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Rossi D, Lippe P, Rocchi MBL, Sarti D, Catalano V, Graziano F, Giordani P, Baldelli A, Fedeli SL, Imperatori L, Laici G, Cappelletti C, Tamburrano T, Bracci R, Alessandroni P. Metronomic Oral Vinorelbine: An Alternative Schedule in Elderly and Patients PS2 With Local/Advanced and Metastatic NSCLC Not Oncogene-addicted. In Vivo 2020; 34:2687-2691. [PMID: 32871800 DOI: 10.21873/invivo.12088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/01/2020] [Accepted: 05/06/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND The MILES and ELVIS studies showed that vinorelbine is one of the best options for elderly patients with advanced non-small-cell-lung cancer (NSCLC). Oral vinorelbine at standard schedule (60-80 mg/m2/weekly) has good activity in terms of response rates and progression-free survival. In recent years, a metronomic schedule of oral vinorelbine (40-50 mg/m2 three times a week, continuously) has been studied in phase II trials, especially in unfit and elderly patients. In the MOVE trial metronomic oral vinorelbine had a clinical benefit [partial response (PR)+stable disease (SD) >12 weeks] in 58.1% of patients with mild toxicity. On this basis, in 2017 we started a phase II study with metronomic oral vinorelbine in elderly (over 70 years) or unfit [Eastern Cooperative Oncology Group performance score (ECOG-PS) of 2] patients with locally/advanced and metastatic NSCLC. Primary aims were clinical benefit (PR+SD ≥6 months) and toxicity; secondary aims were progression-free survival and overall survival. PATIENTS AND METHODS A total of 25 patients entered the study: 11 with local/advanced and 14 with metastatic NSCLC (five squamous and 20 adenocarcinoma). None of the patients had epidermal growth factor receptor (EGFR) mutations, anaplastic lymphoma kinase (ALK) translocation, or programmed death ligand 1 (PDL1) expression; those with squamous carcinoma did not have PDL1 expression. The median age was 79 (range=44-90) years. The PS was 0 in 12 patients (48%), 1 in four patients (16%) and 2 in nine patients (36%). Oral vinorelbine was administered at 40 mg three times a week continuously. RESULTS Clinical benefit was achieved in eight patients (32%). Objective responses were partial response in two patients (8%), stable disease in seven (28%), progressive disease in nine (36%); seven patients were not evaluable for response (28%). Median progression-free survival was 2 months; median overall survival was 4 months but four out of eight patients with clinical benefit were still alive at 18 months. Overall survival at 1 year was 32%. Toxicity was mild: only one patient experienced grade 4 neutropenia, one grade 3 peripheral neuropathy, four grade 2 asthenia, one grade 2 mucositis, and one grade 2 diarrhoea. The dose needed to be reduced to 30 mg/m2/three times a week in three patients. CONCLUSION Our study confirmed the activity and safety of metronomic oral vinorelbine in patients with wild-type local/advanced and metastatic NSCLC unsuitable for treatment with standard i.v. chemotherapy, allowing patients a comfortable home-based therapy, thereby avoiding frequent hospital visits.
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Affiliation(s)
- David Rossi
- Operative Oncology Unit, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Paolo Lippe
- Operative Oncology Unit, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | | | - Donatella Sarti
- Operative Oncology Unit, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Vincenzo Catalano
- Operative Oncology Unit, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Francesco Graziano
- Operative Oncology Unit, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Paolo Giordani
- Operative Oncology Unit, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Annamaria Baldelli
- Operative Oncology Unit, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Stefano Luzi Fedeli
- Operative Oncology Unit, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Luca Imperatori
- Operative Oncology Unit, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Gianluca Laici
- Operative Oncology Unit, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Claudia Cappelletti
- Operative Oncology Unit, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Tiziana Tamburrano
- Operative Oncology Unit, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Raffaella Bracci
- Operative Oncology Unit, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Paolo Alessandroni
- Operative Oncology Unit, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
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Bracci R, Gasperini B, Capalbo M, Campanelli T, Caimmi E, Mattioli R, Espinosa E, Prospero E. How to improve the identification of patients with cancer eligible for genetic counselling? Eur J Cancer Care (Engl) 2020; 29:e13276. [DOI: 10.1111/ecc.13276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 02/09/2020] [Accepted: 04/16/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Raffaella Bracci
- Oncology Unit Azienda Ospedaliera Ospedali Riuniti Marche Nord Pesaro Italy
| | - Beatrice Gasperini
- Geriatric Unit Azienda Ospedaliera Ospedali Riuniti Marche Nord Pesaro Italy
| | - Maria Capalbo
- Direzione Generale Azienda Ospedaliera Ospedali Riuniti Marche Nord Pesaro Italy
| | - Tamara Campanelli
- Oncology Unit Azienda Ospedaliera Ospedali Riuniti Marche Nord Pesaro Italy
| | - Eleonora Caimmi
- Section of Hygiene Department of Biomedical Sciences Università Politecnica delle Marche Ancona Italy
| | - Rodolfo Mattioli
- Oncology Unit Azienda Ospedaliera Ospedali Riuniti Marche Nord Pesaro Italy
| | - Emma Espinosa
- Geriatric Unit Azienda Ospedaliera Ospedali Riuniti Marche Nord Pesaro Italy
| | - Emilia Prospero
- Section of Hygiene Department of Biomedical Sciences Università Politecnica delle Marche Ancona Italy
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Ballatore Z, Bracci R, Maccaroni E, Svarca L, Bianchi F, Belvederesi L, Brugiati C, Pagliaretta S, Murrone A, Bini F, Pistelli M, Ricci G, Berardi R. Correction to: Expectations and psychological issues before genetic counseling: analysis of distress determinant factors. Hered Cancer Clin Pract 2020; 18:11. [PMID: 32467738 PMCID: PMC7236283 DOI: 10.1186/s13053-020-00143-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Zelmira Ballatore
- 1Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Raffaella Bracci
- 2Oncologia, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Presidio Santa Croce, Fano, Italy
| | - Elena Maccaroni
- 1Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Lucia Svarca
- 3Neuropsichiatria Infantile, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Francesca Bianchi
- 1Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Laura Belvederesi
- 1Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Cristiana Brugiati
- 1Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Silvia Pagliaretta
- 1Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Alberto Murrone
- 1Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Federica Bini
- 1Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Mirco Pistelli
- 1Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Giulia Ricci
- 1Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Rossana Berardi
- 1Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
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Ballatore Z, Bracci R, Maccaroni E, Svarca L, Bianchi F, Belvederesi L, Bruciati C, Pagliaretta S, Murrone A, Bini F, Pistelli M, Ricci G, Berardi R. Expectations and psychological issues before genetic counseling: analysis of distress determinant factors. Hered Cancer Clin Pract 2020; 18:10. [PMID: 32368313 PMCID: PMC7189592 DOI: 10.1186/s13053-020-00142-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 04/15/2020] [Indexed: 01/17/2023] Open
Abstract
Background Hereditary non-polyposis colorectal cancer (HNPCC) and Hereditary Breast and Ovarian Cancer Syndrome (HBOC) are the most common hereditary cancer syndromes in which a genetic test is available. Potential risks associated with testing include psychological harm, emotional distress and insurance problems. Methods The aim of the present study is to investigate determinants of distress in a sample of Italian subjects undergoing genetic counseling. Demographic information and psychological distress were assessed by using a self-reported questionnaire and the "Hospital Anxiety and Depression Scale" (HAD), before attending the first counseling session. Results Of the all subjects referred for the first time to our Center (January 2012-June 2013), a total of 227 were eligible (female/male = 174/53) for the survey, 134 (59%) were oncologic patients and of these, 116 received genetic test (36 for HNPCC and 80 for HBOC). The remaining 93 (41%) were healthy subjects referred for suspected familiar history and of this group, 65 subjects performed predictive test in a family with a known pathogenic mutation (53 for HBOC and 12 for HNPCC). Affected subjects had a significantly higher level of anxiety (p = 0.02) and HAD global score (p = 0.01) than healthy ones. There was no difference in HAD score between individuals testing for different syndromes (p = 0.3). In the affected subgroup, there was a significant linear correlation between the HAD anxiety score and how much subjects perceived their disease as hereditary (p = 0.01). Female and younger subjects had higher levels of anxiety (p = 0.05). Also healthy single subjects show more general distress (p = 0.02) than those with a partner. Conclusions Greater level of distress identified on females, single and younger subjects.
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Affiliation(s)
- Zelmira Ballatore
- 1Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Raffaella Bracci
- 2Oncologia, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Presidio Santa Croce, Fano, Italy
| | - Elena Maccaroni
- 1Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Lucia Svarca
- 3Neuropsichiatria Infantile, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Francesca Bianchi
- 1Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Laura Belvederesi
- 1Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Cristiana Bruciati
- 1Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Silvia Pagliaretta
- 1Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Alberto Murrone
- 1Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Federica Bini
- 1Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Mirco Pistelli
- 1Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Giulia Ricci
- 1Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Rossana Berardi
- 1Clinica Oncologica, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
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Grillo-Ruggieri F, Mantello G, Cardinali M, Fabbietti L, Fenu F, Montisci M, Bracci R, Delprete S, Guerrieri M, Marmorale C. Down-Staging after Two Different Preoperative Chemoradiation Schedules in Rectal Cancer. Tumori 2018; 89:164-7. [PMID: 12841664 DOI: 10.1177/030089160308900211] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims To compare preoperative downstaging, toxicity and sphincter-saving procedures obtained with preoperative radiotherapy and two different concomitant chemotherapy schedules. Methods From February 1997 to August 2001, 68 consecutive patients were treated with external radiotherapy (5040 cGy in 28 fractions) and concomitant chemotherapy: group a) 36 patients (10T2, 19T3, 7T4, 25 adenocarcinoma and 11 mucinous histology) were treated with cis-diamminedichloroplatinum bolus + 5-fluorouracil continuous infusion; group b) 32 patients (14 T2, 18 T3, 27 adenocarcinoma and 5 mucinous histology) were treated with 5-fluorouracil bolus ± mitomycin C. The interval between the end of radiotherapy and surgery ranged from 4 to 9 weeks. Results Group a) Overall downstaging was 63.9%. Longitudinal shrinkage of the neoplasm allowed conservative surgery in 6 of 11 patients with a pre-chemoradiation tumor location ≤3 cm from the external anal ring. When patients with adenocarcinoma (25/36) were studied separately from patients with mucinous histology, 7/25 patients (28%) were found to have no microscopic evidence of residual tumor (pTO); 8/25 (32%) were found to have only rare isolated cancer cells (pTmic); only 7/25 patients (28%) were found to have no change. Overall, 72% patients had downstaging. In contrast, only 5/11 (45.5%) of mucinous tumors had partial downstaging and 6/11 (54.5%) no downstaging at all. Group b) Overall downstaging was 46.9%. When patients with adenocarcinoma (27/32) were studied separately, 7/27 (26%) were found to have pTO, 3/27 (11.1%) pTmic, and 13/27 (48.1%) no change. Only 1/5 (20%) of mucinous tumors had downstaging and 4/5 (80%) had no downstaging at all. Overall toxicity was comparable among groups a and b, except for lower hematologic and gastrointestinal G3-4 toxicity observed in group a. Conclusions The overall response allowed conservative surgery in 56 (82.3%) of the 68 patients. Continuous infusion of 5-fluorouracil and diamminedichloroplatinum as a radipsensitizer determined better results in group a than group b (63.9% downstaging vs 46.9% even with a higher incidence of mucinous histology). Mucinous histology, for a definitely lower response rate, could benefit from an even more aggressive approach.
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Nannini M, Nigro MC, Vincenzi B, Fumagalli E, Grignani G, D'Ambrosio L, Badalamenti G, Incorvaia L, Bracci R, Gasperoni S, Saponara M, Gatto L, Indio V, Astolfi A, Di Scioscio V, Casali PG, Tonini G, Aglietta M, Russo A, Biasco G, Pantaleo MA. Personalization of regorafenib treatment in metastatic gastrointestinal stromal tumours in real-life clinical practice. Ther Adv Med Oncol 2017; 9:731-739. [PMID: 29449894 PMCID: PMC5808843 DOI: 10.1177/1758834017742627] [Citation(s) in RCA: 14] [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: 07/05/2017] [Accepted: 10/12/2017] [Indexed: 12/12/2022] Open
Abstract
Background: Regorafenib (REG) has now been approved as the standard third-line therapy in metastatic gastrointestinal stromal tumour (GIST) patients at the recommended dose and schedule of 160 mg once daily for the first 3 weeks of each 4-week cycle. However, it has a relevant toxicity profile that mainly occurs within the first cycles of therapy, and dose and schedule adjustments are often required to reduce the frequency or severity of adverse events and to avoid early treatment discontinuation. To date, large amounts of data on the use of REG in metastatic GIST patients in daily clinical practice are not available, and we lack information about how this treatment personalization really affects the quality of life (QoL) of patients. The aim of the present retrospective study is to build a comprehensive picture of all alternative REG strategies adopted in daily clinical practice for use in metastatic GIST patients. Methods: Metastatic GIST patients treated with dose adjustment or alternative schedules of REG at seven reference Italian centres were retrospectively included. Results: For a total of 62 metastatic GIST patients, we confirmed that REG treatment adjustment is common in clinical practice and that it is very heterogeneous, with approximately 20 different strategies being adopted. Independent of which strategy is chosen, treatment personalization has led to a clinical benefit defined as complete or partial resolution of side effects in almost all patients, affecting the duration of REG treatment. Conclusions: The personalization of REG, even if it is heterogeneous, seems to be crucial to maximize the overall treatment duration.
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Affiliation(s)
- Margherita Nannini
- Department of Specialized, Experimental and Diagnostic Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy
| | - Maria Concetta Nigro
- Department of Specialized, Experimental and Diagnostic Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Bruno Vincenzi
- Department of Oncology, University Campus Bio-Medico, Rome, Italy
| | - Elena Fumagalli
- Adult Mesenchymal Tumor Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Giovanni Grignani
- Sarcoma Unit, Division of Medical Oncology Candiolo Cancer Institute - FPO, IRCCS, Strada Provinciale, Candiolo, TO, Italy
| | - Lorenzo D'Ambrosio
- Sarcoma Unit, Division of Medical Oncology Candiolo Cancer Institute - FPO, IRCCS, Strada Provinciale, Candiolo, TO, Italy
| | - Giuseppe Badalamenti
- Section of Medical Oncology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Lorena Incorvaia
- Section of Medical Oncology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Raffaella Bracci
- Department of Internal Medicine, Ospedali Riuniti di Ancona, Ancona, Italy
| | | | - Maristella Saponara
- Department of Specialized, Experimental and Diagnostic Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Lidia Gatto
- Department of Specialized, Experimental and Diagnostic Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Valentina Indio
- Giorgio Prodi Cancer Research Center, University of Bologna, Bologna, Italy
| | - Annalisa Astolfi
- Giorgio Prodi Cancer Research Center, University of Bologna, Bologna, Italy
| | - Valerio Di Scioscio
- Department of Radiology, S. Orsola Malpighi Hospital, University of Bologna, Italy
| | - Paolo G Casali
- Adult Mesenchymal Tumor Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Giuseppe Tonini
- Department of Oncology, University Campus Bio-Medico, Rome, Italy
| | - Massimo Aglietta
- Sarcoma Unit, Division of Medical Oncology Candiolo Cancer Institute - FPO, IRCCS, Strada Provinciale, Candiolo, TO, Italy
| | - Antonio Russo
- Section of Medical Oncology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Guido Biasco
- Department of Specialized, Experimental and Diagnostic Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy Giorgio Prodi Cancer Research Center, University of Bologna, Bologna, Italy
| | - Maria A Pantaleo
- Department of Specialized, Experimental and Diagnostic Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy Giorgio Prodi Cancer Research Center, University of Bologna, Bologna, Italy
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Bini F, Ballatore Z, Bianchi F, Maccaroni E, Belvederesi L, Brugiati C, Pagliaretta S, Murrone A, Savini A, Pistelli M, Bracci R, Berardi R. Pathogenetic mutations in BRCA related triple negative breast cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx424.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Maccaroni E, Giampieri R, Del Prete M, Principi G, Bracci R, Calcinari A, Della Mora A, Bianchi F, Belvederesi L, Brugiati C, Pagliaretta S, Pistelli M, Savini A, Pagliacci A, Ballatore Z, Bini F, Baleani M, Cantini L, Murrone A, Berardi R. Prognostic impact of CA15-3 pre-treatment levels in ovarian cancer patients. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx429.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Ballatore Z, Bracci R, Bianchi F, Maccaroni E, Belvederesi L, Brugiati C, Murrone A, Pagliaretta S, Pistelli M, Berardi R. BRCA related breast cancer and sporadic tumors: same prognosis or survivorship bias? Ann Oncol 2017. [DOI: 10.1093/annonc/mdx424.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Bianchi F, Maccaroni E, Belvederesi L, Brugiati C, Giampieri R, Bini F, Bracci R, Pagliaretta S, Del Prete M, Piva F, Mandolesi A, Scarpelli M, Berardi R. A germline missense mutation in exon 3 of the MSH2 gene in a Lynch syndrome family: correlation with phenotype and localization assay. Fam Cancer 2017; 17:215-224. [PMID: 28785832 DOI: 10.1007/s10689-017-0030-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Lynch syndrome is caused by germline mutations in any of the MisMatch Repair (MMR) genes. About 37% of MSH2 variants are missense variants causing single amino-acid substitutions. Whether missense variants affect the normal function of MMR proteins is crucial both to provide affected families a more accurate risk assessment and to offer predictive testing to family members. Here we report one family, fulfilling both Amsterdam I and II criteria and Bethesda guidelines, referred to our center for genetic counselling. The proband and some of her relatives have been investigated for microsatellite instability (MSI), immunohistochemical MMR protein staining, direct sequencing and Multiplex Ligation-dependent Probe Amplification (MLPA). Also Subcellular Localization Assay and Splice site predictions analyses were used. A germline missense variant of uncertain significance (exon 3, p.Val161Asp) was found in MSH2 gene in proband and in some relatives. The variant was associated with lack of expression of MSH2 protein (DMMR) and MSI-High status in tumour tissues. The localization assay of the MSH2 protein showed an abnormal subcellular localization pattern of the corresponding protein. Finally, splice-site prediction analysis ruled out a potential role of new splice sites as the cause behind the lack of expression of MSH2 protein and we suppose a potential correlation with other forms of post-transcriptional regulation (circular RNAs). The variant here reported shows a high correlation with phenotype and is located in an evolutionary conserved domain. The localization assay also suggest a potential pathogenic role, thus supporting further research on this matter.
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Affiliation(s)
- Francesca Bianchi
- Clinica Oncologica e Centro Regionale di Genetica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Via Conca 71, 60126, Ancona, Italy
| | - Elena Maccaroni
- Clinica Oncologica e Centro Regionale di Genetica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Via Conca 71, 60126, Ancona, Italy.
| | - Laura Belvederesi
- Clinica Oncologica e Centro Regionale di Genetica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Via Conca 71, 60126, Ancona, Italy
| | - Cristiana Brugiati
- Clinica Oncologica e Centro Regionale di Genetica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Via Conca 71, 60126, Ancona, Italy
| | - Riccardo Giampieri
- Clinica Oncologica e Centro Regionale di Genetica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Via Conca 71, 60126, Ancona, Italy
| | - Federica Bini
- Clinica Oncologica e Centro Regionale di Genetica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Via Conca 71, 60126, Ancona, Italy
| | - Raffaella Bracci
- Clinica Oncologica e Centro Regionale di Genetica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Via Conca 71, 60126, Ancona, Italy
| | - Silvia Pagliaretta
- Clinica Oncologica e Centro Regionale di Genetica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Via Conca 71, 60126, Ancona, Italy
| | - Michela Del Prete
- Clinica Oncologica e Centro Regionale di Genetica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Via Conca 71, 60126, Ancona, Italy
| | - Francesco Piva
- Dipartimento di Scienze Cliniche Specialistiche e Odontostomatologiche, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - Alessandra Mandolesi
- Anatomia Patologica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - Marina Scarpelli
- Anatomia Patologica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - Rossana Berardi
- Clinica Oncologica e Centro Regionale di Genetica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Via Conca 71, 60126, Ancona, Italy
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Giampieri R, Maccaroni E, Mandolesi A, Del Prete M, Andrikou K, Faloppi L, Bittoni A, Bianconi M, Scarpelli M, Bracci R, Scartozzi M, Cascinu S. Mismatch repair deficiency may affect clinical outcome through immune response activation in metastatic gastric cancer patients receiving first-line chemotherapy. Gastric Cancer 2017; 20:156-163. [PMID: 26796888 DOI: 10.1007/s10120-016-0594-4] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 01/09/2016] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The microsatellite-instable gastric cancer subtype, because of its supposed high antigenic potential, is a promising candidate for immunotherapy. We analyzed if the presence of a defective mismatch repair (MMR) system is associated with other markers of immune response and their relationship with outcome in advanced gastric cancer patients. METHODS We analyzed the relationship between clinical outcome and MMR status, the presence of tumor-infiltrating lymphocytes (TIL), lymphocytosis, and neutrophil-to-lymphocyte ratio (NLR) in metastatic gastric cancer patients treated with a chemotherapy doublet in the first-line setting. Other stratification factors were sex, age, Eastern Cooperative Oncology Group performance status, adjuvant/neoadjuvant chemotherapy, metastatic sites, and histotype. RESULTS One hundred three patients were eligible for analysis. Defective MMR was found in 15 patients (14 %), TILs were found in 18 patients (17 %), lymphocytosis was found in 24 patients (23 %), and high NLR was found in 75 patients (72 %). Significant correlations were found between defective MMR and TIL positivity (p = 0.0004), between defective MMR and lymphocytosis (p = 0.0062), between defective MMR and low NLR (p = 0.000069), and between TIL positivity and lymphocytosis (p = 0.000147). All factors had a statistically significant impact on overall survival, although on multivariate analysis only defective MMR (p = 0.0001) and TIL positivity (p = 0.0192) maintained their independent prognostic role. Similar results were observed for progression-free survival, with defective MMR (p = 0.0001) and TIL positivity (p = 0.0195) maintaining their prognostic role on multivariate analysis. CONCLUSIONS Our analysis confirms the favorable prognosis of metastatic gastric cancer patients with a defective MMR system and suggests that expression of TILs might also be linked to better outcome. Because of the correlation between defective MMR status and measures of immune system activity, this group of patients would be the best candidates for novel immunotherapy-based therapies.
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Affiliation(s)
- Riccardo Giampieri
- Department of Medical Oncology, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Elena Maccaroni
- Department of Medical Oncology, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy.
| | | | - Michela Del Prete
- Department of Medical Oncology, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Kalliopi Andrikou
- Department of Medical Oncology, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Luca Faloppi
- Department of Medical Oncology, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Alessandro Bittoni
- Department of Medical Oncology, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Maristella Bianconi
- Department of Medical Oncology, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Marina Scarpelli
- Department of Pathology, Università Politecnica delle Marche, Ancona, Italy
| | - Raffaella Bracci
- Department of Medical Oncology, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Mario Scartozzi
- Department of Medical Oncology, Università di Cagliari, Cagliari, Italy
| | - Stefano Cascinu
- Department of Medical Oncology, Azienda Ospedaliero Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
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Maccaroni E, Bracci R, Giampieri R, Bianchi F, Belvederesi L, Brugiati C, Pagliaretta S, Del Prete M, Scartozzi M, Cascinu S. Prognostic impact of mismatch repair genes germline defects in colorectal cancer patients: are all mutations equal? Oncotarget 2016; 6:38737-48. [PMID: 26485756 PMCID: PMC4770733 DOI: 10.18632/oncotarget.5395] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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: 07/23/2015] [Accepted: 10/05/2015] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Lynch syndrome (LS) is the most common hereditary colorectal cancer (CRC) syndrome, caused by germline mutations in MisMatch Repair (MMR) genes, particularly in MLH1, MSH2 and MSH6. Patients with LS seem to have a more favourable prognosis than those with sporadic CRC, although the prognostic impact of different mutation types is unknown. Aim of our study is to compare survival outcomes of different types of MMR mutations in patients with LS-related CRC. METHODS 302 CRC patients were prospectively selected on the basis of Amsterdam or Revised Bethesda criteria to undergo genetic testing: direct sequencing of DNA and MLPA were used to examine the entire MLH1, MSH2 and MSH6 coding sequence. Patients were classified as mutation-positive or negative according to the genetic testing result. RESULTS A deleterious MMR mutation was found in 38/302 patients. Median overall survival (OS) was significantly higher in mutation-positive vs mutation-negative patients (102.6 vs 77.7 months, HR:0.63, 95%CI:0.46-0.89, p = 0.0083). Different types of mutation were significantly related with OS: missense or splicing-site mutations were associated with better OS compared with rearrangement, frameshift or non-sense mutations (132.5 vs 82.5 months, HR:0.46, 95%CI:0.16-0.82, p = 0.0153). CONCLUSIONS Our study confirms improved OS for LS-patients compared with mutation-negative CRC patients. In addition, not all mutations could be considered equal: the better prognosis in CRC patients with MMR pathogenic missense or splicing site mutation could be due to different functional activity of the encoded MMR protein. This matter should be investigated by use of functional assays in the future.
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Affiliation(s)
- Elena Maccaroni
- Clinica di Oncologia Medica e Centro Regionale di Genetica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - Raffaella Bracci
- Clinica di Oncologia Medica e Centro Regionale di Genetica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - Riccardo Giampieri
- Clinica di Oncologia Medica e Centro Regionale di Genetica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - Francesca Bianchi
- Clinica di Oncologia Medica e Centro Regionale di Genetica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - Laura Belvederesi
- Clinica di Oncologia Medica e Centro Regionale di Genetica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - Cristiana Brugiati
- Clinica di Oncologia Medica e Centro Regionale di Genetica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - Silvia Pagliaretta
- Clinica di Oncologia Medica e Centro Regionale di Genetica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - Michela Del Prete
- Clinica di Oncologia Medica e Centro Regionale di Genetica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - Mario Scartozzi
- Medical Oncology, Azienda Ospedaliero-Universitaria di Cagliari, Monserrato (CA), Cagliari, Italy
| | - Stefano Cascinu
- Clinica di Oncologia Medica e Centro Regionale di Genetica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
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Maccaroni E, Bracci R, Giampieri R, Bianchi F, Belvederesi L, Brugiati C, Pagliaretta S, De Mora A, Tronconi F, Pistelli M, Pagliacci A, Battelli N, Ballatore Z, De Lisa M, Berardi R. Hypersensitivity reactions to antineoplastic agents in BRCA-mutated ovarian cancer (OC) patients: a single centre experience. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw374.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Ballatore Z, Pistelli M, Bracci R, Bianchi F, Maccaroni E, Belvederesi L, Brugiati C, Pagliaretta S, De Lisa M, Della Mora A, Cantini L, Bastianelli L, Pagliacci A, Battelli N, Berardi R. Triple-negative breast cancer and BRCA mutation: looking at the future. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw364.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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15
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Pistelli M, Santinelli A, Santoni M, Piva F, Bianchi F, Belvederesi L, Biscotti T, De Lisa M, Ballatore Z, Occhipinti G, Pagliacci A, Maccaroni E, Bracci R, Battelli N, Cantini L, Bastianelli L, Berardi R, Cascinu S. BRCA mutations and IGF-R1 expression in modulating sensitivity to trastuzumab in HER2-positive breast cancer. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw364.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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De Lisa M, Pistelli M, Ballatore Z, Lucia B, Pagliacci A, Matteo S, Luca C, Tahani H, Battelli N, Maccaroni E, Bracci R, Santinelli A, Berardi R. Potential role of PLR and NLR in clinical decision making in locally advanced breast cancer. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw337.33] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Cantini L, Pistelli M, Paesani M, Ballatore Z, Bastianelli L, De Lisa M, Santoni M, Pagliacci A, Battelli N, Bracci R, Maccaroni E, Valeri I, Biscotti T, Santinelli A, Berardi R. Impact of hormonal receptor status on prognosis in HER2 positive breast cancer. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw337.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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18
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Ballatore Z, Pistelli M, Bracci R, Bianchi F, Maccaroni E, Belvederesi L, Brugiati C, Pagliaretta S, De Lisa M, Della Mora A, Cantini L, Bastianelli L, Pagliacci A, Battelli N, Berardi R. Triple-negative breast cancer and BRCA mutation: looking at the future. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw337.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Bastianelli L, De Lisa M, Pistelli M, Ballatore Z, Santoni M, Cantini L, Pagliacci A, Battelli N, Maccaroni E, Bracci R, Santinelli A, Tahani H, Berardi R. The link between obesity and advanced breast cancer is a matter of much interest. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw337.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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20
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Pistelli M, Santinelli A, Santoni M, Piva F, Bianchi F, Biscotti T, Belvederesi L, Ballatore Z, Occhipinti G, De Lisa M, Pagliacci A, Battelli N, Bracci R, Maccaroni E, Bastinelli L, Cantini L, Berardi R, Cascinu S. BRCA mutations and IGF-R1 expression in modulating sensitivity to Trastuzumab in patients with HER2-positive breast cancer. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw337.19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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21
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Gasparotto D, Rossi S, Polano M, Tamborini E, Lorenzetto E, Sbaraglia M, Mondello A, Massani M, Lamon S, Bracci R, Mandolesi A, Frate E, Stanzial F, Agaj J, Mazzoleni G, Pilotti S, Gronchi A, Dei Tos AP, Maestro R. Quadruple-Negative GIST Is a Sentinel for Unrecognized Neurofibromatosis Type 1 Syndrome. Clin Cancer Res 2016; 23:273-282. [PMID: 27390349 DOI: 10.1158/1078-0432.ccr-16-0152] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 05/26/2016] [Accepted: 06/14/2016] [Indexed: 11/16/2022]
Abstract
PURPOSE The majority of gastrointestinal stromal tumors (GIST) are driven by KIT, PDGFRA, or, less commonly, BRAF mutations, and SDH gene inactivation is involved in a limited fraction of gastric lesions. However, about 10% of GISTs are devoid of any of such alterations and are poorly responsive to standard treatments. This study aims to shed light on the molecular drivers of quadruple-negative GISTs. EXPERIMENTAL DESIGN Twenty-two sporadic quadruple-negative GISTs with no prior association with Neurofibromatosis Type 1 syndrome were molecularly profiled for a panel of genes belonging to tyrosine kinase pathways or previously implicated in GISTs. For comparison purposes, 24 GISTs carrying KIT, PDGFRA, or SDH gene mutations were also analyzed. Molecular findings were correlated to clinicopathologic features. RESULTS Most quadruple-negative GISTs featured intestinal localization, with a female predilection. About 60% (13/22) of quadruple-negative tumors carried NF1 pathogenic mutations, often associated with biallelic inactivation. The analysis of normal tissues, available in 11 cases, indicated the constitutional nature of the NF1 mutation in 7 of 11 cases, unveiling an unrecognized Neurofibromatosis Type 1 syndromic condition. Multifocality and a multinodular pattern of growth were common findings in NF1-mutated quadruple-negative GISTs. CONCLUSIONS NF1 gene mutations are frequent in quadruple-negative GISTs and are often constitutional, indicating that a significant fraction of patients with apparently sporadic quadruple-negative GISTs are affected by unrecognized Neurofibromatosis Type 1 syndrome. Hence, a diagnosis of quadruple-negative GIST, especially if multifocal or with a multinodular growth pattern and a nongastric location, should alert the clinician to a possible Neurofibromatosis Type 1 syndromic condition. Clin Cancer Res; 23(1); 273-82. ©2016 AACR.
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Affiliation(s)
- Daniela Gasparotto
- Experimental Oncology 1, CRO Aviano National Cancer Institute, Aviano, Italy
| | - Sabrina Rossi
- Department of Pathology and Molecular Genetics, Treviso General Hospital, Treviso, Italy
| | - Maurizio Polano
- Experimental Oncology 1, CRO Aviano National Cancer Institute, Aviano, Italy
| | - Elena Tamborini
- Department of Pathology and Molecular Biology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Erica Lorenzetto
- Experimental Oncology 1, CRO Aviano National Cancer Institute, Aviano, Italy
| | - Marta Sbaraglia
- Department of Pathology and Molecular Genetics, Treviso General Hospital, Treviso, Italy
| | - Alessia Mondello
- Experimental Oncology 1, CRO Aviano National Cancer Institute, Aviano, Italy
| | - Marco Massani
- Department of Surgery, Treviso General Hospital, Treviso, Italy
| | - Stefano Lamon
- Department of Oncology, Treviso General Hospital, Treviso, Italy
| | - Raffaella Bracci
- Department of Internal Medicine, Ospedali Riuniti di Ancona, Ancona, Italy
| | | | | | - Franco Stanzial
- Clinical Genetics Service, Bolzano General Hospital, Bolzano/Bozen, Italy
| | - Jerin Agaj
- Department of Surgery, Vipiteno General Hospital, Vipiteno/Sterzing, Italy
| | - Guido Mazzoleni
- Department of Pathology, Bolzano General Hospital, Bolzano/Bozen, Italy
| | - Silvana Pilotti
- Department of Pathology and Molecular Biology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Angelo Paolo Dei Tos
- Department of Pathology and Molecular Genetics, Treviso General Hospital, Treviso, Italy
| | - Roberta Maestro
- Experimental Oncology 1, CRO Aviano National Cancer Institute, Aviano, Italy.
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Pistelli M, Ballatore Z, Santinelli A, Biscotti T, Piva F, Occhipinti G, Della Mora A, Pagliacci A, Battelli N, Bastianelli L, De Lisa M, Bracci R, Maccaroni E, Berardi R, Cascinu S. Phosphorylated mTOR is associated to androgen receptor expression in early triple-negative breast cancer. Oncol Rep 2016; 36:755-62. [PMID: 27350136 DOI: 10.3892/or.2016.4903] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 02/24/2016] [Indexed: 11/06/2022] Open
Abstract
The significance of phosphorylated mTOR (p-mTOR) expression is unknown in triple-negative breast carcinoma (TNBC). The aims of the present study were to assess the expression of p-mTOR in early TNBC and to evaluate possible correlations between androgen receptor (AR) expression, clinicopathological parameters and disease outcome. Between January 2009 and December 2013, all consecutive patients who were diagnosed and completed the treatment of invasive TNBC at our institution were eligible for this analysis. Patients with stage IV disease were excluded. The evaluation of p-mTOR immunohistochemical staining was semi-quantitatively considering both the percentage of positive tumor cells (range, 0-100%) and staining intensity (range, 0-3+). Ninety-eight TNBC patients were included. Approximately 33% of cases were p-mTOR positive and there was no association between positive immunostaining for p-mTOR and DFS (p=0.74) and OS (p=0.81). p-mTOR positivity was associated with small tumor size (p=0.03) and AR expression (p=0.04). High expression of p-mTOR may drive tumor proliferation in almost one third of TNBC. The biological association between mTOR activation and AR pathway suggests that there may exist a subgroup of TNBC in which the combination of both AR antagonism and mTOR inhibition should have a synergistic effect on cell growth and tumor progression.
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Affiliation(s)
- M Pistelli
- Department of Medical Oncology, AOU Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Z Ballatore
- Department of Medical Oncology, AOU Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - A Santinelli
- Department of Pathology, AOU Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - T Biscotti
- Department of Pathology, AOU Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - F Piva
- Department of Specialistic Clinical and Odontostomatological Sciences, Polytechnic University of Marche, Ancona, Italy
| | - G Occhipinti
- Department of Medical Oncology, AOU Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - A Della Mora
- Department of Medical Oncology, AOU Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - A Pagliacci
- Department of Medical Oncology, AOU Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - N Battelli
- Department of Medical Oncology, AOU Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - L Bastianelli
- Department of Medical Oncology, AOU Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - M De Lisa
- Department of Medical Oncology, AOU Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - R Bracci
- Department of Medical Oncology, AOU Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - E Maccaroni
- Department of Medical Oncology, AOU Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - R Berardi
- Department of Medical Oncology, AOU Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - S Cascinu
- Department of Medical Oncology, AOU Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
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Pistelli M, Ballatore Z, Bracci R, Bianchi F, Maccaroni E, Belvederesi L, Bini F, De Lisa M, Della Mora A, Pagliacci A, Battelli N, Santinelli A, Biscotti T, Cascinu S. Endocrine therapy is not effective in BRCA2 mutated breast cancers even when they express hormonal receptors. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv336.28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ballatore Z, Bracci R, Pistelli M, Bianchi F, Maccaroni E, Belvederesi L, Panni V, De Lisa M, Della Mora A, Pagliacci A, Battelli N, Santinelli A, Biscotti T, Cascinu S. BRCA1/2 mutations and hereditary breast cancer: clinical phenotype, type of mutation and founder effect. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv336.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Bracci R, Maccaroni E, Del Prete M, Bianchi F, Belvederesi L, Brugiati C, Pagliaretta S, Pistelli M, Pagliacci A, Battelli N, Ballatore Z, De Lisa M, Della Mora A, Cascinu S. Soft tissue sarcoma after haematological malignancies in childhood/adolescence: a hospital series. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv338.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Della Mora A, Pistelli M, Battelli N, Ballatore Z, Pagliacci A, Berardi R, De Lisa M, Maccaroni E, Bracci R, Santinelli A, Biscotti T, Cascinu S. Everolimus in ER + /HER-2 negative metastatic breast cancer (MBC): what we have learned from two years of clinical practice. A single Institution experience. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv336.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Maccaroni E, Bracci R, Giampieri R, Bianchi F, Belvederesi L, Brugiati C, Pagliaretta S, Del Prete M, Pistelli M, Pagliacci A, Battelli N, Ballatore Z, De Lisa M, Della Mora A, Cascinu S. Evaluation of clinical and pathological features in patients with Lynch Syndrome-related Endometrial Cancer: a single centre experience. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv339.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pistelli M, Ballatore Z, De Lisa M, Della Mora A, Biscotti T, Santinelli A, Pagliacci A, Battelli N, Maccaroni E, Bracci R, Berardi R, Cascinu S. PI3K/AKT/mTOR pathway and androgen receptor expression as potential therapeutic targets for triple-negative breast cancer. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e12069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Mirco Pistelli
- Clinica di Oncologia Medica, Università Politecnica delle Marche, AO Ospedali Riuniti, Ancona, Italy
| | - Zelmira Ballatore
- Clinica di Oncologia Medica, Università Politecnica delle Marche, AO Ospedali Riuniti, Ancona, Italy
| | - Mariagrazia De Lisa
- Clinica di Oncologia Medica, Università Politecnica delle Marche, AO Ospedali Riuniti, Ancona, Italy
| | - Arianna Della Mora
- Clinica di Oncologia Medica, Università Politecnica delle Marche, AO Ospedali Riuniti, Ancona, Italy
| | - Tommasina Biscotti
- Anatomia Patologica, Università Politecnica delle Marche, AO Ospedali Riuniti, Ancona, Italy
| | - Alfredo Santinelli
- Anatomia Patologica, Università Politecnica delle Marche, AO Ospedali Riuniti, Ancona, Italy
| | - Alessandra Pagliacci
- Clinica di Oncologia Medica, Università Politecnica delle Marche, AO Ospedali Riuniti, Ancona, Italy
| | - Nicola Battelli
- Clinica di Oncologia Medica, Università Politecnica delle Marche, AO Ospedali Riuniti, Ancona, Italy
| | - Elena Maccaroni
- Clinica di Oncologia Medica, Università Politecnica delle Marche, AO Ospedali Riuniti, Ancona, Italy
| | - Raffaella Bracci
- Clinica di Oncologia Medica, Università Politecnica delle Marche, AO Ospedali Riuniti, Ancona, Italy
| | - Rossana Berardi
- Clinica di Oncologia Medica, Università Politecnica delle Marche, AO Ospedali Riuniti, Ancona, Italy
| | - Stefano Cascinu
- Clinica di Oncologia Medica, Università Politecnica delle Marche, AO Ospedali Riuniti, Ancona, Italy
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Belfiori G, Sartelli M, Cardinali L, Tranà C, Bracci R, Gesuita R, Marmorale C. Risk stratification systems for surgically treated localized primary Gastrointestinal Stromal Tumors (GIST). Review of literature and comparison of the three prognostic criteria: MSKCC Nomogramm, NIH-Fletcher and AFIP-Miettinen. Ann Ital Chir 2015; 86:219-227. [PMID: 26098671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE The discovery of Imatinib mesylate (Gleevec®) has revolutionized the treatment of GIST, increasing diseasefree survival (DFS) after complete surgical resection of a primary localized GIST and extending overall survival in metastatic disease. The definition of an accurate prognostic system is critical for the therapeutic decision making process. In literature, there are three main prognostic criteria F/NIH consensus, AFIP standards and modified NIH standards. In recent years were added various risk identification methods applying mathematical calculation model, including MSKCC risk nomogram, Rossi nomogram and Joensuu high Hotline Dengjun. Despite all these attempts, it seems that the recurrence risk probability still cannot be predicted accurately. The aim of our study was to assess and compare the real ability of these prognostic instruments in our single-centre clinical experience, and to define if the use of the MSKCC nomogram can bring benefits in the therapeutic decision. METHODS All data regarding 37 GIST, who underwent surgical resection from 1996 to 2011 in our institution were retrospectively reviewed. We selected only primary GIST without metastatic disease who underwent a radical resection (R0) but no other therapy. The literature data concerning GISTs prognostication criteria were reviewed. All patients were classified according to the three prognostic criteria (NIH, AFIP and Nomogram MSKCC) and the three instruments were compared with the Kaplan-Meier method. Then we compared the three criteria for their c-index value and we assessed the performance of the nomogram with the calibration test. RESULTS We observed 9 recurrences (24%) with an average time to relapse of 43 months; the median follow-up was 65 months. In the study selected sample occurred 5 relapses. The probability of relapsing after radical surgery was 7.9% (95% CI 0 - 17.3) at 2 years and 13.3% at 5 years (95% CI 0 - 26.4). The C-Index of the three risk assessment tools was 0.93 (95% CI 0.83-1) for the Nomogram at 5 years, 0.86 (95% CI 0.76-0.95) for the NIH risk criteria and 0.88 (95% CI 0.74-1) for the AFIP risk criteria. The calibration analysis of the nomogram showed an overestimating trend both at 2 and 5 years. CONCLUSION MSKCC nomogram seems to perform better than NIH, NIH modified and AFIP in our sample and can be used in clinical practice to predict the risk of recurrence, being especially helpful for the therapeutic decision making since it is at the same time simple to use and accurate. As showed from calibration, MSKCC doesn't seem to neglect relapses, even though it is not impeccable in predicting the RFS. Among the 2 older criteria AFIP was more precise than NIH, but considering size in not linear way represented a limit in comparison with the MSKCC Nomogram. All the three risk assessement tools criteria con sidered are capable to predict recurrence in high-risk GISTs while they performed worse in those with lower risk. MSKCC nomogram main limit remains the not linear consideration of mitotic count.
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Pistelli M, De Lisa M, Ballatore Z, Caramanti M, Pagliacci A, Battelli N, Ridolfi F, Santoni M, Maccaroni E, Bracci R, Santinelli A, Biscotti T, Berardi R, Cascinu S. Pre-treatment neutrophil to lymphocyte ratio may be a useful tool in predicting survival in early triple negative breast cancer patients. BMC Cancer 2015; 15:195. [PMID: 25884918 PMCID: PMC4428113 DOI: 10.1186/s12885-015-1204-2] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [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: 07/21/2014] [Accepted: 03/17/2015] [Indexed: 12/31/2022] Open
Abstract
Background There is a growing body of evidence that immune response plays a large role in cancer outcome. The neutrophil to lymphocyte ratio (NLR) has been used as a simple parameter of systemic inflammation in several tumors. The purpose was to investigate the association between pre-treatment NLR, disease-free survival and overall survival in patients with early triple negative breast cancer (TNBC). Methods We reviewed the records of patients with stage I-III TNBC at our Institution from 2006 to 2012. The association between pre-treatment NLR and survival was analyzed. The difference among variables was calculated by chi-square test. DFS and OS were estimated using Kaplan-Meier method. Cox analysis was performed to analyze clinical parameters for their prognostic relevance. Results A total of 90 patients were eligible. There was no significant correlation among pre-treatment NLR and various clinical pathological factors. Patients with NLR higher than 3 showed significantly lower DFS (p = 0.002) and OS (p = 0.009) than patients with NLR equal or lower than 3. The Cox proportional multivariate hazard model revealed that higher pre-treatment NLR was independently correlated with poor DFS and OS, with hazard ratio 5.15 (95% confidence interval [CI] 1.11-23.88, p = 0.03) and 6.16 (95% CI 1.54-24.66, p = 0.01) respectively. Conclusion Our study suggests that pre-treatment NLR may be associated with DFS and OS patients with early TNBC. Further validation and a feasibility study are required before it can be considered for clinical use.
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Affiliation(s)
- Mirco Pistelli
- Clinica di Oncologia Medica, Università Politecnica delle Marche, Ancona, AO Ospedali Riuniti-Ancona, Italy.
| | - Mariagrazia De Lisa
- Clinica di Oncologia Medica, Università Politecnica delle Marche, Ancona, AO Ospedali Riuniti-Ancona, Italy.
| | - Zelmira Ballatore
- Clinica di Oncologia Medica, Università Politecnica delle Marche, Ancona, AO Ospedali Riuniti-Ancona, Italy.
| | - Miriam Caramanti
- Clinica di Oncologia Medica, Università Politecnica delle Marche, Ancona, AO Ospedali Riuniti-Ancona, Italy.
| | - Alessandra Pagliacci
- Clinica di Oncologia Medica, Università Politecnica delle Marche, Ancona, AO Ospedali Riuniti-Ancona, Italy.
| | - Nicola Battelli
- Clinica di Oncologia Medica, Università Politecnica delle Marche, Ancona, AO Ospedali Riuniti-Ancona, Italy.
| | - Francesca Ridolfi
- Clinica di Oncologia Medica, Università Politecnica delle Marche, Ancona, AO Ospedali Riuniti-Ancona, Italy.
| | - Matteo Santoni
- Clinica di Oncologia Medica, Università Politecnica delle Marche, Ancona, AO Ospedali Riuniti-Ancona, Italy.
| | - Elena Maccaroni
- Clinica di Oncologia Medica, Università Politecnica delle Marche, Ancona, AO Ospedali Riuniti-Ancona, Italy.
| | - Raffaella Bracci
- Clinica di Oncologia Medica, Università Politecnica delle Marche, Ancona, AO Ospedali Riuniti-Ancona, Italy.
| | - Alfredo Santinelli
- Anatomia Patologica, AO Ospedali Riuniti-Ancona, Università Politecnica delle Marche, Ancona, Italy.
| | - Tommasina Biscotti
- Anatomia Patologica, AO Ospedali Riuniti-Ancona, Università Politecnica delle Marche, Ancona, Italy.
| | - Rossana Berardi
- Clinica di Oncologia Medica, Università Politecnica delle Marche, Ancona, AO Ospedali Riuniti-Ancona, Italy.
| | - Stefano Cascinu
- Clinica di Oncologia Medica, Università Politecnica delle Marche, Ancona, AO Ospedali Riuniti-Ancona, Italy.
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Ballatore Z, Pistelli M, Bracci R, Bianchi F, De Lisa M, Napolitano M, Pagliacci A, Battelli N, Ridolfi F, Maccaroni E, Santinelli A, Biscotti T, Berardi R, Cascinu S. Prognosis of Brca1 and Brca2-Related Breast Cancers: are There Differences? Ann Oncol 2014. [DOI: 10.1093/annonc/mdu335.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Pistelli M, Caramanti M, Biscotti T, Santinelli A, Pagliacci A, De Lisa M, Ballatore Z, Ridolfi F, Maccaroni E, Bracci R, Berardi R, Battelli N, Cascinu S. Androgen receptor expression in early triple-negative breast cancer: clinical significance and prognostic associations. Cancers (Basel) 2014; 6:1351-62. [PMID: 24978437 PMCID: PMC4190544 DOI: 10.3390/cancers6031351] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 05/27/2014] [Accepted: 06/19/2014] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Triple-negative breast cancers (TNBC) are characterized by aggressive tumour biology resulting in a poor prognosis. Androgen receptor (AR) is one of newly emerging biomarker in TNBC. In recent years, ARs have been demonstrated to play an important role in the genesis and in the development of breast cancer, although their prognostic role is still debated. In the present study, we explored the correlation of AR expression with clinical, pathological and molecular features and its impact on prognosis in early TNBC. PATIENTS AND METHODS ARs were considered positive in case of tumors with >10% nuclear-stained. Survival distribution was estimated by the Kaplan Meier method. The univariate and multivariate analyses were performed. The difference among variables were calculated by chi-square test. RESULTS 81 TNBC patients diagnosed between January 2006 and December 2011 were included in the analysis. Slides were stained immunohistochemically for estrogen and progesterone receptors, HER-2, Ki-67, ALDH1, e-cadherin and AR. Of the 81 TNBC samples, 18.8% showed positive immunostaining for AR, 23.5% and 44.4% of patients were negative for e-cadherin and ALDH1, respectively. Positive AR immunostaining was inversely correlated with a higher Ki-67 (p < 0.0001) and a lympho-vascular invasion (p = 0.01), but no other variables. Univariate survival analysis revealed that AR expression was not associated with disease-free survival (p = 0.72) or overall survival (p = 0.93). CONCLUSIONS The expression of AR is associated with some biological features of TNBC, such as Ki-67 and lympho-vascular invasion; nevertheless the prognostic significance of AR was not documented in our analysis. However, since ARs are expressed in a significant number of TNBC, prospective studies in order to determine the biological mechanisms and their potential role as novel treatment target.
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Affiliation(s)
- Mirco Pistelli
- Clinica di Oncologia Medica, AO Ospedali Riuniti-Ancona, Università Politecnica delle Marche, Ancona 60020, Italy.
| | - Miriam Caramanti
- Clinica di Oncologia Medica, AO Ospedali Riuniti-Ancona, Università Politecnica delle Marche, Ancona 60020, Italy
| | - Tommasina Biscotti
- Anatomia Patologica, AO Ospedali Riuniti-Ancona, Università Politecnica delle Marche, Ancona 60020, Italy
| | - Alfredo Santinelli
- Anatomia Patologica, AO Ospedali Riuniti-Ancona, Università Politecnica delle Marche, Ancona 60020, Italy
| | - Alessandra Pagliacci
- Clinica di Oncologia Medica, AO Ospedali Riuniti-Ancona, Università Politecnica delle Marche, Ancona 60020, Italy
| | - Mariagrazia De Lisa
- Clinica di Oncologia Medica, AO Ospedali Riuniti-Ancona, Università Politecnica delle Marche, Ancona 60020, Italy
| | - Zelmira Ballatore
- Clinica di Oncologia Medica, AO Ospedali Riuniti-Ancona, Università Politecnica delle Marche, Ancona 60020, Italy
| | - Francesca Ridolfi
- Clinica di Oncologia Medica, AO Ospedali Riuniti-Ancona, Università Politecnica delle Marche, Ancona 60020, Italy
| | - Elena Maccaroni
- Clinica di Oncologia Medica, AO Ospedali Riuniti-Ancona, Università Politecnica delle Marche, Ancona 60020, Italy
| | - Raffaella Bracci
- Clinica di Oncologia Medica, AO Ospedali Riuniti-Ancona, Università Politecnica delle Marche, Ancona 60020, Italy
| | - Rossana Berardi
- Clinica di Oncologia Medica, AO Ospedali Riuniti-Ancona, Università Politecnica delle Marche, Ancona 60020, Italy
| | - Nicola Battelli
- Clinica di Oncologia Medica, AO Ospedali Riuniti-Ancona, Università Politecnica delle Marche, Ancona 60020, Italy
| | - Stefano Cascinu
- Clinica di Oncologia Medica, AO Ospedali Riuniti-Ancona, Università Politecnica delle Marche, Ancona 60020, Italy
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Varesco L, Viassolo V, Viel A, Gismondi V, Radice P, Montagna M, Alducci E, Della Puppa L, Oliani C, Tommasi S, Caligo MA, Vivanet C, Zuradelli M, Mandich P, Tibiletti MG, Cavalli P, Lucci Cordisco E, Turchetti D, Boggiani D, Bracci R, Bruzzi P, Bonelli L. Performance of BOADICEA and BRCAPRO genetic models and of empirical criteria based on cancer family history for predicting BRCA mutation carrier probabilities: a retrospective study in a sample of Italian cancer genetics clinics. Breast 2013; 22:1130-5. [PMID: 24011770 DOI: 10.1016/j.breast.2013.07.053] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 06/14/2013] [Accepted: 07/16/2013] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To evaluate in current practice the performance of BOADICEA and BRCAPRO risk models and empirical criteria based on cancer family history for the selection of individuals for BRCA genetic testing. PATIENTS AND METHODS The probability of BRCA mutation according to the three tools was retrospectively estimated in 918 index cases consecutively undergone BRCA testing at 15 Italian cancer genetics clinics between 2006 and 2008. RESULTS 179 of 918 cases (19.5%) carried BRCA mutations. With the strict use of the criteria based on cancer family history 173 BRCA (21.9%) mutations would have been detected in 789 individuals. At the commonly used 10% threshold of BRCA mutation carrier probability, the genetic models showed a similar performance [PPV (38% and 37%), sensitivity (76% and 77%) and specificity (70% and 69%)]. Their strict use would have avoided around 60% of the tests but would have missed approximately 1 every 4 carriers. CONCLUSION Our data highlight the complexity of BRCA testing referral in routine practice and question the strict use of genetic models for BRCA risk assessment.
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Affiliation(s)
- L Varesco
- Unit of Hereditary Cancer, IRCCS AOU San Martino - IST, Largo Rosanna Benzi, 10, 16132 Genoa, Italy.
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Belvederesi L, Bianchi F, Loretelli C, Bracci R, Cascinu S, Cellerino R. Sub-cellular localization analysis of MSH6 missense mutations does not reveal an overt MSH6 nuclear transport impairment. Fam Cancer 2012; 11:675-80. [PMID: 22851212 DOI: 10.1007/s10689-012-9558-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Nearly one-third of the identified MSH6 germline mutations deal with single amino acid substitutions. For an effective genetic counselling it is necessary to clearly elucidate by functional tools the specific sub-processes underlying the mismatch repair (MMR) misfunctioning in MSH6 non-truncating mutants. Since the MMR repair pathway occurs in the nucleus, we suppose the impairment of MutSα nuclear trafficking to be a possible Lynch syndrome susceptibility causative mechanism. In the present study the MMR status of the tumour, the main clinical features of mutation carriers and population data associated to the MSH6 missense variants, were complemented with computational data about tolerability predictions and amino acid substitution conservation. The selected panel of ten potentially pathogenic MSH6 mutations was analyzed in a homologous expression system for possible deleterious effects on nucleo-cytoplasmic shuttling through the assessment of the sub-cellular localization of the corresponding mutated proteins. Localization analysis results do not reveal an apparent role of MSH6 missense mutations in nuclear import impairment and provide the first hint to exclude the MSH6 nuclear translocation sub-process as a possible causative mechanisms of MMR misfunctioning.
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Galizia E, Giorgetti G, Piccinini G, Santinelli A, Loretelli C, Bianchi F, Gagliardini D, Carbonari G, Pisa E, Belvederesi L, Bracci R, Ferretti C, Corradini F, Cellerino R. BRCA1 expression in triple negative sporadic breast cancers. Anal Quant Cytol Histol 2010; 32:24-29. [PMID: 20701084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To study how to identify patients with "triple negative" sporadic breast cancers (BCs) having BRCA1 silenced or down-regulated due to epigenetic BRCA1 inactivation. STUDY DESIGN We selected, from our database, patients diagnosed with BC between 1995 and 2001 with tumors exhibiting the "triple negative" phenotype. "Triple positive" tumors were used as controls. BRCA1 protein expression was determined by immunohistochemistry. Methylation specific polymerase chain reaction (PCR) and bisulfite sequencing on genomic DNA were used to assess BRCA1 promoter methylation. BRCA1 m-RNA expression analysis was conducted by real-time PCR. RESULTS Forty-four triple negative and 68 controls (triple positive) were eligible for our analysis. BRCA1 promoter methylation was present in 31.8% of triple negative and in 20.6% of triple positive cases. BRCA1 was inactivated (absent BRCA1 m-RNA expression and lack of BRCA1 protein) in 21.4% of tumors with BRCA1 promoter methylation, as compared with 6% of non-methylated ones (p = 0.0453). CONCLUSION BRCA1 inactivation due to promoter methylation could play an important role in some sporadic BC cases. Patients with this signature could represent the basis for prospective studies aiming to compare clinical response to different drugs.
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MESH Headings
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/metabolism
- Breast Neoplasms/genetics
- Breast Neoplasms/metabolism
- Breast Neoplasms/mortality
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/genetics
- Carcinoma, Ductal, Breast/metabolism
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/secondary
- DNA Methylation
- Down-Regulation
- Female
- Gene Expression Regulation, Neoplastic
- Gene Silencing
- Humans
- Neoplasms, Hormone-Dependent/metabolism
- RNA, Messenger/metabolism
- Receptor, ErbB-2/metabolism
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/metabolism
- Retrospective Studies
- Survival Rate
- Ubiquitin-Protein Ligases/genetics
- Ubiquitin-Protein Ligases/metabolism
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Affiliation(s)
- Eva Galizia
- Regional Center of Genetic Oncology, Department of Anatomic and Histologic Pathology and Clinic of Medical Oncology, Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
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Passalacqua R, Caminiti C, Campione F, Diodati F, Todeschini R, Bisagni G, Labianca R, Dalla Chiesa M, Bracci R, Aragona M, Artioli F, Cavanna L, Masina A, De Falco F, Marzocchini B, Iacono C, Contu A, Di Costanzo F, Bertetto O, Annunziata MA. Prospective, multicenter, randomized trial of a new organizational modality for providing information and support to cancer patients. J Clin Oncol 2009; 27:1794-9. [PMID: 19273715 DOI: 10.1200/jco.2007.15.0615] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE No structured modality for providing information and support to patients in oncology wards has been validated in clinical trials. METHODS This is a pragmatic, two-arm, cluster randomized trial, with the oncology ward as random assignment unit. Centers were allocated to implement a Point of Information and Support (PIS) or to a control group. The PIS included a library for cancer patients and a specifically trained oncology nurse. End points, measured at patient level, were psychological distress and satisfaction with received information. Both intent-to-treat and per-protocol analyses considering clustering were performed. RESULTS Thirty-eight Italian cancer centers were randomly assigned, and 6 months after PIS creation, 3,286 unselected, consecutive cancer patients were surveyed (1,654 in the experimental group and 1,632 in the control group). Three thousand one hundred ninety-seven (97%) questionnaires were collected and deemed valid. Fifty-two percent of centers (11 of 21 centers) in the experimental arm did not implement the PIS in accordance with the protocol. Overall, 34% of patients showed moderate to severe psychological distress, and only 9% declared dissatisfaction. Intent-to-treat analysis did not yield significant differences. Although the per-protocol analysis did show a reduction in psychological distress (28.9% for functioning PIS v 33.3% for no PIS) and dissatisfaction (6.4% for functioning PIS v 9.3% for no PIS), differences did not reach significance. CONCLUSION This is the first cluster randomized trial aiming to demonstrate that a structured modality of providing information reduces psychological distress. We did not find this, but we believe results should be interpreted cautiously, particularly because of the low compliance with PIS implementation. Context analysis preceding such interventions is essential.
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Belvederesi L, Bianchi F, Galizia E, Loretelli C, Bracci R, Catalani R, Amati M, Cellerino R. MSH2 missense mutations and HNPCC syndrome: pathogenicity assessment in a human expression system. Hum Mutat 2008; 29:E296-309. [PMID: 18781619 DOI: 10.1002/humu.20875] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Hereditary Non-Polyposis Colorectal Cancer (HNPCC) is associated with germline mutations in one of several MisMatch Repair (MMR) genes. An increasing proportion (20-25%) of the reported MSH2 variants consists of single amino-acid substitution with uncertain disease-causing significance. The present study was undertaken to functionally characterize 3 MSH2 nontruncating variants: p.Gly162Arg (c.484G>C), p.Asp167His (c.499G>C) and p.Arg359Ser (c.1077A>T). Missense alterations, were assessed in a human system for expression/stability and for the ability to heterodimerize with MSH6 and correctly localize into the nucleus. Functional assays results were correlated with clinical and genetic features indicative of HNPCC as MicroSatellite-Instability (MSI), abnormalities of MMR gene expression in tumour tissue (IHC) and familial history. p.Gly162Arg and p.Arg359Ser variants showed a clearly decreased expression level of the MutSá complex and were associated with an abnormal subcellular localization pattern, which can be suggestive of an incorrect MSH2/MSH6 heterodimerization. Functional analysis results were supported by MSI and IHC data and by familial cancer history. The subcellular localization assay, performed in a human expression system, classifies as pathogenetic two MSH2 nontruncating alterations providing a useful tool in genetic testing programs.
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Affiliation(s)
- Laura Belvederesi
- Centro Regionale di Genetica Oncologica - Oncologia Medica, Università Politecnica delle Marche, Ancona, Italy.
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Abstract
Gastrointestinal Stromal Tumors (GISTs) are the most common mesenchimal tumors of the gastrointestinal tract. Such tumors usually have activating mutations in either KIT (75-80%) or Platelet Derived Growth Factor Receptor alpha (PDGFRa) (5-10%) which lead to ligand-independent signal transduction. Targeting these activated proteins with Imatinib mesylate, a small-molecule kinase inhibitor, has proven useful in the treatment of recurrent or metastatic GISTs. However, more than half of patients develop resistance to Imatinib after about 2 years. Therefore, other targets have been studying in order to implement the therapeutical armamentarium for this disease. Sunitinib malate is an oral multikinase inhibitor that targets several receptor tyrosine kinases and has proved to prolong survival in Imatinib-resistant patients. Other molecules, such as Nilotinib, Sorafenib and Dasatinib were shown to be useful in Imatinib resistant mutant cell lines and the results of their activity in humans are being awaited. Recent evidence suggests that GIST cells acquire the capability to escape from the control of KIT and PDGFRa through the activation of alternative pathways. Therefore, further effort should be invested in the discovery of new signaling pathways, such as AXL, MET, IGF-R, which might be involved in the evolution of the disease. After a description of KIT and PDGFRa as known targets of anti-GIST treatments, we review other mechanisms and mediators that might be potential targets of new therapies, providing a comprehensive revision of the new molecular strategies under investigation.
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Affiliation(s)
- C Braconi
- Centro Regionale di Genetica Oncologica-Oncologia Medica, Università Politecnica delle Marche, Ancona, Italy
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Belvederesi L, Bianchi F, Galizia E, Catalani R, Bracci R, Loretelli C, Amati M, Cellerino R. Assessement of the pathogenic role of MSH2 missense variants in HNPCC syndrome. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.22154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Braconi C, Bracci R, Bearzi I, Bianchi F, Sabato S, Mandolesi A, Belvederesi L, Cascinu S, Valeri N, Cellerino R. Insulin-like growth factor (IGF) 1 and 2 help to predict disease outcome in GIST patients. Ann Oncol 2008; 19:1293-1298. [PMID: 18372285 DOI: 10.1093/annonc/mdn040] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The expression of the insulin-like growth factor (IGF) system has never been studied in gastrointestinal stromal tumors (GISTs). PATIENTS AND METHODS We studied the immunohistochemical expression of IGF1 receptor (IGFR-I), IGF1 and IGF2 in 94 samples of GISTs. IGF1 and IGF2 expression was scored in three classes: negative (N), moderate (M) and strong (S), according to staining intensity and extent. RESULTS IGFR-I was overexpressed in all cases. IGF1 and IGF2 expression was absent in 25 and 48 cases, moderate in 29 and 16 cases and strong in 40 and 30 cases, respectively. Strong IGF1 expression significantly correlated with higher mitotic index (P = 0.0001), larger (P = 0.01), higher risk (P = 0.0002), metastatic (P = 0.0001) and relapsed (P = 0.04) GISTs. Strong IGF2 expression correlated with higher mitotic index (P = 0.05) and higher risk GISTs (P = 0.001). The Kaplan-Meier analysis (N versus M versus S) showed a significant worsening of the disease-free survival (DFS) with the increase of IGF1 (P = 0.02) and IGF2 (P = 0.02) expression. In the subgroup of patients with operated high-risk GISTs, there was a better trend in DFS for patients affected by GISTs with negative IGF1 and IGF2. CONCLUSIONS The expression of IGF1 and IGF2 seems to predict relapse in GIST patients.
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Affiliation(s)
- C Braconi
- Centro Regionale di Genetica Oncologica-Oncologia Medica, Università Politecnica delle Marche.
| | - R Bracci
- Centro Regionale di Genetica Oncologica-Oncologia Medica, Università Politecnica delle Marche; Clinica di Oncologia Medica, Ospedali Riuniti Ancona
| | - I Bearzi
- Anatomia ed Istologia Patologica
| | - F Bianchi
- Centro Regionale di Genetica Oncologica-Oncologia Medica, Università Politecnica delle Marche
| | - S Sabato
- Anatomia ed Istologia Patologica
| | | | - L Belvederesi
- Centro Regionale di Genetica Oncologica-Oncologia Medica, Università Politecnica delle Marche
| | - S Cascinu
- Clinica di Oncologia Medica, Ospedali Riuniti Ancona
| | - N Valeri
- Scuola di Specializzazione in Oncologia, Università Politecnica delle Marche, Ancona, Italy
| | - R Cellerino
- Centro Regionale di Genetica Oncologica-Oncologia Medica, Università Politecnica delle Marche
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Di Costanzo F, Gasperoni S, Manzione L, Bisagni G, Labianca R, Bravi S, Cortesi E, Carlini P, Bracci R, Tomao S, Messerini L, Arcangeli A, Torri V, Bilancia D, Floriani I, Tonato M, Dinota A, Strafiuso G, Corgna E, Porrozzi S, Boni C, Rondini E, Giunta A, Monzio Compagnoni B, Biagioni F, Cesari M, Fornarini G, Nelli F, Carboni M, Cognetti F, Enzo MR, Piga A, Romiti A, Olivetti A, Masoni L, De Stefanis M, Dalla Mola A, Camera S, Recchia F, De Filippis S, Scipioni L, Zironi S, Luppi G, Italia M, Banducci S, Pisani Leretti A, Massidda B, Ionta MT, Nicolosi A, Canaletti R, Biscottini B, Grigniani F, Di Costanzo F, Rovei R, Croce E, Carroccio R, Gilli G, Cavalli C, Olgiati A, Pandolfi U, Rossetti R, Natalini G, Foa P, Oldani S, Bruno L, Cascinu S, Catalano G, Catalano V, Lungarotti F, Farris A, Sarobba MG, Trignano M, Muscogiuri A, Francavilla F, Figoli F, Leoni M, Papiani G, Orselli G, Antimi M, Bellini V, Cabassi A, Contu A, Pazzola A, Frignano M, Lastraioli E, Saggese M, Bianchini D, Antonuzzo L, Mela M, Camisa R. Adjuvant chemotherapy in completely resected gastric cancer: a randomized phase III trial conducted by GOIRC. J Natl Cancer Inst 2008; 100:388-98. [PMID: 18334706 DOI: 10.1093/jnci/djn054] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Complete surgical resection of gastric cancer is potentially curative, but long-term survival is poor. METHODS Patients with histologically proven adenocarcinoma of the stomach of stages IB, II, IIIA and B, or IV (T4N2M0) and treated with potentially curative surgery were randomly assigned to follow-up alone or to intravenous treatment with four cycles (repeated every 21 days) of PELF (cisplatin [40 mg/m(2), on days 1 and 5], epirubicin [30 mg/m(2), days 1 and 5], L-leucovorin [100 mg/m(2), days 1-4], and 5-fluorouracil [300 mg/m(2), days 1-4] in a hospital setting. Frequencies and severity of adverse events were determined. Overall survival (OS) and disease-free survival (DFS) were compared between the treatment arms using Kaplan-Meier analysis and a Cox proportional hazards regression model. All statistical tests were two-sided. RESULTS From January 1995 through September 2000, 258 patients were randomly assigned to chemotherapy (n = 130) or surgery alone (n = 128). Patient characteristics were well balanced between the two arms. Among those who received chemotherapy, grade 3 or 4 toxic effects including vomiting, mucositis, and diarrhea were experienced by 21.1%, 8.4%, and 11.8% of patients, respectively. Leucopenia, anemia, and thrombocytopenia of grade 3 or 4 were experienced by 20.3%, 3.3%, and 4.2% of patients, respectively. After a median follow-up of 72.8 months, 128 patients (49.6%) experienced recurrence and 139 (53.9%) deaths were observed, one toxicity-related. Relative to treatment with surgery alone, adjuvant chemotherapy did not increase disease-free survival (hazard ratio [HR] of recurrence = 0.92; 95% confidence interval [CI] = 0.66 to 1.27) or overall survival (HR of death = 0.90; 95% CI = 0.64 to 1.26). CONCLUSIONS Our results failed to provide proof of an effect of adjuvant chemotherapy with PELF on overall survival or disease-free survival. The estimated effect of chemotherapy (10% reduction in the hazard of death or relapse) is modest and consistent with the results of meta-analyses of adjuvant chemotherapy without platinum agents.
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Affiliation(s)
- Francesco Di Costanzo
- Unit of Medical Oncology, Azienda Ospedaliero Universitaria Careggi, Viale Pieraccini 17, 50139 Florence, Italy.
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Bracci R, Zanon E, Cellerino R, Gesuita R, Puglisi F, Aprile G, Barbieri V, Misuraca D, Venuta S, Carle F, Piga A. Information to cancer patients: a questionnaire survey in three different geographical areas in Italy. Support Care Cancer 2008; 16:869-77. [DOI: 10.1007/s00520-007-0375-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2007] [Accepted: 12/06/2007] [Indexed: 01/03/2023]
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Braconi C, Bracci R, Bearzi I, Bianchi F, Costagliola A, Catalani R, Mandolesi A, Ranaldi R, Galizia E, Cascinu S, Rossi G, Giustini L, Latini L, Valeri N, Cellerino R. KIT and PDGFRalpha mutations in 104 patients with gastrointestinal stromal tumors (GISTs): a population-based study. Ann Oncol 2008; 19:706-10. [PMID: 18187489 DOI: 10.1093/annonc/mdm503] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The prognostic significance of KIT or platelet-derived growth factor receptor alpha (PDGFRalpha) mutations in gastrointestinal stromal tumors (GISTs) is still controversial. PATIENTS AND METHODS In all, 104 patients were diagnosed with GISTs by KIT immunoreactivity; tumor DNA was sequenced for the presence of mutations in KIT exons 9, 11, 13 and 17 and in PDGFRalpha exons 12 and 18. Disease-free survival (DFS) was analyzed in 85 radically resected patients. RESULTS KIT mutations occurred in exon 11 (69), in exon 9 (11) and in exon 17 (1). PDGFRalpha mutations were detected in exon 18 (10) and in exon 12 (3). Ten GISTs were wild type. Exon 11 mutations were as follows: deletions in 42 cases and point mutations in 20 cases and insertions and duplications, respectively, in 2 and 5 cases. A better trend in DFS was evident for duplicated and point-mutated exon 11 KIT GISTs. There was a significant association between PDGFRalpha mutations, gastric location and lower mitotic index. Moreover, PDGFRalpha-mutated GISTs seemed to have a better outcome. CONCLUSIONS Point mutations and duplications in KIT exon 11 are associated with a better clinical trend in DFS. PDGFRalpha-mutated GISTs are preferentially localized in the stomach and seem to have a favorable clinical behavior.
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Affiliation(s)
- C Braconi
- Centro Regionale di Genetica Oncologica, Oncologia Medica, Ancona, Italy.
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Bianchi F, Galizia E, Porfiri E, Belvederesi L, Catalani R, Loretelli C, Bracci R, Bearzi I, Turchi C, Viel A, Cellerino R. A missense germline mutation in exon 7 of the MSH2 gene in a HNPCC family from center-Italy. Fam Cancer 2007; 6:97-102. [PMID: 17165155 DOI: 10.1007/s10689-006-9110-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2006] [Accepted: 10/17/2006] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Hereditary Non-Polyposis Colorectal Cancer (HNPCC) is an autosomal dominant inherited disease predisposing to the development of colorectal cancers and several other malignancies (endometrium, ovaries, stomach, small bowel, hepatobiliary and urinary tract). HNPCC is caused by germline mutations in any of the MisMatch Repair (MMR) genes. Mutations in MLH1 and MSH2 account for almost 90% of all identified ones. About 15% of mutations identified in MSH2 are missense ones. PATIENTS AND METHODS We studied one family, fulfilling Amsterdam II criteria, referred to our Center for genetic counselling. The proband, and some of her relatives, have been investigated for microsatellite instability (MSI), immunohistochemical MMR protein staining and by direct sequencing and Multiplex Ligation-dependent Probe Amplification (MLPA). RESULTS All patients carried the same novel MSH2 germline missense mutation (R359S) in exon 7, which determines the substitution of an Arginine, which is a basic amino acid, with a polar Serine residue (R359S). The mutation was associated with lack of expression of MSH2 protein and high microsatellite instability in tumour tissues. The same mutation has been detected in one healthy relative. CONCLUSIONS The mutation here reported shows a high correlation with phenotype. The mutation is located in an evolutionary conserved domain. Taken together, our findings suggest evidence that the amino acid substitution can be interpreted as pathogenetic.
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Affiliation(s)
- Francesca Bianchi
- Istituto di Medicina Clinica e Biotecnologie Applicate-Oncologia Medica, Università Politecnica delle Marche, via Tronto, 60020 Ancona, Italy
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Braconi C, Bearzi I, Bianchi F, Bracci R, Costagliola A, Arduini F, Mandolesi A, Cellerino R. Different types of mutations in GISTs: Different clinical implications? J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.20505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
20505 Background: Mutations of KIT or PDGFRa are associated with the pathogenesis of gastrointestinal stromal tumors (GISTs). The prognostic significance of these mutations is still controversial. Methods: We examined 125 patients diagnosed with GISTs. Genomic DNA was extracted from paraffin-embedded tumor tissues and analysed for the presence of KIT exon 9 and 11 mutations and PDGFRa exon 12 and 18 mutations. DFS (Disease Free Survival) was analysed in 92 radically resected patients. The relation between mutations and clinico-pathological factors was analysed using Fisher's exact test and Kaplan-Meyer analysis. Results: KIT mutations occurred in exon 9 in 15 cases and in exon 11 in 78 cases. PDGFRa mutations have been detected mainly in exon 18 (10 cases) and less frequently in exon 12 (3 cases). Exon 11 mutations were as follows: deletions in 58%, point mutations in 30%, insertions and duplications respectively in 4 and 5 cases. Although type of mutations within exon 11 KIT didn't correlate with DFS, a better trend was evident for duplicated and point mutated GISTs. Exon 9 KIT mutated GISTs were associated with intestinal location and higher grade. There was significant association between PDGFRa mutations, gastric location and lower mitotic index. Moreover, PDGFRa mutated and wild type GISTs seemed to have a better outcome. Conclusions: Point mutations and duplications in exon 11 KIT were associated with a better clinical trend in DFS. Exon 9 KIT mutations significantly correlated with intestinal location and higher mitotic count. PDGFRa mutated GISTs were localized in the stomach and seemed to have a favorable clinical behavior. No significant financial relationships to disclose.
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Affiliation(s)
- C. Braconi
- Università Politecnica delle Marche, Ancona, Italy
| | - I. Bearzi
- Università Politecnica delle Marche, Ancona, Italy
| | - F. Bianchi
- Università Politecnica delle Marche, Ancona, Italy
| | - R. Bracci
- Università Politecnica delle Marche, Ancona, Italy
| | | | - F. Arduini
- Università Politecnica delle Marche, Ancona, Italy
| | - A. Mandolesi
- Università Politecnica delle Marche, Ancona, Italy
| | - R. Cellerino
- Università Politecnica delle Marche, Ancona, Italy
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Bianchi F, Galizia E, Bracci R, Belvederesi L, Catalani R, Loretelli C, Giorgetti G, Ferretti C, Bearzi I, Porfiri E, Cellerino R. Effectiveness of the CRCAPRO program in identifying patients suspected for HNPCC. Clin Genet 2007; 71:158-64. [PMID: 17250665 DOI: 10.1111/j.1399-0004.2007.00746.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Subjects affected by hereditary non-polyposis colorectal cancer exhibit a high susceptibility to colon and extracolonic tumours, due to MMR gene defects. Revised Bethesda criteria are used to select patients as candidates for genetic tests. Recently, the CRCAPRO model has been developed, based on family history of colorectal and endometrial cancers. Our study aims to evaluate the reliability of CRCAPRO in identifying mutation carriers. We used the CRCAPRO program to evaluate carrier probability risk in 99 patients fulfilling Amsterdam or Bethesda guidelines. MLH1 and MSH2 were studied by direct sequencing in all the 99 patients, and the study of microsatellite instability and of MMR proteins expression was performed. Nine MLH1 and nine MSH2 germline mutations were identified. Five out of the nine patients with MLH1 mutation showed a CRCAPRO risk evaluation of less than 20%. The same happened for four out of nine patients with MSH2 mutation. Of the 17 patients with an estimated risk of more than 80%, only four harboured a mutation, all in the MSH2 gene. The highest risk calculated by the CRCAPRO system in the nine carriers of a MLH1 mutation has been 31.7%. In our experience, the CRCAPRO program sensitivity and specificity appears to be low but needs to be further evaluated in larger samples.
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Affiliation(s)
- F Bianchi
- Centro Regionale di Genetica Oncologica, Oncologia Medica, Università Politecnica delle Marche, Ancona, Italy.
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Piga A, Zanon E, Bracci R, Barbieri V, Puglisi F, Aprile G, Gesuita R, Carle F, Venuta S, Cellerino R. Information to cancer patients: A questionnaire survey in three different geographical areas in Italy. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.18593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
18593 Background: The way information to cancer patients is delivered widely varies among different countries. In Italy, as in other Mediterranean countries, the traditional approach has been of partial disclosure of the truth. Methods: We asked 200 cancer patients in 3 different Centres form Northern, Central and Southern Italy (Udine, Ancona, Catanzaro) to answer a 26-item questionnaire on communication aspects, in order to verify if information received was correct and adequate, and dependent on geographical variations. Statistics included univariate and multiple correspondence analysis, which studies relations between all variables, and provides a graphical representation in which associated variables tend to aggregate spatially. Results: Questionnaires were completed by 587 patients, of median age 60 yrs, 57% females, mainly with gastrointestinal (32%) or breast cancer (30%); 63% had active disease at time of interview. 77% of patients interviewed had a correct knowledge of their diagnosis, with no difference between different Centres. More informed were patients of female gender (p = 0.004), young age, better education, and with breast cancer (all p < 0.001). Patients appropriately informed on prognosis were 41%. More informed were those with good prognosis, breast cancer, and not receiving treatment; less informed patients from Southern Italy and those with advanced disease. Degree of information was not directly related to desire for information, which was more pronounced for patients from Central and Southern Italy. Satisfaction for information received was higher for patients from Northern Italy, not on treatment, with limited disease. Multiple correspondence analysis identified clusters of patients such as those of old age, lower education, male sex, advanced disease, preferred paternalistic approach, characterized by poor level of information; and young age, female sex, high scholarity, breast cancer, patient-centered relationship with their doctor, characterized by high level of information. Conclusions: The cultural attitude towards communication aspects in oncology is changing in Italy. There are still significant differences at different latitudes, but there is a general trend to improving awareness about cancer. No significant financial relationships to disclose.
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Affiliation(s)
- A. Piga
- University of Udine, Udine, Italy; University of Ancona, Ancona, Italy; University of Catanzaro, Catanzaro, Italy
| | - E. Zanon
- University of Udine, Udine, Italy; University of Ancona, Ancona, Italy; University of Catanzaro, Catanzaro, Italy
| | - R. Bracci
- University of Udine, Udine, Italy; University of Ancona, Ancona, Italy; University of Catanzaro, Catanzaro, Italy
| | - V. Barbieri
- University of Udine, Udine, Italy; University of Ancona, Ancona, Italy; University of Catanzaro, Catanzaro, Italy
| | - F. Puglisi
- University of Udine, Udine, Italy; University of Ancona, Ancona, Italy; University of Catanzaro, Catanzaro, Italy
| | - G. Aprile
- University of Udine, Udine, Italy; University of Ancona, Ancona, Italy; University of Catanzaro, Catanzaro, Italy
| | - R. Gesuita
- University of Udine, Udine, Italy; University of Ancona, Ancona, Italy; University of Catanzaro, Catanzaro, Italy
| | - F. Carle
- University of Udine, Udine, Italy; University of Ancona, Ancona, Italy; University of Catanzaro, Catanzaro, Italy
| | - S. Venuta
- University of Udine, Udine, Italy; University of Ancona, Ancona, Italy; University of Catanzaro, Catanzaro, Italy
| | - R. Cellerino
- University of Udine, Udine, Italy; University of Ancona, Ancona, Italy; University of Catanzaro, Catanzaro, Italy
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Belvederesi L, Bianchi F, Loretelli C, Gagliardini D, Galizia E, Bracci R, Rosati S, Bearzi I, Viel A, Cellerino R, Porfiri E. Assessing the pathogenicity of MLH1 missense mutations in patients with suspected hereditary nonpolyposis colorectal cancer: correlation with clinical, genetic and functional features. Eur J Hum Genet 2006; 14:853-9. [PMID: 16724012 DOI: 10.1038/sj.ejhg.5201628] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Assessing the pathogenicity of missense mutations of MLH1 and MSH2 is critical to counsel patients with suspected hereditary nonpolyposis colorectal cancer (HNPCC). Approximately 32% of all MLH1 mutations and 18% of MSH2 mutations are missense variants which often have an uncertain genetic significance. To assess the pathogenicity of four MLH1 missense mutations which were found in five patients with suspected HNPCC, P648S (CCC --> TCC), L559R (CTG --> CGG), K618A (AAG --> GCG), Y646C (TAT --> TGT), we studied their ability to disrupt MLH1 protein function and their relationship with all those clinical, genetic and pathological features which are typical of this syndrome. Our results indicated that the P648S and L559R mutations were probably pathogenic because they disrupted MLH1 protein interaction with its partner PMS2 in vitro and abolished MLH1 expression in HCT116 cells. In addition these variants were associated with features often found in HNPCC patients: in particular high microsatellite instability, occurrence of high grade tumours and, in one case, strong family history. The pathogenicity of the K618A and Y646C mutations was questionable as their correlation with features typical of HNPCC was low and the outcome of the functional analysis was ambiguous. These observations suggested that a clinically usable assessment of the pathogenicity of MLH missense variants can be achieved through the analysis of multiple mutation characteristics among which loss of protein function, occurrence of microsatellite instability and family history seemed to have a predominant role.
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Affiliation(s)
- Laura Belvederesi
- Oncologia Medica, Facolta' di Medicina e Chirurgia, Università Politecnica delle Marche, Ancona, Italy
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Bianchi F, Rosati S, Belvederesi L, Loretelli C, Catalani R, Mandolesi A, Bracci R, Bearzi I, Porfiri E, Cellerino R. MSH2 splice site mutation and endometrial cancer. Int J Gynecol Cancer 2006; 16:1419-23. [PMID: 16803540 DOI: 10.1111/j.1525-1438.2006.00572.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Hereditary nonpolyposis colorectal cancer (HNPCC) is an inherited syndrome of cancer susceptibility caused by germ line mutations of genes participating in mismatch repair (MMR). Carriers of MMR gene mutations have an increased risk of colorectal cancers and cancer of other organs. Tumors of the endometrium represent the most frequent extracolonic malignancies in HNPCC. It has been suggested that women harboring MMR gene mutations have a higher risk of endometrial cancer than of colon cancer. Here, we describe an HNPCC patient with early-onset endometrial cancer and a strong familial history of endometrial tumors who harbored a germ line MSH2 splice site mutation (IVS9_2A>G). This mutation was responsible for abnormal messenger RNA processing, leading to the introduction of a premature stop signal and to the expression of a truncated MSH2 protein. In addition, the same mutation was associated with loss of MSH2 protein expression, high microsatellite instability, and PTEN inactivation. Although a direct relationship between the endometrial cancer susceptibility and the MSH2 mutation we found cannot be established, our observations, consistent with the work of other authors, suggest the involvement of germ line MSH2 abnormalities in endometrial tumor development and support the case for endometrial cancer screening in women from HNPCC families.
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Affiliation(s)
- F Bianchi
- Istituto di Medicina Clinica e Biotecnologie Applicate-Oncologia Medica, Centro Regionale Alta Specializzazione in Genetica Oncologica, Facoltà di Medicina e Chirurgia, Università Politecnica delle Marche, Via Tronto, Ancona 60020, Italy
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