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Bascioni R, Esperide B, Di Fabio F, Giorgi F. The Miracle Drug. J Palliat Med 2019; 22:1002-1003. [DOI: 10.1089/jpm.2019.0008] [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: 11/12/2022] Open
Affiliation(s)
- Romeo Bascioni
- Unità di Oncologia Medica, Ospedale Murri, Fermo, Hospice, Montegranaro (FM), Fermo, Italy
| | - Barbara Esperide
- Unità di Oncologia Medica, Ospedale Murri, Fermo, Hospice, Montegranaro (FM), Fermo, Italy
| | - Fiorinda Di Fabio
- Unità di Oncologia Medica, Ospedale Murri, Fermo, Hospice, Montegranaro (FM), Fermo, Italy
| | - Francesca Giorgi
- Unità di Oncologia Medica, Ospedale Madonna del Soccorso, San Benedetto del Tronto (AP), Italy
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Abstract
Aims and Background Various attempts have been made to prevent 5-fluorouracil-induced stomatitis, with unsatisfactory results. Sucralfate is an aluminum hydroxide, complex of sulfated sucrose commonly used in the treatment of gastroduodenal ulcers. We used the compound in a phase II study to reduce and minimize the stomatotoxicity of 5-fluorouracil chemotherapy administered in a multiple-day schedule. Methods Fifty-two patients entered the study, and 129 cycles of chemotherapy were evaluated. Seven patients refused sucralfate rinses for taste intolerance. Results A low level of stomatotoxicity was recorded: grade 2 stomatitis was observed after 14 cycles (10.8%) and grade 3 after 3 cycles (2.3%). Conclusions Sucralfate administration could have a role in the prevention of 5-fluorouracil-induced stomatitis.
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Affiliation(s)
- F Giorgi
- Oncology Unit, Ospedale Madonna del Soccorso, San Benedetto del Tronto, Italy
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Silva RR, Bascioni R, Rossini S, Zuccatosta L, Mattioli R, Pilone A, Delprete S, Battelli N, Gasparini S, Battelli T. A Phase II Study of Mitomycin C, Vindesine and Cisplatin Combined with Alpha Interferon in Advanced Non-Small Cell Lung Cancer. Tumori 2018; 82:68-71. [PMID: 8623510 DOI: 10.1177/030089169608200115] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and background MVP chemotherapy (mitomycin C, vindesine or vinblastine, cisplatin) is one of the most commonly used regimens for advanced non-small cell lung cancer (NSCLC). Experimental data suggest a synergistic cytotoxic activity of alpha-interferon (α-IFN) when combined with cisplatin, mitomycin C, and vinca alkaloids. In an effort to improve MVP chemotherapy activity, we have combined this regimen with α-IFN. Patients and methods Thirty-five patients with advanced NSCLC (19 stage IV) were treated with the MVP regimen (mitomycin C, 8 mg/m2; vindesine, 3 mg/m2; cisplatin, 75 mg/m2, all on day 1) plus α-2a-IFN, 3×106 U im from day 1 to 7. The cycles were repeated every 28 days. Results There were no complete responses and 18 partial responses, for an overall response rate of 51%. Median time to treatment failure was 6 months (range, 1-18), and median survival was 9.5 months (range, 1-32). WHO grade 3 toxicity was recorded in up to 8% of patients, flu-like syndrome was a common complaint; one toxic death occurred. Conclusions The combination yielded a level of response comparable to that of other cisplatin-based regimens. Larger randomized trials are needed to assess the role of α-IFN combined with chemotherapy in advanced NSCLC.
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Affiliation(s)
- R R Silva
- Oncology Unit, Ospedale ¿Profili¿, Fabriano (An), Italy
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Rastelli F, Biancanelli S, Falzetta A, Martignetti A, Casi C, Bascioni R, Giustini L, Crispino S. Triple-Negative Breast Cancer: Current State of the Art. Tumori Journal 2018. [DOI: 10.1177/548.6505] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Francesca Rastelli
- Oncology Unit Zona Territoriale 11, Ospedale “Murri”, Azienda Sanitaria Unica Regionale Marche, Fermo
| | | | | | | | | | - Romeo Bascioni
- Oncology Unit Zona Territoriale 11, Ospedale “Murri”, Azienda Sanitaria Unica Regionale Marche, Fermo
| | - Lucio Giustini
- Oncology Unit Zona Territoriale 11, Ospedale “Murri”, Azienda Sanitaria Unica Regionale Marche, Fermo
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Affiliation(s)
- Romeo Bascioni
- 1 Unità di Oncologia Medica, Ospedale Murri, Fermo & Hospice di Montegranaro (FM) , Italy
| | - Francesca Giorgi
- 2 Unità di Oncologia Medica, Ospedale Madonna del Soccorso , San Benedetto del Tronto (AP), Italy
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Bascioni R, Esperide B, Miandro S, Bregoli J, Gucciardino C, Borriello MR, Basirat F, Rastelli F, Giustini L, Giorgi F. Family caregivers' attitude toward inpatients hospice enrollment: An exploratory study. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e20507] [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
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Affiliation(s)
- Romeo Bascioni
- Romeo Bascioni and Barbara Esperide, Unità di Oncologia Medica, Ospedale Murri, Fermo, Hospice di Montegranaro, Montegranaro; and Francesca Giorgi, Unità di Oncologia Medica, Ospedale Madonna del Soccorso, San Benedetto del Tronto, Italy
| | - Francesca Giorgi
- Romeo Bascioni and Barbara Esperide, Unità di Oncologia Medica, Ospedale Murri, Fermo, Hospice di Montegranaro, Montegranaro; and Francesca Giorgi, Unità di Oncologia Medica, Ospedale Madonna del Soccorso, San Benedetto del Tronto, Italy
| | - Barbara Esperide
- Romeo Bascioni and Barbara Esperide, Unità di Oncologia Medica, Ospedale Murri, Fermo, Hospice di Montegranaro, Montegranaro; and Francesca Giorgi, Unità di Oncologia Medica, Ospedale Madonna del Soccorso, San Benedetto del Tronto, Italy
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Bascioni R, Giorgi F, Esperide B, Basirat F, Borriello MR, Brugni M, Scriboni S, Rastelli F, Appignanesi R, Picciotti G, De Signoribus G, Giustini L. Medical oncologist’s commitment in the end of life (EoL) care of cancer patients: The caregiver's perspective. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.9098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9098 Background: Optimizing the impact of EoL care on cancer patients (pts) and their caregivers should be a primary goal of an oncology unit. In this study we evaluated satisfaction of family caregivers when the medical oncology team assisted pts until death. Methods: Two oncology units were reorganized to ensure continuity of care; oncologists trained in palliative care medicine assisted pts until EoL. The model assumes that the medical oncologist (MO) is the physician in charge throughout the entire disease trajectory. Relatives of pts assisted at home or at an inpatient hospice underwent a semistructured phone interview conducted by a psychologist or a social worker > 1 month after pts' death. Satisfaction was evaluated for symptoms control, communication, psychological support, overall quality of care and continuity of therapeutic relationship with the MO. A final open-ended question was included for any additional comment. Satisfaction was measured using a five-point Likert scale ranging from very dissatisfied to very satisfied and converted to a 0-to-100 scale. Results: Relatives of 65 pts were contacted, 55 accepted the interview (27 spouses, 22 sons, 5 in-laws, 1 parent); 50/55 were the leader caregiver. Patients were followed at home (41) or at an inpatient hospice (14), for 1-24 wks. Satisfaction mean scores were: symptoms control 76/100, communication 85, psychological support 82 and overall quality of care 87; a specific question on the relevance of the MO in EoL care produced a score of 87, with no negative or neutral responses recorded for this item. Of note, a common perception among caregivers was the appreciation of the MO's commitment during EoL in addition to the technical quality of the intervention. The overall satisfaction score was higher than in our previous study in which a continuity of care model was not formally adopted, with a score improvement from 55 to 87/100. Conclusions: A care pathway where the MO is involved in EoL management of cancer pts improved satisfaction of caregivers.When a longstanding and trusting relationship has been established, the pts-MO connection should not be lost to prevent feelings of abandonment.
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Affiliation(s)
| | | | | | | | | | - Manuela Brugni
- Ospedale Madonna del Soccorso, San Benedetto del Tronto, Italy
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Giorgi F, Bascioni R. Bearing the unbearable. J Palliat Med 2011; 14:247-8. [PMID: 21314581 DOI: 10.1089/jpm.2010.0346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Francesca Giorgi
- Unità di Oncologia Medica, Ospedale Madonna del Soccorso, San Benedetto del Tronto (AP), Italy.
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Bascioni R, Giorgi F, Rastelli F, di Pietro Paolo M, Brugni M, Basirat F, Mulattieri S, Giuliodori L, De Signoribus G, Silva RR, Giustini L. Impact of hospice and palliative home care on chemotherapy use at the end of life (EOL). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e16611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Rastelli F, Biancanelli S, Falzetta A, Martignetti A, Casi C, Bascioni R, Giustini L, Crispino S. Triple-negative breast cancer: current state of the art. Tumori 2010; 96:875-888. [PMID: 21388048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
AIMS AND BACKGROUND Triple-negative breast cancer, defined by a lack of expression of estrogen, progesterone and HER-2 receptors, accounts for 15% of all types of breast cancer. The subtype mainly includes a molecularly distinct subgroup, the basal-like subtype (accounting for 75% of all cases). We attempt to define triple-negative breast cancer and compare it with basal-like disease, review the molecular, pathologic and clinical features of triple-negative disease, provide an overview of a retrospective subset analysis of clinical trials, and outline ongoing therapeutic trials and possible paths for future research. METHODS We collected data regarding classification, molecular and clinical features and treatment, drawn from the existing literature, including abstracts and verbal accounts. By the term "basal-like", we defined all cases where gene expression array or more sophisticated immunophenotypes are used for identification. When the analysis is restricted to clinical assay (immunohistochemistry), we refer to "triple-negative". RESULTS Basal-like breast cancer expresses genes characteristic of basal epithelial cells, which include high-molecular weight basal cytokeratins (CK5/6, CK14, CK17), vimentin, p-cadherin, alpha B crystalline, caveolins 1 and 2 and EGFR. The expression of basal markers (basal cytokeratins and EGFR) is related to a worse prognosis and identifies a clinically distinct subgroup within the triple-negative breast cancer. BRCA1 mutations are present in 11% of triple-negative tumors and even more rare is BRCA2 deficiency. BR-CA1-associated breast cancers types are typically characterized by a high rate of DNA aberrations and defective DNA repair pathways (the so-called "BRCAness"). The use of regimens based on DNA-damaging agents, such as anthracyclines, platinum derivatives and cyclophosphamide seems a sensible option for this breast cancer subtypes. Clinical data support a strong sensitivity to primary chemotherapy with pathologic response rates ranging from 27-45% (with anthracyclines and taxanes) to more than 60% with platinum-based triplets. However, based on retrospective data, major response to chemotherapy does not carry better survival ("triple-negative paradox"). There is no specific targeted therapy in the armamentarium: ongoing trials include anti-angiogenic agents, anti-EGFR and EGFR-TK inhibitors, epothilones and PARP inhibitors. CONCLUSIONS A specific systemic regimen cannot yet be recommended. Moreover, only a few data are available on which treatment selection can be based. Use of the existing cytotoxic agents can be optimized for this patient subgroup by investigating the proliferative signals and the suitability of these signals as therapeutic targets, besides assessing the BRCA1-pathway in this subgroup as regards treatment. A greater understanding of the pathologic and molecular characteristics of this phenotype may lead to customized treatment for these patients.
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Affiliation(s)
- Francesca Rastelli
- Oncology Unit Zona Territoriale 11, Ospedale Murri Azienda Sanitaria Unica Regionale Marche, Fermo, Italy.
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Bascioni R, Esperide B, Iacopini D, Basirat F, Rastelli F, Acito L, Bisonni R, Giustini L, Giorgi F. Continuity of care for cancer patients at the end of life (EoL). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.6145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Bascioni R, Giorgi F, Safi M, Giustini L, De Signoribus G, Silva R. Chemotherapy in very elderly cancer patients (85 years and over): A retrospective study. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e20632] [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
e20632 Background: Elderly cancer patients (pts) population is expanding due to demographic changes. Currently 2.4 % of Italian population is older than 85, with this group accounting ∼8 % of all cancer pts in our geographic area. Since very elderly (85 years and over) cancer pts are generally excluded from clinical trials, few data are available about tolerability of chemotherapy in this population. Methods: We conducted a retrospective analysis of cancer pts aged 85 years and over receiving chemotherapy for advanced disease in the years 2005–2007 in three Oncology Unit of the Regione Marche, Italy. Results: We identified 50 patients (26 males, 24 females) with a mean age of 86.4 (range 85–95), ECOG PS 0 (4 pts) 1 (25 pts) 2 (13 pts) 3 (8 pts). Type of cancer (pts): NSCLC (13), colorectal (11), breast (5), prostate (4), gastric (3), NHL (3), bladder (2), head-neck (2), ovarian (2), vulvar (1), skin (1), pancreas (1), GIST (1), UPT (1). Main co-morbidities included hypertension (18 pts), COPD (8 pts) and heart disease (6 pts). The median number of cycles in first line chemotherapy were 6 (1–44); 20 pts received 2 or more lines of chemotherapy (range 2–5). Dose reductions were planned in all pts: in 26 dose reduction was 30 %, in 22 was 50%, in 2 > 50 %. Most used drugs were: vinorelbine os or iv (14 pts), capecitabine (9 pts), gemcitabine (7 pts). Target agents were used in 7 pts (5 erlotinib, 2 gefitinib, 2 rituximab, 1 sunitinib). Ten partial responses were observed; main toxicities were: grade 3–4 neutropenia (10 %), grade 3 diarrhea (5 %), and 1 pts had grade 3 hand-foot syndrome. No treatment related deaths were observed. Conclusions: Very elderly cancer pts (85 years and over) in good PS and few co-morbid conditions receiving dose reduced chemotherapy experienced acceptable toxic effects; a partial response was documented in 10 out of 50 pts. The expanding use of chemotherapy and target therapy in this clinical setting has profound influence on health care management and costs. Prospective studies specifically designed for this pts population could clarify the benefit, in terms of quality of life and survival, of an interventionist instead of a supportive care only approach. No significant financial relationships to disclose.
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Affiliation(s)
- R. Bascioni
- Ospedale Murri, Fermo, Italy; Ospedale Madonna del Soccorso, San Benedetto del Tronto, Italy; Ospedale E. Profili, Fabriano, Italy
| | - F. Giorgi
- Ospedale Murri, Fermo, Italy; Ospedale Madonna del Soccorso, San Benedetto del Tronto, Italy; Ospedale E. Profili, Fabriano, Italy
| | - M. Safi
- Ospedale Murri, Fermo, Italy; Ospedale Madonna del Soccorso, San Benedetto del Tronto, Italy; Ospedale E. Profili, Fabriano, Italy
| | - L. Giustini
- Ospedale Murri, Fermo, Italy; Ospedale Madonna del Soccorso, San Benedetto del Tronto, Italy; Ospedale E. Profili, Fabriano, Italy
| | - G. De Signoribus
- Ospedale Murri, Fermo, Italy; Ospedale Madonna del Soccorso, San Benedetto del Tronto, Italy; Ospedale E. Profili, Fabriano, Italy
| | - R. Silva
- Ospedale Murri, Fermo, Italy; Ospedale Madonna del Soccorso, San Benedetto del Tronto, Italy; Ospedale E. Profili, Fabriano, Italy
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Affiliation(s)
- Francesca Giorgi
- From Unità di Oncologia Medica, Ospedale Madonna del Soccorso, San Benedetto del Tronto; and Unità di Oncologia Medica, Ospedale Murri, Fermo, Italy
| | - Romeo Bascioni
- From Unità di Oncologia Medica, Ospedale Madonna del Soccorso, San Benedetto del Tronto; and Unità di Oncologia Medica, Ospedale Murri, Fermo, Italy
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15
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Bascioni R, Giorgi F, Esperide B, Iacopini D, Brugni M, Giustini L, de Signoribus G. Quality of life (QOL) assessment with EORTC QLQ-C30 in daily clinical practice. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.8205] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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)
- R. Bascioni
- Osp Murri, Fermo, Italy; Osp Madonna del Soccorso, San Benedetto del Tronto, Italy
| | - F. Giorgi
- Osp Murri, Fermo, Italy; Osp Madonna del Soccorso, San Benedetto del Tronto, Italy
| | - B. Esperide
- Osp Murri, Fermo, Italy; Osp Madonna del Soccorso, San Benedetto del Tronto, Italy
| | - D. Iacopini
- Osp Murri, Fermo, Italy; Osp Madonna del Soccorso, San Benedetto del Tronto, Italy
| | - M. Brugni
- Osp Murri, Fermo, Italy; Osp Madonna del Soccorso, San Benedetto del Tronto, Italy
| | - L. Giustini
- Osp Murri, Fermo, Italy; Osp Madonna del Soccorso, San Benedetto del Tronto, Italy
| | - G. de Signoribus
- Osp Murri, Fermo, Italy; Osp Madonna del Soccorso, San Benedetto del Tronto, Italy
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Giorgi F, Bascioni R, Brugni M, Safi M, Berardi R, Giustini L, De Signoribus G, Silva R, Cascinu S. Chemotherapy use at the end of life: An analysis of the decision making process. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.6081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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)
- F. Giorgi
- Ospedale Madonna del Soccorso, San Benedetto d. TR., AP, Italy; Ospedale Murri, Fermo, Italy; Ospedale Profili, Fabriano, Italy; Oncologia Medica Università di Ancona, Ancona, Italy
| | - R. Bascioni
- Ospedale Madonna del Soccorso, San Benedetto d. TR., AP, Italy; Ospedale Murri, Fermo, Italy; Ospedale Profili, Fabriano, Italy; Oncologia Medica Università di Ancona, Ancona, Italy
| | - M. Brugni
- Ospedale Madonna del Soccorso, San Benedetto d. TR., AP, Italy; Ospedale Murri, Fermo, Italy; Ospedale Profili, Fabriano, Italy; Oncologia Medica Università di Ancona, Ancona, Italy
| | - M. Safi
- Ospedale Madonna del Soccorso, San Benedetto d. TR., AP, Italy; Ospedale Murri, Fermo, Italy; Ospedale Profili, Fabriano, Italy; Oncologia Medica Università di Ancona, Ancona, Italy
| | - R. Berardi
- Ospedale Madonna del Soccorso, San Benedetto d. TR., AP, Italy; Ospedale Murri, Fermo, Italy; Ospedale Profili, Fabriano, Italy; Oncologia Medica Università di Ancona, Ancona, Italy
| | - L. Giustini
- Ospedale Madonna del Soccorso, San Benedetto d. TR., AP, Italy; Ospedale Murri, Fermo, Italy; Ospedale Profili, Fabriano, Italy; Oncologia Medica Università di Ancona, Ancona, Italy
| | - G. De Signoribus
- Ospedale Madonna del Soccorso, San Benedetto d. TR., AP, Italy; Ospedale Murri, Fermo, Italy; Ospedale Profili, Fabriano, Italy; Oncologia Medica Università di Ancona, Ancona, Italy
| | - R. Silva
- Ospedale Madonna del Soccorso, San Benedetto d. TR., AP, Italy; Ospedale Murri, Fermo, Italy; Ospedale Profili, Fabriano, Italy; Oncologia Medica Università di Ancona, Ancona, Italy
| | - S. Cascinu
- Ospedale Madonna del Soccorso, San Benedetto d. TR., AP, Italy; Ospedale Murri, Fermo, Italy; Ospedale Profili, Fabriano, Italy; Oncologia Medica Università di Ancona, Ancona, Italy
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Bascioni R. [Oxaliplatin]. Suppl Tumori 2004; 3:S111-2. [PMID: 15206232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
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Cascinu S, Catalano V, Piga A, Mattioli R, Marcellini M, Pancotti A, Bascioni R, Torresi U, Silva RR, Pieroni V, Giorgi F, Catalano G, Cellerino R. The Role of Levamisole in the Adjuvant Treatment of Stage III Colon Cancer Patients: A Randomized Trial of 5-Fluorouracil and Levamisole Versus 5-Fluorouracil Alone. Cancer Invest 2003; 21:701-7. [PMID: 14628428 DOI: 10.1081/cnv-120023769] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [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: 11/03/2022]
Abstract
Adjuvant 5-fluorouracil (5FU) and levamisole (Lev) have been considered standard treatment for stage III colon cancer patients. However, the uncertain contribution of Lev to the efficacy of treatment has led many oncologists to prefer the 5FU/leucovorin combination. To establish the role of Lev, we conducted a randomized trial comparing the 5FU/Lev combination with 5FU alone in patients with Dukes' C colon cancer. Patients with stage III colon cancer were randomized to receive 5FU alone (450 mg/m2 i.v. bolus daily for 5 days and then, beginning at day 28, weekly for 48 weeks) or the same plus Lev (50 mg orally three times/day for 3 days, repeated every 2 weeks for 1 year). From December 1994 to March 1998, 92 patients were assigned to receive 5FU/Lev, and 93 were assigned to receive 5FU alone. Leukopenia and hepatic toxicity were more frequent in patients receiving 5FU/Lev as compared with those receiving 5FU (respectively, p = 0.003 and p = 0.039), whereas other toxicities were equivalent and mild in both arms. After a median follow-up time of 48 months, 80 patients have had recurrences (40 in each arm) and no advantages in terms of disease-free survival and overall survival could be demonstrated for the combination arm. The addition of Lev to 5FU does not seem to be relevant for the clinical activity of this adjuvant regimen, whereas toxicity related to Lev should be considered when an adjuvant treatment for stage III colon cancer patients is proposed.
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Affiliation(s)
- Stefano Cascinu
- Clinica di Oncologia Medica, Università degli Studi di Ancona, Ospedale di Torrette, 60020 Ancona, Italy
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Massacesi C, Bascioni R, Cellerino R, Scartozzi M, Bracci R, Alessandroni P, Antognoli S, Ciavattini A, De Nictolis M, Piga A. Cisplatin, epirubicin and cyclophosphamide (PEC) in the treatment of advanced ovarian cancer. J Exp Clin Cancer Res 2000; 19:13-6. [PMID: 10840930] [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: 02/16/2023]
Abstract
We report the long-term results of a series of patients affected by advanced epithelial ovarian cancer treated with the PEC combination (cisplatin 60 mg/m2, epirubicin 60 mg/m2 and cyclophosphamide 750 mg/m2, all at day 1, every 21 days). Response was evaluated after three cycles, and treatment continued in responsive patients. A total of 80 patients with a median follow-up of 55 months were studied. Fifty-eight patients with stage III ovarian cancer and 22 patients with stage IV received PEC as primary treatment (41 patients), or for residual disease after surgery (37 patients), or for relapsed disease after primary surgery (2 patients). The overall response rate was 67.5% (20.0% complete response, 47.5% partial response), with 22.5% stable disease and 3.7% progressive disease. Median progression free survival was 13.0 months, and median survival was 25 months. Grade III-IV toxicity was moderate: leukopenia 20.0% of patients, thrombocytopenia 5.0%, anemia 16.2%. No cardiac toxicity was observed. In conclusion, the PEC combination, an anthracycline-containing platinum-based regimen, proved to be effective in advanced ovarian cancer, in terms of response rate and overall survival. The regimen was devoid of significant toxicity and in particular of cardiac toxicity.
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Affiliation(s)
- C Massacesi
- Medical Oncology, University of Ancona, Italy
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Bascioni R, Giorgi F, Silva RR, Acito L, Giustini L, De Signoribus G, Giuliodori L, Testa E. Mitoxantrone, fluorouracil, and L-folinic acid in anthracycline-pretreated metastatic breast cancer patients. Breast Cancer Res Treat 1997; 45:205-10. [PMID: 9386863 DOI: 10.1023/a:1005856028736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [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: 02/05/2023]
Abstract
In this phase II trial we have evaluated the activity and toxicity of a combination regimen containing mitoxantrone, L-leucovorin, and fluorouracil in patients with advanced breast cancer pretreated with anthracyclines. Forty-six patients were included into the study; they received a total of 227 cycles of chemotherapy. Median age was 63 years (range 34-78), median performance status was 80 (range 60-100). Visceral metastases were present in 37 patients, 6 patients had bone involvement only, while 3 patients had soft tissue/lymph node disease. Median number of previous chemotherapy regimens for advanced disease was 2 (range 1-3). Ten patients had anthracycline primary resistance (progressive disease during treatment). Twenty-three patients received mitoxantrone 12 mg/sqm day 1; fluorouracil 370 mg/sqm and L-folinic acid 100 mg/sqm days 1-3 administered every three weeks. Another group of 23 patients were treated with the same regimen using a prolonged 5FU/L-FA schedule (5 days). Two complete responses and 6 partial responses were recorded with the 3-day schedule; 7 partial responses in the 5-day schedule (overall response rate 32.6%, 95% C.I. 19-46%). Two partial responses were observed in patients with anthracycline primary resistance. Median response duration was 9 months (range 3-16). Hematologic toxicity was mild: grade 3-4 leukopenia was recorded in 5 patients, grade 3-4 thrombocytopenia in 3 patients. Grade III-IV stomatitis and diarrhea was recorded in 4 and 5 patients respectively (all receiving the 5-day 5-FU/L-FA schedule). Cardiac toxicity was observed in two cases. This regimen proved active in advanced breast cancer following anthracycline-containing chemotherapy, and the 3-day schedule could be offered to such patients with acceptable toxicity.
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Affiliation(s)
- R Bascioni
- Oncology Unit, City Hospital of Fermo, Italy
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Piga A, Cascinu S, Latini L, Marcellini M, Bavosi M, Acito L, Bascioni R, Giustini L, Francini G, Pancotti A, Rossi G, Del Papa M, Carle F, Cellerino R. A phase II randomised trial of 5-fluorouracil with or without interferon alpha-2a in advanced colorectal cancer. Br J Cancer 1996; 74:971-4. [PMID: 8826868 PMCID: PMC2074731 DOI: 10.1038/bjc.1996.467] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
With the association of 5-fluorouracil (5-FU) and alpha-interferon (IFN), objective responses as high as 26 63% have been reported in untreated patients with advanced colorectal cancer. However, grade 3-4 toxicity has also been reported. We have conducted a prospective phase II randomised study comparing 5-FU to 5-FU + IFN, to investigate whether the addition of IFN to a weekly 5-FU regimen devoid of significant toxicity used at our institutions could improve the effectiveness of 5-FU while maintaining acceptable toxicity. Patients with histologically proven advanced colorectal carcinoma were randomised to receive 5-FU 500 mg m-2 intravenous (i.v.) bolus on days 1-5 followed by 5-FU 500 mg m-2 i.v. bolus weekly from day 15, with or without IFN alpha-2a intramuscularly (i.m.) 1.5 mU daily on days 6-12 and 3 mU i.m. daily thereafter. The treatment was administered on an outpatient basis. Response was evaluated every 3 months, and treatment continued until progression or after two consecutive judgements of stable disease. Response rate was the main end point of the study. Of 141 patients eligible, 72 were randomised to 5-FU alone (arm A) and 69 to 5-FU + IFN (arm B). Responses were 9/72 (12.5%) in arm A and 6/69 (8.7%) in arm B; complete responses were three in arm A and two in arm B. Progression-free survival (median 4 months) and survival (median 12 months) were identical in the two arms. Toxicity was almost absent in arm A and moderate in arm B, represented mainly by haematological toxicity (usually leucopenia). In conclusion, overall survival was good in both arms of treatment and toxicity was moderate. While the response rate with 5-FU alone was in accord with the literature data, response to 5-FU + IFN was lower than expected. At least at this dosage and schedule, the association of 5-FU and IFN is no better than 5-FU alone and is of no clinical interest.
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Affiliation(s)
- A Piga
- Medical Oncology and Statistics, University of Ancona, Italy
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Silva RR, Bascioni R, Giorgi F, Acito L, Giustini L, De Signoribus G, Marcellini M, Menichetti ET, Giuliodori L. Granisetron plus dexamethasone in moderately emetogenic chemotherapy: evaluation of activity during three consecutive courses of chemotherapy. Support Care Cancer 1996; 4:287-90. [PMID: 8829306 DOI: 10.1007/bf01358881] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [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: 02/02/2023]
Abstract
In this study we evaluated the antiemetic activity of a combination of 3 mg granisetron in a short i.v. infusion followed by 12 mg dexamethasone i.v. in 64 patients with cancer receiving moderately emetogenic chemotherapy scheduled in a single day. No patient had previously undergone chemotherapy and three consecutive cycles were evaluated. Response to antiemetic treatment was graded as follows: complete response, no episodes of vomiting; major response, only one episode; minor response, two to four episodes; failure, more than four episodes. Nausea was graded as absent, mild, moderate or severe (patients bedridden). At the first cycle a complete protection from acute vomiting and nausea was achieved in 95% and 73% of patients respectively; the rate of complete response for delayed vomiting was 90%, while 45% of patients complained of delayed nausea. The antiemetic and antinausea efficacy remained substantially unchanged during the second and third cycles of chemotherapy. Constipation and headache were the most frequent adverse events. In conclusion this antiemetic regimen appears very effective in preventing nausea and vomiting in moderately emetogenic chemotherapy.
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Affiliation(s)
- R R Silva
- Oncology Unit, City Hospital of Fabriano (Profili), Italy
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Piga A, Graziano F, Bascioni R, Di Giuseppe M, Cellerino R. Continuing medical education through the videotex system in Italy. J Cancer Educ 1995; 10:203-206. [PMID: 8924395 DOI: 10.1080/08858199509528374] [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: 05/22/2023]
Abstract
Continuing education for medical doctors is not compulsory in Italy. The link with the university is lost shortly after the final medical examination, and there is no other teaching institution for structured continuing medical education (CME). Distance learning gives physicians the opportunity to use updating programs at home at their convenience. Videotel, the Italian videotex system, is the first telematic tool that, at low cost, can reach every home nationwide. Through this system information can be exchanged 24 hours a day, using the Videotel database as central memory, the telephone network as connecting system, and low-cost devices as peripherals. The authors evaluated the technical capacity and didactic efficacy of the Videotel system as a vehicle for CME (in both oncology and general medicine). In an exploratory phase they surveyed physicians of the Italian Province designated for the study, with the objective of promoting the initiative and enrolling physicians interested in this innovative approach to CME. Teachers at Italian universities provided the educational material: interactive lessons, clinical case discussions and problem solving, and multiple-choice questions. Twenty-nine physicians agreed to participate. Despite the interest shown by these physicians, they made very little use of the didactic database. The main reasons for failure to connect with the educational database were the lack of time and unfamiliarity with the instrument. Although the results of the study were discouraging, the authors believe that the resolution of technical problems linked with the system and an increasing familiarity of physicians with telematic and informatic tools in general, together with appropriate incentives, will make the videotex system a feasible, low-cost, efficient vehicle for CME.
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Affiliation(s)
- A Piga
- Division of Medical Oncology, University of Ancona, Italy
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Mattioli R, Silva RR, Battelli N, Manocchi P, Pilone A, Rossini S, Delprete S, Mazzanti P, Bascioni R, Battelli T. Mitomycin C, 5Fluorouracil and Folinic Acid in Combination with Alpha 2b Interferon for Advanced Colorectal Cancer. Tumori 1993; 79:393-6. [PMID: 8171737 DOI: 10.1177/030089169307900604] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and Background This study was conducted to investigate the activity and toxicity of 5fluorouracll + folinic acid + mitomycin C combined with alpha 2b Interferon in advanced colorectal cancer based upon recent studies suggesting a possible biochemical modulation of 5 fluorouracil by interferon. Patients and methods Between June 1990 and April 1991 25 previously untreated patients with advanced colorectal carcinoma were treated with mitomycin C 10 mg/m2 iv bolus on day 1, 5fluorouracil 375 mg/m2 on days 1 to 4 and folinic acid 200 mg/m2 on days 1 to 4 every 4 weeks, combined with alpha 2b interferon 3 million U day continuously. Response Of the 25 patients entered into the study, 20 were evaluable for response as 5 patients withdrew due to toxicity (grade 3-4 thrombocytopenia in 4 cases and fatigue in 1). No complete response was recorded, 6 patients had partial remission (30 %; 95 % confidence interval, 10 % to 50 %), 4 experienced no change and 10 showed progressive disease. The toxicity of this regimen was significant, particularly myelosuppression. Conclusions This combination showed a significant toxicity and low response rate compared with other 5 fluorouracil based regimens in advanced colorectal cancer.
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Affiliation(s)
- R Mattioli
- Division of Medical Oncology, Regional Hospital Torrette, Ancona
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Piga A, Bascioni R, Di Giuseppe M, Cellerino R. Continuing medical education by the videotex system. Rays 1991; 16:513-7. [PMID: 1788420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- A Piga
- Cattedra di Oncologia, Università di Ancona, Italy
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