapan S, Frassoldati A, Sarobba MG, Grasso D, Zamagni C. Safety and Efficacy of Ribociclib in Combination with Letrozole in Patients with HR+, HER2- Advanced Breast Cancer: Results from the Italian Subpopulation of Phase 3b CompLEEment-1 Study. Target Oncol 2022; 17:615-625. [PMID: 36152144 DOI: 10.1007/s11523-022-00913-x] [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] [Accepted: 08/10/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Ribociclib plus letrozole demonstrated manageable safety and efficacy profiles in hormone receptor-positive (HR+), human epidermal growth factor receptor-2-negative (HER2-) advanced breast cancer (ABC) in the Phase 3b CompLEEment-1 trial. OBJECTIVE To evaluate the safety and efficacy of ribociclib plus letrozole in the Italian subpopulation with HR+, HER2- ABC from the CompLEEment-1 trial. PATIENTS AND METHODS Patients with HR+, HER2- ABC received ribociclib (600 mg/day, 3 weeks on/1 week off) plus letrozole (2.5 mg/day) while men and premenopausal women additionally received goserelin. Patients were allowed with ≤ 1 line of prior chemotherapy and an Eastern Cooperative Oncology Group performance status of ≤ 2. The primary outcome included safety and tolerability. RESULTS Of the 554 Italian patients, 246 (44.4 %) patients completed treatment. The reasons for treatment discontinuation included progressive disease (PD; 36.6 %), adverse events (AEs; 11.9 %), and death (1.6 %). All-grade AEs and grade ≥ 3 AEs occurred in 98.9 % and 77.8 % patients, respectively. The most common treatment-related AEs were neutropenia (73.6 %), followed by leukopenia (32.1 %), and nausea (25.3 %). The overall response rate was 28.2 % (95 % confidence interval [CI], 24.4-32.1); clinical benefit rate was 71.7 % (95 % CI, 67.7-75.4); and median time to progression was 26.7 months (95 % CI, 24.8-non-estimable). Health-related quality of life scores were maintained during treatment. CONCLUSION The safety and efficacy profiles of ribociclib plus letrozole in the Italian subpopulation was found to be consistent with the CompLEEment-1 global population result, MONALEESA-2, and MONALEESA-7 outcomes, which reaffirm ribociclib plus letrozole as the frontline treatment option in patients with HR+, HER2- ABC. TRIAL REGISTRATION NUMBER AND DATE OF REGISTRATION NCT02941926 (30 November 2016).
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Affiliation(s)
| | - Roberta Caputo
- Istituto Nazionale Tumori "Fondazione Pascale", Napoli, Italy
| | - Manuelita Mazza
- Senologia Medica, Istituto Europeo di Oncologia, Milano, Italy
| | - Mauro Mansutti
- Department of Oncology, Santa Maria della Misericordia hospital, Udine, Italy
| | - Riccardo Masetti
- Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Gemelli IRCSS, Roma, Italy
| | - Zelmira Ballatore
- Clinica Oncologica e Centro Regionale di Genetica Oncologica, AOU Ospedali Riuniti Ancona Università Politecnica delle Marche, Ancona, Italy
| | - Rosalba Torrisi
- Department of Medical Oncology, IRCCS-Humanitas Clinical and Research Hospital, Rozzano, Italy
| | - Andrea Michelotti
- U.O. Oncologia Medica I, Azienda Ospedaliera Universitaria Pisana, Ospedale S. Chiara, Pisa, Italy
| | | | | | - Daniele Generali
- U.O.C. Multidisciplinare di Patologia Mammaria, Istituti Ospitalieri di Cremona, ASST di Cremona, Cremona, Italy
| | - Patrizia Vici
- UOSD Sperimentazioni di fase IV, IRCCS Regina Elena National Cancer Institute, Roma, Italy
| | - Luigi Coltelli
- U.O.C. di Oncologia Medica, Presidio Ospedaliero Livorno, Livorno, Italy
| | - Alessandra Fabi
- Division of Medical Oncology 1, IRCCS Regina Elena National Cancer Institute, Roma, Italy
| | - Paolo Marchetti
- UOC Oncologia Medica, Azienda Ospedaliera St. Andrea, Rome, Italy
| | - Alberto Ballestrero
- Dipartimento di Medicina Interna DIMI, Ospedale Policlinico San Martino IRCCS, Genova, Italy
| | - Simon Spazzapan
- S.O.C. Oncologia Medica e Prevenzione Oncologica, Centro di Riferimento Oncologico IRCCS, Aviano, Italy
| | - Antonio Frassoldati
- U.O.C. Oncologia Clinica, Azienda Ospedaliero, Universitaria di Ferrara - Arcispedale Sant'Anna, Ferrara, Italy
| | | | | | - Claudio Zamagni
- Addarii Medical Oncology Unit IRCCS Azienda Ospedaliero-universitaria di Bologna, Bologna, Italy
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Botticelli A, Scagnoli S, Pisegna S, Toss A, Fabi A, Criscitiello C, D'Auria G, Fabbri M, Orlandi A, Barberi V, Caputo R, Vici P, Palleschi M, Santini D, Tomasello G, Ricevuto E, M. Simmaco, Preissner R, Cortesi E, Marchetti P. 267P AB-ITALY: The impact of drug-drug interaction on abemaciclib treatment in Italian real world experience. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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21
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Bottero M, Faiella A, Giannarelli D, Farneti A, D'Urso P, Bertini L, Landoni V, Vici P, Sanguineti G. A prospective study assessing the pattern of response of local disease at DCE-MRI after salvage radiotherapy for prostate cancer. Clin Transl Radiat Oncol 2022; 35:21-26. [PMID: 35516461 PMCID: PMC9065465 DOI: 10.1016/j.ctro.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/18/2022] [Accepted: 04/25/2022] [Indexed: 10/29/2022] Open
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22
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Canino F, Piacentini F, Omarini C, Toss A, Barbolini M, Vici P, Dominici M, Moscetti L. Role of Intrinsic Subtype Analysis with PAM50 in Hormone Receptors Positive HER2 Negative Metastatic Breast Cancer: A Systematic Review. Int J Mol Sci 2022; 23:ijms23137079. [PMID: 35806079 PMCID: PMC9266387 DOI: 10.3390/ijms23137079] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/19/2022] [Accepted: 06/22/2022] [Indexed: 02/04/2023] Open
Abstract
Endocrine therapy (ET), associated with CDK 4/6 inhibitors, represents the first choice of treatment for HR+/HER2- metastatic breast cancer (mBC). Primary or secondary endocrine resistance could develop; however validated biomarkers capable of predicting such a conditions are not available. Several studies have shown that HR+/HER2- mBC comprises five intrinsic subtypes. The purpose of this systematic review was to analyze the potential correlations between intrinsic subtype, efficacy of treatment, and patient outcome. Five papers that analyzed the intrinsic subtype with PAM50 assay in patients (pts) with HR+/HER2- mBC treated with ET (alone or in combination) within seven phase III clinical trials (EGF30008, BOLERO-2, PALOMA-2,3, MONALEESA-2,3,7) were identified. Non-luminal subtypes are more frequent in endocrine-resistant pts and in metastatic sites (vs. primary tumors), have less benefit from ET, and worse prognosis. Among these, HER2-enriched subtypes are similar to HER2+ tumors and benefit from the addition of anti-HER2 agents (lapatinib) and, for less clear reasons, of ribociclib (unconfirmed data for palbociclib and everolimus). Basal-like subtypes are similar to triple-negative tumors, making them more sensitive to chemotherapy. The intrinsic subtype is also not static but can vary over time with the evolution of the disease. Currently, the intrinsic subtype does not play a decisive role in the choice of treatment in clinical practice, but has potential prognostic and predictive value that should be further investigated.
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Affiliation(s)
- Fabio Canino
- Division of Medical Oncology, Department of Medical and Surgical Sciences for Children and Adults, University Hospital of Modena, 41125 Modena, Italy; (F.P.); (A.T.); (M.D.)
- Correspondence:
| | - Federico Piacentini
- Division of Medical Oncology, Department of Medical and Surgical Sciences for Children and Adults, University Hospital of Modena, 41125 Modena, Italy; (F.P.); (A.T.); (M.D.)
- Division of Medical Oncology, Department of Oncology and Hematology, University Hospital of Modena, 41125 Modena, Italy; (C.O.); (M.B.); (L.M.)
- Gruppo Oncologico Italiano per la Ricerca Clinica (GOIRC), 43100 Parma, Italy
| | - Claudia Omarini
- Division of Medical Oncology, Department of Oncology and Hematology, University Hospital of Modena, 41125 Modena, Italy; (C.O.); (M.B.); (L.M.)
| | - Angela Toss
- Division of Medical Oncology, Department of Medical and Surgical Sciences for Children and Adults, University Hospital of Modena, 41125 Modena, Italy; (F.P.); (A.T.); (M.D.)
- Division of Medical Oncology, Department of Oncology and Hematology, University Hospital of Modena, 41125 Modena, Italy; (C.O.); (M.B.); (L.M.)
| | - Monica Barbolini
- Division of Medical Oncology, Department of Oncology and Hematology, University Hospital of Modena, 41125 Modena, Italy; (C.O.); (M.B.); (L.M.)
| | - Patrizia Vici
- Department of Phase IV Clinical Trials, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy;
| | - Massimo Dominici
- Division of Medical Oncology, Department of Medical and Surgical Sciences for Children and Adults, University Hospital of Modena, 41125 Modena, Italy; (F.P.); (A.T.); (M.D.)
- Division of Medical Oncology, Department of Oncology and Hematology, University Hospital of Modena, 41125 Modena, Italy; (C.O.); (M.B.); (L.M.)
| | - Luca Moscetti
- Division of Medical Oncology, Department of Oncology and Hematology, University Hospital of Modena, 41125 Modena, Italy; (C.O.); (M.B.); (L.M.)
- Gruppo Oncologico Italiano per la Ricerca Clinica (GOIRC), 43100 Parma, Italy
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Loria R, Vici P, Di Lisa FS, Soddu S, Maugeri-Saccà M, Bon G. Cross-Resistance Among Sequential Cancer Therapeutics: An Emerging Issue. Front Oncol 2022; 12:877380. [PMID: 35814399 PMCID: PMC9259985 DOI: 10.3389/fonc.2022.877380] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 02/16/2022] [Accepted: 05/04/2022] [Indexed: 11/13/2022] Open
Abstract
Over the past two decades, cancer treatment has benefited from having a significant increase in the number of targeted drugs approved by the United States Food and Drug Administration. With the introduction of targeted therapy, a great shift towards a new era has taken place that is characterized by reduced cytotoxicity and improved clinical outcomes compared to traditional chemotherapeutic drugs. At present, targeted therapies and other systemic anti-cancer therapies available (immunotherapy, cytotoxic, endocrine therapies and others) are used alone or in combination in different settings (neoadjuvant, adjuvant, and metastatic). As a result, it is not uncommon for patients affected by an advanced malignancy to receive subsequent anti-cancer therapies. In this challenging complexity of cancer treatment, the clinical pathways of real-life patients are often not as direct as predicted by standard guidelines and clinical trials, and cross-resistance among sequential anti-cancer therapies represents an emerging issue. In this review, we summarize the main cross-resistance events described in the diverse tumor types and provide insight into the molecular mechanisms involved in this process. We also discuss the current challenges and provide perspectives for the research and development of strategies to overcome cross-resistance and proceed towards a personalized approach.
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Affiliation(s)
- Rossella Loria
- Cellular Network and Molecular Therapeutic Target Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Patrizia Vici
- Unit of Phase IV Trials, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Francesca Sofia Di Lisa
- Unit of Phase IV Trials, IRCCS Regina Elena National Cancer Institute, Rome, Italy
- Medical Oncology A, Department of Radiological, Oncological, and Anatomo-Pathological Sciences, Umberto I University Hospital, University Sapienza, Rome, Italy
| | - Silvia Soddu
- Cellular Network and Molecular Therapeutic Target Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Marcello Maugeri-Saccà
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giulia Bon
- Cellular Network and Molecular Therapeutic Target Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
- *Correspondence: Giulia Bon,
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Bottero M, Faiella A, Giannarelli D, Farneti A, Bertini L, Landoni V, Vici P, Sanguineti G. OC-0766 Response of local disease at magnetic resonance after salvage radiotherapy for prostate cancer. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02672-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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25
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Mosconi P, Roberto A, Cerana N, Colombo N, Didier F, D’Incalci M, Lorusso D, Peccatori FA, Artioli G, Cavanna L, Ceccherini R, Cirigliano G, Comerci G, Cormio G, Crippa A, Farolfi A, Febbraro A, Giardina D, Greggi S, Lalle M, Lapresa M, Marzola M, Merisio C, Mosconi AM, Peiretti M, Ricci G, Ronzino G, Scambia G, Scollo P, Sina F, Stella GC, Tomao F, Vici P, Zola P. Knowledge and attitudes towards clinical trials among women with ovarian cancer: results of the ACTO study. J Ovarian Res 2022; 15:45. [PMID: 35422000 PMCID: PMC9010065 DOI: 10.1186/s13048-022-00970-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 03/18/2022] [Indexed: 11/30/2022] Open
Abstract
Background Despite several initiatives by research groups, regulatory authorities, and scientific associations to engage citizens/patients in clinical research, there are still obstacles to participation. Among the main discouraging aspects are incomplete understanding of the concepts related to a clinical trial, and the scant, sometimes confused, explanations given. This observational, cross-sectional multicenter study investigated knowledge, attitudes and trust in clinical research. We conducted a survey among women with ovarian cancer at their first follow-up visit or first therapy session, treated in centers belonging to the Mario Negri Gynecologic Oncology (MaNGO) and Multicenter Italian Trials in Ovarian Cancer (MITO) groups. A questionnaire on knowledge, attitudes and experience was assembled ad hoc after a literature review and a validation process involving patients of the Alliance against Ovarian Cancer (ACTO). Results From 25 centers 348 questionnaire were collected; 73.5% of responders were 56 years or older, 54.8% had a high level of education, more than 80% had no experience of trial participation. Among participants 59% knew what clinical trials were and 71% what informed consent was. However, more than half did not know the meaning of the term randomization. More than half (56%) were in favor of participating in a clinical trial, but 35% were not certain. Almost all responders acknowledged the doctor’s importance in decision-making. Patients’ associations were recognized as having a powerful role in the design and planning of clinical trials. Conclusions This study helps depict the knowledge and attitudes of women with ovarian cancer in relation to clinical trials, suggesting measures aimed at improving trial “culture”, literacy and compliance, and fresh ways of communication between doctors and patients. Supplementary Information The online version contains supplementary material available at 10.1186/s13048-022-00970-w.
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Ferranti FR, Vasselli F, Barba M, Sperati F, Terrenato I, Graziano F, Vici P, Botti C, Vidiri A. Diagnostic Accuracy of Contrast-Enhanced, Spectral Mammography (CESM) and 3T Magnetic Resonance Compared to Full-Field Digital Mammography plus Ultrasound in Breast Lesions: Results of a (Pilot) Open-Label, Single-Centre Prospective Study. Cancers (Basel) 2022; 14:cancers14051351. [PMID: 35267659 PMCID: PMC8909837 DOI: 10.3390/cancers14051351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction: To assess the diagnostic accuracy of CESM and 3T MRI compared to full-field digital mammography (FFDM), plus US, in the evaluation of advanced breast lesions. Materials and Methods: Consenting women with suspicious findings underwent FFDM, US, CESM and 3T MRI. Breast lesions were histologically assessed, with histology being the gold standard. Two experienced breast radiologists, blinded to cancer status, read the images. Diagnostic accuracy of (1) CESM as an adjunct to FFDM and US, and (2) 3T MRI as an adjunct to CESM compared to FFDM and US, was assessed. Measures of accuracy were sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV). Results: There were 118 patients included along with 142 histologically characterized lesions. K agreement values were 0.69, 0.68, 0.63 and 0.56 for concordance between the gold standard and FFDM, FFDM + US, CESM and MRI, respectively (p < 0.001, for all). K concordance for CESM was 0.81 with FFDM + US and 0.73 with MRI (p value < 0.001 for all). Conclusions: CESM may represent a valuable alternative and/or an integrating technique to MRI in the evaluation of breast cancer patients.
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Affiliation(s)
- Francesca Romana Ferranti
- Radiology and Diagnostic Imaging Department, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy; (F.R.F.); (F.V.)
| | - Federica Vasselli
- Radiology and Diagnostic Imaging Department, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy; (F.R.F.); (F.V.)
| | - Maddalena Barba
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
- Correspondence: (M.B.); (A.V.); Tel.: +39-0652665419 (M.B.); +39-0652662731 (A.V.)
| | - Francesca Sperati
- Biostatistics-Scientific Direction, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy; (F.S.); (I.T.)
| | - Irene Terrenato
- Biostatistics-Scientific Direction, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy; (F.S.); (I.T.)
| | - Franco Graziano
- Division of Breast Surgery, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy; (F.G.); (C.B.)
| | - Patrizia Vici
- Sperimentazioni di Fase IV, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy;
| | - Claudio Botti
- Division of Breast Surgery, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy; (F.G.); (C.B.)
| | - Antonello Vidiri
- Radiology and Diagnostic Imaging Department, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy; (F.R.F.); (F.V.)
- Correspondence: (M.B.); (A.V.); Tel.: +39-0652665419 (M.B.); +39-0652662731 (A.V.)
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Caprara G, Tieri M, Fabi A, Guarneri V, Falci C, Dieci MV, Turazza M, Ballardini B, Bin A, Cinieri S, Vici P, Montagna E, Zamagni C, Mazzi C, Modena A, Marchetti F, Verzè M, Ghelfi F, Titta L, Nicolis F, Gori S. Corrigendum: Results of the ECHO (Eating habits CHanges in Oncologic patients) Survey: An Italian Cross-Sectional Multicentric Study to Explore Dietary Changes and Dietary Supplement Use, in Breast Cancer Survivors. Front Oncol 2022; 12:851999. [PMID: 35186773 PMCID: PMC8848580 DOI: 10.3389/fonc.2022.851999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Greta Caprara
- Department of Experimental Oncology, Istituto Europeo di Oncologia (IEO), European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milano, Italy
| | - Maria Tieri
- Department of Experimental Oncology, Istituto Europeo di Oncologia (IEO), European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milano, Italy.,Fondazione Tera, Novara, Italy
| | - Alessandra Fabi
- Medical Oncology 1 - Istituto Nazionale Tumori Regina Elena Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy.,Precision Medicine in Breast Cancer Unit, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy
| | - Valentina Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy.,Medical Oncology 2 - Istituto Oncologico Veneto Istituto Oncologico Veneto (IOV) Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padova, Italy
| | - Cristina Falci
- Medical Oncology 2 - Istituto Oncologico Veneto Istituto Oncologico Veneto (IOV) Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padova, Italy
| | - Maria Vittoria Dieci
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy.,Medical Oncology 2 - Istituto Oncologico Veneto Istituto Oncologico Veneto (IOV) Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padova, Italy
| | - Monica Turazza
- Department of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Italy
| | - Bettina Ballardini
- Breast Division, MultiMedica Breast Unit Multimedica Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milano, Italy
| | - Alessandra Bin
- Dipartimento di Oncologia, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Saverio Cinieri
- Unità Operativa Complessa di Oncologia Medica, ASL Brindisi Senatore Antonio Perrino Hospital, Brindisi, Italy
| | - Patrizia Vici
- Unità Operativa Semplice Dipartimentale (UOSD), Sperimentazioni di FASE IV, Istituto Nazionale Tumori Regina Elena Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy
| | - Emilia Montagna
- Division of Medical Senology, Istituto Europeo di Oncologia (IEO), European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milano, Italy
| | - Claudio Zamagni
- Medical Oncology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-universitaria di Bologna, Bologna, Italy
| | - Cristina Mazzi
- Clinical Research Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Italy
| | - Alessandra Modena
- Department of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Italy
| | - Fabiana Marchetti
- Clinical Research Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Italy
| | - Matteo Verzè
- Medical Direction, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Italy
| | - Francesca Ghelfi
- Fondazione De Marchi-Department of Pediatrics, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.,The Need For Nutrition Education/Innovation Programme (NNEdPro) Global Centre for Nutrition and Health, St John's Innovation Centre, Cambridge, United Kingdom
| | - Lucilla Titta
- Department of Experimental Oncology, Istituto Europeo di Oncologia (IEO), European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milano, Italy.,Fondazione Tera, Novara, Italy
| | - Fabrizio Nicolis
- Associazione Italiana di Oncologia Medica (AIOM) Foundation Past President, Medical Direction, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Italy
| | - Stefania Gori
- Associazione Italiana di Oncologia Medica (AIOM) Foundation President, Department of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Italy
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28
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La Verde N, Damia G, Garrone O, Santini D, Fabi A, Ciccarese M, Generali DG, Nunzi M, Poletto E, Ferraris E, Cretella E, Scandurra G, Meattini I, Bertolini AS, Cavanna L, Collovà E, Romagnoli E, Rulli E, Legramandi L, Guffanti F, Bramati A, Moretti A, Cassano A, Vici P, Torri V, Farina G. Tolerability of Eribulin and correlation between polymorphisms and neuropathy in an unselected population of female patients with metastatic breast cancer: results of the multicenter, single arm, phase IV PAINTER study. Breast Cancer Res 2022; 24:71. [PMID: 36307826 PMCID: PMC9615373 DOI: 10.1186/s13058-022-01560-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 09/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Metastatic breast cancer (MBC) is an incurable disease and its treatment focuses on prolonging patients' (pts) overall survival (OS) and improving their quality of life. Eribulin is a microtubule inhibitor that increases OS in pre-treated MBC pts. The most common adverse events (AEs) are asthenia, neutropenia and peripheral neuropathy (PN). METHODS PAINTER is a single arm, phase IV study, aimed at evaluating the tolerability of eribulin in MBC pts. Secondary objectives were the description of treatment efficacy and safety, the assessment of the incidence and severity of PN and its association with genetic polymorphisms. Genomic DNA was isolated from blood samples and 15 Single Nucleotide Polymorphisms (SNPs) were genotyped by Taqman specific assays. The association between PN and SNPs were evaluated by Fisher exact test. RESULTS Starting from May 2014 until June 2018 180 pts were enrolled in this study by 20 Italian centers. 170 of these pts could be evaluated for efficacy and toxicity and 159 for polymorphisms analysis. The median age of pts was 60 years old and the biological subtypes were luminal type (64.7%), Her2 positive (18.3%) and triple negative (17%). Pts were pretreated with a median of 5 lines for MBC. The median follow up of this study was 15.4 months with a median number of 4.5 cycles administered (minimum-maximum 1-23). The median overall survival was 12 months. 48.8% of pts experienced a dose reduction, mainly for neutropenia (23.9%) and liver toxicity (12%). 65 pts (38.2%) reported at least one severe toxicity. Neutropenia and neurotoxicity were the most frequent severe AEs (15.3% and 14.7%, respectively); other reported toxicities were osteo-muscular, abdominal or tumor site pain (19.4%), liver toxicity (6.6%), pulmonary toxicity (6.5%) and dermatological toxicity (3.6%). Among the 15 evaluated SNPs, an association with PN was found for rs2233335 and rs7214723. CONCLUSIONS Eribulin is a well-tolerated treatment option in MBC. Schedule and dosage modifications were common, but toxicity rarely led to treatment discontinuation. SNPs rs2233335 (G/T and T/T) in the NDRG1 gene and rs7214723 (CC and CT) in the CAMKK1 gene were associated with PN. These findings, if validated, could allow a tailored treatment with eribulin in cancer patients. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT02864030.
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Affiliation(s)
- Nicla La Verde
- grid.144767.70000 0004 4682 2907Department of Oncology, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Giovanna Damia
- grid.4527.40000000106678902Laboratory of Molecular Pharmacology, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Ornella Garrone
- grid.414818.00000 0004 1757 8749Medical Oncology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniele Santini
- grid.9657.d0000 0004 1757 5329Oncologia Medica Università Campus Biomedico, Rome, Italy ,grid.7841.aUOC Oncologia Universitaria, Sapienza University of Rome Polo Pontino, Latina, Italy
| | - Alessandra Fabi
- grid.414603.4Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Mariangela Ciccarese
- grid.417011.20000 0004 1769 6825Dept of Oncology Vito Fazzi Hospital, Lecce, Italy
| | - Daniele Giulio Generali
- U.O. Multidisciplinare Di Patologia Mammaria E Ricerca, Traslazionale Azienda Socio-Sanitaria Territoriale Di Cremona, Cremona, Italy
| | - Martina Nunzi
- grid.416377.00000 0004 1760 672XDept. of Oncology Medical and Translational Oncology Unit, Azienda Ospedaliera S.Maria, Terni, Italy
| | - Elena Poletto
- ASUFC Presidio Ospedaliero Universitario S.M. Misericordia, Udine, Italy
| | - Elisa Ferraris
- grid.419425.f0000 0004 1760 3027Division of Medical Oncology, IRCCS San Matteo University Hospital Foundation, Pavia, Italy
| | - Elisabetta Cretella
- grid.415844.80000 0004 1759 7181Oncologia Medica Ospedale Di Bolzano, AS Alto Adige, Bolzano, Italy
| | - Giuseppa Scandurra
- grid.413340.10000 0004 1759 8037Medical Oncology Unit, Cannizzaro Hospital, Catania, Italy
| | - Icro Meattini
- grid.24704.350000 0004 1759 9494Radiation Oncology Unit, Oncology Department, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | | | - Luigi Cavanna
- Oncology Haematology Department, ASL Piacenza, Piacenza, Italy
| | - Elena Collovà
- ASST Ovest Milanese, Ospedale Di Legnano, Legnano, MI Italy
| | | | - Eliana Rulli
- grid.4527.40000000106678902Laboratory of Methodology for Clinical Research, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Lorenzo Legramandi
- grid.4527.40000000106678902Laboratory of Methodology for Clinical Research, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Federica Guffanti
- grid.4527.40000000106678902Laboratory of Molecular Pharmacology, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Annalisa Bramati
- grid.414759.a0000 0004 1760 170XDepartment of Oncology, Fatebenefratelli Hospital, ASST Fatebenefratelli-Sacco, Piazza Principessa Clotilde 3, 20121 Milan, Italy
| | - Anna Moretti
- grid.414759.a0000 0004 1760 170XDepartment of Oncology, Fatebenefratelli Hospital, ASST Fatebenefratelli-Sacco, Piazza Principessa Clotilde 3, 20121 Milan, Italy
| | - Alessandra Cassano
- Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Patrizia Vici
- grid.417520.50000 0004 1760 5276Phase IV Clinical Studies Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Valter Torri
- Department of Oncology, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Gabriella Farina
- grid.414759.a0000 0004 1760 170XDepartment of Oncology, Fatebenefratelli Hospital, ASST Fatebenefratelli-Sacco, Piazza Principessa Clotilde 3, 20121 Milan, Italy
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29
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Pizzuti L, Krasniqi E, Sperduti I, Barba M, Gamucci T, Mauri M, Veltri EM, Meattini I, Berardi R, Di Lisa FS, Natoli C, Pistelli M, Iezzi L, Risi E, D’Ostilio N, Tomao S, Ficorella C, Cannita K, Riccardi F, Cassano A, Bria E, Fabbri MA, Mazzotta M, Barchiesi G, Botticelli A, D’Auria G, Ceribelli A, Michelotti A, Russo A, Salimbeni BT, Sarobba G, Giotta F, Paris I, Saltarelli R, Marinelli D, Corsi D, Capomolla EM, Sini V, Moscetti L, Mentuccia L, Tonini G, Raffaele M, Marchetti L, Minelli M, Ruggeri EM, Scavina P, Bacciu O, Salesi N, Livi L, Tinari N, Grassadonia A, Fedele Scinto A, Rossi R, Valerio MR, Landucci E, Stani S, Fratini B, Maugeri-Saccà M, De Tursi M, Maione A, Santini D, Orlandi A, Lorusso V, Cortesi E, Sanguineti G, Pinnarò P, Cappuzzo F, Landi L, Botti C, Tomao F, Cappelli S, Bon G, Pelle F, Cavicchi F, Fiorio E, Foglietta J, Scagnoli S, Marchetti P, Ciliberto G, Vici P. PANHER study: a 20-year treatment outcome analysis from a multicentre observational study of HER2-positive advanced breast cancer patients from the real-world setting. Ther Adv Med Oncol 2021; 13:17588359211059873. [PMID: 35173816 PMCID: PMC8842182 DOI: 10.1177/17588359211059873] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 10/27/2021] [Indexed: 12/16/2022] Open
Abstract
Background: The evolution of therapeutic landscape of human epidermal growth factor
receptor-2 (HER2)-positive breast cancer (BC) has led to an unprecedented
outcome improvement, even if the optimal sequence strategy is still debated.
To address this issue and to provide a picture of the advancement of
anti-HER2 treatments, we performed a large, multicenter, retrospective study
of HER2-positive BC patients. Methods: The observational PANHER study included 1,328 HER2-positive advanced BC
patients treated with HER2 blocking agents since June 2000 throughout July
2020. Endpoints of efficacy were progression-free survival (PFS) and overall
survival (OS). Results: Patients who received a first-line pertuzumab-based regimen showed better PFS
(p < 0.0001) and OS (p = 0.004)
than those receiving other treatments. Median PFS and mOS from second-line
starting were 8 and 28 months, without significant differences among various
regimens. Pertuzumab-pretreated patients showed a mPFS and a mOS from
second-line starting not significantly affected by type of second line, that
is, T-DM1 or lapatinib/capecitabine (p = 0.80 and
p = 0.45, respectively). Conversely, pertuzumab-naïve
patients receiving second-line T-DM1 showed a significantly higher mPFS
compared with that of patients treated with lapatinib/capecitabine
(p = 0.004). Median OS from metastatic disease
diagnosis was higher in patients treated with trastuzumab-based first line
followed by second-line T-DM1 in comparison to pertuzumab-based first-line
and second-line T-DM1 (p = 0.003), although these data
might be partially influenced by more favorable prognostic characteristics
of patients in the pre-pertuzumab era. No significant
differences emerged when comparing patients treated with ‘old’ or ‘new’
drugs (p = 0.43), even though differences in the length of
the follow-up between the two cohorts should be taken into account. Conclusion: Our results confirmed a relevant impact of first-line pertuzumab-based
treatment and showed lower efficacy of second-line T-DM1 in
trastuzumab/pertuzumab pretreated, as compared with pertuzumab-naïve
patients. Our findings may help delineate a more appropriate therapeutic
strategy in HER2-positive metastatic BC. Prospective randomized trials
addressing this topic are awaited.
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Affiliation(s)
- Laura Pizzuti
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Eriseld Krasniqi
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, via Elio Chianesi 53, 00144 Rome, Italy
| | - Isabella Sperduti
- Biostatistics Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Maddalena Barba
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, via Elio Chianesi 53, 00144 Rome, Italy
| | | | - Maria Mauri
- Division of Oncology, San Giovanni Hospital, Rome, Italy
| | | | - Icro Meattini
- Radiation Oncology Unit and Department of Clinical and Experimental Biomedical Sciences ‘Mario Serio’, Careggi University Hospital, University of Florence, Florence, Italy
| | - Rossana Berardi
- Oncology Clinic, ‘Ospedali iuniti di Ancona’ Hospital, Ancona, Italy
| | - Francesca Sofia Di Lisa
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
- Medical Oncology A, Policlinico Umberto I, Rome, Italy
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, ‘Sapienza’ University of Rome, Umberto I University Hospital, Rome, Italy
| | - Clara Natoli
- Department of Medical, Oral and Biotechnological Sciences and Center for Advanced Studies and Technology (CAST), G. D’Annunzio University, Chieti, Italy
| | - Mirco Pistelli
- Oncology Clinic, ‘Ospedali Riuniti di Ancona’ Hospital, Ancona, Italy
| | - Laura Iezzi
- Oncology Division, Hospital ‘Maria SS. dello Splendore’ ASL 4, Giulianova, Italy
| | - Emanuela Risi
- Sandro Pitigliani Medical Oncology Department, Hospital of Prato, Prato, Italy
| | | | - Silverio Tomao
- Medical Oncology A, Policlinico Umberto I, Rome, Italy
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, ‘Sapienza’ University of Rome, Umberto I University Hospital, Rome, Italy
| | - Corrado Ficorella
- Medical Oncology, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | | | | | - Alessandra Cassano
- U.O.C. Medical Oncology, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Emilio Bria
- U.O.C. Medical Oncology, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Marco Mazzotta
- Medical Oncology Unit, Belcolle Hospital, Viterbo, Italy
| | - Giacomo Barchiesi
- Medical Oncology A, Policlinico Umberto I, Rome, Italy
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, ‘Sapienza’ University of Rome, Umberto I University Hospital, Rome, Italy
- Medical Oncology Unit, Ospedale dell’Angelo, Mestre, Italy
| | - Andrea Botticelli
- Medical Oncology B, Policlinico Umberto I, Rome, Italy
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Giuliana D’Auria
- Medical Oncology, Sandro Pertini Hospital, Rome, Italy
- Paola ScavinaSan Giovanni Addolorata Hospital, 00184 Rome, Italy
| | - Anna Ceribelli
- Medical Oncology Unit, San Camillo de Lellis Hospital, ASL Rieti, Rieti, Italy
| | - Andrea Michelotti
- UO Medical Oncology I, S. Chiara Hospital, Pisa, Italy
- Oncology, Transplant and New Technologies Department, Pisa University Hospital, Pisa, Italy
| | - Antonio Russo
- Medical Oncology, AOU Policlinico Paolo Giaccone, Palermo, Italy
| | | | | | - Francesco Giotta
- Department of Medical Oncology, IRCCS Giovanni Paolo II Institute, Bari, Italy
| | - Ida Paris
- Gynaecology – Oncology Unit, IRCCS Catholic University of the Sacred Heart, Rome, Italy
| | - Rosa Saltarelli
- UOC Oncology, San Giovanni Evangelista Hospital, ASL RM5, Rome, Italy
| | - Daniele Marinelli
- Medical Oncology B, Policlinico Umberto I, Rome, Italy
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Domenico Corsi
- Medical Oncology Unit, Fatebenefratelli Hospital, Rome, Italy
| | | | | | - Luca Moscetti
- Division of Medical Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Lucia Mentuccia
- Medical Oncology, Ospedale ‘Parodi-Delfino’, Colleferro, Italy
| | - Giuseppe Tonini
- Department of Oncology, University Campus Biomedico of Rome, Rome, Italy
| | - Mimma Raffaele
- UOSD Presidio Oncologico Cassia – S. Andrea, ASL Roma 1, Rome, Italy
| | - Luca Marchetti
- UOC Oncology, San Pietro Fatebenefratelli Hospital, Rome, Italy
| | - Mauro Minelli
- Division of Oncology, San Giovanni Hospital, Rome, Italy
| | | | | | - Olivia Bacciu
- Division of Oncology, San Giovanni Hospital, Rome, Italy
| | - Nello Salesi
- Medical Oncology Unit, Santa Maria Goretti, Latina, Italy
| | - Lorenzo Livi
- Radiation Oncology Unit and Department of Clinical and Experimental Biomedical Sciences ‘Mario Serio’, Careggi University Hospital, University of Florence, Florence, Italy
| | - Nicola Tinari
- Department of Medical, Oral and Biotechnological Sciences and Center for Advanced Studies and Technology (CAST), G. D’Annunzio University, Chieti, Italy
| | - Antonino Grassadonia
- Department of Medical, Oral and Biotrechnological Sciences and Centre for Advanced Studues and Echnology (CAST), G. D’Annunzio University, Chieti, Italy
| | | | | | | | - Elisabetta Landucci
- UO Medical Oncology I, S. Chiara Hospital, Pisa, Italy
- Oncology, Transplant and New Technologies Department, Pisa University Hospital, Pisa, Italy
| | | | - Beatrice Fratini
- UO Medical Oncology I, S. Chiara Hospital, Pisa, Italy
- Oncology, Transplant and New Technologies Department, Pisa University Hospital, Pisa, Italy
| | - Marcello Maugeri-Saccà
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Michele De Tursi
- Department of Medical, Oral and Biotechnological Sciences and Center for Advanced Studies and Technology (CAST), G. D’Annunzio University, Chieti, Italy
| | - Angela Maione
- Oncology Unit, Antonio Cardarelli Hospital, Naples, Italy
| | - Daniele Santini
- Department of Oncology, University Campus Biomedico of Rome, Rome, Italy
| | - Armando Orlandi
- U.O.C. Medical Oncology, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vito Lorusso
- Department of Medical Oncology, IRCCS Giovanni Paolo II Institute, Bari, Italy
| | - Enrico Cortesi
- Medical Oncology B, Policlinico Umberto I, Rome, Italy
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Sanguineti
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Paola Pinnarò
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Federico Cappuzzo
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Lorenza Landi
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Claudio Botti
- Department of Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Federica Tomao
- Department of Gynecologic Oncology, European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | - Sonia Cappelli
- Department of Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giulia Bon
- Cellular Network and Molecular Therapeutic Target Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Fabio Pelle
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Flavia Cavicchi
- Department of Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Elena Fiorio
- U.O.C. Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Simone Scagnoli
- Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy
| | - Paolo Marchetti
- Medical Oncology B, Policlinico Umberto I, Rome, Italy
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Gennaro Ciliberto
- Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Patrizia Vici
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
- Sperimentazioni di Fase IV, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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Barchiesi G, Roberto M, Verrico M, Vici P, Tomao S, Tomao F. Emerging Role of PARP Inhibitors in Metastatic Triple Negative Breast Cancer. Current Scenario and Future Perspectives. Front Oncol 2021; 11:769280. [PMID: 34900718 PMCID: PMC8655309 DOI: 10.3389/fonc.2021.769280] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 11/05/2021] [Indexed: 12/31/2022] Open
Abstract
Triple negative tumors represent 15% of breast cancer and are characterized by the lack of estrogen receptors, progesterone receptor, and HER2 amplification or overexpression. Approximately 25% of patients diagnosed with triple negative breast cancer carry a germline BRCA1 or BRCA2 mutation. They have an aggressive biology, and chemotherapy has been the mainstay of treatment for a long time. Despite intensive therapies, prognosis is still poor, and many patients will eventually relapse or die due to cancer. Therefore, novel targeted agents that can increase the treatment options for this disease are urgently needed. Recently, a new class of molecules has emerged as a standard of care for patients with triple negative breast cancer and germline BRCA1 or BRCA2 mutation: poly (ADP-ribose) (PARP) inhibitors. In the first part of the review, we summarize and discuss evidence supporting the use of PARP inhibitors. Currently, two PARP inhibitors have been approved for triple negative metastatic breast cancer-olaparib and talazoparib-based on two phase III trials, which showed a progression-free survival benefit when compared to chemotherapy. Safety profile was manageable with supportive therapies and dose reductions/interruptions. In addition, other PARP inhibitors are currently under investigation, such as talazoparib, rucaparib, and veliparib. Subsequently, we will discuss the potential role of PARP inhibitors in the future. Clinical research areas are investigating PARP inhibitors in combination with other agents and are including patients without germline BRCA mutations: ongoing phase II/III studies are combining PARP inhibitors with immunotherapy, while phases I and II trials are combining PARP inhibitors with other targeted agents such as ATM and PIK3CA inhibitors. Moreover, several clinical trials are enrolling patients with somatic BRCA mutation or patients carrying mutations in genes, other than BRCA1/2, involved in the homologous recombination repair pathway (e.g., CHECK2, PALB2, RAD51, etc.).
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Affiliation(s)
- Giacomo Barchiesi
- Dipartimento di Scienze Radiologiche, Oncologiche ed Anatomo Patologiche, Università di Roma Sapienza, Rome, Italy
| | - Michela Roberto
- Dipartimento di Scienze Radiologiche, Oncologiche ed Anatomo Patologiche, Università di Roma Sapienza, Rome, Italy
| | - Monica Verrico
- Dipartimento di Scienze Radiologiche, Oncologiche ed Anatomo Patologiche, Università di Roma Sapienza, Rome, Italy
| | - Patrizia Vici
- UOSD Sperimentazioni Di Fase IV, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
| | - Silverio Tomao
- Dipartimento di Scienze Radiologiche, Oncologiche ed Anatomo Patologiche, Università di Roma Sapienza, Rome, Italy
| | - Federica Tomao
- Gynecologic Oncology Program, European Institute of Oncology, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
- Maternal and Child Department, Sapienza University of Rome, Rome, Italy
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31
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Caprara G, Tieri M, Fabi A, Guarneri V, Falci C, Dieci MV, Turazza M, Ballardini B, Bin A, Cinieri S, Vici P, Montagna E, Zamagni C, Mazzi C, Modena A, Marchetti F, Verzè M, Ghelfi F, Titta L, Nicolis F, Gori S. Results of the ECHO (Eating habits CHanges in Oncologic patients) Survey: An Italian Cross-Sectional Multicentric Study to Explore Dietary Changes and Dietary Supplement Use, in Breast Cancer Survivors. Front Oncol 2021; 11:705927. [PMID: 34804915 PMCID: PMC8596328 DOI: 10.3389/fonc.2021.705927] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 10/13/2021] [Indexed: 12/25/2022] Open
Abstract
The role of a healthy diet in cancer prevention is well recognized. Recent data indicate that following the same advices can also improve cancer survivors’ quality of life. Breast cancer (BC) patients are commonly concerned about diet and nutrition and frequently express the need to obtain health-related information and the will to change their diet and lifestyle. Hence, be aware of survivors’ dietary changes and information needs is crucial for healthcare professionals to guide them toward optimal lifestyle choices. In order to investigate eating habits changes in a BC survivors’ population, we conceived the cross-sectional multicentric study ECHO (Eating habits CHanges in Oncologic patients) Survey. Data were collected from 684 patients, diagnosed with invasive breast cancer, in order to investigate their changes in food consumption, use of supplements, or the beginning of a specific diet, after BC diagnosis. We also examined the sources of information used and if any modification in their diets was reported to the oncologist. We primarily observed that patients increased their consumption of vegetables, pulses, nuts, fruits, wholemeal bread/pasta, grains and fish; while decreasing red and processed meat, refined bread/pasta, baked good and animal fat consumption. Survivors also reported the use of dietary supplements, mainly vitamins, aimed at counteracting therapies’ side effects. Changes in nutritional habits were often adopted without asking or informing the oncologist. Despite BC survivors made some positive changes in their nutritional habits, those modifications were mostly pursued by less than half of them, while the majority of patients consumed nutritional supplements after diagnosis. These results, as well as the failure to communicate with the physicians, reinforce the need to both improve the patient-healthcare professional relationship and to develop tailored nutrition counselling and intervention programs for cancer survivors.
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Affiliation(s)
- Greta Caprara
- Department of Experimental Oncology, Istituto Europeo di Oncologia (IEO), European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milano, Italy
| | - Maria Tieri
- Department of Experimental Oncology, Istituto Europeo di Oncologia (IEO), European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milano, Italy.,Fondazione Tera, Novara, Italy
| | - Alessandra Fabi
- Medical Oncology 1 - Istituto Nazionale Tumori Regina Elena Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy.,Breast Precision Medicine Unit, Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy
| | - Valentina Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy.,Medical Oncology 2 - Istituto Oncologico Veneto Istituto Oncologico Veneto (IOV) Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padova, Italy
| | - Cristina Falci
- Medical Oncology 2 - Istituto Oncologico Veneto Istituto Oncologico Veneto (IOV) Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padova, Italy
| | - Maria Vittoria Dieci
- Medical Oncology 2 - Istituto Oncologico Veneto Istituto Oncologico Veneto (IOV) Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padova, Italy
| | - Monica Turazza
- Department of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Italy
| | - Bettina Ballardini
- Breast Division, MultiMedica Breast Unit Multimedica Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milano, Italy
| | - Alessandra Bin
- Dipartimento di Oncologia, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Saverio Cinieri
- Unità Operativa Complessa di Oncologia Medica, ASL Brindisi Senatore Antonio Perrino Hospital, Brindisi, Italy
| | - Patrizia Vici
- Medical Oncology 2 - Istituto Nazionale Tumori Regina Elena Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy
| | - Emilia Montagna
- Division of Medical Senology, Istituto Europeo di Oncologia (IEO), European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milano, Italy
| | - Claudio Zamagni
- Medical Oncology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-universitaria di Bologna, Bologna, Italy
| | - Cristina Mazzi
- Clinical Research Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Italy
| | - Alessandra Modena
- Department of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Italy
| | - Fabiana Marchetti
- Clinical Research Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Italy
| | - Matteo Verzè
- Medical Direction, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Italy
| | - Francesca Ghelfi
- Fondazione De Marchi-Department of Pediatrics, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.,The Need For Nutrition Education/Innovation Programme (NNEdPro) Global Centre for Nutrition and Health, St John's Innovation Centre, Cambridge, United Kingdom
| | - Lucilla Titta
- Department of Experimental Oncology, Istituto Europeo di Oncologia (IEO), European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milano, Italy.,Fondazione Tera, Novara, Italy
| | - Fabrizio Nicolis
- Associazione Italiana di Oncologia Medica (AIOM) Foundation Past President, Medical Direction, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Italy
| | - Stefania Gori
- Associazione Italiana di Oncologia Medica (AIOM) Foundation President, Department of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Italy
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32
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Pinnaro P, Takanen S, Landoni V, Vici P, Nucciarelli S, Botti C, Sanguineti G. Ten Fraction Adjuvant Hypofractionated Radiotherapy in Node Positive Breast Cancer: 3 Year-Follow-Up of a Phase II Toxicity Study. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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33
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Cazzaniga ME, Vallini I, Montagna E, Amoroso D, Berardi R, Butera A, Cagossi K, Cavanna L, Ciccarese M, Cinieri S, Cretella E, De Conciliis E, Febbraro A, Ferraù F, Ferzi A, Baldelli A, Fontana A, Gambaro AR, Garrone O, Gebbia V, Generali D, Gianni L, Giovanardi F, Grassadonia A, Leonardi V, Marchetti P, Sarti S, Musolino A, Nicolini M, Putzu C, Riccardi F, Santini D, Saracchini S, Sarobba MG, Schintu MG, Scognamiglio G, Spadaro P, Taverniti C, Toniolo D, Tralongo P, Turletti A, Valenza R, Valerio MR, Vici P, Di Mauro P, Cogliati V, Capici S, Clivio L, Torri V. Metronomic chemotherapy (mCHT) in metastatic triple-negative breast cancer (TNBC) patients: results of the VICTOR-6 study. Breast Cancer Res Treat 2021; 190:415-424. [PMID: 34546500 PMCID: PMC8558172 DOI: 10.1007/s10549-021-06375-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 08/26/2021] [Indexed: 11/30/2022]
Abstract
Purpose Triple-negative breast cancer (TNBC) represents a subtype of breast cancer which lacks the expression of oestrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor-2 (HER2): TNBC accounts for approximately 20% of newly diagnosed breast cancers and is associated with younger age at diagnosis, greater recurrence risk and shorter survival time. Therapeutic options are very scarce. Aim of the present analysis is to provide further insights into the clinical activity of metronomic chemotherapy (mCHT), in a real-life setting. Methods We used data included in the VICTOR-6 study for the present analysis. VICTOR-6 is an Italian multicentre retrospective cohort study, which collected data of metastatic breast cancer (MBC) patients who have received mCHT between 2011 and 2016. Amongst the 584 patients included in the study, 97 were triple negative. In 40.2% of the TNBC patients, mCHT was the first chemotherapy treatment, whereas 32.9% had received 2 or more lines of treatment for the metastatic disease. 45.4% out of 97 TNBC patients received a vinorelbine (VRL)-based regimen, which resulted in the most used type of mCHT, followed by cyclophosphamide (CTX)-based regimens (30.9%) and capecitabine (CAPE)-based combinations (22.7%). Results Overall response rate (ORR) and disease control rate (DCR) were 17.5% and 64.9%, respectively. Median progression free survival (PFS) and overall survival (OS) were 6.0 months (95% CI: 4.9–7.2) and 12.1 months (95% CI: 9.6–16.7). Median PFS was 6.9 months for CAPE-based regimens (95% CI: 5.0–18.4), 6.1 months (95% CI: 4.0–8.9) for CTX-based and 5.3 months (95% CI: 4.1–9.5) for VRL-based ones. Median OS was 18.2 months (95% CI: 9.1-NE) for CAPE-based regimens and 11.8 months for VRL- (95% CI: 9.3–16.7 and CTX-based ones (95%CI: 8.7–52.8). Tumour response, PFS and OS decreased proportionally in later lines. Conclusion This analysis represents the largest series of TNBC patients treated with mCHT in a real-life setting and provides further insights into the advantages of using this strategy even in this poor prognosis subpopulation.
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Affiliation(s)
- M E Cazzaniga
- Phase 1 Research Centre and Oncology Unit, Department of Medicine and Surgery, University of Milano-Bicocca, ASST Monza, Via Pergolesi 33, 20900, Monza, MB, Italy.
- Oncology Unit, ASST Monza, Monza, MB, Italy.
| | - I Vallini
- Medical Oncology, ASST Sette Laghi Ospedale Di Circolo E Fondazione Macchi, Varese, VA, Italy
| | - E Montagna
- Medical Senology Division, IEO, Milan, Italy
| | - D Amoroso
- Medical Oncology, Ospedale Versilia, ATNO, Lido Di Camaiore, LU, Italy
| | - R Berardi
- Medical Oncology, Università Politecnica Delle Marche, AOU Ospedali Riuniti, Ancona, Italy
| | - A Butera
- Medical Oncology, Ospedale San Giovanni Di Dio, Agrigento, Italy
| | - K Cagossi
- Medical Oncology, Ospedale Ramazzini, Carpi, Italy
| | - L Cavanna
- Medical Oncology, Azienda Ospedaliera Piacenza, Piacenza, Italy
| | - M Ciccarese
- Medical Oncology, Ospedale Vito Fazzi, Lecce, Italy
| | - S Cinieri
- Medical Oncology, ASL Brindisi, Brindisi, Italy
| | - E Cretella
- Medical Oncology, Ospedale Bolzano, Bolzano, Italy
| | | | - A Febbraro
- Medical Oncology, Ospedale S. Cuore di Gesù Fatebenefratelli, Benevento, Italy
| | - F Ferraù
- Medical Oncology, Osp Taormina, Taormina, Italy
| | - A Ferzi
- Medical Oncology, A.S.S.T. Ovest Milanese Legnano, Legnano, Italy
| | - A Baldelli
- Medical Oncology, Ospedale San Salvatore, Pesaro, Italy
| | - A Fontana
- Medical Oncology 2, Az. Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - A R Gambaro
- Medical Oncology, ASST Fatebenefratelli Sacco, Milano, Italy
| | - O Garrone
- Breast Unit Medical Oncology, A.O. S. Croce e Carle, Cuneo, Italy
| | - V Gebbia
- Medical Oncology, Ospedale La Maddalena, Palermo, Italy
| | - D Generali
- Medical Oncology, Istituti Ospitalieri Cremona, Cremona, Italy
| | - L Gianni
- Medical Oncology, Azienda USL Romagna, U.O. di Oncologia Rimini, Cattolica, Italy
| | - F Giovanardi
- AUSL IRCCS Reggio Emilia Provincial Oncology Unit, Reggio Emilia, Italy
| | - A Grassadonia
- Medical Oncology, P.O. SS Annunziata -ASL2 Lanciano-Vasto, Chieti, Italy
| | - V Leonardi
- Medical Oncology, Ospedale Civico, Palermo, Italy
| | - P Marchetti
- Medical Oncology, A.O. Sant'Andrea, Roma, Italy
| | - S Sarti
- IRCCS Istituto Romagnolo per lo studio dei Tumori (IRST) "Dino Amadori", 47014, Meldola, Italy
| | - A Musolino
- Department of Medicine and Surgery, Medical Oncology and Breast Unit, University of Parma and University Hospital of Parma, Parma, Italy
| | - M Nicolini
- Medical Oncology, Azienda USL Romagna, U.O. di Oncologia Rimini, Cattolica, Italy
| | - C Putzu
- Medical Oncology, A. Ospedaliera-Universitaria, Sassari, Italy
| | - F Riccardi
- Medical Oncology, A. Ospedaliera Antonio Cardarelli, Napoli, Italy
| | - D Santini
- Medical Oncology, Università Campus Bio-Medico, Roma, Italy
| | - S Saracchini
- Medical Oncology, Az. Osp. Santa Maria degli Angeli, Pordenone, Italy
| | - M G Sarobba
- Medical Oncology, Ospedale San Francesco, Nuoro, Italy
| | - M G Schintu
- Medical Oncology, Osp Giovanni Paolo II, Olbia, Italy
| | | | - P Spadaro
- Medical Oncology, Casa di Cura Villa Salus-Messina, Messina, Italy
| | - C Taverniti
- Medical Oncology, A.O.U. Città della Salute e della Scienza, Osp. Molinette, Torino, Italy
| | - D Toniolo
- Medical Oncology, ASST Rhodense, Ospedale di Circolo Rho, Rho, Italy
| | - P Tralongo
- Medical Oncology, Osp. Umberto I, Siracusa, Italy
| | - A Turletti
- Medical Oncology, P.O. Martini, Torino, Italy
| | - R Valenza
- Medical Oncology, P.O. Vittorio Emanuele, Gela, Italy
| | - M R Valerio
- Department of Discipline Chirurgiche, Oncologiche e Stomatologiche (DICHIRONS), Medical Oncology, A.O.U. Policlinico Paolo Giaccone, Palermo, Italy
| | - P Vici
- Phase IV trials, IRCCS, INT Regina Elena, Rome, Italy
| | - P Di Mauro
- Oncology Unit, ASST Monza, Monza, MB, Italy
| | - V Cogliati
- Phase 1 Research Centre and Oncology Unit, Department of Medicine and Surgery, University of Milano-Bicocca, ASST Monza, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - S Capici
- Phase 1 Research Centre and Oncology Unit, Department of Medicine and Surgery, University of Milano-Bicocca, ASST Monza, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - L Clivio
- Oncology Department, IRCCS Mario Negri Institute, Milan, Italy
| | - V Torri
- Oncology Department, IRCCS Mario Negri Institute, Milan, Italy
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Torrisi R, Palumbo R, De Sanctis R, Vici P, Bianchi GV, Cortesi L, Leonardi V, Gueli R, Fabi A, Valerio MR, Gambaro AR, Tagliaferri B, Pizzuti L, Cazzaniga ME, Santoro A. Fulvestrant and trastuzumab in patients with luminal HER2-positive advanced breast cancer (ABC): an Italian real-world experience (HERMIONE 9). Breast Cancer Res Treat 2021; 190:103-109. [PMID: 34453206 DOI: 10.1007/s10549-021-06371-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/20/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The most appropriate therapy for HR + /HER2-positive (HER2 +) advanced breast cancer (ABC) is a matter of debate. Co-targeting of both receptors represents an attractive strategy to overcome the cross-talk between them. METHODS The HERMIONE 9 is an observational retrospective multicentric study which aimed to describe the clinical outcome of patients with HR + /HER2 + ABC who received the combination of Fulvestrant (F) and Trastuzumab (T) as part of their routine treatment at 10 Italian Institutions. RESULTS Eighty-seven patients were included. Median age was 63 (range, 35-87) years. The median number of previous treatments was 3 (range, 0-10) and F and T were administered as ≥ 3rd line in 67 patients. Among the 86 evaluable patients, 6 (6.9%) achieved CR, 18 (20.7%) PR, and 44 (50.6%) had SD ≥ 24 weeks with an overall CBR of 78.2%. At a median follow-up of 33.6 months, mPFS of the entire cohort was 12.9 months (range, 2.47-128.67). No difference was observed in mPFS between patients treated after progression or as maintenance therapy (mPFS 12.9 and 13.9 months in 64 and 23 patients, respectively), neither considering the number of previous treatment lines (≤ 3 or < 3). CONCLUSION The combination of F and T was active in this cohort at poor prognosis and deserves further investigations possibly in combination with pertuzumab in patients with high ER expression.
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Affiliation(s)
- Rosalba Torrisi
- Department of Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, via A. Manzoni 56 20089, Rozzano, Milano, Italy.
| | | | - Rita De Sanctis
- Department of Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, via A. Manzoni 56 20089, Rozzano, Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Patrizia Vici
- UOC OM2 IRCCS Regina Elena National Cancer Institute, Roma, Italy
| | | | - Laura Cortesi
- Department of Oncology and Haematology, Modena Hospital University, Modena, Italy
| | - Vita Leonardi
- Department of Medical Oncology, ARNAS Civico, Palermo, Italy
| | | | - Alessandra Fabi
- Precision Medicine in Breast Cancer Unit, Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Maria Rosaria Valerio
- Medical Oncology Unit, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Anna Rita Gambaro
- Medical Oncology, ASST Fatebenefratelli Sacco PO Sacco, Milano, Italy
| | | | - Laura Pizzuti
- UOC OM2 IRCCS Regina Elena National Cancer Institute, Roma, Italy
| | - Marina Elena Cazzaniga
- Centro Ricerca Fase 1 ASST Monza and Università Degli Studi Milano Bicocca, Milano, Italy
| | - Armando Santoro
- Department of Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, via A. Manzoni 56 20089, Rozzano, Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
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35
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Ronchetti L, Boubaker NS, Barba M, Vici P, Gurtner A, Piaggio G. Neutrophil extracellular traps in cancer: not only catching microbes. J Exp Clin Cancer Res 2021; 40:231. [PMID: 34261496 PMCID: PMC8281578 DOI: 10.1186/s13046-021-02036-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/05/2021] [Indexed: 12/16/2022]
Abstract
Neutrophils are the most abundant type of white blood cells circulating throughout the bloodstream and are often considered the frontline defenders in innate immunity. However, neutrophils are increasingly being recognized as having an important role in tumorigenesis and carcinogenesis due to their aberrant activation by molecules released into the tumor microenvironment. One defensive response of neutrophils that is aberrantly triggered during the neoplastic process is called NETosis, where activated neutrophils expel their DNA and intracellular contents in a web-like structure known as a neutrophil extracellular trap (NET). In cancer, NETosis has been linked to increased disease progression, metastasis, and complications such as venous thromboembolism. NET structures released by neutrophils can also serve as a scaffold for clot formation, shining new light on the role of neutrophils and NETosis in coagulation-mediated diseases. Here, we review current available knowledge regarding NET and the related NETosis process in cancer patients, with an emphasis on pre-clinical and clinical data fostering the identification and validation of biomarkers of NET with a predictive/prognostic role in cancer patients treated with immunotherapy agents. NETosis biomarkers, e.g., citH3, may integrate correlates of immunogenicity currently available (e.g., PD-L1 expression, TMB, TILs) and help select the subsets of patients who may most benefit from the use of the therapeutic weapons under discussion.
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Affiliation(s)
- Livia Ronchetti
- SAFU Unit, IRCCS - Regina Elena National Cancer Institute, Rome, Italy
| | - Nouha Setti Boubaker
- SAFU Unit, IRCCS - Regina Elena National Cancer Institute, Rome, Italy.,Laboratory of proteins engineering and bioactive molecules (LIP-MB), National Institute of Applied Sciences and Technology of Tunis (INSAT), The University of Carthage, Tunis, Tunisia
| | - Maddalena Barba
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Patrizia Vici
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Aymone Gurtner
- SAFU Unit, IRCCS - Regina Elena National Cancer Institute, Rome, Italy. .,Institute of Translational Pharmacology (IFT), National Research Council (CNR), Rome, Italy.
| | - Giulia Piaggio
- SAFU Unit, IRCCS - Regina Elena National Cancer Institute, Rome, Italy
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36
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Krasniqi E, Sacconi A, Marinelli D, Pizzuti L, Mazzotta M, Sergi D, Capomolla E, Donzelli S, Carosi M, Bagnato A, Gamucci T, Tomao S, Natoli C, Marchetti P, Grassadonia A, Tinari N, De Tursi M, Vizza E, Ciliberto G, Landi L, Cappuzzo F, Barba M, Blandino G, Vici P. MicroRNA-based signatures impacting clinical course and biology of ovarian cancer: a miRNOmics study. Biomark Res 2021; 9:57. [PMID: 34256855 PMCID: PMC8276429 DOI: 10.1186/s40364-021-00289-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 04/26/2021] [Indexed: 02/06/2023] Open
Abstract
Background In Western countries, ovarian cancer (OC) still represents the leading cause of gynecological cancer-related deaths, despite the remarkable gains in therapeutical options. Novel biomarkers of early diagnosis, prognosis definition and prediction of treatment outcomes are of pivotal importance. Prior studies have shown the potentials of micro-ribonucleic acids (miRNAs) as biomarkers for OC and other cancers. Methods We focused on the prognostic and/or predictive potential of miRNAs in OC by conducting a comprehensive array profiling of miRNA expression levels in ovarian tissue samples from 17 non-neoplastic controls, and 60 tumor samples from OC patients treated at the Regina Elena National Cancer Institute (IRE). A set of 54 miRNAs with differential expression in tumor versus normal samples (T/N-deregulated) was identified in the IRE cohort and validated against data from the Cancer Genoma Atlas (TCGA) related to 563 OC patients and 8 non-neoplastic controls. The prognostic/predictive role of the selected 54 biomarkers was tested in reference to survival endpoints and platinum resistance (P-res). Results In the IRE cohort, downregulation of the 2 miRNA-signature including miR-99a-5p and miR-320a held a negative prognostic relevance, while upregulation of miR-224-5p was predictive of less favorable event free survival (EFS) and P-res. Data from the TCGA showed that downregulation of 5 miRNAs, i.e., miR-150, miR-30d, miR-342, miR-424, and miR-502, was associated with more favorable EFS and overall survival outcomes, while miR-200a upregulation was predictive of P-res. The 9 miRNAs globally identified were all included into a single biologic signature, which was tested in enrichment analysis using predicted/validated miRNA target genes, followed by network representation of the miRNA-mRNA interactions. Conclusions Specific dysregulated microRNA sets in tumor tissue showed predictive/prognostic value in OC, and resulted in a promising biological signature for this disease. Supplementary Information The online version contains supplementary material available at 10.1186/s40364-021-00289-6.
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Affiliation(s)
- E Krasniqi
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - A Sacconi
- UOSD Clinical Trial Center, Biostatistics and Bioinformatics, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - D Marinelli
- Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Medical Oncology Unit, Sapienza University, Via di Grottarossa 1035/1039, 00189, Rome, Italy
| | - L Pizzuti
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - M Mazzotta
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - D Sergi
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - E Capomolla
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - S Donzelli
- Oncogenomic and Epigenetic Unit, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - M Carosi
- Pathology Department IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - A Bagnato
- Preclinical Models and New Therapeutic Agents Unit, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - T Gamucci
- Medical Oncology, Sandro Pertini Hospital, Via dei Monti Tiburtini 385, 00157, Rome, Italy
| | - S Tomao
- Department of Radiological Oncological and Pathological Sciences, Division of Medical Oncology A, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - C Natoli
- Department of Medical, Oral & Biotechnological Sciences, University G. D'Annunzio, Via dei Vestini, 31, 66100, Chieti, Italy
| | - P Marchetti
- Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Medical Oncology Unit, Sapienza University, Via di Grottarossa 1035/1039, 00189, Rome, Italy
| | - A Grassadonia
- Department of Medical, Oral & Biotechnological Sciences, University G. D'Annunzio, Via dei Vestini, 31, 66100, Chieti, Italy
| | - N Tinari
- Department of Medical, Oral & Biotechnological Sciences, University G. D'Annunzio, Via dei Vestini, 31, 66100, Chieti, Italy
| | - M De Tursi
- Department of Medical, Oral & Biotechnological Sciences, University G. D'Annunzio, Via dei Vestini, 31, 66100, Chieti, Italy
| | - E Vizza
- Department of Oncological Surgery, Gynecologic Oncologic Unit, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - G Ciliberto
- Scientific Direction, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - L Landi
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - F Cappuzzo
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - M Barba
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.
| | - G Blandino
- Oncogenomic and Epigenetic Unit, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.
| | - P Vici
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
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Cognetti F, Masetti R, Fabi A, Bianchi G, Santini D, Rognone A, Catania G, Angelucci D, Naso G, Giuliano M, Vassalli L, Vici P, Scognamiglio G, Generali D, Zambelli A, Colleoni M, Tinterri C, Scanzi F, Vigna L, Scavina P, Gamucci T, Marrazzo E, Scinto AF, Berardi R, Fabbri MA, Pinotti G, Franco D, Terribile DA, Tonini G, Cianniello D, Barni S. PONDx: real-life utilization and decision impact of the 21-gene assay on clinical practice in Italy. NPJ Breast Cancer 2021; 7:47. [PMID: 33953182 PMCID: PMC8099872 DOI: 10.1038/s41523-021-00246-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 11/12/2020] [Indexed: 12/19/2022] Open
Abstract
Clinicopathological prognostic features have limited value to identify with precision newly diagnosed patients with hormone receptor (HR)-positive, HER2-negative breast cancer (BC), who would benefit from chemotherapy (CT) in addition to adjuvant hormonal therapy (HT). The 21-gene Oncotype DX Breast Recurrence Score® (RS) assay has been demonstrated to predict CT benefit, hence supporting personalized decisions on adjuvant CT. The multicenter, prospective, observational study PONDx investigated the real-life use of RS® results in Italy and its impact on treatment decisions. Physicians' treatment recommendations (HT ± CT) were documented before and after availability of RS results, and changes in recommendations were determined. In the HR+ HER2- early BC population studied (N = 1738), physicians recommended CT + HT in 49% of patients pre-RS. RS-guided treatment decisions resulted in 36% reduction of CT recommendations. PONDx confirms that RS results provide clinically relevant information for CT recommendation in early-stage BC, resulting in a reduction of more than a third of CT use.
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Affiliation(s)
- Francesco Cognetti
- Università La Sapienza di Roma, Dipartimento Medicina Clinica e Molecolare, Rome, Italy.
| | | | | | - Giulia Bianchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | | | | | | | | | - Mario Giuliano
- Azienda Ospedaliera Universitaria Federico II, Napoli, Italy
| | | | - Patrizia Vici
- IRCCS Regina Elena National Cancer Institute, Roma, Italy
| | | | | | | | | | | | | | | | - Paola Scavina
- Azienda Ospedaliera San Giovanni - Addolorata, Roma, Italy
| | | | | | | | - Rossana Berardi
- Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona, Torrette, Italy
| | | | | | | | | | | | | | - Sandro Barni
- ASST BG Ovest Ospedale Treviglio, Treviglio, BG, Italy
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38
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Krasniqi E, Pizzuti L, Valerio MR, Capomolla E, Botti C, Sanguineti G, Marchetti P, Anselmi E, Tomao S, Giordano A, Ficorella C, Cannita K, Livi L, Meattini I, Mauri M, Greco F, Veltri EM, Michelotti A, Moscetti L, Giotta F, Lorusso V, Paris I, Tomao F, Santini D, Tonini G, Villa A, Gebbia V, Gamucci T, Ciliberto G, Sperduti I, Mazzotta M, Barba M, Vici P. Second-line Eribulin in Triple Negative Metastatic Breast Cancer patients. Multicentre Retrospective Study: The TETRIS Trial. Int J Med Sci 2021; 18:2245-2250. [PMID: 33859534 PMCID: PMC8040412 DOI: 10.7150/ijms.54996] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 12/18/2020] [Indexed: 12/31/2022] Open
Abstract
Introduction: Large and consistent evidence supports the use of eribulin mesylate in clinical practice in third or later line treatment of metastatic triple negative breast cancer (mTNBC). Conversely, there is paucity of data on eribulin efficacy in second line treatment. Methods: We investigated outcomes of 44 mTNBC patients treated from 2013 through 2019 with second line eribulin mesylate in a multicentre retrospective study involving 14 Italian oncologic centres. Results: Median age was 51 years, with 11.4% of these patients being metastatic at diagnosis. Median overall survival (OS) and progression free survival (PFS) from eribulin starting were 11.9 (95%CI: 8.4-15.5) and 3.5 months (95%CI: 1.7-5.3), respectively. We observed 8 (18.2%) partial responses and 10 (22.7%) patients had stable disease as best response. A longer PFS on previous first line treatment predicted a better OS (HR=0.87, 95%CI: 0.77-0.99, p= 0.038) and a longer PFS on eribulin treatment (HR=0.92, 95%CI: 0.85-0.98, p=0.018). Progression free survival to eribulin was also favorably influenced by prior adjuvant chemotherapy (HR=0.44, 95%CI: 0.22-0.88, p=0.02). Eribulin was generally well tolerated, with grade 3-4 adverse events being recorded in 15.9% of patients. Conclusions: The outcomes described for our cohort are consistent with those reported in the pivotal Study301 and subsequent observational studies. Further data from adequately-sized, ad hoc trials on eribulin use in second line for mTNBC are warranted to confirm our findings.
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Affiliation(s)
- Eriseld Krasniqi
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Laura Pizzuti
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Maria Rosaria Valerio
- Department of Surgical, Oncological and Oral Sciences, Medical Oncology Unit, University of Palermo, Italy
| | - Elisabetta Capomolla
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Claudio Botti
- Department of Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppe Sanguineti
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Paolo Marchetti
- Medical Oncology Unit B, Policlinico Umberto I, Rome, Italy
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Sant'Andrea, Rome, Italy
| | - Elisabetta Anselmi
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Sant'Andrea, Rome, Italy
| | - Silverio Tomao
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, 'Sapienza' University of Rome, Policlinico Umberto I, Rome, Italy
| | - Antonio Giordano
- Sbarro Institute for Cancer Research and Molecular Medicine and Center of Biotechnology, College of Science and Technology, Temple University, Philadelphia, Pennsylvania, USA
| | - Corrado Ficorella
- Medical Oncology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Katia Cannita
- Medical Oncology, St. Salvatore Hospital, L'Aquila, Italy
| | - Lorenzo Livi
- Radiation Oncology Unit and Department of Clinical and Experimental Biomedical Sciences “Mario Serio”, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Icro Meattini
- Radiation Oncology Unit and Department of Clinical and Experimental Biomedical Sciences “Mario Serio”, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Maria Mauri
- Division of Oncology, San Giovanni Addolorata Hospital, Rome, Italy
| | - Filippo Greco
- Department of Pathology, Surgery and Oncology, “Mater Salutis” Hospital, ULSS21, Verona, Italy
| | | | - Andrea Michelotti
- UO Oncologia Medica I, S. Chiara Hospital, Dipartimento di Oncologia, Dei Trapianti e Delle Nuove Tecnologie, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Luca Moscetti
- Division of Medical Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Francesco Giotta
- Department of Medical Oncology, “Giovanni Paolo II” Institute, Bari, Italy
| | - Vito Lorusso
- Department of Medical Oncology, “Giovanni Paolo II” Institute, Bari, Italy
| | - Ida Paris
- Gynecology Oncology Unit, Catholic University of the Sacred Heart, Rome, Italy
| | - Federica Tomao
- Department of Gynecology-Obstetrics and Urology, “Sapienza” University of Rome, Rome, Italy
| | - Daniele Santini
- Department of Oncology, University Campus Biomedico of Rome, Rome, Italy
| | - Giuseppe Tonini
- Department of Oncology, University Campus Biomedico of Rome, Rome, Italy
| | - Alice Villa
- Department of Medical Oncology, Policlinico Universitario “A. Gemelli”, Rome, Italy
| | - Vittorio Gebbia
- Medical Oncology, La Maddalena Nursing Home, University of Palermo, Palermo, Italy
| | - Teresa Gamucci
- Medical Oncology Unit, Sandro Pertini Hospital, Rome, Italy
| | - Gennaro Ciliberto
- Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Isabella Sperduti
- Bio-Statistics Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Marco Mazzotta
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Maddalena Barba
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Patrizia Vici
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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Vici P, Krasniqi E, Pizzuti L, Ciliberto G, Mazzotta M, Marinelli D, Barba M. Burnout of health care providers during the COVID-19 pandemic: Focus on Medical Oncologists. Int J Med Sci 2021; 18:2235-2238. [PMID: 33859532 PMCID: PMC8040416 DOI: 10.7150/ijms.54025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 01/04/2021] [Indexed: 01/12/2023] Open
Abstract
The spread of the coronavirus disease 2019 (Covid-19) has challenged hard the national health system worldwide. At any level, the role of health care providers has been rapidly revisited and eventually modified to face the pandemic. The search of the balance between the provision of the most appropriate health-related services and safety of both patients and health care providers has become an indisputable necessity. The consequently increased work load, along with a widespread feeling of intellectual isolation, emotional overload, sense of inadequacy for involvement in tasks and disciplines which are not always familiar have all been proposed as factors related to the onset and/or worsening of the burnout phenomenon. This latter is sadly renown among care givers and is particularly common among medical oncologists. We herein share our perspectives on the burnout phenomenon over the course of the Covid-19 pandemic, with a specific focus on medical oncologists. Results from the most recent and inherent studies are presented and commented in light of hints provided by the experience matured by a quite restricted, still potentially representative, number of professionals figures from the medical oncologists' category. Reasons are proposed to explain the sense of inadequacy currently perceived in relation to the limits imposed by the current pandemic. In more detail, we illustrate the nature and extents of some of the most relevant difficulties in the optimal management of cancer patients and constant efforts towards the scientific upgrade which allows for the improvement of the professional performance. The need for a deeper understanding of the roots and consequences of the Covid-19 pandemic on the mental health of medical oncologists is finally stressed.
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Affiliation(s)
- Patrizia Vici
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi, 00144 Rome, Italy
| | - Eriseld Krasniqi
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi, 00144 Rome, Italy
| | - Laura Pizzuti
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi, 00144 Rome, Italy
| | - Gennaro Ciliberto
- Scientific Direction, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Marco Mazzotta
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi, 00144 Rome, Italy
| | - Daniele Marinelli
- Department of Clinical and Molecular Medicine, "Sapienza" University of Rome, Azienda Ospedaliera Sant'Andrea, 00189 Rome, Italy
| | - Maddalena Barba
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi, 00144 Rome, Italy
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40
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Barba M, Krasniqi E, Pizzuti L, Mazzotta M, Marinelli D, Giuliano G, Di Liso FS, Cappuzzo F, Landi L, Tomao S, Ciliberto G, Vici P. COVID-19 risk in breast cancer patients receiving CDK4/6 inhibitors: literature data and a monocentric experience. Breast J 2021; 27:359-362. [PMID: 33677841 PMCID: PMC8251317 DOI: 10.1111/tbj.14204] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 02/11/2021] [Indexed: 12/30/2022]
Abstract
Substantial changes in the management of cancer patients have been required worldwide in response to the COVID‐19 pandemic. Beyond the due details on the primitive cancer site and setting at diagnosis, these latter adaptions are most commonly exemplified by a significant reduction in the screening of asymptomatic subjects, delays in elective surgery and radiotherapy for primary tumors, and dose reductions and/or delays in systemic therapy administration. Advanced breast cancer patients with hormonal receptor positive, HER2 negative tumors are usually treated with endocrine therapy combined with CDK 4/6 inhibitors as first‐ and second‐line treatment. During the pandemic, experts’ recommendations have suggested the omission or delay of CDK 4/6 inhibitors delivery, or a careful evaluation of their real need due to the hypothesized increased risk of SARS‐Cov‐2 infection and disease possibly related to neutropenia. The inherent literature is sparse and inconsistent. We herein present data on the use of CDK 4/6 inhibitors during the pandemic. The evidence reported punctually reflects the experience matured at our Institution, a comprehensive cancer centre, on the topic of interest.
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Affiliation(s)
- Maddalena Barba
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Eriseld Krasniqi
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Laura Pizzuti
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Marco Mazzotta
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Daniele Marinelli
- Medical Oncology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Greta Giuliano
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Francesca Sofia Di Liso
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Policlinico Umberto I, Sapienza - Università di Roma, Rome, Italy
| | - Federico Cappuzzo
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Lorenza Landi
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Silverio Tomao
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Policlinico Umberto I, Sapienza - Università di Roma, Rome, Italy
| | - Gennaro Ciliberto
- Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Patrizia Vici
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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41
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Roberto M, Astone A, Botticelli A, Carbognin L, Cassano A, D’Auria G, Fabbri A, Fabi A, Gamucci T, Krasniqi E, Minelli M, Orlandi A, Pantano F, Paris I, Pizzuti L, Portarena I, Salesi N, Scagnoli S, Scavina P, Tonini G, Vici P, Marchetti P. CDK4/6 Inhibitor Treatments in Patients with Hormone Receptor Positive, Her2 Negative Advanced Breast Cancer: Potential Molecular Mechanisms, Clinical Implications and Future Perspectives. Cancers (Basel) 2021; 13:332. [PMID: 33477469 PMCID: PMC7830463 DOI: 10.3390/cancers13020332] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [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: 12/14/2020] [Revised: 01/07/2021] [Accepted: 01/12/2021] [Indexed: 02/06/2023] Open
Abstract
Hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative breast cancer is the most common breast cancer subtype, and endocrine therapy (ET) remains its therapeutic backbone. Although anti-estrogen therapies are usually effective initially, approximately 50% of HR+ patients develop resistance to ET within their lifetime, ultimately leading to disease recurrence and limited clinical benefit. The recent addition of cyclin-dependent kinase 4 (CDK4) and CDK6 inhibitors (palbociclib, ribociclib, abemaciclib) to ET have remarkably improved the outcome of patients with HR+ advanced breast cancer (ABC) compared with anti-estrogens alone, by targeting the cell-cycle machinery and overcoming some aspects of endocrine resistance. However, which patients are the better candidates for these drugs, which are the main characteristics for a better selection of patients or if there are predictive biomarkers of response, is still unknown. In this review we reported the mechanism of action of CDK4/6 inhibitors as well as their potential mechanism of resistance, their implications in clinical practice and the forthcoming strategies to enhance their efficacy in improving survival and quality of life of patients affected with HR+, HER2-, ABC.
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Affiliation(s)
- Michela Roberto
- Oncology Unit, Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1035-1039, 00189 Rome, Italy;
| | - Antonio Astone
- Division of Medical Oncology, Fatebenefratelli San Pietro Hospital, 00189 Rome, Italy;
| | | | - Luisa Carbognin
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (L.C.); (I.P.)
| | - Alessandra Cassano
- Department of Medical Oncology, Catholic University of Sacred Heart, 00168 Rome, Italy; (A.C.); (A.O.)
| | - Giuliana D’Auria
- Medical Oncology, Sandro Pertini Hospital, 00157 Rome, Italy; (G.D.); (T.G.)
| | - Agnese Fabbri
- Medical Oncology Unit, Belcolle Hospital, 01100 Viterbo, Italy;
| | - Alessandra Fabi
- Phase 1 Unit and Pre+cision Medicine, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy;
| | - Teresa Gamucci
- Medical Oncology, Sandro Pertini Hospital, 00157 Rome, Italy; (G.D.); (T.G.)
| | - Eriseld Krasniqi
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (E.K.); (L.P.); (P.V.)
| | - Mauro Minelli
- San Giovanni Addolorata Hospital, 00184 Rome, Italy; (M.M.); (P.S.)
| | - Armando Orlandi
- Department of Medical Oncology, Catholic University of Sacred Heart, 00168 Rome, Italy; (A.C.); (A.O.)
| | - Francesco Pantano
- Department of Oncology, University Campus Biomedico of Rome, 00155 Rome, Italy; (F.P.); (G.T.)
| | - Ida Paris
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (L.C.); (I.P.)
| | - Laura Pizzuti
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (E.K.); (L.P.); (P.V.)
| | - Ilaria Portarena
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata Clinical Center University Hospital, 00133 Rome, Italy;
| | - Nello Salesi
- Medical Oncology, S.M. Goretti Hospital, 04100 Latina, Italy;
| | - Simone Scagnoli
- Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University of Rome, 00185 Rome, Italy;
| | - Paola Scavina
- San Giovanni Addolorata Hospital, 00184 Rome, Italy; (M.M.); (P.S.)
| | - Giuseppe Tonini
- Department of Oncology, University Campus Biomedico of Rome, 00155 Rome, Italy; (F.P.); (G.T.)
| | - Patrizia Vici
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (E.K.); (L.P.); (P.V.)
| | - Paolo Marchetti
- Oncology Unit, Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1035-1039, 00189 Rome, Italy;
- Medical Oncology Unit B, Policlinico Umberto I, 00161 Rome, Italy;
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42
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Goeman F, De Nicola F, Amoreo CA, Scalera S, Marinelli D, Sperati F, Mazzotta M, Terrenato I, Pallocca M, Ciuffreda L, Sperandio E, Barba M, Pizzuti L, Sergi D, Amodio A, Paoletti G, Krasniqi E, Vici P, Casini B, Gallo E, Buglioni S, Diodoro MG, Pescarmona E, Vitale I, De Maria R, Grazi GL, Ciliberto G, Fanciulli M, Maugeri-Saccà M. Multicohort and cross-platform validation of a prognostic Wnt signature in colorectal cancer. Clin Transl Med 2020; 10:e199. [PMID: 33377637 PMCID: PMC7770515 DOI: 10.1002/ctm2.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 09/23/2020] [Indexed: 11/15/2022] Open
Affiliation(s)
- Frauke Goeman
- Oncogenomic and Epigenetic Unit, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Francesca De Nicola
- SAFU Laboratory, Department of Research, Advanced Diagnostic, and Technological Innovation, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Carla Azzurra Amoreo
- Department of Pathology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Stefano Scalera
- SAFU Laboratory, Department of Research, Advanced Diagnostic, and Technological Innovation, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Daniele Marinelli
- Medical Oncology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Francesca Sperati
- Biostatistics Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Marco Mazzotta
- Division of Medical Oncology 2, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Irene Terrenato
- Biostatistics-Scientific Direction, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Matteo Pallocca
- SAFU Laboratory, Department of Research, Advanced Diagnostic, and Technological Innovation, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Ludovica Ciuffreda
- SAFU Laboratory, Department of Research, Advanced Diagnostic, and Technological Innovation, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Eleonora Sperandio
- SAFU Laboratory, Department of Research, Advanced Diagnostic, and Technological Innovation, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Maddalena Barba
- Division of Medical Oncology 2, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Laura Pizzuti
- Division of Medical Oncology 2, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Domenico Sergi
- Division of Medical Oncology 2, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Antonella Amodio
- Division of Medical Oncology 2, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Giancarlo Paoletti
- Division of Medical Oncology 2, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Eriseld Krasniqi
- Division of Medical Oncology 2, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Patrizia Vici
- Division of Medical Oncology 2, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Beatrice Casini
- Department of Pathology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Enzo Gallo
- Department of Pathology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Simonetta Buglioni
- Department of Pathology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Maria Grazia Diodoro
- Department of Pathology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Edoardo Pescarmona
- Department of Pathology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Ilio Vitale
- Italian Institute for Genomic Medicine (IIGM), IRCSS Candiolo, Turin, Italy.,Candiolo Cancer Institute, FPO - IRCCS, Turin, Italy
| | - Ruggero De Maria
- Institute of General Pathology, Catholic University of the Sacred Heart, Rome, Italy.,Institute of General Pathology, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Gian Luca Grazi
- Hepato-Pancreato-Biliary Surgery, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Gennaro Ciliberto
- Scientific Direction, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Maurizio Fanciulli
- SAFU Laboratory, Department of Research, Advanced Diagnostic, and Technological Innovation, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Marcello Maugeri-Saccà
- Division of Medical Oncology 2, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
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43
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Bon G, Pizzuti L, Laquintana V, Loria R, Porru M, Marchiò C, Krasniqi E, Barba M, Maugeri-Saccà M, Gamucci T, Berardi R, Livi L, Ficorella C, Natoli C, Cortesi E, Generali D, La Verde N, Cassano A, Bria E, Moscetti L, Michelotti A, Adamo V, Zamagni C, Tonini G, Barchiesi G, Mazzotta M, Marinelli D, Tomao S, Marchetti P, Valerio MR, Mirabelli R, Russo A, Fabbri MA, D'Ostilio N, Veltri E, Corsi D, Garrone O, Paris I, Sarobba G, Giotta F, Garufi C, Cazzaniga M, Del Medico P, Roselli M, Sanguineti G, Sperduti I, Sapino A, De Maria R, Leonetti C, Di Leo A, Ciliberto G, Falcioni R, Vici P. Loss of HER2 and decreased T-DM1 efficacy in HER2 positive advanced breast cancer treated with dual HER2 blockade: the SePHER Study. J Exp Clin Cancer Res 2020; 39:279. [PMID: 33302999 PMCID: PMC7731769 DOI: 10.1186/s13046-020-01797-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 12/02/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND HER2-targeting agents have dramatically changed the therapeutic landscape of HER2+ advanced breast cancer (ABC). Within a short time frame, the rapid introduction of new therapeutics has led to the approval of pertuzumab combined with trastuzumab and a taxane in first-line, and trastuzumab emtansine (T-DM1) in second-line. Thereby, evidence of T-DM1 efficacy following trastuzumab/pertuzumab combination is limited, with data from some retrospective reports suggesting lower activity. The purpose of the present study is to investigate T-DM1 efficacy in pertuzumab-pretreated and pertuzumab naïve HER2 positive ABC patients. We also aimed to provide evidence on the exposure to different drugs sequences including pertuzumab and T-DM1 in HER2 positive cell lines. METHODS The biology of HER2 was investigated in vitro through sequential exposure of resistant HER2 + breast cancer cell lines to trastuzumab, pertuzumab, and their combination. In vitro experiments were paralleled by the analysis of data from 555 HER2 + ABC patients treated with T-DM1 and evaluation of T-DM1 efficacy in the 371 patients who received it in second line. Survival estimates were graphically displayed in Kaplan Meier curves, compared by log rank test and, when possibile, confirmed in multivariate models. RESULTS We herein show evidence of lower activity of T-DM1 in two HER2+ breast cancer cell lines resistant to trastuzumab+pertuzumab, as compared to trastuzumab-resistant cells. Lower T-DM1 efficacy was associated with a marked reduction of HER2 expression on the cell membrane and its nuclear translocation. HER2 downregulation at the membrane level was confirmed in biopsies of four trastuzumab/pertuzumab-pretreated patients. Among the 371 patients treated with second-line T-DM1, median overall survival (mOS) from diagnosis of advanced disease and median progression-free survival to second-line treatment (mPFS2) were 52 and 6 months in 177 patients who received trastuzumab/pertuzumab in first-line, and 74 and 10 months in 194 pertuzumab-naïve patients (p = 0.0006 and 0.03 for OS and PFS2, respectively). CONCLUSIONS Our data support the hypothesis that the addition of pertuzumab to trastuzumab reduces the amount of available plasma membrane HER2 receptor, limiting the binding of T-DM1 in cancer cells. This may help interpret the less favorable outcomes of second-line T-DM1 in trastuzumab/pertuzumab pre-treated patients compared to their pertuzumab-naïve counterpart.
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Affiliation(s)
- Giulia Bon
- Cellular Network and Molecular Therapeutic Target Unit, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.
| | - Laura Pizzuti
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | | | - Rossella Loria
- Cellular Network and Molecular Therapeutic Target Unit, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Manuela Porru
- Area of Translational Research, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Caterina Marchiò
- Department of Medical Sciences, University of Turin, Turin, Italy.,Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | - Eriseld Krasniqi
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.
| | - Maddalena Barba
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Marcello Maugeri-Saccà
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | | | - Rossana Berardi
- Oncology Clinic, "Ospedali Riuniti di Ancona" Hospital, Ancona, Italy
| | - Lorenzo Livi
- Radiotherapy Unit, Department of Oncology, Careggi University Hospital, Florence, Italy
| | | | - Clara Natoli
- Department of Medical, Oral and Biotechnological Sciences, University Gabriele D'Annunzio, Chieti, Italy
| | - Enrico Cortesi
- Department of Medical Oncology, University La Sapienza, Rome, Italy
| | | | - Nicla La Verde
- Oncology Unit, ASST Fatebenefratelli Sacco-PO Fatebenefratelli, Milan, Italy
| | - Alessandra Cassano
- Oncology Unit, IRCCS Foundation Polyclinic University A. Gemelli, University Cattolica Del Sacro Cuore, Rome, Italy
| | - Emilio Bria
- Oncology Unit, IRCCS Foundation Polyclinic University A. Gemelli, University Cattolica Del Sacro Cuore, Rome, Italy.,University of Verona, Verona, Italy
| | - Luca Moscetti
- Department of Oncology and Hematology, University Hospital, Modena, Italy
| | | | - Vincenzo Adamo
- Medical Oncology Unit, A.O. Papardo & Department of Human Pathology, University of Messina, Messina, Italy
| | - Claudio Zamagni
- Medical Oncology Unit, Addarii Institute of Oncology, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Giuseppe Tonini
- Department of Oncology, University Campus Biomedico, Rome, Italy
| | - Giacomo Barchiesi
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Marco Mazzotta
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Daniele Marinelli
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.,Medical Oncology Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Silverio Tomao
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, University La Sapienza, Umberto I University Hospital, Rome, Italy
| | - Paolo Marchetti
- Department of Medical Oncology, University La Sapienza, Rome, Italy.,Medical Oncology Unit, Sant'Andrea University Hospital, Rome, Italy
| | | | - Rosanna Mirabelli
- Department of Ematology & Oncology, Pugliese-Ciaccio Hospital, Catanzaro, Italy
| | - Antonio Russo
- Medical Oncology, Paolo Giaccone University Hospital, Palermo, Italy
| | | | | | - Enzo Veltri
- Medical Oncology Unit, Santa Maria Goretti Hospital, Latina, Italy
| | - Domenico Corsi
- Medical Oncology Unit, Fatebenefratelli Hospital, Rome, Italy
| | - Ornella Garrone
- Medical Oncology AO S. Croce and Carle Teaching Hospital, Cuneo, Italy
| | - Ida Paris
- Gynaecology - Oncology Unit, University Cattolica del Sacro Cuore, Rome, Italy
| | | | - Francesco Giotta
- Department of Medical Oncology, IRCCS Giovanni Paolo II, Bari, Italy
| | - Carlo Garufi
- Division of Medical Oncology, Pescara Hospital, Pescara, Italy
| | - Marina Cazzaniga
- Research Unit Phase I Trials and Oncology Unit, ASST, Monza, Italy
| | - Pietro Del Medico
- Division of Medical Oncology, Reggio Calabria General Hospital, Reggio Calabria, Italy
| | - Mario Roselli
- Department of Systems Medicine, Medical Oncology, University Tor Vergata, Rome, Italy
| | - Giuseppe Sanguineti
- Radiotherapy Department, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Isabella Sperduti
- Biostatistics Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Anna Sapino
- Department of Medical Sciences, University of Turin, Turin, Italy.,Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | - Ruggero De Maria
- Institute of General Pathology, University Cattolica del Sacro Cuore, Rome, Italy.,Department of Medical Oncology, IRCCS Foundation University A. Gemelli, Rome, Italy
| | - Carlo Leonetti
- Area of Translational Research, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Angelo Di Leo
- Sandro Pitigliani Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - Gennaro Ciliberto
- Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Rita Falcioni
- Cellular Network and Molecular Therapeutic Target Unit, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Patrizia Vici
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
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Marinelli D, Giusti R, Mazzotta M, Filetti M, Krasniqi E, Pizzuti L, Landi L, Tomao S, Cappuzzo F, Ciliberto G, Barba M, Vici P, Marchetti P. Palliative- and non-palliative indications for glucocorticoids use in course of immune-checkpoint inhibition. Current evidence and future perspectives. Crit Rev Oncol Hematol 2020; 157:103176. [PMID: 33276183 DOI: 10.1016/j.critrevonc.2020.103176] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 03/19/2020] [Revised: 11/08/2020] [Accepted: 11/09/2020] [Indexed: 12/17/2022] Open
Abstract
Immune-checkpoint inhibitors significantly reshaped treatment landscapes in several solid tumors. Concurrently with disease-oriented therapies, cancer patients often require proper management of drug-related adverse events and/or cancer-related symptoms. Glucocorticoids (GC) are a cornerstone of symptom management in advanced cancer care and in the management of immune-related adverse events (irAEs) due to immune-modulating therapies. Moreover, GC are often administered in patients with autoimmune diseases (AID), either alone or in combination with other treatments. While handling of irAEs with GC is supported by multiple guidelines, it is unclear whether GC administration because of pre-existing AID or because of palliative needs is associated with inferior outcomes in cancer patients treated with immune-checkpoint inhibitors (ICIs). When globally considered, the available evidence seems to orient towards less favorable survival outcomes when GC administration is driven by a palliative intent. Conversely, steroid administration for non-palliative intent seems to be associated with stable or negligibly reduced survival outcomes.
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Affiliation(s)
- Daniele Marinelli
- Department of Clinical and Molecular Medicine, Sapienza - University of Rome, Sant'Andrea Hospital, Rome, Italy; Division of Medical Oncology 2, IRCCS Regina Elena, National Cancer Institute, Rome, Italy
| | | | - Marco Mazzotta
- Division of Medical Oncology 2, IRCCS Regina Elena, National Cancer Institute, Rome, Italy
| | - Marco Filetti
- Department of Clinical and Molecular Medicine, Sapienza - University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Eriseld Krasniqi
- Division of Medical Oncology 2, IRCCS Regina Elena, National Cancer Institute, Rome, Italy
| | - Laura Pizzuti
- Division of Medical Oncology 2, IRCCS Regina Elena, National Cancer Institute, Rome, Italy
| | - Lorenza Landi
- Division of Medical Oncology 2, IRCCS Regina Elena, National Cancer Institute, Rome, Italy
| | - Silverio Tomao
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Policlinico Umberto I, 'Sapienza' University of Rome, Rome, Italy
| | - Federico Cappuzzo
- Division of Medical Oncology 2, IRCCS Regina Elena, National Cancer Institute, Rome, Italy
| | - Gennaro Ciliberto
- Scientific Direction, IRCCS Regina Elena, National Cancer Institute, Rome, Italy
| | - Maddalena Barba
- Division of Medical Oncology 2, IRCCS Regina Elena, National Cancer Institute, Rome, Italy.
| | - Patrizia Vici
- Division of Medical Oncology 2, IRCCS Regina Elena, National Cancer Institute, Rome, Italy
| | - Paolo Marchetti
- Department of Clinical and Molecular Medicine, Sapienza - University of Rome, Sant'Andrea Hospital, Rome, Italy
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Franconi R, Massa S, Paolini F, Vici P, Venuti A. Plant-Derived Natural Compounds in Genetic Vaccination and Therapy for HPV-Associated Cancers. Cancers (Basel) 2020; 12:cancers12113101. [PMID: 33114220 PMCID: PMC7690868 DOI: 10.3390/cancers12113101] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/13/2020] [Accepted: 10/21/2020] [Indexed: 12/22/2022] Open
Abstract
Simple Summary DNA vaccination represents a useful approach for human papillomavirus (HPV) cancer therapy. The therapeutic potential of plant-based natural compounds for control of HPV- associated cancers has been also widely explored. Genetic vaccines for HPV-associated tumors that include plant protein-encoding gene sequences, used alone or in combinations with plant metabolites, are being investigated but are still in their infancy. Main focus of this paper is to provide an overview of the current state of novel therapeutic strategies employing genetic vaccines along with plant-derived compounds and genes. We highlight the importance of multimodality treatment regimen such as combining immunotherapy with plant-derived agents. Abstract Antigen-specific immunotherapy and, in particular, DNA vaccination provides an established approach for tackling human papillomavirus (HPV) cancers at different stages. DNA vaccines are stable and have a cost-effective production. Their intrinsic low immunogenicity has been improved by several strategies with some success, including fusion of HPV antigens with plant gene sequences. Another approach for the control of HPV cancers is the use of natural immunomodulatory agents like those derived from plants, that are able to interfere in carcinogenesis by modulating many different cellular pathways and, in some instances, to reduce chemo- and radiotherapy resistance of tumors. Indeed, plant-derived compounds represent, in many cases, an abundantly available, cost-effective source of molecules that can be either harvested directly in nature or obtained from plant cell cultures. In this review, an overview of the most relevant data reported in literature on the use of plant natural compounds and genetic vaccines that include plant-derived sequences against HPV tumors is provided. The purpose is also to highlight the still under-explored potential of multimodal treatments implying DNA vaccination along with plant-derived agents.
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Affiliation(s)
- Rosella Franconi
- Division of Health Protection Technology, Department for Sustainability, Italian National Agency for New Technologies, Energy and Sustainable Economic Development, ENEA, 00123 Rome, Italy
- Correspondence: (R.F.); (S.M.); Tel.: +39-06-3048-4482 (R.F.); +39-06-3048-4052 (S.M.)
| | - Silvia Massa
- Division of Biotechnology and Agroindustry, Department for Sustainability, ENEA, 00123 Rome, Italy
- Correspondence: (R.F.); (S.M.); Tel.: +39-06-3048-4482 (R.F.); +39-06-3048-4052 (S.M.)
| | - Francesca Paolini
- HPV-UNIT—UOSD Tumor Immunology and Immunotherapy, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (F.P.); (A.V.)
| | - Patrizia Vici
- Division of Medical Oncology B, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy;
| | - Aldo Venuti
- HPV-UNIT—UOSD Tumor Immunology and Immunotherapy, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (F.P.); (A.V.)
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46
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Marinelli D, Mazzotta M, Pizzuti L, Krasniqi E, Gamucci T, Natoli C, Grassadonia A, Tinari N, Tomao S, Sperduti I, Sanguineti G, Botticelli A, Fabbri A, Botti C, Ciliberto G, Barba M, Vici P. Neoadjuvant Immune-Checkpoint Blockade in Triple-Negative Breast Cancer: Current Evidence and Literature-Based Meta-Analysis of Randomized Trials. Cancers (Basel) 2020; 12:cancers12092497. [PMID: 32899209 PMCID: PMC7565914 DOI: 10.3390/cancers12092497] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/26/2020] [Accepted: 08/28/2020] [Indexed: 02/06/2023] Open
Abstract
Simple Summary Breast cancer is a heterogeneous disease, which encompasses several subgroups of entities widely varying by clinical-pathological features. Triple negative breast cancer is characterized by a particularly aggressive biological behavior. The administration of chemotherapy has long represented the most efficacious weapon in combating triple negative breast cancer in both its initial and late phase of development. A pivot point has been recently reached throughout the approval of the immunotherapic agent atezolizumab in combination with chemotherapy as first-line treatment for programmed-death ligand 1-positive, unresectable locally advanced, or metastatic triple-negative breast cancer. Results from the registrative trial, IMpassion 130, have increasingly fueled the flourishing of studies of immune-checkpoint inhibitors in the early stage of triple negative breast cancer development. We critically interpret results from the most recent literature in light of relevant issues of methodological nature and also present a quantitative summary of data from the inherent trials. Future directions are also highlighted. Abstract Chemotherapy based on the sequential use of anthracyclines and taxanes has long represented the most efficacious approach in the management of early-stage, triple-negative breast cancer, whose aggressive behavior is widely renowned. This standard chemotherapy backbone was subsequently enriched by the use of carboplatin, based on its association with increased pathologic complete response and efficacy in the metastatic setting. Following the results from the IMpassion130 trial, the recent approval of the immunotherapic agent atezolizumab in combination with chemotherapy as first-line treatment for programmed-death ligand 1-positive, unresectable locally advanced, or metastatic triple-negative breast cancer increasingly fueled the flourishing of trials of immune-checkpoint inhibitors in the early setting. In this work, we review the most recent inherent literature in light of key methodological issues and provide a quantitative summary of the results from phase II–III randomized trials of immunotherapic agents combined with chemotherapy in the setting of interest. Hints regarding future directions are also discussed.
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Affiliation(s)
- Daniele Marinelli
- Department of Clinical and Molecular Medicine, Oncology Unit, Sant’Andrea Hospital, Sapienza University, 00189 Rome, Italy;
| | - Marco Mazzotta
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (M.M.); (E.K.); (P.V.)
| | - Laura Pizzuti
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (M.M.); (E.K.); (P.V.)
- Correspondence: (L.P.); (M.B.); Tel.: +39-06-52665698 (L.P.); +39-06-52665419 (M.B.)
| | - Eriseld Krasniqi
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (M.M.); (E.K.); (P.V.)
| | - Teresa Gamucci
- Medical Oncology, Sandro Pertini Hospital, 00157 Rome, Italy;
| | - Clara Natoli
- Department of Medical, Oral and Biotechnological Sciences and CeSI-MeT, G. D’Annunzio University, 66100 Chieti, Italy; (C.N.); (A.G.); (N.T.)
| | - Antonino Grassadonia
- Department of Medical, Oral and Biotechnological Sciences and CeSI-MeT, G. D’Annunzio University, 66100 Chieti, Italy; (C.N.); (A.G.); (N.T.)
| | - Nicola Tinari
- Department of Medical, Oral and Biotechnological Sciences and CeSI-MeT, G. D’Annunzio University, 66100 Chieti, Italy; (C.N.); (A.G.); (N.T.)
| | - Silverio Tomao
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Policlinico Umberto I, ‘Sapienza’ University of Rome, 00161 Rome, Italy;
| | - Isabella Sperduti
- Biostatistics Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy;
| | - Giuseppe Sanguineti
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy;
| | | | - Agnese Fabbri
- Medical Oncology Unit, Belcolle Hospital, 01100 Viterbo, Italy;
| | - Claudio Botti
- Department of Surgery, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy;
| | - Gennaro Ciliberto
- Scientific Direction, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy;
| | - Maddalena Barba
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (M.M.); (E.K.); (P.V.)
- Correspondence: (L.P.); (M.B.); Tel.: +39-06-52665698 (L.P.); +39-06-52665419 (M.B.)
| | - Patrizia Vici
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (M.M.); (E.K.); (P.V.)
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47
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Marinelli D, Mazzotta M, Scalera S, Terrenato I, Sperati F, D'Ambrosio L, Pallocca M, Corleone G, Krasniqi E, Pizzuti L, Barba M, Carpano S, Vici P, Filetti M, Giusti R, Vecchione A, Occhipinti M, Gelibter A, Botticelli A, De Nicola F, Ciuffreda L, Goeman F, Gallo E, Visca P, Pescarmona E, Fanciulli M, De Maria R, Marchetti P, Ciliberto G, Maugeri-Saccà M. KEAP1-driven co-mutations in lung adenocarcinoma unresponsive to immunotherapy despite high tumor mutational burden. Ann Oncol 2020; 31:1746-1754. [PMID: 32866624 DOI: 10.1016/j.annonc.2020.08.2105] [Citation(s) in RCA: 129] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/07/2020] [Accepted: 08/12/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs) have demonstrated significant overall survival (OS) benefit in lung adenocarcinoma (LUAD). Nevertheless, a remarkable interpatient heterogeneity characterizes immunotherapy efficacy, regardless of programmed death-ligand 1 (PD-L1) expression and tumor mutational burden (TMB). KEAP1 mutations are associated with shorter survival in LUAD patients receiving chemotherapy. We hypothesized that the pattern of KEAP1 co-mutations and mutual exclusivity may identify LUAD patients unresponsive to immunotherapy. PATIENTS AND METHODS KEAP1 mutational co-occurrences and somatic interactions were studied in the whole MSKCC LUAD dataset. The impact of coexisting alterations on survival outcomes in ICI-treated LUAD patients was verified in the randomized phase II/III POPLAR/OAK trials (blood-based sequencing, bNGS cohort, N = 253). Three tissue-based sequencing studies (Rome, MSKCC and DFCI) were used for independent validation (tNGS cohort, N = 289). Immunogenomic features were analyzed using The Cancer Genome Atlas (TCGA) LUAD study. RESULTS On the basis of KEAP1 mutational co-occurrences, we identified four genes potentially associated with reduced efficacy of immunotherapy (KEAP1, PBRM1, SMARCA4 and STK11). Independent of the nature of co-occurring alterations, tumors with coexisting mutations (CoMut) had inferior survival as compared with single-mutant (SM) and wild-type (WT) tumors (bNGS cohort: CoMut versus SM log-rank P = 0.048, CoMut versus WT log-rank P < 0.001; tNGS cohort: CoMut versus SM log-rank P = 0.037, CoMut versus WT log-rank P = 0.006). The CoMut subset harbored higher TMB than the WT disease and the adverse significance of coexisting alterations was maintained in LUAD with high TMB. Significant immunogenomic differences were observed between the CoMut and WT groups in terms of core immune signatures, T-cell receptor repertoire, T helper cell signatures and immunomodulatory genes. CONCLUSIONS This study indicates that coexisting alterations in a limited set of genes characterize a subset of LUAD unresponsive to immunotherapy and with high TMB. An immune-cold microenvironment may account for the clinical course of the disease.
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Affiliation(s)
- D Marinelli
- Department of Clinical and Molecular Medicine, Oncology Unit, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - M Mazzotta
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - S Scalera
- SAFU Laboratory, Department of Research, Advanced Diagnostic, and Technological Innovation, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - I Terrenato
- Biostatistics-Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - F Sperati
- Biostatistics Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - L D'Ambrosio
- SAFU Laboratory, Department of Research, Advanced Diagnostic, and Technological Innovation, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - M Pallocca
- SAFU Laboratory, Department of Research, Advanced Diagnostic, and Technological Innovation, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - G Corleone
- SAFU Laboratory, Department of Research, Advanced Diagnostic, and Technological Innovation, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - E Krasniqi
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - L Pizzuti
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - M Barba
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - S Carpano
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - P Vici
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - M Filetti
- Department of Clinical and Molecular Medicine, Oncology Unit, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - R Giusti
- Medical Oncology Unit, Sant'Andrea Hospital, Rome, Italy
| | - A Vecchione
- Department of Clinical and Molecular Medicine, Pathology Unit, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - M Occhipinti
- Medical Oncology Unit B, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - A Gelibter
- Medical Oncology Unit B, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - A Botticelli
- Medical Oncology Unit B, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - F De Nicola
- SAFU Laboratory, Department of Research, Advanced Diagnostic, and Technological Innovation, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - L Ciuffreda
- SAFU Laboratory, Department of Research, Advanced Diagnostic, and Technological Innovation, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - F Goeman
- Oncogenomic and Epigenetic Unit, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - E Gallo
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - P Visca
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - E Pescarmona
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - M Fanciulli
- SAFU Laboratory, Department of Research, Advanced Diagnostic, and Technological Innovation, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - R De Maria
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Institute of General Pathology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - P Marchetti
- Department of Clinical and Molecular Medicine, Oncology Unit, Sant'Andrea Hospital, Sapienza University, Rome, Italy; Medical Oncology Unit B, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - G Ciliberto
- Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - M Maugeri-Saccà
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy.
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48
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Pelle F, Cappelli S, Graziano F, Piarulli L, Cavicchi F, Magagnano D, De Luca A, De Vita R, Pozzi M, Costantini M, Varanese A, Panimolle M, Gullo PP, Barba M, Vici P, Vizza E, Cognetti F, Sanguineti G, Saracca E, Ciliberto G, Botti C. Breast cancer surgery during the Covid-19 pandemic: a monocentre experience from the Regina Elena National Cancer Institute of Rome. J Exp Clin Cancer Res 2020; 39:171. [PMID: 32854728 PMCID: PMC7450921 DOI: 10.1186/s13046-020-01683-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 08/20/2020] [Indexed: 12/22/2022]
Abstract
The Covid-19 pandemic has challenged hard the national health systems worldwide. According to the national policy issued in March 2020 in response to the evolving Covid-19 pandemic, several hospitals were re-configured as Covid-19 centers and elective surgery procedures were rescheduled according to the most recent recommendations. In addition, Covid-19 protected cancer hubs were established, including the Regina Elena National Cancer Institute of Rome, Central Italy. At our Institute, the Breast Surgery Department continued working under the sign of a multidisciplinary approach. The number of professional figures involved in case evaluation was reduced to a minimum and interactions took place in the full respect of the required safety measures. Treatments for benign disease, pure prophylactic surgery and elective reconstructive procedures were all postponed and priority was assigned to the histologically-proven malignant breast tumors and highly suspicious lesions. From March 15th though April 30th 2020, we treated a total of 79 patients. This number is fully consistent with the average quantitative standards reached by our Department under ordinary circumstances. Patients were mostly discharged the day after surgery and none was readmitted due to surgery-related late complications. More generally, post-operative complications rates were unexpectedly low, particularly in light of the relatively high number of reconstructive procedures performed in this emergency situation. A strict follow up was performed based on the close contact with the surgical staff by telephone, messaging apps and telemedicine.Patients ascertainment for their Covid-19 status prior to hospital admission and hospital discharge allowed to maintain the "no-Covid-19" status at our Institution. In addition, during the aforementioned time window, none of the care providers developed SARS-CoV-2 infection or disease, as shown by the results of anti-SARS-CoV-2 immunoglobulin M and G profiling. In conclusions, elective breast cancer surgery procedures were successfully performed in a lockdown situation due to a novel viral pandemic. The well-coordinated regional and hospital efforts in terms of medical resource re-allocation and definition of clinical priorities allowed to maintain high quality standards of breast cancer care while ensuring safety to the cancer patients and care providers involved.
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Affiliation(s)
- Fabio Pelle
- Department of Surgery, Division of Breast Surgery, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Sonia Cappelli
- Department of Surgery, Division of Breast Surgery, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Franco Graziano
- Department of Surgery, Division of Breast Surgery, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Loredana Piarulli
- Department of Surgery, Division of Breast Surgery, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Flavia Cavicchi
- Department of Surgery, Division of Breast Surgery, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Domenico Magagnano
- Department of Surgery, Division of Breast Surgery, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Assunta De Luca
- Quality and Risk Management, Medical Direction, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Roy De Vita
- Department of Surgery, Division of Plastic and Reconstructive Surgery, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Marcello Pozzi
- Department of Surgery, Division of Plastic and Reconstructive Surgery, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Maurizio Costantini
- Department of Surgery, Division of Plastic and Reconstructive Surgery, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Antonio Varanese
- Department of Surgery, Division of Plastic and Reconstructive Surgery, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Massimo Panimolle
- Department of Surgery, Division of Plastic and Reconstructive Surgery, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Pietro Paolo Gullo
- Department of Surgery, Division of Plastic and Reconstructive Surgery, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Maddalena Barba
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Patrizia Vici
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Enrico Vizza
- Unit of Gynecologic Oncology, Department of Experimental Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Francesco Cognetti
- Division of Medical Oncology 1, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Giuseppe Sanguineti
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Elena Saracca
- Department of Radiology, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Gennaro Ciliberto
- Scientific Direction, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Claudio Botti
- Department of Surgery, Division of Breast Surgery, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.
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49
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Barba M, Krasniqi E, Ciliberto G, Vici P. Cancer patients and coronavirus disease 2019: evidence in context. J Transl Med 2020; 18:315. [PMID: 32799883 PMCID: PMC7429080 DOI: 10.1186/s12967-020-02483-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 08/08/2020] [Indexed: 01/08/2023] Open
Abstract
In the rapidly evolving coronavirus disease 2019 (COVID-19) outbreak, inherent literature has been increasing at an impressive rate. Such a dynamic scenario imposes the necessity to define a new framework for cancer care. The first emerging evidence has transmitted contrasting messages with regards to cancer care management. Some authors have hypothesized an increased infection risk for cancer patients, with a more severe disease, requiring a reorganization of health care system that could disrupt an established high quality cancer care routine in many developed countries. Other authors have attempted to interpret data related to cancer patients by better defining their “active status”. We herein present our point of view in the light of current evidence and based on the experience matured at our cancer institute in managing cancer patients during the COVID-19 pandemic. Our core idea is that “active cancer” may be considered a proxy of more recent exposure to diagnostic or therapeutic procedures, and the frequency of access to health care facilities can be predicted as a function of the severity of cancer symptoms. Hence, COVID-19 screening program and the adjustment of cancer care provision in a cancer institutions should be led by this risk model, while awaiting new evidence.
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Affiliation(s)
- Maddalena Barba
- Division of Medical Oncology 2, IRCCS IFO-Regina Elena National Cancer Institute, 00144, Rome, Italy.
| | - Eriseld Krasniqi
- Division of Medical Oncology 2, IRCCS IFO-Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Gennaro Ciliberto
- Scientific Direction, IRCCS IFO-Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Patrizia Vici
- Division of Medical Oncology 2, IRCCS IFO-Regina Elena National Cancer Institute, 00144, Rome, Italy
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50
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Mazzotta M, Filetti M, Occhipinti M, Marinelli D, Scalera S, Terrenato I, Sperati F, Pallocca M, Rizzo F, Gelibter A, Botticelli A, Scafetta G, Di Napoli A, Krasniqi E, Pizzuti L, Barba M, Carpano S, Vici P, Fanciulli M, De Nicola F, Ciuffreda L, Goeman F, De Maria R, Vecchione A, Giusti R, Ciliberto G, Marchetti P, Maugeri-Saccà M. Efficacy of immunotherapy in lung cancer with co-occurring mutations in NOTCH and homologous repair genes. J Immunother Cancer 2020; 8:jitc-2020-000946. [PMID: 32759236 PMCID: PMC7409965 DOI: 10.1136/jitc-2020-000946] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2020] [Indexed: 12/11/2022] Open
Abstract
Background Immune checkpoint inhibitors (ICIs) provide significant survival benefits in non-small cell lung cancer (NSCLC). Nevertheless, while some patients obtain a prolonged benefit, a non-negligible fraction of patients experiences an ultrarapid disease progression. Identifying specific molecular backgrounds predicting opposite outcomes is instrumental to optimize the use of these agents in clinical practice. Methods We carried out an observational study with prospective design envisioning targeted next-generation sequencing (NGS) with an approved assay in 55 patients with metastatic NSCLC (Rome cohort), of whom 35 were treated with ICIs. Data from three clinically comparable datasets were collected and combined into a metadataset containing 779 patients. The datasets were related to the Memorial Sloan Kettering Cancer Center (MSKCC) cohort (tissue-based NGS) and the randomized phase II and III POPLAR and OAK trials (blood-based NGS). Results In patients treated with ICIs in the Rome cohort, co-occurring mutations in NOTCH1-3 and homologous repair (HR) genes were associated with durable clinical benefit. Using the MSKCC/POPLAR/OAK metadaset, we confirmed the relationship between the NOTCHmut/HRmut signature and longer progression-free survival (PFS) in ICI-treated patients (multivariate Cox: HR 0.51, 95% CI 0.34 to 0.76, p=0.001). The NOTCHmut/HRmut genomic predictor was also associated with longer survival (log-rank p=0.008), despite patients whose tumors carried the NOTCHmut/HRmut signature had higher metastatic burden as compared with their negative counterpart. Finally, we observed that this genomic predictor was also associated with longer survival in patients with other tumor types treated with ICIs (n=1311, log-rank p=0.002). Conclusions Co-occurring mutations in the NOTCH and HR pathways are associated with increased efficacy of immunotherapy in advanced NSCLC. This genomic predictor deserves further investigation to fully assess its potential in informing therapeutic decisions.
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Affiliation(s)
- Marco Mazzotta
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Marco Filetti
- Department of Clinical and Molecular Medicine, Oncology Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Mario Occhipinti
- Medical Oncology Unit B, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Daniele Marinelli
- Department of Clinical and Molecular Medicine, Oncology Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Stefano Scalera
- SAFU Laboratory, Department of Research, Advanced Diagnostic, and Technological Innovation, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Irene Terrenato
- Biostatistics-Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Francesca Sperati
- Biostatistics Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Matteo Pallocca
- SAFU Laboratory, Department of Research, Advanced Diagnostic, and Technological Innovation, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Francesco Rizzo
- Department of Clinical and Molecular Medicine, Oncology Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Alain Gelibter
- Medical Oncology Unit B, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Andrea Botticelli
- Medical Oncology Unit B, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Giorgia Scafetta
- Department of Clinical and Molecular Medicine, Pathology Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Arianna Di Napoli
- Department of Clinical and Molecular Medicine, Pathology Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Eriseld Krasniqi
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Laura Pizzuti
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Maddalena Barba
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Silvia Carpano
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Patrizia Vici
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Maurizio Fanciulli
- SAFU Laboratory, Department of Research, Advanced Diagnostic, and Technological Innovation, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Francesca De Nicola
- SAFU Laboratory, Department of Research, Advanced Diagnostic, and Technological Innovation, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Ludovica Ciuffreda
- SAFU Laboratory, Department of Research, Advanced Diagnostic, and Technological Innovation, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Frauke Goeman
- Oncogenomic and Epigenetic Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Ruggero De Maria
- Institute of General Pathology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Institute of General Pathology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Vecchione
- Department of Clinical and Molecular Medicine, Pathology Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Gennaro Ciliberto
- Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Paolo Marchetti
- Department of Clinical and Molecular Medicine, Oncology Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.,Medical Oncology Unit B, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Marcello Maugeri-Saccà
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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