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Barni S, Fabi A, Petrelli F. Lobular Carcinoma of the Breast and Utility of Oncotype Dx®: a Retrospective Decision Impact Analysis. Clin Breast Cancer 2023; 23:e173-e174. [PMID: 36586733 DOI: 10.1016/j.clbc.2022.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/02/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE It is still relatively questioned if the benefit of Recurrent Score (RS) extends to invasive lobular carcinoma (ILC), which represents 10-15% of all invasive Breast Cancer (BC). We present the results of the lobular carcinoma subgroup of the PONDx Italy study[1]. that collected data on real-life use of the Oncotype DX® test in Italian oncological community clinical practice. METHODS We present the results of the lobular carcinoma subgroup of the PONDx Italy study that collected data on real-life use of the Oncotype DX® test in Italian oncological community clinical practice. The study primarily evaluated the impact of the Oncotype DX assay results on physicians' treatment decisions. In the primary analysis, data from 1724 BC patients who underwent Oncotype DX testing were available from 27 reference centers located in 6 regions of Italy (Lombardia, Lazio, Emilia Romagna, Campania, Abruzzo, and Marche). RESULTS Among patients with data available, 214 had ILC. In this cohort, 100 (47%) of patients with ILC had treatment recommendations for CT + HT before the availability of their RS result. After the availability of the RS result, recommendations for CT+HT decreased to 47 cases (22%). CONCLUSION the decision to opt for the Oncotype Dx test should not be based on the histology subgroup only because a small population of ER+ ILC BC patients may still attain important information from testing. Despite this information, its predictive value needs more dedicated trials to be confirmed.
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Affiliation(s)
- Sandro Barni
- Oncology Unit, ASST Bergamo ovest, Treviglio, Italy
| | - Alessandra Fabi
- Precision Medicine in Breast Cancer Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Muñoz M, Barni S. 8 th International Multidisciplinary Course on Iron Deficiency, Stresa (Italy), 21-22 October 2022. Blood Transfus 2023:BloodTransfus.2023.Suppl1. [PMID: 36877179 DOI: 10.2450/bloodtransfus.2023.suppl1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
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Rosati G, Cella CA, Cavanna L, Codecà C, Prisciandaro M, Mosconi S, Luchena G, Silvestris N, Bernardini I, Casaretti R, Zoratto F, Amoroso D, Ciarlo A, Barni S, Cascinu S, Davite C, Di Sanzo A, Casolaro A, Bilancia D, Labianca R. A randomized phase III study of fractionated docetaxel, oxaliplatin, capecitabine (low-tox) vs epirubicin, oxaliplatin and capecitabine (eox) in patients with locally advanced unresectable or metastatic gastric cancer: the lega trial. Gastric Cancer 2022; 25:783-793. [PMID: 35352176 DOI: 10.1007/s10120-022-01292-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 03/16/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND EOX (epirubicin, oxaliplatin, and capecitabine) is one of the standard regimens for metastatic or locally advanced gastric cancer (GC). A new combination based on fractional docetaxel (low-TOX) has been developed in an attempt to increase the efficacy of EOX and reduce the heavy toxicity of classical docetaxel regimens. METHODS Overall, 169 previously untreated GC patients were randomized between EOX (arm A) and low-TOX (arm B). The primary endpoint was progression-free survival (PFS), while secondary ones were overall survival (OS), overall response rate (ORR), disease control rate (DCR), and tolerability. The study was designed to detect a 35% (80% power at a two-sided 5% significance level) PFS increase with low-TOX and an interim analysis for futility was planned after the first 127 events. RESULTS At the cut-off date of interim analysis, median PFS was 6.3 months [95% confidence interval (CI) 5.0-8.1] in arm A vs 6.3 months (95% CI 5.0-7.8) in arm B, without statistical difference. OS was comparable in the two arms: 12.4 in arm A (95% CI 9.1-19.2) vs 11.5 months in arm B (95% CI 8.6-15.0). ORR was 33% and 24%, while DCR was 68% and 67%, respectively. Treatment modification (91% vs 78%, P = 0.017) and number of patients with CTC grade ≥ 3 adverse events (42 vs 35) were higher in arm B. CONCLUSIONS A triplet regimen based on the fractional dose of docetaxel achieves no improvement over EOX which remains a potential standard treatment in many patients with inoperable, locally advanced or metastatic GC.
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Affiliation(s)
- Gerardo Rosati
- UOC di Oncologia Medica, Azienda Ospedaliera San Carlo, Via P. Petrone 1, 85100, Potenza, Italy.
| | - Chiara Alessandra Cella
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Luigi Cavanna
- Dipartimento di Oncologia-Ematologia, Azienda USL, Ospedale di Piacenza, Piacenza, Italy
| | - Carla Codecà
- U.O. Oncologia Medica, ASST Santi Paolo e Carlo, Presidio Ospedaliero San Paolo, Milan, Italy
| | - Michele Prisciandaro
- Divisione di Oncologia Medica, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stefania Mosconi
- Dipartimento di Oncologia ed Ematologia, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Nicola Silvestris
- U.O.C. Oncologia Medica, IRCCS Istituto Tumori Giovanni Paolo II, Bari, Italy
| | | | - Rossana Casaretti
- Department of Abdominal Oncology, Istituto Nazionale Tumori-IRCCS Fondazione "G. Pascale", Napoli, Italy
| | - Federica Zoratto
- U.O.C. Oncologia Medica, Ospedale Santa Maria Goretti, Latina, Italy
| | - Domenico Amoroso
- Ospedale Versilia, Azienda USL Toscana Nordovest (ATNO), Lido di Camaiore, Italy
| | - Andrea Ciarlo
- U.O. Oncologia Medica, AUSL Toscana Centro, Ospedale di Prato, Prato, Italy
| | - Sandro Barni
- U.O. Oncologia Medica, ASST Bergamo Ovest, Ospedale di Treviglio-Caravaggio, Treviglio, BG, Italy
| | - Stefano Cascinu
- Unità di Medicina Oncologica, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Cristina Davite
- Global Clinical Development, Nerviano Medical Sciences, Nerviano, MI, Italy
| | | | - Alessia Casolaro
- Global Clinical Development, Nerviano Medical Sciences, Nerviano, MI, Italy
| | - Domenico Bilancia
- UOC di Oncologia Medica, Azienda Ospedaliera San Carlo, Via P. Petrone 1, 85100, Potenza, Italy
| | - Roberto Labianca
- Dipartimento di Oncologia ed Ematologia, ASST Papa Giovanni XXIII, Bergamo, Italy
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Barni S, Cognetti F, Petrelli F. Is the oncotype DX test useful in elderly breast cancer patients: a subgroup analysis of real-life Italian PONDx study. Breast Cancer Res Treat 2021; 191:477-480. [PMID: 34817748 DOI: 10.1007/s10549-021-06464-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 07/29/2021] [Accepted: 11/17/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The 21-gene Oncotype DX Breast Recurrence Score® test, (Genomic Health, Redwood City CA) has not been formally evaluated in an older cohort with estrogen receptor (ER)-positive breast cancer (BC) in term of physicians' treatment decisions. We determine the utility of Recurrence Score® (RS) result on adjuvant therapy prescription in elderly patients with resected early BC. MATERIAL AND METHODS PONDx was a multicenter, prospective, observational study, and which investigated the real-life use of the Oncotype DX® test by physicians treating early BC patients in clinical practice. RESULTS Data from the elderly extracted from 1724 BC patients who underwent Oncotype DX testing were available from 27 reference centers located in 6 regions of Italy (Lombardia, Lazio, Emilia Romagna, Campania, Abruzzo, and Marche). A total of 230 patients (13% of the total population) aged > 70 years were analyzed. The study primarily evaluated the impact of the Oncotype DX test on adjuvant treatment decisions. Physicians chosen chemotherapy plus endocrine therapy in 36% of elderly patients and 46% of those 50-70 years before the Oncotype DX test. After knowing the RS data, these rates fell to 23 and 33% (38 and 28% relative reduction, respectively). CONCLUSIONS 21-gene test may be helpful even in a relatively low-risk group as elderly patients and may avoid the toxicity of adjuvant chemotherapy in a significant amount. If the Oncotype DX test is currently adopted on a large scale among the elderly and may impact the general prognosis of elderly BC patients, it is challenging and still unproven.
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Affiliation(s)
- Sandro Barni
- Oncology Unit, Medical Sciences Department, ASST Bergamo Ovest, Piazzale Ospedale 1, 24047, Treviglio, BG, Italy
| | - Francesco Cognetti
- Dipartimento Medicina Clinica e Molecolare, Università La Sapienza di Roma, Rome, Italy
| | - Fausto Petrelli
- Oncology Unit, Medical Sciences Department, ASST Bergamo Ovest, Piazzale Ospedale 1, 24047, Treviglio, BG, Italy.
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Petrelli F, Ghidini A, Cabiddu M, Perego G, Lonati V, Ghidini M, Oggionni E, Galli E, Moleri G, Barni S, Bossi AC, Colombelli PL, Dognini G, Sganzerla P. Effects of hypertension on cancer survival: A meta-analysis. Eur J Clin Invest 2021; 51:e13493. [PMID: 33470426 DOI: 10.1111/eci.13493] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 11/17/2020] [Revised: 01/03/2021] [Accepted: 01/16/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND Hypertension is usually associated with increased cardiovascular mortality. Uncertainty exists about the possible role of hypertension as a poor prognostic factor for cancer-specific mortality (CSM). To assess the association between pre-existing hypertension and the risk of mortality and relapse after a diagnosis of cancer, we performed a systematic review and meta-analysis of published studies. METHODS PubMed, Scopus, Web of Science, the Cochrane Library and EMBASE were searched from inception until May 2020, without language restrictions, for observational studies reporting the prognosis of patients with hypertension and cancer. The primary outcome of the study refers to CSM in hypertensive vs nonhypertensive patients, and secondary endpoints were overall mortality (OM) and progression- or relapse-free survival. The effect size was reported as hazard ratios (HRs) with 95% CIs. RESULTS Mortality and relapse associated with hypertension in patients with various cancers were evaluated among 1 603 437 participants (n = 66 studies). Overall, diagnosis of cancer and hypertension was associated with an increased independent risk of OM (HR = 1.2 [95% CI, 1.13-1.27], P < .01) and CSM (HR = 1.12 [95% CI, 1.04-1.21], P < .01) but not of relapse (HR = 1.08 [95% CI, 0.98-1.19], P = .14). CONCLUSIONS Among cancer patients, those with pre-existing hypertension have a poorer outcome, probably due to multifactorial reasons. Adequate control of lifestyle, more intensive follow-ups, monitoring for hypertension- and anticancer-related cardiovascular complications, and establishing multidisciplinary cardio-oncology units can be useful measures for reducing mortality and improving care in this setting.
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Affiliation(s)
| | | | - Mary Cabiddu
- Oncology Unit, ASST Bergamo Ovest, Treviglio, Italy
| | | | | | - Michele Ghidini
- Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | | | - Emilio Galli
- Nephrology Unit, ASST Bergamo Ovest, Treviglio, Italy
| | - Giovanna Moleri
- Direzione Socio-Sanitaria, Centro Servizi, ASST Bergamo Ovest, Treviglio, Italy
| | - Sandro Barni
- Oncology Unit, ASST Bergamo Ovest, Treviglio, Italy
| | - Antonio Carlo Bossi
- Endocrine Diseases Unit-Diabetes regional center, ASST Bergamo Ovest, Treviglio, Italy
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Cognetti F, Masetti R, Fabi A, Bianchi G, Santini D, Rognone A, Catania G, Angelucci D, Naso G, Giuliano M, Vassalli L, Vici P, Scognamiglio G, Generali D, Zambelli A, Colleoni M, Tinterri C, Scanzi F, Vigna L, Scavina P, Gamucci T, Marrazzo E, Scinto AF, Berardi R, Fabbri MA, Pinotti G, Franco D, Terribile DA, Tonini G, Cianniello D, Barni S. PONDx: real-life utilization and decision impact of the 21-gene assay on clinical practice in Italy. NPJ Breast Cancer 2021; 7:47. [PMID: 33953182 PMCID: PMC8099872 DOI: 10.1038/s41523-021-00246-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 11/12/2020] [Indexed: 12/19/2022] Open
Abstract
Clinicopathological prognostic features have limited value to identify with precision newly diagnosed patients with hormone receptor (HR)-positive, HER2-negative breast cancer (BC), who would benefit from chemotherapy (CT) in addition to adjuvant hormonal therapy (HT). The 21-gene Oncotype DX Breast Recurrence Score® (RS) assay has been demonstrated to predict CT benefit, hence supporting personalized decisions on adjuvant CT. The multicenter, prospective, observational study PONDx investigated the real-life use of RS® results in Italy and its impact on treatment decisions. Physicians' treatment recommendations (HT ± CT) were documented before and after availability of RS results, and changes in recommendations were determined. In the HR+ HER2- early BC population studied (N = 1738), physicians recommended CT + HT in 49% of patients pre-RS. RS-guided treatment decisions resulted in 36% reduction of CT recommendations. PONDx confirms that RS results provide clinically relevant information for CT recommendation in early-stage BC, resulting in a reduction of more than a third of CT use.
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Affiliation(s)
- Francesco Cognetti
- Università La Sapienza di Roma, Dipartimento Medicina Clinica e Molecolare, Rome, Italy.
| | | | | | - Giulia Bianchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | | | | | | | | | - Mario Giuliano
- Azienda Ospedaliera Universitaria Federico II, Napoli, Italy
| | | | - Patrizia Vici
- IRCCS Regina Elena National Cancer Institute, Roma, Italy
| | | | | | | | | | | | | | | | - Paola Scavina
- Azienda Ospedaliera San Giovanni - Addolorata, Roma, Italy
| | | | | | | | - Rossana Berardi
- Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona, Torrette, Italy
| | | | | | | | | | | | | | - Sandro Barni
- ASST BG Ovest Ospedale Treviglio, Treviglio, BG, Italy
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7
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Cognetti F, Biganzoli L, De Placido S, del Mastro L, Masetti R, Naso G, Pruneri G, Santini D, Tondini CA, Tinterri C, Tonini G, Barni S. Multigene tests for breast cancer: the physician's perspective. Oncotarget 2021; 12:936-947. [PMID: 33953847 PMCID: PMC8092339 DOI: 10.18632/oncotarget.27948] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 04/01/2021] [Indexed: 11/29/2022] Open
Abstract
Breast cancer is the most common tumour in women and the first cause of death for cancer in the female population. Preserving the quality of life has therefore become an important objective in the management of the disease. The benefits of adjuvant chemotherapy in patients with HR+ HER2- early breast cancer should always be balanced against its potential short and long-term adverse effects, and identifying the appropriate patients for whom chemotherapy can offer the highest clinical benefit is critical. Besides clinical and pathological factors, today four multigene tests able to guide the choice of the adjuvant therapy early breast cancer are available in Italy: Oncotype DX®, EndoPredict®, MammaPrint® e Prosigna®. This review evaluates the main characteristics of these diagnostic tests, the studies on clinical utility, their economic impact and their inclusion in international and national guidelines. The Oncotype DX Breast Recurrence Score® test is the only multigene test validated, with level IA evidence, to guide the adjuvant therapy decisions: hormone therapy alone for most patients with RS results 0-25, and chemotherapy for patients with RS results 26-100. Clinical data demonstrate that the Oncotype DX test is able to significantly impact therapeutic decisions, reducing chemotherapy use up to 49% and supporting the use of chemotherapy (up to 12%) in potentially under-treated patients. Based on the level of clinical evidence and established clinical utility, several multigene tests have been included in the main international guidelines, with recommendations ranging from "strong" to "moderate".
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Affiliation(s)
- Francesco Cognetti
- Scuola di specializzazione di Oncologia, La Sapienza University, Rome, Italy
| | - Laura Biganzoli
- Sandro Pitigliani Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - Sabino De Placido
- Università Degli Studi di Napoli Federico II Dipartimento di Medicina clinica e Chirurgia Professore di Oncologia Medica, Napoli, Italy
| | - Lucia del Mastro
- Oncology, IRCCS AOU San Martino - IST Istituto Nazionale per la Ricerca del Cancro, Genova, Italy
| | | | - Giuseppe Naso
- Department of Radiology, Pathology and Oncology, La Sapienza University, Rome, Italy
| | - Giancarlo Pruneri
- Department of Pathology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Donatella Santini
- Department of Pathology, IRCCS Azienda Ospedaliera Universitaria di Bologna, Policlinico di Sant’Orsola, Bologna, Italy
| | | | | | - Giuseppe Tonini
- Medical Oncology, School University Campus Bio-Medico, Rome, Italy
| | - Sandro Barni
- Emeritus, Department of Oncology, ASST Bergamo Ovest, Treviglio, Bergamo, Italy
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Petrelli F, Cortellini A, Indini A, Tomasello G, Ghidini M, Nigro O, Salati M, Dottorini L, Iaculli A, Varricchio A, Rampulla V, Barni S, Cabiddu M, Bossi A, Ghidini A, Zaniboni A. Association of Obesity With Survival Outcomes in Patients With Cancer: A Systematic Review and Meta-analysis. JAMA Netw Open 2021; 4:e213520. [PMID: 33779745 PMCID: PMC8008284 DOI: 10.1001/jamanetworkopen.2021.3520] [Citation(s) in RCA: 169] [Impact Index Per Article: 56.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 02/08/2021] [Indexed: 12/11/2022] Open
Abstract
Importance Obesity, defined as a body mass index (BMI) greater than 30, is associated with a significant increase in the risk of many cancers and in overall mortality. However, various studies have suggested that patients with cancer and no obesity (ie, BMI 20-25) have worse outcomes than patients with obesity. Objective To assess the association between obesity and outcomes after a diagnosis of cancer. Data Sources PubMed, the Cochrane Library, and EMBASE were searched from inception to January 2020. Study Selection Studies reporting prognosis of patients with obesity using standard BMI categories and cancer were included. Studies that used nonstandard BMI categories, that were limited to children, or that were limited to patients with hematological malignant neoplasms were excluded. Screening was performed independently by multiple reviewers. Among 1892 retrieved studies, 203 (17%) met inclusion criteria for initial evaluation. Data Extraction and Synthesis The Meta-analysis of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines were reporting guideline was followed. Data were extracted by multiple independent reviewers. Risk of death, cancer-specific mortality, and recurrence were pooled to provide an adjusted hazard ratio (HR) with a 95% CI . A random-effects model was used for the retrospective nature of studies. Main Outcomes and Measures The primary outcome of the study was overall survival (OS) in patients with cancer, with and without obesity. Secondary end points were cancer-specific survival (CSS) and progression-free survival (PFS) or disease-free survival (DFS). The risk of events was reported as HRs with 95% CIs, with an HR greater than 1 associated with a worse outcome among patients with obesity vs those without. Results A total of 203 studies with 6 320 365 participants evaluated the association of OS, CSS, and/or PFS or DFS with obesity in patients with cancer. Overall, obesity was associated with a reduced OS (HR, 1.14; 95% CI, 1.09-1.19; P < .001) and CSS (HR, 1.17; 95% CI, 1.12-1.23; P < .001). Patients were also at increased risk of recurrence (HR, 1.13; 95% CI, 1.07-1.19; P < .001). Conversely, patients with obesity and lung cancer, renal cell carcinoma, or melanoma had better survival outcomes compared with patients without obesity and the same cancer (lung: HR, 0.86; 95% CI, 0.76-0.98; P = .02; renal cell: HR, 0.74; 95% CI, 0.53-0.89; P = .02; melanoma: HR, 0.74; 95% CI, 0.57-0.96; P < .001). Conclusions and Relevance In this study, obesity was associated with greater mortality overall in patients with cancer. However, patients with obesity and lung cancer, renal cell carcinoma, and melanoma had a lower risk of death than patients with the same cancers without obesity. Weight-reducing strategies may represent effective measures for reducing mortality in these patients.
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Affiliation(s)
- Fausto Petrelli
- Oncology Unit, Azienda Socio Sanitaria Territoriale Bergamo Ovest, Treviglio, Italy
| | - Alessio Cortellini
- Oncology Unit, Department of Biotechnology and Applied Clinical Sciences, San Salvatore Hospital, University of L’Aquila, L’Aquila, Italy
| | - Alice Indini
- Oncology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Maggiore Policlinico, Milano, Italy
| | - Gianluca Tomasello
- Oncology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Maggiore Policlinico, Milano, Italy
| | - Michele Ghidini
- Oncology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Maggiore Policlinico, Milano, Italy
| | - Olga Nigro
- Oncology Unit, Azienda Socio Sanitaria Territoriale Sette Laghi, Ospedale di Circolo, Varese, Italy
| | - Massimiliano Salati
- Oncology Unit, University Hospital of Modena, Modena Cancer Centre, Modena, Italy
| | - Lorenzo Dottorini
- Oncology Unit, Azienda Socio Sanitaria Territoriale Bergamo Est, Seriate, Italy
| | - Alessandro Iaculli
- Oncology Unit, Azienda Socio Sanitaria Territoriale Bergamo Est, Seriate, Italy
| | - Antonio Varricchio
- Surgical Oncology Unit, Azienda Socio Sanitaria Territoriale Bergamo Ovest, Treviglio, Italy
| | - Valentina Rampulla
- Surgical Oncology Unit, Azienda Socio Sanitaria Territoriale Bergamo Ovest, Treviglio, Italy
| | - Sandro Barni
- Oncology Unit, Azienda Socio Sanitaria Territoriale Bergamo Ovest, Treviglio, Italy
| | - Mary Cabiddu
- Oncology Unit, Azienda Socio Sanitaria Territoriale Bergamo Ovest, Treviglio, Italy
| | - Antonio Bossi
- Endocrine Diseases Unit–Diabetes Regional Center, Azienda Socio Sanitaria Territoriale Bergamo Ovest, Treviglio, Italia
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Venturini E, Gilchrist S, Corsi E, DI Lorenzo A, Cuomo G, D'Ambrosio G, Pacileo M, D'Andrea A, Canale ML, Iannuzzo G, Sarullo FM, Vigorito C, Barni S, Giallauria F. The core components of cardio-oncology rehabilitation. Panminerva Med 2021; 63:170-183. [PMID: 33528152 DOI: 10.23736/s0031-0808.21.04303-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The increased efficacy of cancer therapy has resulted in greater cancer survival and increasing number of people with cancer and cardiovascular diseases. The sharing of risk factors, the bidirectional relationship between cancer and cardiovascular diseases and the cardiotoxic effect of chemotherapy and radiotherapy, are the cause of the rapid expansion of cardio-oncology. All strategies to preserve cardiovascular health and mitigate the negative effect of cancer therapy, by reducing the cardiovascular risk, must be pursued to enable the timely and complete delivery of anticancer therapy and to achieve the longest remission of the disease. Comprehensive cardiac rehabilitation is an easy-to-use model, even in cancer care, and is the basis of Cardio-Oncology REhabilitation (CORE), an exercise-based multi-component intervention. In addition, CORE, besides using the rationale and knowledge of cardiac rehabilitation, can leverage the network of cardiac rehabilitation services to offer to cancer patients exercise programs, control of risk factors, psychological support, and nutrition counseling. The core components of CORE will be discussed, describing the beneficial effect on cardiorespiratory fitness, quality of life, psychological and physical well-being, and weight management. Furthermore, particular attention will be paid to how CORE can counterbalance the negative effect of therapies in those at heightened cardiovascular risk after a cancer diagnosis. Barriers for implementation, including personal, family, social and of the health care system barriers for a widespread diffusion of the CORE will also be discussed. Finally, there will be a call-to-action, for randomized clinical trials that can test the impact of CORE, on morbidity and mortality.
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Affiliation(s)
- Elio Venturini
- Unit of Cardiac Rehabilitation, AUSL Toscana Nord-Ovest, Cecina Civil Hospital, Cecina, Livorno, Italy -
| | - Susan Gilchrist
- Department of Clinical Cancer Prevention, Anderson Cancer Center, the University of Texas, Houston, TX, USA.,Department of Cardiology, Anderson Cancer Center, the University of Texas, Houston, TX, USA
| | - Elisabetta Corsi
- Unit of Cardiac Rehabilitation, AUSL Toscana Nord-Ovest, Cecina Civil Hospital, Cecina, Livorno, Italy
| | - Anna DI Lorenzo
- Division of Internal Medicine and Cardiac Rehabilitation, Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Gianluigi Cuomo
- Division of Internal Medicine and Cardiac Rehabilitation, Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Giuseppe D'Ambrosio
- Division of Internal Medicine and Cardiac Rehabilitation, Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Mario Pacileo
- Unit of Cardiology and Intensive Care, Umberto I Hospital, Nocera Inferiore, Salerno, Italy
| | - Antonello D'Andrea
- Unit of Cardiology and Intensive Care, Umberto I Hospital, Nocera Inferiore, Salerno, Italy
| | - Maria L Canale
- Department of Cardiology, AUSL Toscana Nord-Ovest, Versilia Hospital, Lido di Camaiore, Lucca, Italy
| | - Gabriella Iannuzzo
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Filippo M Sarullo
- Unit of Cardiovascular Rehabilitation, Buccheri La Ferla Fatebenefratelli Hospital, Palermo, Italy
| | - Carlo Vigorito
- Division of Internal Medicine and Cardiac Rehabilitation, Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Sandro Barni
- Department of Oncology, ASST Bergamo Ovest, Bergamo, Italy
| | - Francesco Giallauria
- Division of Internal Medicine and Cardiac Rehabilitation, Department of Translational Medical Sciences, Federico II University, Naples, Italy.,Faculty of Sciences and Technology, University of New England, Armidale, Australia
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La Verde N, Collovà E, Blasi L, Pinotti G, Palumbo R, Bonotto M, Garrone O, Brunello A, Rimanti A, Bareggi C, Zaniboni A, Frassoldati A, Foglietta J, Berardi R, Moretti A, Farina G, Porcu L, Barni S. Overall Survival in Metastatic Breast Cancer Patients in the Third Millennium: Results of the COSMO Study. Clin Breast Cancer 2020; 21:e489-e496. [PMID: 33342749 DOI: 10.1016/j.clbc.2020.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 10/09/2020] [Accepted: 11/02/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Metastatic breast cancer (MBC) is a life-threatening disease, and although some data suggest a trend in survival improvement, it has not yet been unequivocally demonstrated. This study aimed to evaluate the overall survival (OS) of MBC patients, assessing its correlation with prognostic factors. PATIENTS AND METHODS COSMO (Checking Overall Survival in a MBC Observational study) is an Italian longitudinal retrospective multicenter study that enrolled patients with MBC diagnosed between 2000 and 2008. The primary objective was to detect a temporal difference in OS; the secondary objective was to identify prognostic factors as causal factors of the temporal variation in OS. RESULTS A total of 3721 of 3930 patients from 31 centers were distributed in 3 periods: 886 (23.8%), 1302 (35.0%), and 1533 (41.2%) in 2000-2002, 2003-2005, and 2006-2008, respectively. With a median follow-up of 9.3 years, median OS was 2.8 years (95% confidence interval, 2.6-2.9). No difference in OS was found in the 3 cohorts (P for trend = .563). The worst prognosis was observed for patients with triple-negative MBC (OS, 1.5 years) and for those with central nervous system metastases (1.7 years); the best prognosis was observed in those with bone metastases or nonvisceral disease (3.4 and 3.2 years, respectively) and in patients with a disease-free interval, defined as the time between resection of the primary malignancy and diagnosis of MBC, of > 2 years (3 years). CONCLUSIONS The COSMO study found improvement in OS between 2000 and 2008. Molecular subtype remained the strongest prognostic factor, and the role of other prognostic factors was confirmed, in particular disease-free interval, site of metastasis, and age.
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Affiliation(s)
- Nicla La Verde
- Department of Oncology, PO Sacco, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Elena Collovà
- Department of Oncology, ASST Ovest Milanese, Legnano, MI, Italy
| | - Livio Blasi
- Department of Oncology, ARNAS AO Ospedale Civico Cristina Benfratelli, Palermo, Italy
| | | | | | - Marta Bonotto
- Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Ornella Garrone
- Department of Oncology, S. Croce & Carle Teaching Hospital, Cuneo, Italy
| | - Antonella Brunello
- Medical Oncology Unit 1, Istituto Oncologico Veneto-IRCCS, Padova, Italy
| | - Anita Rimanti
- Department of Oncology, ASST Mantova, AO Carlo Poma, Mantova, Italy
| | - Claudia Bareggi
- Department of Oncology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Alberto Zaniboni
- Department of Medical Oncology, Poliambulanza Foundation, Brescia, Italy
| | | | | | - Rossana Berardi
- Oncology Clinic, Università Politecnica delle Marche, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Anna Moretti
- Department of Oncology PO Fatebenefratelli, ASST Fatebenefratelli Sacco, Milan, Italy.
| | - Gabriella Farina
- Department of Oncology PO Fatebenefratelli, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Luca Porcu
- IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Oncology Department, Milan, Italy
| | - Sandro Barni
- Department of Oncology, ASST Bergamo Ovest Ospedale di Treviglio, Treviglio, Italy
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11
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Giovannini M, Castagnoli R, Mori F, Arasi S, Barni S, Saretta F, Mastrorilli C, Pecoraro L, Liotti L, Caminiti L, Marseglia G, Novembre E. Hymenoptera venom allergy among children in Italy: time for pediatricians to take action. Allergol Immunopathol (Madr) 2020; 48:804-809. [PMID: 32653226 DOI: 10.1016/j.aller.2020.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 10/23/2022]
Abstract
Hymenoptera venom allergy (HVA) is one of the most frequent causes of anaphylaxis following a bee, vespid or ant sting. Real-life data regarding the management of HVA in children are lacking. To address this unmet need, we carried out a survey defining the current management of HVA in children among pediatric allergists in Italy. Educational investments on the improvement of the management of pediatric patients with HVA are urgently needed, and our analysis represents a relevant instrument in targeting a roadmap with this aim. The time for pediatric allergists to take action has come, and a task force from the Rare Allergic Diseases Commission of the Italian Society of Pediatric Allergy and Immunology is working on the topic to improve pediatricians' knowledge and optimize the care of these patients.
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12
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Gulizia Chairperson MM, Parrini Co-Chairperson I, Colivicchi Co-Chairperson F, Bisceglia I, Caiazza F, Gensini GF, Mureddu GF, Santomauro M, Ageno W, Ambrosetti M, Aspromonte N, Barni S, Bellocci F, Caldarola P, Carletti M, De Luca L, Di Fusco SA, Di Lenarda A, Di Nisio M, Domenicucci S, Enea I, Francese GM, Lestuzzi C, Lucà F, Maurea N, Nassiacos D, Pedretti RFE, Pusineri E, Roscio G, Rossini R, Russo A, Volterrani M, Gabrielli Co-Chairperson D. [HCF-ANMCO/AICPR/GIEC/ITAHFA/SICOA/SICP/SIMG/SIT Cardiological Societies Council Consensus document: Anticoagulant therapy in venous thromboembolism and atrial fibrillation of the patient with cancer. Current knowledge and new evidence]. G Ital Cardiol (Rome) 2020; 21:687-738. [PMID: 33094745 DOI: 10.1714/3413.33967] [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] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Venous thromboembolism (VTE), including pulmonary embolism and deep venous thrombosis, either symptomatic or incidental, is a common complication in the history of cancer disease. The risk of VTE is 4-7-fold higher in oncology patients, and it represents the second leading cause of death, after cancer itself. In cancer patients, compared with the general population, VTE therapy is associated with higher rates of recurrent thrombosis and/or major bleeding. The need for treatment of VTE in patients with cancer is a challenge for the clinician because of the multiplicity of types of cancer, the disease stage and the imbricated cancer treatment. Historically, in cancer patients, low molecular weight heparins have been preferred for treatment of VTE. More recently, in large randomized clinical trials, direct oral anticoagulants (DOACs) demonstrated to reduce the risk of VTE. However, in the "real life", uncertainties remain on the use of DOACs, especially for the bleeding risk in patients with gastrointestinal cancers and the potential drug-to-drug interactions with specific anticancer therapies.In cancer patients, atrial fibrillation can arise as a perioperative complication or for the side effect of some chemotherapy agents, as well as a consequence of some associated risk factors, including cancer itself. The current clinical scores for predicting thrombotic events (CHA2DS2-VASc) or for predicting bleeding (HAS-BLED), used to guide antithrombotic therapy in the general population, have not yet been validated in cancer patients. Encouraging data for DOAC prescription in patients with atrial fibrillation and cancer are emerging: recent post-hoc analysis showed safety and efficacy of DOACs for the prevention of embolic events compared to warfarin in cancer patients. Currently, anticoagulant therapy of cancer patients should be individualized with multidisciplinary follow-up and frequent reassessment. This consensus document represents an advanced state of the art on the subject and provides useful notes on clinical practice.
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Affiliation(s)
- Michele Massimo Gulizia Chairperson
- U.O.C. Cardiologia, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione "Garibaldi", Catania - Fondazione per il Tuo cuore, Firenze - Heart Care Foundation Onlus
| | | | | | - Irma Bisceglia
- U.O.S.D. Servizi Cardiologici Integrati, A.O. San Camillo-Forlanini, Roma
| | | | - Gian Franco Gensini
- Tuscany Region Medical Guideline Authority, IRCCS MultiMedica, Sesto San Giovanni (MI)
| | - Gian Francesco Mureddu
- U.O.C. Cardiologia 2 e Riabilitazione Cardiologica, Ospedale San Giovanni Addolorata, Roma
| | - Maurizio Santomauro
- Dipartimento di Emergenze Cardiovascolari, Medicina Clinica e Geriatria, Università degli Studi "Federico II", Napoli
| | - Walter Ageno
- S.S.D., Università degli Studi dell'Insubria, Varese
| | - Marco Ambrosetti
- U.O. Riabilitazione Cardiologica, Istituti Clinici Scientifici Maugeri, IRCCS, Pavia
| | | | | | - Fulvio Bellocci
- Centro Benito Stirpe per la Prevenzione della Morte Improvvisa nel Giovane, Policlinico Universitario Agostino Gemelli, Roma
| | | | | | | | - Stefania Angela Di Fusco
- U.O.C. Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri, ASL Roma 1, Roma
| | - Andrea Di Lenarda
- S.C. Cardiovascolare e Medicina dello Sport, Ospedale Maggiore di Trieste, ASUGI Trieste
| | | | | | | | - Giuseppina Maura Francese
- U.O.C. Cardiologia, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione "Garibaldi", Catania
| | - Chiara Lestuzzi
- ASFO Riabilitazione Cardiologica e Cardioncologica, Centro Oncologico di Aviano (PN)
| | - Fabiana Lucà
- Divisione di Cardiololgia, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria
| | - Nicola Maurea
- S.C. Cardiologia, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli
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13
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Marchetti M, Giaccherini C, Masci G, Verzeroli C, Russo L, Celio L, Sarmiento R, Gamba S, Tartari CJ, Diani E, Vignoli A, Malighetti P, Spinelli D, Kuderer NM, Nichetti F, Minelli M, Tondini C, Barni S, Giuliani F, Petrelli F, D'Alessio A, Gasparini G, Labianca R, Santoro A, De Braud F, Falanga A. Thrombin generation predicts early recurrence in breast cancer patients. J Thromb Haemost 2020; 18:2220-2231. [PMID: 32397009 DOI: 10.1111/jth.14891] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 04/28/2020] [Accepted: 04/30/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cancer patients present with a hypercoagulable state often associated with poor disease prognosis. OBJECTIVES This study aims to evaluate whether thrombin generation (TG), a global coagulation test, may be a useful tool to improve the identification of patients at high risk of early disease recurrence (ie, E-DR within 2 years) after breast cancer surgery. PATIENTS/METHODS A cohort of 522 newly diagnosed patients with surgically resected high-risk breast cancer were enrolled in the ongoing prospective HYPERCAN study. TG potential was measured in plasma samples collected before starting systemic chemotherapy. Significant predictive hemostatic and clinic-pathological parameters were identified in the derivation cohort by Cox regression analysis. A risk prognostic score for E-DR was generated in the derivation and tested in the validation cohort. RESULTS After a median observation period of 3.4 years, DR occurred in 51 patients, 28 of whom were E-DR. E-DR subjects presented with the highest TG values as compared to both late-DR (from 2 to 5 years) and no relapse subjects (P < .01). Multivariate analysis in the derivation cohort identified TG, mastectomy, triple negative and Luminal B HER2-neg molecular subtypes as significant independent predictors for E-DR, which were utilized to generate a risk assessment score. In the derivation and validation cohorts, E-DR rates were 2.3% and 0% in the low-risk, 10.1% and 6.3% in the intermediate-risk, and 18.2% and 16.7%, in the high-risk categories, respectively. CONCLUSIONS Inclusion of TG in a risk-assessment model for E-DR significantly helps the identification of operated breast cancer patients at high risk of very early relapse.
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Affiliation(s)
- Marina Marchetti
- Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Cinzia Giaccherini
- Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Giovanna Masci
- Oncology Unit, IRCCS Humanitas Institute, Rozzano, Italy
| | - Cristina Verzeroli
- Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Laura Russo
- Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Luigi Celio
- Oncology Unit, IRCCS National Cancer Institute, Milan, Italy
| | | | - Sara Gamba
- Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Carmen J Tartari
- Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Erika Diani
- Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Alfonso Vignoli
- Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Paolo Malighetti
- Department of Management, Information and Production Engineering, University of Bergamo, Bergamo, Italy
| | - Daniele Spinelli
- Department of Management, Information and Production Engineering, University of Bergamo, Bergamo, Italy
| | | | | | - Mauro Minelli
- Oncology Unit, Hospital San Giovanni Addolorata, Rome, Italy
| | - Carlo Tondini
- Oncology Unit, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Sandro Barni
- Oncology Unit, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | | | - Fausto Petrelli
- Oncology Unit, Hospital Treviglio-Caravaggio, Treviglio, Italy
| | - Andrea D'Alessio
- Medical Oncology and Internal Medicine, Policlinico San Marco, Bergamo, Italy
| | | | - Roberto Labianca
- Department Oncology Bergamo Province, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | | | | | - Anna Falanga
- Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
- School of Medicine, University of Milan Bicocca, Italy
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14
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Rea F, Ieva F, Pastorino U, Apolone G, Barni S, Merlino L, Franchi M, Corrao G. Number of lung resections performed and long-term mortality rates of patients after lung cancer surgery: evidence from an Italian investigation. Eur J Cardiothorac Surg 2020; 58:70-77. [PMID: 32034907 DOI: 10.1093/ejcts/ezaa031] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 12/18/2019] [Accepted: 12/25/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Although it has been postulated that patients might benefit from the centralization of high-volume specialized centres, conflicting results have been reported on the relationship between the number of lung resections performed and the long-term, all-cause mortality rates among patients who underwent surgery for lung cancer. A population-based observational study was performed to contribute to the ongoing debate. METHODS The 2613 patients, all residents of the Lombardy region (Italy), who underwent lung resection for lung cancer from 2012 to 2014 were entered into the cohort and were followed until 2018. The hospitals were classified according to the annual number of pulmonary resections performed. Three categories of lung resection cases were identified: low (≤30), intermediate (31-95) and high (>95). The outcome of interest was all-cause death. A frailty model was used to estimate the death risk associated with the categories of numbers of lung resections performed, taking into account the multilevel structure of the data. A set of sensitivity analyses was performed to account for sources of systematic uncertainty. RESULTS The 1-year and 5-year survival rates of cohort members were 90% and 63%. Patients operated on in high-volume centres were on average younger and more often women. Compared to patients operated on in a low-volume centre, the mortality risk exhibited a significant, progressive reduction as the numbers of lung resections performed increased to intermediate (-13%; 95% confidence interval +10% to -31%) and high (-26%; 0% to -45%). Sensitivity analyses revealed that the association was consistent. CONCLUSIONS Further evidence that the volume of lung resection cases performed strongly affects the long-term survival of lung cancer patients has been supplied.
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Affiliation(s)
- Federico Rea
- National Centre for Healthcare Research and Pharmacoepidemiology, Milan, Italy.,Laboratory of Healthcare Research & Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Francesca Ieva
- National Centre for Healthcare Research and Pharmacoepidemiology, Milan, Italy.,MOX, Department of Mathematics, Politecnico di Milano, Milan, Italy.,CADS-Center for Analysis Decisions and Society, Human Technopole, Milan, Italy
| | - Ugo Pastorino
- Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | | | - Sandro Barni
- Department of Oncology, ASST Bergamo Ovest, Bergamo, Italy
| | - Luca Merlino
- Epidemiologic Observatory, Lombardy Regional Health Service, Milan, Italy
| | - Matteo Franchi
- National Centre for Healthcare Research and Pharmacoepidemiology, Milan, Italy.,Laboratory of Healthcare Research & Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Giovanni Corrao
- National Centre for Healthcare Research and Pharmacoepidemiology, Milan, Italy.,Laboratory of Healthcare Research & Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
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15
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Cuomo A, Cascella M, Forte CA, Bimonte S, Esposito G, De Santis S, Cavanna L, Fusco F, Dauri M, Natoli S, Maltoni M, Morabito A, Mediati RD, Lorusso V, Barni S, Porzio G, Mercadante S, Crispo A. Careful Breakthrough Cancer Pain Treatment through Rapid-Onset Transmucosal Fentanyl Improves the Quality of Life in Cancer Patients: Results from the BEST Multicenter Study. J Clin Med 2020; 9:jcm9041003. [PMID: 32252426 PMCID: PMC7230287 DOI: 10.3390/jcm9041003] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/31/2020] [Accepted: 04/01/2020] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES To explore the effect of breakthrough cancer pain (BTcP) treatment on quality of sleep and other aspects of the health-related quality of life (HRQoL) in patients with cancer pain. METHODS In an observational, multicenter, cohort study, cancer patients from palliative care units, oncology departments, and pain clinics and affected by BTcP were included. Enrolled patients were assessed at the four visits: T0 (baseline), T7, T14, and T28. Stable chronic background pain (numeric rating scale, NRS ≤ 4) during the whole study period was mandatory. BTcP was treated through transmucosal fentanyl. Three questionnaires were used to measure the HRQoL: EORTC QLQ-C15-PAL, Pittsburgh Sleep Quality Index (PSQI), and the Edmonton Symptom Assessment System (ESAS). RESULTS In 154 patients, the HRQoL showed a significant improvement for all physical and emotional characteristics in the EORTC QLQ-C15-PAL, except for nausea and vomiting (linear p-value = 0.1) and dyspnea (Linear p-value = 0.05). The ESAS and PSQI questionnaires confirmed these positive results (p < 0.0001 and p = 0.002, respectively). CONCLUSIONS This prospective investigation by an Italian expert group, has confirmed that careful management of BTcP induces a paramount improvement on the HRQoL. Because in cancer patients there is a high prevalence of BTcP and this severe acute pain has deleterious consequences, this information can have an important clinical significance.
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Affiliation(s)
- Arturo Cuomo
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, IRCCS. Fondazione G. Pascale, 80131 Napoli, Italy; (A.C.); (C.A.F.); (S.B.); (G.E.)
| | - Marco Cascella
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, IRCCS. Fondazione G. Pascale, 80131 Napoli, Italy; (A.C.); (C.A.F.); (S.B.); (G.E.)
- Correspondence: ; Tel./Fax: +39-081-5903-778
| | - Cira Antonietta Forte
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, IRCCS. Fondazione G. Pascale, 80131 Napoli, Italy; (A.C.); (C.A.F.); (S.B.); (G.E.)
| | - Sabrina Bimonte
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, IRCCS. Fondazione G. Pascale, 80131 Napoli, Italy; (A.C.); (C.A.F.); (S.B.); (G.E.)
| | - Gennaro Esposito
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, IRCCS. Fondazione G. Pascale, 80131 Napoli, Italy; (A.C.); (C.A.F.); (S.B.); (G.E.)
| | - Stefano De Santis
- Palliative Care and Oncologic Pain Service, S. Camillo-Forlanini Hospital, 00149 Rome, Italy;
| | - Luigi Cavanna
- Department of Oncology-Hematology, G. da Saliceto Hospital, 29121 Piacenza, Italy;
| | - Flavio Fusco
- Palliative Home Care Unit, ASL 3, 16153 Genova, Italy;
| | - Mario Dauri
- Department of Anesthesiology and Resuscitation, II University of Rome, Tor Vergata, 00133 Roma, Italy; (M.D.); (S.N.)
| | - Silvia Natoli
- Department of Anesthesiology and Resuscitation, II University of Rome, Tor Vergata, 00133 Roma, Italy; (M.D.); (S.N.)
| | - Marco Maltoni
- Palliative Care Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy;
| | - Alessandro Morabito
- Medical Oncology Unit, Istituto Nazionale Tumori, IRCCS. Fondazione G. Pascale, 80131 Napoli, Italy;
| | - Rocco Domenico Mediati
- Palliative Care and Pain Therapy Unit, University Hospital Careggi, 50134 Firenze, Italy;
| | - Vito Lorusso
- UO Oncologia Medica, Istituto Tumori “G Paolo II”, 70124 Bari, Italy;
| | - Sandro Barni
- Oncology Unit, ASST Bergamo Ovest, 24047 Treviglio, Italy;
| | - Giampiero Porzio
- Medical Oncology Unit, San Salvatore Hospital, University of L’Aquila, 67100 L’Aquila, Italy;
| | - Sebastiano Mercadante
- Main regional center for Pain Relief & Supportive Care, La Maddalena Cancer Center, 90146 Palermo, Italy;
| | - Anna Crispo
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori, IRCCS. Fondazione G. Pascale, 80131 Napoli, Italy;
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16
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Barni S, Rosati G, Lonardi S, Pella N, Banzi M, Zampino MG, Dotti KF, Rimassa L, Marchetti P, Maiello E, Artioli F, Ferrari D, Labianca R, Bidoli P, Zaniboni A, Sobrero A, Iaffaioli V, De Placido S, Frassineti GL, Ciarlo A, Buonadonna A, Silvestris N, Piazza E, Pavesi L, Moroni M, Clerico M, Aglietta M, Giordani P, Galli F, Galli F, Petrelli F. Khorana score and thromboembolic risk in stage II-III colorectal cancer patients: a post hoc analysis from the adjuvant TOSCA trial. Ther Adv Med Oncol 2020; 12:1758835919899850. [PMID: 32010236 PMCID: PMC6974756 DOI: 10.1177/1758835919899850] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 12/09/2019] [Indexed: 11/16/2022] Open
Abstract
Background: The risk of venous thromboembolic events (VTE) during adjuvant chemotherapy
for colorectal cancer (CRC) is unknown. We aim to evaluate if the Khorana
score (KS) can predict this risk, and if it represents a prognostic factor
for overall survival (OS) through a post hoc analysis of
the phase III TOSCA trial of different durations (3- versus
6-months) of adjuvant chemotherapy. Methods: A logistic regression model was used to test the associations between the
risk of VTE and the KS. The results are expressed as odds ratios (OR) with
95% confidence intervals (95% CI). To assess the effect of the KS on OS,
multivariable analyses using Cox regression models were performed. The
results are expressed as hazard ratios (HR) with 95% CI. Results: Among 1380 CRC patients with available data, the VTE risk
(n = 72 events: 5.2%) was similar in the two duration arms
(5.5% versus 4.9%), with 0.2% of patients belonging to the
high-risk KS group. Rates of VTE were similar in the low- and
intermediate-risk groups (4.8% versus 6.4%). KS did not
represent an independent predictive factor for VTE occurrence. Chemotherapy
duration was not associated with VTE risk. In addition, KS was not
prognostic for OS in multivariate analysis (HR: 0.92, 95% CI, 0.63–1.36;
p = 0.6835). Conclusions: The use of the KS did not predict VTEs in a low–moderate thromboembolic risk
population as CRC. These data did not support the use of KS to predict VTE
during adjuvant chemotherapy, and suggest that other risk assessment models
should be researched.
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Affiliation(s)
- Sandro Barni
- Oncology Unit, Medical Science Department, ASST Bergamo Ovest, Treviglio (BG), Italy
| | - Gerardo Rosati
- Medical Oncology Unit, Ospedale San Carlo, Potenza, Italy
| | - Sara Lonardi
- Medical Oncology Unit 1, Istituto Oncologico Veneto-IRCCS, Padova, Italy
| | - Nicoletta Pella
- Medical Oncology Unit, Azienda Ospedaliero Universitaria Santa Maria della Misericordia, Udine, Italy
| | - Maria Banzi
- Medical Oncology Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Maria G Zampino
- Gastrointestinal Medical Oncology Unit and Neuroendocrine Tumors, Istituto Europeo di Oncologia-IRCCS, Milano, Italy
| | - Katia F Dotti
- Medical Oncology Unit, Fondazione Istituto Nazionale Tumori-IRCCS, Milano, Italy
| | - Lorenza Rimassa
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano (MI), Italy
| | - Paolo Marchetti
- Medical Oncology Unit, Sant'Andrea Hospital, Sapienza University of Rome and IDI-IRCCS, Roma, Italy
| | - Evaristo Maiello
- Medical Oncology Unit, Hospital Casa Sollievo della Sofferenza-IRCCS, San Giovanni Rotondo, Italy
| | | | - Daris Ferrari
- Medical Oncology Unit, Azienda Ospedaliera San Paolo, Milano, Italy
| | | | - Paolo Bidoli
- Medical Oncology Unit San Gerardo dei Tintori Hospital, Monza, Italy
| | | | | | - Vincenzo Iaffaioli
- Abdominal Medical Oncology, National Cancer Institute, IRCCS Foundation Pascale, Napoli, Italy
| | - Sabino De Placido
- Department of Clinical Medicine and Surgery, Federico II University, Napoli, Italy
| | - Gian Luca Frassineti
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori IRST, IRCCS, Meldola, Italy
| | | | - Angela Buonadonna
- Medical Oncology Unit Centro di Riferimento Oncologico Aviano-IRCCS, Aviano, Italy
| | - Nicola Silvestris
- Medical Oncology Unit Ospedale Oncologico 'Giovanni Paolo II' and Scientific Directorate-IRCCS, Bari, Italy
| | - Elena Piazza
- Medical Oncology Unit AOU Sacco Hospital, Milano, Italy
| | - Lorenzo Pavesi
- Medical Oncology Unit Fondazione Maugeri-IRCCS, Pavia, Italy
| | - Mauro Moroni
- Medical Oncology Unit AO San Carlo Borromeo, Milano, Italy
| | - Mario Clerico
- Medical Oncology Department ASL Biella, Biella, Italy
| | - Massimo Aglietta
- Candiolo Cancer Institute FPO-IRCCS, Candiolo, Italy, Department of Oncology, University of Torino, Torino, Italy
| | - Paolo Giordani
- Medical Oncology Unit AO Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Francesca Galli
- Laboratory of Methodology for Clinical Research, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Fabio Galli
- Laboratory of Methodology for Clinical Research, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Fausto Petrelli
- Oncology Unit, Medical Science Department, ASST Bergamo Ovest, Piazzale Ospedale 1, Treviglio (BG), 24047, Italy
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17
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Pantano F, Russano M, Berruti A, Mansueto G, Migliorino MR, Adamo V, Aprile G, Gelibter A, Ficorella C, Falcone A, Russo A, Aieta M, Maio M, Martelli O, Barni S, Napolitano A, Roca E, Quadrini S, Iacono D, Russo A, Calvetti L, Occhipinti MA, Cortellini A, Vasile E, Passiglia F, Imperatori M, Calabrò L, Di Giacomo AM, Petrelli F, Pasquini G, Franchina T, Venditti O, Intagliata S, Galvano A, Fioroni I, Vincenzi B, Tonini G, Santini D. Prognostic clinical factors in patients affected by non-small-cell lung cancer receiving Nivolumab. Expert Opin Biol Ther 2020; 20:319-326. [PMID: 32011207 DOI: 10.1080/14712598.2020.1724953] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background: Immune-checkpoint inhibitors have radically changed the treatment landscape of Non-Small-Cell Lung Cancer (NSCLC). It is still unclear whether specific clinical characteristics might identify those patients benefiting from immunotherapy more than others. The aim of this study was to identify clinical characteristics associated with disease-specific survival (DSS), time-to-treatment failure (TTF), objective responses (OR) and progressive disease (PD) in NSCLC patients treated with Nivolumab.Methods: This was a multicenter retrospective study conducted on 294 patients treated with Nivolumab for advanced NSCLC.Results: Of the more than 50 variables analyzed, five showed a significant correlation with DSS: ECOG PS, size of the biggest brain metastasis, number of metastatic sites, toxicity, and malignant pleural effusion. Three variables significantly correlated with TTF: malignant pleural effusion, number of metastatic sites, number of liver metastases. Malignant pleural effusion was the only variable showing a significant correlation with OR, as well as the only one correlating with all the endpoints of the study.Conclusions: This study identified clinical characteristics associated with survival and response during treatment with Nivolumab in NSCLC patients. The unfavorable association between malignant pleural effusion and objective response is a novel finding with important translational implications.
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Affiliation(s)
- Francesco Pantano
- Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
| | - Marco Russano
- Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
| | - Alfredo Berruti
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Medical Oncology, ASST Spedali Civili, Brescia, Italy
| | | | | | - Vincenzo Adamo
- Medical Oncology Unit A.O. Papardo & Department of Human Pathology, University of Messina, Messina, Italy
| | - Giuseppe Aprile
- Department of Oncology, University and General Hospital, Udine, Italy.,Department of Oncology, San Bortolo General Hospital, ULSS8 Berica, Vicenza, Italy
| | - Alain Gelibter
- Medical Oncology Unit, Policlinico Umberto I, Rome, Italy
| | - Corrado Ficorella
- Medical Oncology Unit, St. Salvatore Hospital, L'Aquila, Italy.,Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Alfredo Falcone
- Unit of Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Antonio Russo
- Section of Medical Oncology, Department of Surgical and Oncological Sciences, University of Palermo, Palermo, Italy
| | - Michele Aieta
- Division of Medical Oncology, Department of Onco-Hematology, IRCCS-CROB, Referral Cancer Center of Basilicata, Rionero, Vulture, Italy
| | - Michele Maio
- Department of Oncology, Center for Immuno-Oncology, Medical Oncology and Immunotherapy, University Hospital of Siena, Siena, Italy
| | - Olga Martelli
- Medical Oncology Unit, Azienda Ospedale San Giovanni Addolorata, Roma, Italy
| | - Sandro Barni
- Division of Oncology, Azienda Ospedaliera Treviglio, Treviglio, Italy
| | - Andrea Napolitano
- Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
| | - Elisa Roca
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Medical Oncology, ASST Spedali Civili, Brescia, Italy
| | | | - Daniela Iacono
- Pulmonary Oncology Unit, St. Camillo Forlanini Hospital, Rome, Italy
| | - Alessandro Russo
- Medical Oncology Unit A.O. Papardo & Department of Human Pathology, University of Messina, Messina, Italy
| | - Lorenzo Calvetti
- Department of Oncology, University and General Hospital, Udine, Italy.,Department of Oncology, San Bortolo General Hospital, ULSS8 Berica, Vicenza, Italy
| | | | - Alessio Cortellini
- Medical Oncology Unit, St. Salvatore Hospital, L'Aquila, Italy.,Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Enrico Vasile
- Unit of Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Francesco Passiglia
- Section of Medical Oncology, Department of Surgical and Oncological Sciences, University of Palermo, Palermo, Italy
| | - Marco Imperatori
- Division of Medical Oncology, Department of Onco-Hematology, IRCCS-CROB, Referral Cancer Center of Basilicata, Rionero, Vulture, Italy
| | - Luana Calabrò
- Department of Oncology, Center for Immuno-Oncology, Medical Oncology and Immunotherapy, University Hospital of Siena, Siena, Italy
| | - Anna M Di Giacomo
- Department of Oncology, Center for Immuno-Oncology, Medical Oncology and Immunotherapy, University Hospital of Siena, Siena, Italy
| | - Fausto Petrelli
- Division of Oncology, Azienda Ospedaliera Treviglio, Treviglio, Italy
| | - Giulia Pasquini
- Unit of Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Tindara Franchina
- Medical Oncology Unit A.O. Papardo & Department of Human Pathology, University of Messina, Messina, Italy
| | - Olga Venditti
- Medical Oncology Unit, St. Salvatore Hospital, L'Aquila, Italy.,Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Salvatore Intagliata
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Medical Oncology, ASST Spedali Civili, Brescia, Italy
| | - Antonio Galvano
- Section of Medical Oncology, Department of Surgical and Oncological Sciences, University of Palermo, Palermo, Italy
| | - Iacopo Fioroni
- Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
| | - Bruno Vincenzi
- Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
| | - Giuseppe Tonini
- Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
| | - Daniele Santini
- Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
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18
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Ruzzo A, Graziano F, Galli F, Galli F, Rulli E, Lonardi S, Ronzoni M, Massidda B, Zagonel V, Pella N, Mucciarini C, Labianca R, Ionta MT, Bagaloni I, Veltri E, Sozzi P, Barni S, Ricci V, Foltran L, Nicolini M, Biondi E, Bramati A, Turci D, Lazzarelli S, Verusio C, Bergamo F, Sobrero A, Frontini L, Magnani M. Author Correction: Sex-Related Differences in Impact on Safety of Pharmacogenetic Profile for Colon Cancer Patients Treated with FOLFOX-4 or XELOX Adjuvant Chemotherapy. Sci Rep 2020; 10:1918. [PMID: 32005869 PMCID: PMC6994718 DOI: 10.1038/s41598-020-58486-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Annamaria Ruzzo
- Department of Biomolecular Sciences, Università degli Studi di Urbino "Carlo Bo", Urbino, Italy.
| | | | - Francesca Galli
- Laboratory of Methodology for Clinical research, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Fabio Galli
- Laboratory of Methodology for Clinical research, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Eliana Rulli
- Laboratory of Methodology for Clinical research, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Sara Lonardi
- Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
| | | | - Bruno Massidda
- Azienda Ospedaliera Universitaria di Cagliari, P.O. Monserrato, Monserrato, Italy
| | | | - Nicoletta Pella
- Azienda Ospedaliera S. Maria della Misericordia, Udine, Italy
| | | | | | - Maria Teresa Ionta
- Azienda Ospedaliera Universitaria di Cagliari, P.O. Monserrato, Monserrato, Italy
| | - Irene Bagaloni
- Department of Biomolecular Sciences, Università degli Studi di Urbino "Carlo Bo", Urbino, Italy
| | | | | | - Sandro Barni
- Ospedale "Treviglio-Caravaggio", Treviglio, Italy
| | | | - Luisa Foltran
- Azienda Ospedaliera Santa Maria degli Angeli, Pordenone, Italy
| | - Mario Nicolini
- Azienda Ospedaliera Ospedale "Cervesi", Cattolica, Italy
| | | | | | | | | | | | | | | | | | - Mauro Magnani
- Department of Biomolecular Sciences, Università degli Studi di Urbino "Carlo Bo", Urbino, Italy
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19
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Piccorossi A, Liccioli G, Barni S, Sarti L, Giovannini M, Verrotti A, Novembre E, Mori F. Epidemiology and drug allergy results in children investigated in allergy unit of a tertiary-care paediatric hospital setting. Ital J Pediatr 2020; 46:5. [PMID: 31924232 PMCID: PMC6954623 DOI: 10.1186/s13052-019-0753-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 11/21/2019] [Indexed: 11/29/2022] Open
Abstract
Background and objective Drug Hypersensitivity Reactions (DHRs) are considered adverse effects of medications that resemble allergy symptoms. The reported positive clinical history of pediatric drug reactions is about 10%, however, after allergy investigations, only a small percent is confirmed as hypersensitivity. The aim of this study was to analyze the clinical history, allergy work-up results and sensitization profile of children and adolescents referred to our Allergy Unit for suspected DHRs. Methods The study evaluated data related to a group of children with a positive history of drug reactions during a two-year period. The allergy work-up consisted of in vivo and in vitro tests, in accordance with the recommendations of the ENDA/EAACI guidelines. Results Data from a group of 637 patients [348 M (54.6%); 289 F (45.4%)] were retrospectively analyzed. Beta lactams (BLs) were the most common drugs involved in the reported clinical history, followed by non-steroidal anti-inflammatory drugs (NSAIDs). Severe cutaneous adverse reactions (SCARs) were most frequently observed during BL treatment. The confirmation of BL hypersensitivity was higher for immediate reactions (IRs) [9.4%; 5.1% through positive skin tests (STs) and 5.5% through drug provocation test (DPT)] compared to non-immediate reactions (non-IRs) (8.1%; 2.2% through STs and 6.2% through DPT). A higher number of positive results was obtained for BLs and macrolides when the tests were performed within 12 months after the index reaction (p < 0.05). During DPTs with amoxicillin-clavulanic acid, four hypersensitivity reactions (including one anaphylaxis) occurred despite negative STs. Conclusion Our data demonstrated that only 9.1% of patients resulted in being positive to allergy tests which is in line with the data in literature. An allergy work-up is mandatory for excluding suspected hypersensitivity.
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Affiliation(s)
- A Piccorossi
- Department of Pediatrics, San Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | - G Liccioli
- Allergy Unit, Anna Meyer Children's Hospital, Florence, Italy.
| | - S Barni
- Allergy Unit, Anna Meyer Children's Hospital, Florence, Italy
| | - L Sarti
- Allergy Unit, Anna Meyer Children's Hospital, Florence, Italy
| | - M Giovannini
- Allergy Unit, Anna Meyer Children's Hospital, Florence, Italy
| | - A Verrotti
- Department of Pediatrics, San Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | - E Novembre
- Allergy Unit, Anna Meyer Children's Hospital, Florence, Italy
| | - F Mori
- Allergy Unit, Anna Meyer Children's Hospital, Florence, Italy
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20
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Petrelli F, Ghidini M, Cabiddu M, Pezzica E, Corti D, Turati L, Costanzo A, Varricchio A, Ghidini A, Barni S, Tomasello G. Microsatellite Instability and Survival in Stage II Colorectal Cancer: A Systematic Review and Meta-analysis. Anticancer Res 2019; 39:6431-6441. [PMID: 31810907 DOI: 10.21873/anticanres.13857] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 11/05/2019] [Accepted: 11/08/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM About 15-20% of colorectal cancers (CRCs) have deficiency in a mismatch repair (MMR) protein. MMR has a high level of microsatellite instability (MSI-H). We have conducted this review and meta-analysis to determine the prognostic role of MSI-H status in stage II CRC. MATERIALS AND METHODS We searched PubMed, EMBASE, The Cochrane Library, Web of Science, and SCOPUS for studies reporting data on overall survival (OS) and disease-free or relapse-free survival (DFS or RFS) for MSI-H compared to microsatellite stable (MSS) CRC. RESULTS A total of 39 studies were analysed, including 12,110 patients. MSI-H status was associated with a significantly reduced risk of death (HR=0.64, 95%CI=0.52-0.8, p<0.01) and relapse (HR=0.59, 95%CI=0.45-0.77, p<0.01) in stage II CRC. CONCLUSION MSI-H represents an important prognostic determinant in stage II CRC and may be considered when estimating the risk of recurrence in stage II CRC.
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Affiliation(s)
| | - Michele Ghidini
- Medical Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mary Cabiddu
- Oncology Unit, ASST Bergamo Ovest, Treviglio, Italy
| | - Ezio Pezzica
- Pathology Unit, ASST Bergamo Ovest, Treviglio, Italy
| | - Daniela Corti
- Pathology Unit, ASST Bergamo Ovest, Treviglio, Italy
| | - Luca Turati
- Surgical Oncology Unit, ASST Bergamo Ovest, Treviglio, Italy
| | | | | | | | - Sandro Barni
- Oncology Unit, ASST Bergamo Ovest, Treviglio, Italy
| | - Gianluca Tomasello
- Oncology Unit, Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
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21
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Petrelli F, De Stefani A, Trevisan F, Parati C, Inno A, Merelli B, Ghidini M, Bruschieri L, Vitali E, Cabiddu M, Borgonovo K, Ghilardi M, Barni S, Ghidini A. Combination of radiotherapy and immunotherapy for brain metastases: A systematic review and meta-analysis. Crit Rev Oncol Hematol 2019; 144:102830. [PMID: 31733443 DOI: 10.1016/j.critrevonc.2019.102830] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 06/15/2019] [Accepted: 10/26/2019] [Indexed: 01/15/2023] Open
Abstract
Radiotherapy (RT) represents a mainstay in the treatment of brain metastases (BMs) from solid tumors. Immunotherapy (IT) has improved survival of metastatic cancer patients across many tumor types. The combination of RT and IT for the treatment of BMs has a strong rationale, but data on efficacy and safety of this combination is still limited. A systematic search of PubMed, the Cochrane Central Register of Controlled Trials, and EMBASE was conducted. 33 studies were included for a total of 1520 patients, most of them with melanoma (87%). Median pooled OS was 15.9 months (95%CI 13.9-18.1). One- and 2-year OS rates were 55.2% (95% CI 49.3-60.9) and 35.7% (95% CI 30.4-41.3), respectively. Addition of IT to RT was associated with improved OS (HR = 0.54, 95%CI 0.44-0.67; P < 0.001). For patients with BMs from solid tumors, addition of concurrent IT to brain RT is able to increase survival and provide long term control.
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Affiliation(s)
- Fausto Petrelli
- Oncology Unit, ASST Bergamo Ovest, Piazzale Ospedale 1, 24047, Treviglio, BG, Italy.
| | - Agostina De Stefani
- Radiotherapy Unit, ASST Bergamo Ovest, Piazzale Ospedale 1, 24047, Treviglio, BG, Italy
| | - Francesca Trevisan
- Radiotherapy Unit, ASST Bergamo Ovest, Piazzale Ospedale 1, 24047, Treviglio, BG, Italy
| | - Chiara Parati
- Oncology Unit, ASST Bergamo Ovest, Piazzale Ospedale 1, 24047, Treviglio, BG, Italy
| | - Alessandro Inno
- Oncology Unit, Ospedale Sacro Cuore don Calabria Cancer Care Center, Via Don A. Sempreboni 5, 37024, Negrar, VR, Italy
| | - Barbara Merelli
- Oncology Unit, ASST Papa Giovanni XXIII, Piazza Oms 1, 24127, Bergamo, Italy
| | - Michele Ghidini
- Oncology Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Viale F. Sforza 28, 20122, Milano, Italy
| | - Lorenza Bruschieri
- Radiotherapy Unit, ASST Bergamo Ovest, Piazzale Ospedale 1, 24047, Treviglio, BG, Italy
| | - Elisabetta Vitali
- Radiotherapy Unit, ASST Bergamo Ovest, Piazzale Ospedale 1, 24047, Treviglio, BG, Italy
| | - Mary Cabiddu
- Oncology Unit, ASST Bergamo Ovest, Piazzale Ospedale 1, 24047, Treviglio, BG, Italy
| | - Karen Borgonovo
- Oncology Unit, ASST Bergamo Ovest, Piazzale Ospedale 1, 24047, Treviglio, BG, Italy
| | - Mara Ghilardi
- Oncology Unit, ASST Bergamo Ovest, Piazzale Ospedale 1, 24047, Treviglio, BG, Italy
| | - Sandro Barni
- Oncology Unit, ASST Bergamo Ovest, Piazzale Ospedale 1, 24047, Treviglio, BG, Italy
| | - Antonio Ghidini
- Oncology Unit, Casa di Cura Igea, Via Marcona 69, 20144, Milano, Italy
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22
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Berardi R, Mastroianni C, Lo Russo G, Buosi R, Santini D, Montanino A, Carnaghi C, Tiseo M, Chiari R, Camerini A, Barni S, De Marino V, Ferrari D, Cristofano A, Doni L, Freddari F, Fumagalli D, Portalone L, Sarmiento R, Schinzari G, Sperandi F, Tucci M, Inno A, Ciuffreda L, Mariotti M, Mariani C, Caramanti M, Torniai M, Gallucci R, Bennati C, Bordi P, Buffoni L, Galeassi A, Ghidini M, Grossi E, Morabito A, Vincenzi B, Arvat E. Syndrome of inappropriate anti-diuretic hormone secretion in cancer patients: results of the first multicenter Italian study. Ther Adv Med Oncol 2019; 11:1758835919877725. [PMID: 31632468 PMCID: PMC6767731 DOI: 10.1177/1758835919877725] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 08/30/2019] [Indexed: 11/22/2022] Open
Abstract
Background: Hyponatremia in cancer patients is often caused by the syndrome of
inappropriate antidiuretic hormone secretion (SIADH). The aim of this
observational multicenter study was to analyze the medical and economic
implications of SIADH in this setting. Methods: This study included 90 oncological patients from 28 Italian institutions that
developed SIADH between January 2010 and September 2015. Data on
clinical–pathological characteristics, anticancer therapies, hyponatremia,
and related treatments were statistically analyzed. Results: The majority were lung cancer patients (73%) with metastatic disease at the
onset of hyponatremia (83%). A total of 76 patients (84%) were hospitalized
because of SIADH and less than half (41%) received tolvaptan for SIADH
treatment. The duration of hospitalization was significantly longer in
patients who did not receive tolvaptan and in those who do not reach sodium
normalization during hospitalization. Patients who experienced a second
episode of hyponatremia following tolvaptan dose
modification/discontinuation presented a significantly lower serum sodium
value at the time of hospitalization and minimum sodium value during
hospitalization compared with patients who had not experienced another
episode. The severity of hyponatremia, defined as minimum sodium value
during hospitalization with a cut-off value of 110 mmol/l, and not obtaining
sodium correction during hospitalization significantly correlated with
overall survival rate. Conclusions: Hyponatremia due to SIADH could result in longer hospitalization and in a
decreased overall survival when not adequately treated, and tolvaptan
represents an effective treatment with a potential effect of both improving
overall survival and decreasing duration of hospitalization.
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Affiliation(s)
| | | | - Giuseppe Lo Russo
- Thoracic Oncology Fondazione IRCCS Istituto dei
Tumori, Milano, Italy
| | - Roberta Buosi
- Oncology Unit- S. Spirito Hospital - Casale M.to
– Alessandria, Italy
| | - Daniele Santini
- Medical Oncology Unit, Campus Bio-Medico
University of Rome, Rome, Italy
| | - Agnese Montanino
- Thoracic Medical Oncology, Istituto Nazionale
Tumori ‘Fondazione G Pascale’, IRCCS, Napoli, Italy
| | | | - Marcello Tiseo
- U.O. Oncologia Medica Azienda
Ospedaliero-Universitaria di Parma, Italy
| | - Rita Chiari
- Medical Oncology, Santa Maria della Misericordia
Hospital, Azienda Ospedaliera di Perugia, Perugia, Italy
| | - Andrea Camerini
- Medical Oncology, Azienda USL Toscana
nord-ovest, Ospedale Versilia, Italy
| | - Sandro Barni
- Oncology Unit, ASST Bergamo Ovest, Treviglio,
Italy
| | - Valeria De Marino
- U.O. Pneumologia ad indirizzo Oncologico.
Azienda dei colli-Monaldi, Napoli, Italy
| | - Daris Ferrari
- U.O. Oncologia Medica ASST Santi Paolo e Carlo,
Presidio Ospedaliero San Paolo, Milano, Italy
| | | | | | | | | | - Luigi Portalone
- Pneumologia Oncologica 2, Az. Osp. S. Camillo
Forlanini, Roma, Italy
| | | | - Giovanni Schinzari
- Polo Scienze Oncologiche ed Ematologiche, UOC
di Oncologia Medica, Università Cattolica del Sacro Cuore, Fondazione
Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Francesca Sperandi
- U.O. Oncologia Medica, Azienda
Ospedaliero-Universitaria S.Orsola-Malpighi, Bologna, Italy
| | - Marcello Tucci
- Division of Medical Oncology, Department of
Oncology, San Luigi Gonzaga Hospital, University of Turin, Turin,
Italy
| | - Alessandro Inno
- Medical Oncology, Ospedale Sacro Cuore Don
Calabria, Negrar, Verona, Italy
| | - Libero Ciuffreda
- Azienda Ospedaliero Universitaria Città della
Salute e della Scienza, Torino, Italy
| | - Marita Mariotti
- Istituto Scientifico Romagnolo per lo Studio e
la Cura dei Tumori, Meldola, Italy
| | | | - Miriam Caramanti
- Clinica Oncologica, Università Politecnica
delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I,
GM Lancisi, G Salesi, Ancona, Italy Current address: UOC Oncologia, Ospedale
E.Profili di Fabriano Asur, Marche Area Vasta 2, Italy
| | - Mariangela Torniai
- Clinica Oncologica, Università Politecnica
delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I,
GM Lancisi, G Salesi, Ancona, Italy
| | - Rosaria Gallucci
- Thoracic Oncology Fondazione IRCCS Istituto dei
Tumori, Milano, Italy
| | - Chiara Bennati
- Dipartimento di Oncologia-Ematologia, AUSL
della Romagna, Ravenna, Italy
| | - Paola Bordi
- U.O. Oncologia Medica Azienda
Ospedaliero-Universitaria di Parma, Italy
| | - Lucio Buffoni
- Azienda Ospedaliero Universitaria Città della
Salute e della Scienza, Torino, Italy
| | | | - Michele Ghidini
- Medical Oncology and Hematology Unit, Humanitas
Cancer Center, Humanitas Clinical and Research Center-IRCCS, Rozzano
(Milan), Italy
| | - Emidio Grossi
- Division of Oncological Endocrinology,
Department of Medical Sciences, University of Turin, Italy
| | - Alessandro Morabito
- Thoracic Medical Oncology, Istituto Nazionale
Tumori ‘Fondazione G Pascale’, IRCCS, Napoli, Italy
| | - Bruno Vincenzi
- Medical Oncology Unit, Campus Bio-Medico
University of Rome, Rome, Italy
| | - Emanuela Arvat
- Division of Oncological Endocrinology,
Department of Medical Sciences, University of Turin, Italy
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23
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Giaccherini C, Marchetti M, Masci G, Verzeroli C, Russo L, Celio L, Sarmiento R, Gamba S, Tartari CJ, Diani E, Vignoli A, Malighetti P, Spinelli D, Tondini C, Barni S, Giuliani F, Petrelli F, D'Alessio A, Gasparini G, De Braud F, Santoro A, Labianca R, Falanga A. Thrombotic biomarkers for risk prediction of malignant disease recurrence in patients with early stage breast cancer. Haematologica 2019; 105:1704-1711. [PMID: 31558668 PMCID: PMC7271573 DOI: 10.3324/haematol.2019.228981] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 06/07/2019] [Accepted: 09/24/2019] [Indexed: 11/09/2022] Open
Abstract
In cancer patients, hypercoagulability is a common finding. It has been associated with an increased risk of venous thromboembolism, but also to tumor proliferation and progression. In this prospective study of a large cohort of breast cancer patients, we aimed to evaluate whether pre-chemotherapy abnormalities in hemostatic biomarkers levels: (i) are associated with breast cancer-specific clinico-pathological features; and (ii) can predict for disease recurrence. D-dimer, fibrinogen, prothrombin fragment 1+2, and FVIIa/antithrombin levels were measured in 701 early-stage resected breast cancer patients candidate to adjuvant chemotherapy and prospectively enrolled in the HYPERCAN study. Significant prognostic parameters for disease recurrence were identified by Cox regression multivariate analysis and used for generating a risk assessment model. Pre-chemotherapy D-dimer, fibrinogen, and pro-thrombin fragment 1+2 levels were significantly associated with tumor size and lymph node metastasis. After 3.4 years of follow up, 71 patients experienced a recurrence. Cox multivariate analysis identified prothrombin fragment 1+2, tumor size, and Luminal B HER2-negative or triple negative molecular subtypes as independent risk factors for disease recurrence. Based on these variables, we generated a risk assessment model that significantly differentiated patients at low- and high-risk of recurrence (cumulative incidence: 6.2 vs. 20.7%; Hazard Ratio=3.5; P<0.001). Our prospective clinical and laboratory data from the HYPERCAN study were crucial for generating a scoring model for assessing risk of disease recurrence in resected breast cancer patients, candidate to systemic chemotherapy. This finding stimulates future investigations addressing the role of plasma prothrombin fragment 1+2 in the management of breast cancer patients to provide the rationale for new therapeutic strategies. (The HYPERCAN study is registered at clinicaltrials.gov identifier 02622815.)
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Affiliation(s)
- Cinzia Giaccherini
- Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo
| | - Marina Marchetti
- Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo
| | | | - Cristina Verzeroli
- Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo
| | - Laura Russo
- Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo
| | - Luigi Celio
- Oncology Unit, IRCCS National Cancer Institute, Milan
| | | | - Sara Gamba
- Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo
| | - Carmen J Tartari
- Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo
| | - Erika Diani
- Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo
| | - Alfonso Vignoli
- Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo
| | - Paolo Malighetti
- Department of Management, Information and Production Engineering, University of Bergamo, Bergamo
| | - Daniele Spinelli
- Department of Management, Information and Production Engineering, University of Bergamo, Bergamo
| | - Carlo Tondini
- Oncology Unit, Hospital Papa Giovanni XXIII, Bergamo
| | - Sandro Barni
- Oncology Unit, Hospital Treviglio-Caravaggio, Treviglio
| | | | | | - Andrea D'Alessio
- Medical Oncology and Internal Medicine, Policlinico San Marco, Zingonia-Bergamo
| | | | | | | | - Roberto Labianca
- Department Oncology Bergamo Province, Hospital Papa Giovanni XXIII, Bergamo
| | - Anna Falanga
- Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo .,University of Milan Bicocca, School of Medicine and Surgery, Milan, Italy
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24
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Ruzzo A, Graziano F, Galli F, Galli F, Rulli E, Lonardi S, Ronzoni M, Massidda B, Zagonel V, Pella N, Mucciarini C, Labianca R, Ionta MT, Bagaloni I, Veltri E, Sozzi P, Barni S, Ricci V, Foltran L, Nicolini M, Biondi E, Bramati A, Turci D, Lazzarelli S, Verusio C, Bergamo F, Sobrero A, Frontini L, Magnani M. Sex-Related Differences in Impact on Safety of Pharmacogenetic Profile for Colon Cancer Patients Treated with FOLFOX-4 or XELOX Adjuvant Chemotherapy. Sci Rep 2019; 9:11527. [PMID: 31395900 PMCID: PMC6687727 DOI: 10.1038/s41598-019-47627-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 01/25/2019] [Accepted: 07/12/2019] [Indexed: 01/28/2023] Open
Abstract
Polymorphisms contribute to inter-individual differences and show a promising predictive role for chemotherapy-related toxicity in colon cancer (CC). TOSCA is a multicentre, randomized, non-inferiority, phase III study conducted in high-risk stage II/stage III CC patients treated with 6 vs 3 months of FOLFOX-4 or XELOX adjuvant chemotherapy. During this post-hoc analysis, 218 women and 294 men were genotyped for 17 polymorphisms: TYMS (rs34743033, rs2853542, rs11280056), MTHFR (rs1801133, rs1801131), ERCC1 (rs11615), XRCC1 (rs25487), XRCC3 (rs861539), XPD (rs1799793, rs13181), GSTP1 (rs1695), GSTT1/GSTM1 (deletion +/−), ABCC1 (rs2074087), and ABCC2 (rs3740066, rs1885301, rs4148386). The aim was to assess the interaction between these polymorphisms and sex, on safety in terms of time to grade ≥3 haematological (TTH), grade ≥3 gastrointestinal (TTG) and grade ≥2 neurological (TTN) toxicity. Interactions were detected on TTH for rs1801133 and rs1799793, on TTG for rs13181 and on TTN for rs11615. Rs1799793 GA genotype (p = 0.006) and A allele (p = 0.009) shortened TTH in men. In women, the rs11615 CC genotype worsened TTN (co-dominant model p = 0.008, recessive model p = 0.003) and rs13181 G allele improved the TTG (p = 0.039). Differences between the two sexes in genotype distribution of rs1885301 (p = 0.020) and rs4148386 (p = 0.005) were found. We highlight that polymorphisms could be sex-specific biomarkers. These results, however, need to be confirmed in additional series.
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Affiliation(s)
- Annamaria Ruzzo
- Department of Biomolecular Sciences, Università degli Studi di Urbino "Carlo Bo", Urbino, Italy.
| | | | - Francesca Galli
- Laboratory of Methodology for Clinical research, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Fabio Galli
- Laboratory of Methodology for Clinical research, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Eliana Rulli
- Laboratory of Methodology for Clinical research, Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Sara Lonardi
- Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
| | | | - Bruno Massidda
- Azienda Ospedaliera Universitaria di Cagliari, P.O. Monserrato, Monserrato, Italy
| | | | - Nicoletta Pella
- Azienda Ospedaliera S. Maria della Misericordia, Udine, Italy
| | | | | | - Maria Teresa Ionta
- Azienda Ospedaliera Universitaria di Cagliari, P.O. Monserrato, Monserrato, Italy
| | - Irene Bagaloni
- Department of Biomolecular Sciences, Università degli Studi di Urbino "Carlo Bo", Urbino, Italy
| | | | | | - Sandro Barni
- Ospedale "Treviglio-Caravaggio", Treviglio, Italy
| | | | - Luisa Foltran
- Azienda Ospedaliera Santa Maria degli Angeli, Pordenone, Italy
| | - Mario Nicolini
- Azienda Ospedaliera Ospedale "Cervesi", Cattolica, Italy
| | | | | | | | | | | | | | | | | | - Mauro Magnani
- Department of Biomolecular Sciences, Università degli Studi di Urbino "Carlo Bo", Urbino, Italy
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25
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Pizzuti L, Krasniqi E, Barchiesi G, Della Giulia M, Izzo F, Sanguineti G, Marchetti P, Mazzotta M, Giusti R, Botticelli A, Gamucci T, Natoli C, Grassadonia A, Tinari N, Iezzi L, Tomao S, Tomao F, Tonini G, Santini D, Astone A, Michelotti A, De Angelis C, Mentuccia L, Vaccaro A, Magnolfi E, Gelibter A, Magri V, Cortesi E, D'Onofrio L, Cassano A, Rossi E, Cazzaniga M, Moscetti L, Omarini C, Piacentini F, Fabbri MA, Scinto AF, Corsi D, Carbognin L, Bria E, La Verde N, Samaritani R, Garufi C, Barni S, Mirabelli R, Sarmiento R, Veltri EM, D'Auria G, Paris I, Giotta F, Lorusso V, Cardillo F, Landucci E, Mauri M, Ficorella C, Roselli M, Adamo V, Ricciardi GRR, Russo A, Berardi R, Pistelli M, Fiorio E, Cannita K, Sini V, D'Ostilio N, Foglietta J, Greco F, Zamagni C, Garrone O, Di Cocco B, Baldini E, Livi L, Desideri I, Meattini I, Sarobba G, Del Medico P, De Tursi M, Generali D, De Maria R, Risi E, Ciliberto G, Sperduti I, Villa A, Barba M, Di Leo A, Vici P. Distinct HR expression patterns significantly affect the clinical behavior of metastatic HER2+ breast cancer and degree of benefit from novel anti-HER2 agents in the real world setting. Int J Cancer 2019; 146:1917-1929. [PMID: 31330065 PMCID: PMC7027476 DOI: 10.1002/ijc.32583] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/07/2019] [Accepted: 07/03/2019] [Indexed: 12/02/2022]
Abstract
We analyzed data from 738 HER2‐positive metastatic breast cancer (mbc) patients treated with pertuzumab‐based regimens and/or T‐DM1 at 45 Italian centers. Outcomes were explored in relation to tumor subtype assessed by immunohistochemistry (IHC). The median progression‐free survival at first‐line (mPFS1) was 12 months. Pertuzumab as first‐line conferred longer mPFS1 compared to other first‐line treatments (16 vs. 9 months, p = 0.0001), regardless of IHC subtype. Median PFS in second‐line (mPFS2) was 7 months, with no difference by IHC subtype, but it was more favorable with T‐DM1 compared to other agents (7 vs. 6 months, p = 0.03). There was no PFS2 gain in patients with tumors expressing both hormonal receptors (HRs; p = 0.17), while a trend emerged for tumors with one HR (p = 0.05). Conversely, PFS2 gain was significant in HRs‐negative tumors (p = 0.04). Median overall survival (mOS) was 74 months, with no significant differences by IHC subtypes. Survival rates at 2 and 3 years in patients treated with T‐DM1 in second‐line after pertuzumab were significantly lower compared to pertuzumab‐naïve patients (p = 0.01). When analyzed by IHC subtype, the outcome was confirmed if both HRs or no HRs were expressed (p = 0.02 and p = 0.006, respectively). Our results confirm that HRs expression impacts the clinical behavior and novel treatment‐related outcomes of HER2‐positive tumors when treatment sequences are considered. Moreover, multivariate analysis showed that HRs expression had no effect on PFS and OS. Further studies are warranted to confirm our findings and clarify the interplay between HER2 and estrogen receptor pathways in HER2‐positive (mbc) patients. What's new? About half of breast cancers positive for human epidermal growth factor (HER2) also express hormone receptors but the impact of hormone receptor status on the success of HER2‐directed treatments is not fully explored. Here the authors retrospectively assessed tumor behavior and treatment outcomes in 738 women with HER2+ metastatic breast cancer treated with new generation anti‐HER2 agents. Distinct hormone receptor expression patterns significantly affected the progression free and overall survival, justifying further studies to define optimal treatment regimens and the interplay between hormone receptor and HER2 signaling.
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Affiliation(s)
- Laura Pizzuti
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Eriseld Krasniqi
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giacomo Barchiesi
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Marina Della Giulia
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Fiorentino Izzo
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppe Sanguineti
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Paolo Marchetti
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Sant'Andrea, Rome, Italy.,Medical Oncology Unit B, Policlinico Umberto I, Rome, Italy
| | - Marco Mazzotta
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Sant'Andrea, Rome, Italy
| | - Raffaele Giusti
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Sant'Andrea, Rome, Italy
| | | | | | - Clara Natoli
- Department of Medical, Oral and Biotechnological Sciences, Centro Scienze dell'Invecchiamento e Medicina Traslazionale -CeSI-MeT, Chieti, Italy
| | - Antonino Grassadonia
- Department of Medical, Oral and Biotechnological Sciences, Centro Scienze dell'Invecchiamento e Medicina Traslazionale -CeSI-MeT, Chieti, Italy
| | - Nicola Tinari
- Department of Medical, Oral and Biotechnological Sciences, Centro Scienze dell'Invecchiamento e Medicina Traslazionale -CeSI-MeT, Chieti, Italy
| | - Laura Iezzi
- Department of Medical, Oral and Biotechnological Sciences, Centro Scienze dell'Invecchiamento e Medicina Traslazionale -CeSI-MeT, Chieti, Italy
| | - Silverio Tomao
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, 'Sapienza' University of Rome, Policlinico Umberto I, Rome, Italy
| | - Federica Tomao
- Department of Gynecology-Obstetrics and Urology, "Sapienza" University of Rome, Rome, Italy
| | - Giuseppe Tonini
- Department of Oncology, University Campus Biomedico of Rome, Rome, Italy
| | - Daniele Santini
- Department of Oncology, University Campus Biomedico of Rome, Rome, Italy
| | - Antonio Astone
- Division of Medical Oncology, Villa San Pietro Hospital, Rome, Italy
| | - Andrea Michelotti
- UO Oncologia Medica I, S. Chiara Hospital, Dipartimentodi Oncologia, Dei Trapianti e Delle Nuove Tecnologie, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Claudia De Angelis
- UO Oncologia Medica I, S. Chiara Hospital, Dipartimentodi Oncologia, Dei Trapianti e Delle Nuove Tecnologie, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | | | | | | | - Alain Gelibter
- Medical Oncology Unit B, Policlinico Umberto I, Rome, Italy
| | | | - Enrico Cortesi
- Medical Oncology Unit B, Policlinico Umberto I, Rome, Italy
| | - Loretta D'Onofrio
- Department of Oncology, University Campus Biomedico of Rome, Rome, Italy
| | - Alessandra Cassano
- Department of Medical Oncology, Policlinico Universitario "A. Gemelli", Rome, Italy.,Universita Cattolica del Sacro Cuore, Roma
| | - Ernesto Rossi
- Department of Medical Oncology, Policlinico Universitario "A. Gemelli", Rome, Italy
| | - Marina Cazzaniga
- Research Unit Phase I trials and Oncology Unit, ASST Monza, Monza, Italy
| | - Luca Moscetti
- Division of Medical Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Claudia Omarini
- Division of Medical Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Federico Piacentini
- Division of Medical Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Maria A Fabbri
- Medical Oncology Unit, Belcolle Hospital, Viterbo, Italy
| | - Angelo F Scinto
- Medical Oncology Unit, Fatebenefratelli Hospital, Rome, Italy
| | - Domenico Corsi
- Medical Oncology Unit, Fatebenefratelli Hospital, Rome, Italy
| | - Luisa Carbognin
- Gynecology Oncology Unit, Catholic University of the Sacred Heart, Rome, Italy
| | - Emilio Bria
- Department of Medical Oncology, Policlinico Universitario "A. Gemelli", Rome, Italy.,Universita Cattolica del Sacro Cuore, Roma
| | - Nicla La Verde
- Oncology Unit, ASST Fatebenefratelli Sacco Presidio Ospedaliero Fatebenefratelli, Milano, Italy
| | | | - Carlo Garufi
- Division of Medical Oncology, Pescara Hospital, Pescara, Italy
| | - Sandro Barni
- Department of Oncology, Oncology Unit, ASST Bergamo Ovest, Treviglio, Italy
| | - Rosanna Mirabelli
- Department of Hematology & Oncology, Azienda Ospedaliera Pugliese-Ciaccio, Catanzaro, Italy
| | | | - Enzo M Veltri
- Oncology Unit, S. Maria Goretti Hospital, Latina, Italy
| | | | - Ida Paris
- Gynecology Oncology Unit, Catholic University of the Sacred Heart, Rome, Italy
| | - Francesco Giotta
- Department of Medical Oncology, "Giovanni PaoloII" Institute, Bari, Italy
| | - Vito Lorusso
- Department of Medical Oncology, "Giovanni PaoloII" Institute, Bari, Italy
| | | | - Elisabetta Landucci
- UO Oncologia Medica I, S. Chiara Hospital, Dipartimentodi Oncologia, Dei Trapianti e Delle Nuove Tecnologie, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Maria Mauri
- Division of Oncology, San Giovanni Hospital, Rome, Italy
| | - Corrado Ficorella
- Medical Oncology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Mario Roselli
- Department of Systems Medicine, Medical Oncology, University of Rome "Tor Vergata", Rome, Italy
| | - Vincenzo Adamo
- Medical Oncology Unit A.O. Papardo & Department Human Pathology University of Messina
| | | | - Antonio Russo
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - Rossana Berardi
- Oncology Clinic, Università Politecnica delle Marche, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Mirco Pistelli
- Oncology Clinic, Università Politecnica delle Marche, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Elena Fiorio
- U.O.C. Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Katia Cannita
- Medical Oncology, St. Salvatore Hospital, L'Aquila, Italy
| | - Valentina Sini
- Oncology Unit, ASL Roma 1, Santo Spirito Hospital, Rome, Italy
| | | | | | - Filippo Greco
- Department of Pathology, Surgery and Oncology, "Mater Salutis" Hospital, ULSS21, Verona, Italy
| | - Claudio Zamagni
- Medical Oncology Unit, Addarii Institute of Oncology, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Ornella Garrone
- Medical Oncology, A.O. Ospedale di Insegnamento S. Crocee Carle, Cuneo, Italy
| | | | | | - Lorenzo Livi
- Radiation Oncology Unit and Department of Clinical and Experimental Biomedical Sciences "Mario Serio", Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Isacco Desideri
- Radiation Oncology Unit and Department of Clinical and Experimental Biomedical Sciences "Mario Serio", Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Icro Meattini
- Radiation Oncology Unit and Department of Clinical and Experimental Biomedical Sciences "Mario Serio", Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | | | - Pietro Del Medico
- Division of Medical Oncology, Reggio Calabria General Hospital, Reggio Calabria, Italy
| | - Michele De Tursi
- Department of Medical, Oral and Biotechnological Sciences, Centro Scienze dell'Invecchiamento e Medicina Traslazionale -CeSI-MeT, Chieti, Italy
| | - Daniele Generali
- Breast Cancer Unit & Translational Research Unit, ASST Cremona, Cremona, Italy
| | - Ruggero De Maria
- Department of Medical Oncology, Policlinico Universitario "A. Gemelli", Rome, Italy.,Universita Cattolica del Sacro Cuore, Roma
| | - Emanuela Risi
- Sandro Pitigliani Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - Gennaro Ciliberto
- Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Isabella Sperduti
- Bio-Statistics Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Alice Villa
- Department of Medical Oncology, Policlinico Universitario "A. Gemelli", Rome, Italy.,Universita Cattolica del Sacro Cuore, Roma
| | - Maddalena Barba
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Angelo Di Leo
- Sandro Pitigliani Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - Patrizia Vici
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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26
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Brunetti O, Luchini C, Argentiero A, Tommasi S, Mangia A, Aprile G, Marchetti P, Vasile E, Casadei Gardini A, Scartozzi M, Barni S, Delfanti S, De Vita F, Di Costanzo F, Milella M, Cella CA, Berardi R, Cataldo I, Santini D, Doglioni C, Maiello E, Lawlor RT, Mazzaferro V, Lonardi S, Giuliante F, Brandi G, Scarpa A, Cascinu S, Silvestris N. The Italian Rare Pancreatic Exocrine Cancer Initiative. Tumori 2019; 105:353-358. [PMID: 30967031 DOI: 10.1177/0300891619839461] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Exocrine pancreatic cancers include common type pancreatic ductal adenocarcinoma and cystic neoplasms, which account for 85% and 10% of cases, respectively. The remaining 5% are rare histotypes, comprising adenosquamous carcinoma, acinar cell carcinoma, signet ring cell carcinoma, medullary carcinoma, pancreatoblastoma, hepatoid carcinoma, undifferentiated carcinoma and its variant with osteoclast-like giant cells, solid pseudopapillary carcinoma, and carcinosarcoma. Due to their low incidence, little knowledge is available on their clinical and molecular features as well as on treatment choices. The national initiative presented here aims at the molecular characterization of series of rare histotypes for which therapeutic and follow-up data are available. METHODS A nationwide Italian Rare Pancreatic Cancer (IRaPaCa) task force whose first initiative is a multicentric retrospective study involving 21 Italian cancer centers to retrieve histologic material and clinical and treatment data of at least 100 patients with rare exocrine pancreatic cancers has been created. After histologic revision by a panel of expert pathologists, DNA and RNA from paraffin tissues will be investigated by next-generation sequencing using molecular pathway-oriented and immune-oriented mutational and expression profiling panels constructed availing of the information from the International Cancer Genome Consortium. Bioinformatic analysis of data will drive validation studies by immunohistochemistry and in situ hybridization, as well as nanostring assays. CONCLUSIONS We expect to gather novel data on rare pancreatic cancer types that will be useful to inform the design of therapeutic choices.
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Affiliation(s)
- Oronzo Brunetti
- 1 Medical Oncology Unit, IRCCS Cancer Institute "Giovanni Paolo II" of Bari, Bari, Italy
| | - Claudio Luchini
- 2 Department of Diagnostics and Public Health, Section of Pathology, University of Verona, Verona, Italy
| | - Antonella Argentiero
- 1 Medical Oncology Unit, IRCCS Cancer Institute "Giovanni Paolo II" of Bari, Bari, Italy
| | - Stefania Tommasi
- 3 Molecular Diagnostics and Pharmacogenetics Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Anita Mangia
- 4 Functional Biomorphology Laboratory, IRCCS-Istituto Tumori, Bari, Italy
| | - Giuseppe Aprile
- 5 Medical Oncology Unit, Hospital of Vicenza, Vicenza, Italy
| | - Paolo Marchetti
- 6 Medical Oncology Unit, Sant'Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Enrico Vasile
- 7 Medical Oncology Unit, University Hospital of Pisa, Pisa, Italy
| | - Andrea Casadei Gardini
- 8 Medical Oncology Unit, Scientific Institute of Romagna for the Study and Treatment of Cancer (IRST), Meldola, Italy
| | - Mario Scartozzi
- 9 Medical Oncology Unit, University of Cagliari, Cagliari, Italy
| | - Sandro Barni
- 10 Medical Oncology Unit, ASST Bergamo Ovest, Treviglio, Italy
| | - Sara Delfanti
- 11 Medical Oncology Unit, IRCCS Foundation Polyclinic San Matteo, Pavia, Italy
| | - Fernando De Vita
- 12 Medical Oncology Unit, II University of Naples, Naples, Italy
| | | | - Michele Milella
- 14 Medical Oncology Unit, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Chiara Alessandra Cella
- 15 Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology (IEO), Milan, Italy
| | - Rossana Berardi
- 16 Medical Oncology Unit, Polytechnic University of the Marche, "Ospedali Riuniti Ancona," Ancona, Italy
| | - Ivana Cataldo
- 17 Department of Pathology and Diagnostics, University of Verona Hospital Trust, Policlinico GB Rossi, Verona, Italy
| | - Daniele Santini
- 18 Medical Oncology Unit, University Campus Biomedico, Rome, Italy
| | - Claudio Doglioni
- 19 Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Evaristo Maiello
- 20 Medical Oncology Unit, IRCCS "Casa Sollievo della Sofferenza" Foundation, San Giovanni Rotondo, Italy
| | - Rita T Lawlor
- 21 Arc-Net Centre for Applied Research on Cancer, University and Hospital Trust of Verona, Verona, Italy
| | - Vincenzo Mazzaferro
- 22 Hepato-Biliary-Pancreatic Surgery, University of Milan, Istituto Nazionale Tumori, Fondazione IRCCS, Milan, Italy
| | - Sara Lonardi
- 23 Medical Oncology Unit, IRCCS Veneto Institute of Oncology (IOV), Padua, Italy
| | - Felice Giuliante
- 24 Hepatobiliary Surgery Unit, IRCCS A. Gemelli Polyclinic Foundation, Catholic University of the Sacred Heart, Rome, Italy
| | - Giovanni Brandi
- 25 Oncology Unit, Department of Experimental, Diagnostic and Specialty Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Aldo Scarpa
- 2 Department of Diagnostics and Public Health, Section of Pathology, University of Verona, Verona, Italy
- 21 Arc-Net Centre for Applied Research on Cancer, University and Hospital Trust of Verona, Verona, Italy
| | - Stefano Cascinu
- 26 Medical Oncology Unit, Modena Cancer Center, University Hospital of Modena, Modena, Italy
| | - Nicola Silvestris
- 1 Medical Oncology Unit, IRCCS Cancer Institute "Giovanni Paolo II" of Bari, Bari, Italy
- 27 Scientific Direction, IRCCS Cancer Institute "Giovanni Paolo II" of Bari, Bari, Italy
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Gori S, Puglisi F, Moroso S, Fabi A, La Verde N, Frassoldati A, Tarenzi E, Garrone O, Vici P, Laudadio L, Cretella E, Turazza M, Foglietta J, Leonardi V, Cavanna L, Barni S, Galanti D, Russo A, Marchetti F, Valerio M, Lunardi G, Alongi F, Inno A. The HERBA Study: A Retrospective Multi-Institutional Italian Study on Patients With Brain Metastases From HER2-Positive Breast Cancer. Clin Breast Cancer 2019; 19:e501-e510. [DOI: 10.1016/j.clbc.2019.05.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/28/2019] [Accepted: 05/07/2019] [Indexed: 10/26/2022]
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Roila F, Ruggeri B, Ballatori E, Patoia L, Palazzo S, Colucci G, Di Costanzo F, Cascinu S, Labianca R, Sobrero A, Cortesi E, Bressi C, Ferraldeschi R, Mazzoli M, Evangelista M, Di Fonzo C, Cigolari S, Angelini V, Cioffi A, Guardasole V, Zarra E, Tonato M, Betti M, Marrocolo F, Bon-ciarelli V, Cetto G, Silingardi V, Cognetti F, Beretta G, Pessi A, Mosconi S, Milesi L, Bertetto O, Malacarne P, Marzola M, Margutti G, Modenesi C, Manente P, Comandone A, Oliva C, Berniolo P, Cutin SC, Luporini G, Colucci G, Recaldin E, Nicodemo M, Picece V, Turaz-za M, Ferrazzi E, Solina G, Rosati G, Rossi A, Manzione L, Sozzi P, Fornarini G, Lavarello A, Catalano G, Giordani P, Alessandroni P, Troccoli G, Ramus GV, Tonda L, Sirgiovanni M, Iannello GP, Tinessa V, Ruggiero A, Palazzo S, Barni S, Mandalà M, Cremonesi M, Porcile G, Destefanis M, Testore F, Carteni G, Daniele B, Volta C, Ferraù F, Zaniboni A, Marchetti P, Citone G, Cefaro GA, Iacono C, Musi M, Mozzicafreddo A, Imperiale FN, Filippelli G, Sciacca V, D'Aprile M, Isa L, Recchia F, Spada S, Cascinu S, Carroccio R, Mustacchi G, Ceccherini R, Chetrì M, Rizzo P, Botturi M, Marchei P, Bretti S, Montalbetti L, Reguzzoni G, Massidda B, Ionta M, Cruciani G, Prosperi A, Mantovani G, Sidoti V, Peta A, Greco E, Cicero G, Sobrero A, Marsilio P, Vigevani E, Rimondi G, Gebbia V, Nuzzo A, Biondi E, Caroti C, D'Amico M, Tuveri G, Pieri G, Enrici RM, Tonini G, Santini D, Iannone T, Pizza C, Belli M, Del Prete S, Pizza C, Trevisonne R, Serlenga M, Laricchiuta R, Lacava V, Bumma C, Roselli M, Verderame F, Mascia V, Perrone D, Prantera T, Venuta S, Nastasi G, Bortolussi V, Lembo A. Adjuvant Systemic Therapies in Patients with Colorectal Cancer: An Audit on Clinical Practice in Italy. Tumori 2019; 91:472-6. [PMID: 16457144 DOI: 10.1177/030089160509100605] [Citation(s) in RCA: 5] [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: 11/16/2022]
Abstract
Aims and Background Rarely are conclusions from clinical trials summarized in international consensus conferences and promptly transferred to patient care. The adjuvant therapy for colorectal cancer used in daily clinical practice in Italy is described and compared with the recommendations of the 1990 NIH Consensus Conference. Patients and Methods We audited prescriptions of adjuvant systemic therapies for Italian colorectal cancer patients in 82 centers during a fixed one-week period. Results Among 434 patients receiving adjuvant chemotherapy there were 139 (42.5%) colon cancer patients with N- and 169 (51.7%) with N+ regional nodal involvement. Treatment at academic centers, a young age, T4 and a low total number of lymph nodes removed at surgery were the factors potentially justifying the decision for adjuvant chemotherapy in stage II colon cancer patients. The most common chemotherapy used was a bolus of 5-fluorouracil/folinic acid for 6 months (75.8%). Adjuvant radiotherapy was not administered to 37 (38.5%) of 96 patients with stage II and III rectal cancer. Conclusions The study shows that a substantial proportion of patients on adjuvant treatment at a certain time point in a large enough sample of Italian centers are stage II (potential over-treatment) and that an under-treatment of stage II and III rectal cancer patients (lack of radiotherapy) occurs too often in daily clinical practice in this country.
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Affiliation(s)
| | - Fausto Roila
- Divisione Oncologia Medica, Ospedale Policlinico, Perugia
| | | | - Enzo Ballatori
- Unità di Statistica Medica, Dip. Medicina Interna e Sanità Pubblica, Università, L'Aquila
| | - Lucio Patoia
- Dip. Medicina Interna e Scienze Oncologiche, Università, Perugia
| | | | - Giuseppe Colucci
- Oncologia Medica e Sperimentale, Istituto Nazionale Tumori, Bari
| | | | | | | | | | - E. Cortesi
- D.H. Oncologico Policlinico Umberto I, Roma
| | - C. Bressi
- D.H. Oncologico Policlinico Umberto I, Roma
| | | | - M. Mazzoli
- D.H. Oncologico Policlinico Umberto I, Roma
| | | | | | - S. Cigolari
- III Medicina Interna, Università Federico II, Napoli
| | - V. Angelini
- III Medicina Interna, Università Federico II, Napoli
| | - A. Cioffi
- III Medicina Interna, Università Federico II, Napoli
| | - V. Guardasole
- III Medicina Interna, Università Federico II, Napoli
| | - E. Zarra
- III Medicina Interna, Università Federico II, Napoli
| | - M. Tonato
- Divisione Oncologia Medica, Policlinico, Perugia
| | - M. Betti
- Divisione Oncologia Medica, Policlinico, Perugia
| | - F. Marrocolo
- Divisione Oncologia Medica, Policlinico, Perugia
| | | | - G. Cetto
- Divisione Clinicizzata Oncologia Medica, Ospedale Maggiore, Verona
| | | | - F. Cognetti
- Divisione Oncologia Medica, Istituto Nazionale dei Tumori, Roma
| | - G. Beretta
- Divisione Oncologia Medica, Ospedali Riuniti, Bergamo
| | - A. Pessi
- Divisione Oncologia Medica, Ospedali Riuniti, Bergamo
| | - S. Mosconi
- Divisione Oncologia Medica, Ospedali Riuniti, Bergamo
| | - L. Milesi
- Divisione Oncologia Medica, Ospedali Riuniti, Bergamo
| | - O. Bertetto
- Divisione Oncologia Medica, Ospedale S. Giovanni Molinette, Torino
| | - P. Malacarne
- Divisione Oncologia Clinica, Ospedale S. Anna, Ferrara
| | - M. Marzola
- Divisione Oncologia Clinica, Ospedale S. Anna, Ferrara
| | - G. Margutti
- Divisione Oncologia Clinica, Ospedale S. Anna, Ferrara
| | - C. Modenesi
- Divisione Oncologia Clinica, Ospedale S. Anna, Ferrara
| | - P. Manente
- Divisione Oncologia Medica, Ospedale Civile, Castelfranco Veneto
| | - A. Comandone
- Divisione Oncologia Medica, Ospedale Gradenigo, Torino
| | - C. Oliva
- Divisione Oncologia Medica, Ospedale Gradenigo, Torino
| | - P. Berniolo
- Divisione Oncologia Medica, Ospedale Gradenigo, Torino
| | | | - G. Luporini
- Divisione Oncologia Medica, Ospedale S. Carlo Borromeo, Milano
| | - G. Colucci
- Divisione Oncologia Medica e Sperimentale, Istituto Nazionale Tumori, Bari
| | - E. Recaldin
- Divisione Oncologia Medica, Ospedale S. Cuore, Negrar, Verona
| | - M. Nicodemo
- Divisione Oncologia Medica, Ospedale S. Cuore, Negrar, Verona
| | - V. Picece
- Divisione Oncologia Medica, Ospedale S. Cuore, Negrar, Verona
| | - M. Turaz-za
- Divisione Oncologia Medica, Ospedale S. Cuore, Negrar, Verona
| | - E. Ferrazzi
- Divisione Oncologia Medica, Ospedale Civile, Rovigo
| | - G. Solina
- Divisione Chirurgia Oncologica, Ospedale Cervello, Palermo
| | - G. Rosati
- Divisione Oncologia Medica, Ospedale Civile, Potenza
| | - A. Rossi
- Divisione Oncologia Medica, Ospedale Civile, Potenza
| | - L. Manzione
- Divisione Oncologia Medica, Ospedale Civile, Potenza
| | - P. Sozzi
- Divisione Oncologia Medica, Ospedale degli Infermi, Biella
| | - G. Fornarini
- Divisione Oncologia Medica, Ospedale degli Infermi, Biella
| | - A. Lavarello
- Divisione Oncologia Medica, Ospedale Civile, Sestri Levante
| | - G. Catalano
- Divisione Oncologia Medica, Ospedale S. Salvatore, Pesaro
| | - P. Giordani
- Divisione Oncologia Medica, Ospedale S. Salvatore, Pesaro
| | | | - G. Troccoli
- Divisione Oncologia Medica, Policlinico Universitario, Bari
| | - G. Vietti Ramus
- UO di Oncologia, Ospedale S. Giovanni Bosco, ASL Torino 4, Torino
| | - L. Tonda
- UO di Oncologia, Ospedale S. Giovanni Bosco, ASL Torino 4, Torino
| | - M.P. Sirgiovanni
- UO di Oncologia, Ospedale S. Giovanni Bosco, ASL Torino 4, Torino
| | | | - V. Tinessa
- Divisione Oncologia Medica, Ospedale Civile, Benevento
| | - A Ruggiero
- Divisione Oncologia Medica, Ospedale Civile, Benevento
| | - S. Palazzo
- Divisione Oncologia Medica, Ospedale Mariano Santo, Cosenza
| | - S. Barni
- UO di Oncologia Medica, Azienda Ospedaliera, Treviglio
| | - M. Mandalà
- UO di Oncologia Medica, Azienda Ospedaliera, Treviglio
| | - M. Cremonesi
- UO di Oncologia Medica, Azienda Ospedaliera, Treviglio
| | - G. Porcile
- Divisione Oncologia Medica, Ospedale Civile, Alba
| | | | - F. Testore
- Divisione Oncologia Medica, Ospedale Civile, Asti
| | - G. Carteni
- Divisione Oncologia Medica, Ospedale Cardarelli, Napoli
| | - B. Daniele
- Divisione Oncologia Medica, Istituto Nazionale Tumori, Napoli
| | - C. Volta
- Divisione Oncologia Medica, Ospedale Maggiore della Carità, Novara
| | - F. Ferraù
- Divisione Oncologia Medica, Ospedale Civile, Taormina
| | - A. Zaniboni
- Divisione Oncologia Medica, C. Cura Poliambulanza, Brescia
| | - P. Marchetti
- Divisione Oncologia Medica, Ospedale S. Salvatore, L'Aquila
| | - G. Citone
- Divisione Oncologia Medica, Ospedale S. Salvatore, L'Aquila
| | | | - C. Iacono
- Divisione Oncologia Medica, Ospedale Civile, Ragusa
| | - M. Musi
- Divisione Oncologia Medica, Ospedale Generale, Aosta
| | | | | | | | - V. Sciacca
- Divisione Oncologia Medica, Ospedale S. Maria Goretti, Latina
| | - M. D'Aprile
- Divisione Oncologia Medica, Ospedale S. Maria Goretti, Latina
| | - L. Isa
- Divisione Oncologia Medica, Ospedale Civile, Gorgonzola
| | - F. Recchia
- Divisione Oncologia Medica, Ospedale Civile, Avezzano
| | - S. Spada
- D.H. Oncologico, Ospedale Umberto I, Siracusa
| | - S. Cascinu
- Divisione Oncologia Medica, Ospedale Civile, Parma
| | - R. Carroccio
- Unità Operativa Complessa di Oncologia Medica, Ospedale Umberto I, Enna
| | | | | | - M. Chetrì
- D.H. Oncologico, Ospedale di Summa, Brindisi
| | - P. Rizzo
- D.H. Oncologico, Ospedale di Summa, Brindisi
| | - M. Botturi
- UO Radioterapia, Ospedale Niguarda, Milano
| | - P. Marchei
- Divisione Oncologia Medica, Università La Sapienza, Roma
| | - S. Bretti
- Divisione Oncologia Medica, Ospedale Civile, Ivrea
| | | | - G. Reguzzoni
- D. H. Oncologico, Ospedale Civile, Busto Arsizio
| | - B. Massidda
- Oncologia Medica, Policlinico Universitario, Monserrato, Cagliari
| | - M.T. Ionta
- Oncologia Medica, Policlinico Universitario, Monserrato, Cagliari
| | - G. Cruciani
- Divisione Oncologia Medica, Ospedale Civile, Lugo
| | | | - G. Mantovani
- Divisione Oncologia Medica, Università, Cagliari
| | - V. Sidoti
- Divisione Oncologia Medica, Ospedale Civile, Pinerolo
| | - A. Peta
- Divisione Ematologia Oncologica, Ospedale Pugliese, Catanzaro
| | - E. Greco
- Divisione Oncologia Medica, Ospedale Civile, Lamezia Terme
| | - G. Cicero
- Divisione Oncologia Medica, Ospedale Civile, Castrovillari
| | - A. Sobrero
- Divisione Oncologia Medica, Policlinico Universitario, Udine
| | - P. Marsilio
- Divisione Oncologia Medica, Ospedale Civile, Udine
| | - E. Vigevani
- Divisione Oncologia Medica, Ospedale Civile, Tolmezzo
| | - G. Rimondi
- Divisione Oncologia Medica, Ospedale Civile, Tolmezzo
| | - V. Gebbia
- Divisione Oncologia Medica, Policlinico Universitario, Palermo
| | - A. Nuzzo
- UO di Oncologia Medica, Ospedale Renzetti, Lanciano
| | - E. Biondi
- UO di Oncologia Medica, Ospedale Renzetti, Lanciano
| | - C. Caroti
- Divisione Oncologia Medica, Ospedale Galliera, Genova
| | - M. D'Amico
- Divisione Oncologia Medica, Ospedale Galliera, Genova
| | - G. Tuveri
- Divisione Oncologia Medica, Ospedale della Pietà, Trieste
| | - G. Pieri
- Divisione Oncologia Medica, Ospedale della Pietà, Trieste
| | | | - G. Tonini
- Oncologia Medica, Università Campus Biomedico, Roma
| | - D. Santini
- Oncologia Medica, Università Campus Biomedico, Roma
| | - T. Iannone
- Unità di Radioterapia Oncologica, Ospedale civile, Belluno
| | - C. Pizza
- Divisione Oncologia Medica, Ospedale S. Maria della Pietà, Nola
| | | | - S. Del Prete
- Divisione Oncologia Medica, Ospedale Civile, Frattamaggiore
| | - C. Pizza
- Divisione Oncologia Medica, Ospedale S. Maria della Pietà, Nola
| | - R. Trevisonne
- Divisione Oncologia Medica e Radioterapia, Ospedale Civile, Ascoli Piceno
| | - M. Serlenga
- Oncologia Radioterapica, Ospedale Civile, Barletta
| | | | - V. Lacava
- D.H. Oncologia, Università La Sapienza, Roma
| | - C. Bumma
- Divisione Oncologia Medica, Ospedale S. Giovanni Vecchio, Torino
| | - M. Roselli
- Oncologia Medica, Università di Roma “Tor Vergata”, Roma
| | | | - V. Mascia
- Divisione Oncologia Medica, Policlinico Universitario, Cagliari
| | - D. Perrone
- Divisione Oncologia Medica, Ospedale Civile, Saluzzo, Cuneo
| | - T. Prantera
- Divisione Oncologia Medica, Ospedale S. Giovanni di Dio, Crotone
| | - S. Venuta
- Divisione Oncologia Medica, Policlinico Universitario, Catanzaro
| | - G. Nastasi
- Divisione Medicina Oncologica, Ospedale Civile, Alzano Lombardo
| | | | - A. Lembo
- Servizio Oncologia Medica, Casa di Cura M. Polo, Roma
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Ratti M, Hahne JC, Toppo L, Castelli E, Petrelli F, Passalacqua R, Barni S, Tomasello G, Ghidini M. Major innovations and clinical applications of disodium-levofolinate: a review of available preclinical and clinical data. Ther Adv Med Oncol 2019; 11:1758835919853954. [PMID: 31210799 PMCID: PMC6552345 DOI: 10.1177/1758835919853954] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 05/07/2019] [Indexed: 12/15/2022] Open
Abstract
The association of folinate salts with 5-fluorouracil (5-FU) represents a gold standard in the treatment of many cancers. In several clinical trials, the simultaneous administration of calcium–folinic acid (Ca-FA) and the prolonged infusion of 5-FU resulted in a better clinical response compared with fluoropyrimidine alone and 5-FU bolus. However, the simultaneous infusion of 5-FU and Ca-FA mixed in the same infusion pump is hindered by the crystallization of calcium salts, which eventually leads to catheter obstruction and damage. The sodium salt of leucovorin-disodium levofolinate (Na-Lv) is a novel molecule with a pharmacological profile similar to Ca-FA. Owing to its higher solubility, it can be safely mixed with 5-FU in a single pump without the risk of precipitation and catheter occlusion. The efficacy and safety of Na-Lv have been widely examined in preclinical and clinical phase II studies in combination with various schedules of 5-FU and in several cancer types. PubMed, EMBASE, SCOPUS and Web of Science databases were searched from inception to November 2018 to retrieve available published phase I and II series, including Western patients. Compared with Ca-FA, Na-Lv shows a more favourable efficacy and toxicity profile in terms of overall response rate, progression-free survival, time to progression and occurrence of severe adverse events. Moreover, it allows treatment time to be shortened, decreasing the number of required human resources for drug administration and limiting the occurrence of catheter damage.
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Affiliation(s)
- Margherita Ratti
- Oncology Unit, Oncology Department, ASST of Cremona, Hospital of Cremona, Italy
| | - Jens Claus Hahne
- Division of Molecular Pathology, The Institute for Cancer Research, Sutton, UK
| | - Laura Toppo
- Oncology Unit, Dept Medicine, Hospital of Voghera, Italy
| | | | - Fausto Petrelli
- Oncology Unit, Oncology Department, ASST of Bergamo Ovest, Treviglio, Italy
| | - Rodolfo Passalacqua
- Oncology Unit, Oncology Department, ASST of Cremona, Hospital of Cremona, Italy
| | - Sandro Barni
- Oncology Unit, Oncology Department, ASST of Bergamo Ovest, Treviglio, Italy
| | - Gianluca Tomasello
- Oncology Unit, Oncology Department, ASST of Cremona, Hospital of Cremona, Italy
| | - Michele Ghidini
- Oncology Unit, Oncology Department, ASST of Cremona, Hospital of Cremona, Viale Concordia, 1, Cremona CR, 26100, Italy
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Perrone F, De Laurentiis M, De Placido S, Orditura M, Cinieri S, Riccardi F, Ribecco AS, Putzu C, Del Mastro L, Rossi E, Tinessa V, Mosconi AM, Nuzzo F, Di Rella F, Gravina A, Iodice G, Landi G, Pacilio C, Forestieri V, Lauria R, Fabbri A, Ibrahim T, De Maio E, Barni S, Gori S, Simeon V, Arenare L, Daniele G, Piccirillo MC, Normanno N, de Matteis A, Gallo C. Adjuvant zoledronic acid and letrozole plus ovarian function suppression in premenopausal breast cancer: HOBOE phase 3 randomised trial. Eur J Cancer 2019; 118:178-186. [PMID: 31164265 DOI: 10.1016/j.ejca.2019.05.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/15/2019] [Accepted: 05/02/2019] [Indexed: 11/13/2022]
Abstract
AIM The aim of the study is to analyse whether letrozole (L) and zoledronic acid plus L (ZL) are more effective than tamoxifen (T) as adjuvant endocrine treatment of premenopausal patients with breast cancer with hormone receptor-positive (HR+) tumours. PATIENTS AND METHODS In a phase 3 trial, 1065 premenopausal patients with HR + early breast cancer received triptorelin to suppress ovarian function and were randomly assigned (1:1:1) to adjuvant T, L or ZL for 5 years. Cancer recurrence, second breast or non-breast cancer and death were considered events for the intention-to-treat disease-free survival (DFS) analysis. RESULTS With a 64-month median follow-up and 134 reported events, the disease-free rate at 5 years was 85.4%, 93.2% and 93.3% with T, L and ZL, respectively (overall P = 0.008). The hazard ratio for a DFS event was 0.52 (95% confidence interval [CI], 0.34 to 0.80; P = 0.003) with ZL vs T, 0.72 (95% CI, 0.48 to 1.07; P = 0.06) with L vs T and 0.70 (95% CI, 0.44 to 1.12; P = 0.22) with ZL vs L. With 36 deaths, there was no significant difference in overall survival (P = 0.14). Treatment was stopped for toxicity or refusal in 7.3%, 7.3% and 16.6% patients, and in the safety population, grade 3-4 side-effects were reported in 4.2%, 6.9% and 9.1% patients treated with T, L or ZL, respectively. CONCLUSION HOBOE study shows that in premenopausal patients with early breast cancer undergoing ovarian function suppression with triptorelin, ZL significantly improves DFS, while worsening compliance and toxicity, as compared with T. (NCT00412022).
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Affiliation(s)
- Francesco Perrone
- Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G.Pascale, Napoli, Italy.
| | - Michelino De Laurentiis
- Clinical and Experimental Senology, Istituto Nazionale Tumori, IRCCS, Fondazione G.Pascale, Napoli, Italy
| | - Sabino De Placido
- Department of Medical and Surgical Clinics, Università Federico II, Napoli, Italy
| | - Michele Orditura
- Oncoematology Unit, Università Degli Studi Della Campania "Luigi Vanvitelli", Napoli, Italy
| | | | | | | | - Carlo Putzu
- Medical Oncology, Azienda Ospedaliera Universitaria, Sassari, Italy
| | - Lucia Del Mastro
- IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Internal Medicine (DIMI), Università di Genova, Italy
| | - Emanuela Rossi
- Medical Oncology, A.O. San Giuseppe Moscati, Avellino, Italy
| | | | - Anna Maria Mosconi
- Medical Oncology, Ospedale Santa Maria Della Misericordia, S.Andrea Delle Fratte, Perugia, Italy
| | - Francesco Nuzzo
- Clinical and Experimental Senology, Istituto Nazionale Tumori, IRCCS, Fondazione G.Pascale, Napoli, Italy
| | - Francesca Di Rella
- Clinical and Experimental Senology, Istituto Nazionale Tumori, IRCCS, Fondazione G.Pascale, Napoli, Italy
| | - Adriano Gravina
- Clinical and Experimental Senology, Istituto Nazionale Tumori, IRCCS, Fondazione G.Pascale, Napoli, Italy
| | - Giovanni Iodice
- Clinical and Experimental Senology, Istituto Nazionale Tumori, IRCCS, Fondazione G.Pascale, Napoli, Italy
| | - Gabriella Landi
- Clinical and Experimental Senology, Istituto Nazionale Tumori, IRCCS, Fondazione G.Pascale, Napoli, Italy
| | - Carmen Pacilio
- Clinical and Experimental Senology, Istituto Nazionale Tumori, IRCCS, Fondazione G.Pascale, Napoli, Italy
| | - Valeria Forestieri
- Department of Medical and Surgical Clinics, Università Federico II, Napoli, Italy
| | - Rossella Lauria
- Department of Medical and Surgical Clinics, Università Federico II, Napoli, Italy
| | - Agnese Fabbri
- Department of Medical Oncology, Ospedale Belcolle, Viterbo, Italy
| | - Toni Ibrahim
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola FC, Italy
| | | | - Sandro Barni
- Medical Oncology - Ospedale di Treviglio Caravaggio BG, Italy
| | - Stefania Gori
- Medical Oncology, IRCCS, Ospedale Sacro Cuore Don Calabria, Negrar VR, Italy
| | - Vittorio Simeon
- Medical Statistics, Università Degli Studi Della Campania "Luigi Vanvitelli", Napoli, Italy
| | - Laura Arenare
- Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G.Pascale, Napoli, Italy
| | - Gennaro Daniele
- Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G.Pascale, Napoli, Italy
| | | | - Nicola Normanno
- Cellular Biology and Biotherapies, Istituto Nazionale Tumori, IRCCS, Fondazione G.Pascale, Napoli, Italy
| | - Andrea de Matteis
- Clinical and Experimental Senology, Istituto Nazionale Tumori, IRCCS, Fondazione G.Pascale, Napoli, Italy
| | - Ciro Gallo
- Medical Statistics, Università Degli Studi Della Campania "Luigi Vanvitelli", Napoli, Italy
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31
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Grizzi G, Petrelli F, Ghidini M, Ghidini A, Ratti M, Panni S, Cabiddu M, Ghilardi M, Borgonovo K, Parati MC, Barni S, Tomasello G, Passalacqua R, Berruti A, Brighenti M. Immune-related adverse events (irAEs) and survival in solid tumors treated with immune checkpoint inhibitors (ICIs): A systematic review and meta-analysis. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e14130] [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
e14130 Background: irAEs are autoimmune-toxic effects associated with ICIs used for treatment of advanced solid tumors. The correlation of these irAEs with survival is presently unknown. The objective of this meta-analysis is to assess the outcome of cancer patients treated with ICIs who develop irAEs. Methods: Two independent reviewers selected prospective or retrospective studies from PubMed, EMBASE, and the Cochrane library database from their inception to November 2018. Studies were selected if: 1) they reported correlation of irAEs (any) with outcome, 2) they included patients with solid tumors; 3) they included treatment with anti-PD-(L)1 or anti-CTLA-4 agents, 4) patients had no previous history of autoimmune disorders, 5) they were published in English language, and 6) they provided availability of adequate data to calculate hazard ratios (HRs) or odds ratios (ORs) and 95% confidence intervals (CIs). Data were pooled using HRs for overall survival (OS) or progression-free survival (PFS) or ORs for overall response rate (ORR) of irAEs vs no irAEs according to fixed or random effect model. HRs for OS (the primary outcome measure) were pooled to provide an aggregate value. Hazard ratio for PFS and ORs for ORR were secondary endpoints. Results: A total of 29 studies for a total of 4242 patients treated with ICIs were selected. Patients who developed irAEs presented a reduced risk of death (HR = 0.52, p < .001). Similarly, the occurrence of irAEs was associated with a reduced risk of progression (HR = 0.51, p < .001). The combined odds of response was 4.87 (p < .001). Conclusions: In patients treated with ICIs, irAEs predict survival and response. Although this correlation cannot be fully explained, it may be related to the strongest T cell activation. Patients showing any form of irAEs can be informed about the positive prognostic effect, and physicians can detect patients with favorable outcome to ICIs.
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Affiliation(s)
- Giulia Grizzi
- Oncology Unit, Oncology Department, ASST of Cremona, Cremona, Italy
| | | | - Michele Ghidini
- Oncology Unit, Oncology Department, ASST of Cremona, Cremona, Italy
| | | | - Margherita Ratti
- Oncology Unit, Oncology Department, ASST of Cremona, Cremona, Italy
| | | | | | | | | | | | | | | | | | - Alfredo Berruti
- Medical Oncology, University of Brescia, Spedali Civili Hospital, Brescia, Italy
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Barni S, Livraghi L, Gravina A, Martella F, D'Onofrio L, Morritti M, Michelotti A, Vici P, Mentuccia L, Porcu L, Orditura M, Puglisi F. Feasibility of Eribulin Mesylate in older patients with locally advanced or metastatic breast cancer: A post-hoc analysis of the ESEMPiO study. J Geriatr Oncol 2019; 10:990-993. [PMID: 31097340 DOI: 10.1016/j.jgo.2019.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 03/29/2019] [Accepted: 05/03/2019] [Indexed: 02/07/2023]
Affiliation(s)
- Sandro Barni
- Treviglio Hospital, ASST-Bergamo Ovest, Treviglio, Italy.
| | | | - Adriano Gravina
- National Cancer Institute Fondazione G. Pascale, Napoli, Italy
| | | | | | - Maria Morritti
- Oncology Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy
| | | | - Patrizia Vici
- Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Roma, Italy
| | | | - Luca Porcu
- Laboratory of Methodology for Clinical Research, Oncology Department, IRCCS- Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | | | - Fabio Puglisi
- Unit of Medical Oncology and Prevention, IRCCS Centro di Riferimento Oncologico Aviano-National Cancer Institute, Aviano (UD), Italy; Medical Oncology, Department of Medicine, University of Udine, Italy
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Ageno W, Barni S, Di Nisio M, Falanga A, Imberti D, Labianca RF, Mantovani L. Treatment of venous thromboembolism with tinzaparin in oncological patients. Minerva Med 2019; 110:251-258. [PMID: 30990000 DOI: 10.23736/s0026-4806.19.06026-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Venous thromboembolism (VTE) is a major cause of morbidity and mortality in patients with cancer. For over a decade, the gold standard of treatment and secondary prevention of cancer-associated thrombosis (CAT) has been represented by low-molecular-weight heparins (LMWHs), which are currently recommended as the first-line treatment for CAT. Among the LMWHs that were more extensively tested in patients with CAT, tinzaparin is a LMWH produced by the enzymatic degradation of porcine-derived unfractionated heparin. The efficacy of tinzaparin in this setting is supported by well-grounded evidence. However, there is a need to discuss the positioning of tinzaparin in the continuously evolving treatment scenario of VTE therapy in cancer patients. In this paper, which was developed by a group of clinicians with wide experience in the treatment of VTE in cancer patients, we discuss the current therapeutic options and the role of tinzaparin for the treatment of CAT.
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Affiliation(s)
- Walter Ageno
- Department of Medicine and Surgery, University of Insubria, Varese, Italy -
| | - Sandro Barni
- Department of Oncology, ASST Bergamo Ovest, Treviglio Hospital, Treviglio, Bergamo, Italy
| | - Marcello Di Nisio
- Department of Medicine and Ageing Sciences, G. D'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Anna Falanga
- Department of Immunohematology and Transfusion Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Davide Imberti
- Service of Internal Medicine, Thrombosis and Hemostasis Center, Piacenza Civil Hospital, Piacenza, Italy
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Tomasello G, Ghidini M, Costanzo A, Ghidini A, Russo A, Barni S, Passalacqua R, Petrelli F. Outcome of head compared to body and tail pancreatic cancer: a systematic review and meta-analysis of 93 studies. J Gastrointest Oncol 2019; 10:259-269. [PMID: 31032093 DOI: 10.21037/jgo.2018.12.08] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [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] [Indexed: 12/22/2022] Open
Abstract
Background Even when resectable pancreatic cancer (PC) is associated with a dismal prognosis. Initial presentation varies according with primary tumor location. Aim of this systematic review and meta-analysis was to evaluate the prognosis associated with site (head versus body/tail) in patients with PC. Methods We searched PubMed, Cochrane Library, SCOPUS, Web of Science, EMBASE, Google Scholar, LILACS, and CINAHL databases from inception to March 2018. Studies reporting information on the independent prognostic role of site in PC and comparing overall survival (OS) in head versus body/tail tumors were selected. Data were aggregated using hazard ratios (HRs) for OS of head versus body/tail PC according to fixed- or random-effect model. Results A total of 93 studies including 254,429 patients were identified. Long-term prognosis of head was better than body/tail cancers (HR =0.96, 95% CI: 0.92-0.99; P=0.02). A pooled HR of 0.95 (95% CI: 0.92-0.99, P=0.02) from multivariate analysis only (n=77 publications) showed that head site was an independent prognostic factor for survival. Conclusions Primary tumor location in the head of the pancreas at the time of diagnosis is a predictor of better survival. Such indicator should be acknowledged when designing future studies, in particular in the operable and neoadjuvant setting.
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Affiliation(s)
| | - Michele Ghidini
- Oncology Department, ASST Ospedale di Cremona, Cremona, Italy
| | - Antonio Costanzo
- Surgical Oncology Unit, Surgery Department, ASST Bergamo Ovest, Treviglio (BG), Italy
| | | | - Alessandro Russo
- Surgical Oncology Unit, Surgery Department, ASST Bergamo Ovest, Treviglio (BG), Italy
| | - Sandro Barni
- Oncology Unit, Oncology Department, ASST Bergamo Ovest, Treviglio (BG), Italy
| | | | - Fausto Petrelli
- Oncology Unit, Oncology Department, ASST Bergamo Ovest, Treviglio (BG), Italy
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Petrelli F, Ghidini A, Torchio M, Prinzi N, Trevisan F, Dallera P, De Stefani A, Russo A, Vitali E, Bruschieri L, Costanzo A, Seghezzi S, Ghidini M, Varricchio A, Cabiddu M, Barni S, de Braud F, Pusceddu S. Adjuvant radiotherapy for Merkel cell carcinoma: A systematic review and meta-analysis. Radiother Oncol 2019; 134:211-219. [PMID: 31005218 DOI: 10.1016/j.radonc.2019.02.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 02/17/2019] [Accepted: 02/18/2019] [Indexed: 01/31/2023]
Abstract
Merkel cell carcinoma (MCC) is a rare and aggressive cutaneous malignancy with a high propensity for local recurrence and regional and distant metastases. The main treatment is surgery with narrow excision margins and draining nodes, plus or minus adjuvant radiotherapy (RT) on the surgical bed and/or lymph nodes. We performed a systematic review and meta-analysis of the benefits of adjuvant RT in MCC treatment. PubMed, EMBASE, and the Cochrane Library were systematically searched to identify relevant studies published before September 2018. Prospective trials and retrospective series comparing adjuvant RT vs. no RT in resected primary MCCs were included. Primary endpoint was to evaluate the outcomes of MCC patients who received adjuvant RT in term of overall survival (OS) and disease-free survival (DFS). Hazard ratios (HRs) for OS and DFS were aggregated according to a fixed or random effect model. Secondary endpoints were local, locoregional, and distant DFS. A total of 17,179 MCCs across 29 studies were analysed. There was a significant difference in OS between the RT and no RT arms (HR = 0.81, 95%CI 0.75-0.86, P < 0.001). There was also a significant difference in DFS in favour of adjuvant RT (HR = 0.45, 95%CI 0.32-0.62, P < 0.001). Adjuvant RT improved locoregional DFS and local DFS but not distant DFS (HR = 0.3, 95%CI 0.22-0.42; HR = 0.21, 95%CI 0.14-0.33, and HR = 0.79, 95%CI 0.49-1.14, respectively). Meta-regression analysis showed that high Newcastle-Ottawa scale scores, stage I-II MCCs, shorter follow-up durations, size >2 cm, and being of a younger age were associated with increased OS. This systematic review and meta-analysis suggests a survival and DFS benefit for postoperative radiation of MCCs. Intermediate stage MCCs derive the maximum benefit with local and regional relapses reduced by 80% and 70%, respectively. Conversely, distant metastases were not significantly prevented.
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Affiliation(s)
- Fausto Petrelli
- Medical Oncology Unit, ASST Bergamo Ovest, Treviglio, Italy.
| | | | - Martina Torchio
- Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Italy
| | - Natalie Prinzi
- Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Italy
| | | | | | | | | | | | | | | | | | | | | | - Mary Cabiddu
- Medical Oncology Unit, ASST Bergamo Ovest, Treviglio, Italy
| | - Sandro Barni
- Medical Oncology Unit, ASST Bergamo Ovest, Treviglio, Italy
| | - Filippo de Braud
- Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Italy
| | - Sara Pusceddu
- Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Italy
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Petrelli F, Ghidini A, Pedersini R, Cabiddu M, Borgonovo K, Parati MC, Ghilardi M, Amoroso V, Berruti A, Barni S. Comparative efficacy of palbociclib, ribociclib and abemaciclib for ER+ metastatic breast cancer: an adjusted indirect analysis of randomized controlled trials. Breast Cancer Res Treat 2019; 174:597-604. [PMID: 30659432 DOI: 10.1007/s10549-019-05133-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 01/08/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Several trials have demonstrated the benefit of anti-CDK4/6 inhibitors plus endocrine therapy in estrogen receptor-positive (ER+) advanced breast cancer (BC), in first or subsequent lines of therapy. However, due to the lack of direct/indirect comparisons, there are no data demonstrating the superiority of one drug over the other. We compared the effectiveness of palbociclib, ribociclib, and abemaciclib in advanced ER + BC via an indirect adjusted analysis. METHODS We performed electronic searches in the PubMed, EMBASE, and Cochrane databases for prospective phase 3 randomized trials evaluating anti-CDK4/6 inhibitors plus endocrine agents. We compared the results with an adjusted indirect analysis of randomized-controlled trials. Outcomes of interest were progression-free survival (PFS), overall response rate (ORR) and G3-4 toxicities occurring in ≥ 5% of patients. RESULTS Six trials and six treatment arms including a total of 3743 participants, were included. For PFS and ORR analysis, the three agents were similar in both first- and second-line studies. All G3-4 toxicities were similar, with reduced risk of diarrhea for palbociclib versus abemaciclib (relative risk [RR] 0.13, 95% CI 0.02-0.92; P = 0.04) and of QTc prolongation for palbociclib versus ribociclib (RR 0.02, 95% CI 0-0.83; P = 0.03). Despite different inclusion criteria and length of follow-up, similar features were noticed among second-line studies with the exception of increased risk of anemia G3-4 and diarrhea G3-4 for abemaciclib. CONCLUSIONS Based on PFS and ORR results of this indirect meta-analysis, palbociclib, ribociclib, and abemaciclib are equally effective in either first- or second-line therapy for advanced ER + BC. They, however, ported different toxicity profiles.
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Affiliation(s)
- Fausto Petrelli
- Medical Oncology Unit, ASST Bergamo Ovest, Piazzale Ospedale 1, 24047, Treviglio, BG, Italy.
| | | | | | - Mary Cabiddu
- Medical Oncology Unit, ASST Bergamo Ovest, Piazzale Ospedale 1, 24047, Treviglio, BG, Italy
| | - Karen Borgonovo
- Medical Oncology Unit, ASST Bergamo Ovest, Piazzale Ospedale 1, 24047, Treviglio, BG, Italy
| | - Maria Chiara Parati
- Medical Oncology Unit, ASST Bergamo Ovest, Piazzale Ospedale 1, 24047, Treviglio, BG, Italy
| | - Mara Ghilardi
- Medical Oncology Unit, ASST Bergamo Ovest, Piazzale Ospedale 1, 24047, Treviglio, BG, Italy
| | - Vito Amoroso
- Breast Unit, ASST Spedali Civili, Brescia, Italy
| | | | - Sandro Barni
- Medical Oncology Unit, ASST Bergamo Ovest, Piazzale Ospedale 1, 24047, Treviglio, BG, Italy
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Vernieri C, Galli F, Ferrari L, Marchetti P, Lonardi S, Maiello E, Iaffaioli RV, Zampino MG, Zaniboni A, De Placido S, Banzi M, Damiani A, Ferrari D, Rosati G, Labianca RF, Bidoli P, Frassineti GL, Nicolini M, Pavesi L, Tronconi MC, Buonadonna A, Ferrario S, Re GL, Adamo V, Tamburini E, Clerico M, Giordani P, Leonardi F, Barni S, Ciarlo A, Cavanna L, Gori S, Cinieri S, Faedi M, Aglietta M, Antista M, Dotti KF, Galli F, Di Bartolomeo M. Impact of Metformin Use and Diabetic Status During Adjuvant Fluoropyrimidine-Oxaliplatin Chemotherapy on the Outcome of Patients with Resected Colon Cancer: A TOSCA Study Subanalysis. Oncologist 2019; 24:385-393. [PMID: 30606884 DOI: 10.1634/theoncologist.2018-0442] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 10/19/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is associated with increased risk of colon cancer (CC), whereas metformin use seems to be protective. However, the impact of metformin use on the risk of death or disease recurrence after radical surgery for CC remains uncertain. MATERIALS AND METHODS This is a substudy conducted in patients with high-risk stage II or stage III CC randomized in the TOSCA trial, which compared 3 versus 6 months of fluoropyrimidine-oxaliplatin adjuvant chemotherapy. Objective of the study was to investigate the impact of metformin exposure during adjuvant chemotherapy on overall survival (OS) and relapse-free survival (RFS). We also evaluated the impact of T2DM or metformin dosage on clinical outcomes. RESULTS Out of 3,759 patients enrolled in the TOSCA trial, 133 patients with diabetes (9.2%) and 1,319 without diabetes (90.8%) were recruited in this study. After excluding 13 patients with diabetes without information on metformin exposure, 76 patients with T2DM (63.3%) were defined as metformin users and 44 (36.7%) as metformin nonusers. After a median follow-up of 60.4 months, 26 (21.7%) patients relapsed and 16 (13.3%) died. Metformin use was neither associated with OS (adjusted hazard ratio [HR], 1.51; 95% confidence interval [CI], 0.48-4.77; p = .4781) nor with RFS (HR, 1.56; 95% CI, 0.69-3.54; p = .2881). Similarly, we found no association between T2DM or metformin dosage and OS or RFS. CONCLUSIONS Metformin use and T2DM did not impact on OS or RFS in patients with resected CC treated with adjuvant fluoropyrimidine-oxaliplatin chemotherapy. Larger studies and longer follow-up are required to clarify the potential efficacy of metformin in improving the prognosis of patients with CC. IMPLICATIONS FOR PRACTICE The role of the antidiabetic drug metformin in colon cancer prevention and treatment is highly debated. While low-dose metformin reduced the incidence of colorectal adenomas in two prospective studies, its effect in patients with already established colon cancer remains unclear. In this study, the potential impact of metformin on the survival of resected colon cancer patients who received adjuvant chemotherapy was investigated in the context of the TOSCA study. We did not find any association between metformin use or dosages and patient survival. Prospective studies are required to draw definitive conclusions about metformin impact on colon cancer recurrence and survival.
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Affiliation(s)
- Claudio Vernieri
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- The Italian Foundation for Cancer Research Institute of Molecular Oncology, Milan, Italy
| | - Fabio Galli
- IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Laura Ferrari
- Azienda Ospedaliero Universitaria Santa Maria della Misericordia, Udine, Italy
| | - Paolo Marchetti
- Sant'Andrea Hospital, Sapienza University of Rome and IRCCS Istituto Dermopatico dell'Immacolata, Rome, Italy
| | | | - Evaristo Maiello
- Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | | | | | | | | | - Maria Banzi
- IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | | | | | | | | | | | - Giovanni L Frassineti
- IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Italy
| | | | | | | | | | | | - Giovanni Lo Re
- Azienda Ospedaliera S. Maria degli Angeli Pordenone, Pordenone, Italy
| | - Vincenzo Adamo
- Dipartimento Universitario di Patologia Umana & Azienda Ospedaliera Papardo, Messina, Italy
| | | | | | | | | | - Sandro Barni
- Ospedale Treviglio Caravaggio Treviglio, Bergamo, Italy
| | | | | | | | | | | | | | - Maria Antista
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Katia F Dotti
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Francesca Galli
- IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
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Pizzuti L, Giordano A, Michelotti A, Mazzotta M, Natoli C, Gamucci T, De Angelis C, Landucci E, Diodati L, Iezzi L, Mentuccia L, Fabbri A, Barba M, Sanguineti G, Marchetti P, Tomao S, Mariani L, Paris I, Lorusso V, Vallarelli S, Cassano A, Aroldi F, Orlandi A, Moscetti L, Sergi D, Sarobba MG, Tonini G, Santini D, Sini V, Veltri E, Vaccaro A, Ferrari L, De Tursi M, Tinari N, Grassadonia A, Greco F, Botticelli A, La Verde N, Zamagni C, Rubino D, Cortesi E, Magri V, Pomati G, Scagnoli S, Capomolla E, Kayal R, Scinto AF, Corsi D, Cazzaniga M, Laudadio L, Forciniti S, Mancini M, Carbognin L, Seminara P, Barni S, Samaritani R, Roselli M, Portarena I, Russo A, Ficorella C, Cannita K, Carpano S, Pistelli M, Berardi R, De Maria R, Sperduti I, Ciliberto G, Vici P. Palbociclib plus endocrine therapy in HER2 negative, hormonal receptor-positive, advanced breast cancer: A real-world experience. J Cell Physiol 2018; 234:7708-7717. [PMID: 30536609 DOI: 10.1002/jcp.27832] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 11/06/2018] [Indexed: 12/11/2022]
Abstract
Data from 423 human epidermal growth factor receptor 2-negative (HER2-), hormone receptor-positive (HR+) advanced breast cancer (aBC) patients treated with palbociclib and endocrine therapy (ET) were provided by 35 Italian cancer centers and analyzed for treatment outcomes. Overall, 158 patients were treated in first line and 265 in second/later lines. We observed 19 complete responses and 112 partial responses. The overall response rate (ORR) was 31% (95% confidence interval [CI], 26.6-35.4) and clinical benefit was 52.7% (95% CI, 48-57.5). ORR was negatively affected by prior exposure to everolimus/exemestane ( p = 0.002) and favorably influenced by early line-treatment ( p < 0.0001). At 6 months, median progression-free survival was 12 months (95% CI, 8-16) and median overall survival was 24 months (95% CI, 17-30). More favorable outcomes were associated with palbociclib in early lines, no visceral metastases and no prior everolimus/exemestane. The main toxicity reported was neutropenia. Our results provide further support to the use of palbociclib with ET in HER2-, HR+ aBC. Differences in outcomes across patients subsets remain largely unexplained.
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Affiliation(s)
- Laura Pizzuti
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Antonio Giordano
- Department of Clinical and Molecular Medicine, "Sapienza" University of Rome, Azienda Ospedaliera Sant'Andrea, Rome, Italy
| | - Andrea Michelotti
- UO Oncologia Medica I, Ospedale S. Chiara, Dipartimento di Oncologia, Dei Trapianti e Delle Nuove Tecnologie, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Marco Mazzotta
- Department of Medical, Oral and Biotechnological Sciences, Centro Scienze Dell'Invecchiamento e Medicina Traslazionale-CeSI-MeT, Chieti, Italy
| | - Clara Natoli
- Medical Oncology Unit, SS Trinità Hospital, Loc. San MarcianoHospital, Sora, Frosinone, Italy
| | - Teresa Gamucci
- Medical Oncology Unit, SS Trinità Hospital, Sora, Italy.,Medical Oncology, Sandro Pertini Hospital, Rome, Italy
| | - Claudia De Angelis
- UO Oncologia Medica I, Ospedale S. Chiara, Dipartimento di Oncologia, Dei Trapianti e Delle Nuove Tecnologie, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Elisabetta Landucci
- UO Oncologia Medica I, Ospedale S. Chiara, Dipartimento di Oncologia, Dei Trapianti e Delle Nuove Tecnologie, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Lucrezia Diodati
- UO Oncologia Medica I, Ospedale S. Chiara, Dipartimento di Oncologia, Dei Trapianti e Delle Nuove Tecnologie, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Laura Iezzi
- Medical Oncology Unit, SS Trinità Hospital, Loc. San MarcianoHospital, Sora, Frosinone, Italy
| | | | - Agnese Fabbri
- Medical Oncology Unit, Belcolle Hospital, Viterbo, Italy
| | - Maddalena Barba
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppe Sanguineti
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Paolo Marchetti
- Department of Medical, Oral and Biotechnological Sciences, Centro Scienze Dell'Invecchiamento e Medicina Traslazionale-CeSI-MeT, Chieti, Italy.,Department of Clinical and Molecular Medicine, A Oncology Division, "Sapienza" University of Rome, Rome, Italy
| | - Silverio Tomao
- Department of Clinical and Molecular Medicine, A Oncology Division, La "Sapienza" University of Rome, Rome, Italy
| | - Luciano Mariani
- HPV Unit, Department of Gynaecologic Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Ida Paris
- Gynecology Oncology Unit, Catholic University of the Sacred Heart, Rome, Italy
| | - Vito Lorusso
- Division of Medical Oncology, IRCCS, Giovanni Paolo II Hospital, Bari, Italy
| | - Simona Vallarelli
- Division of Medical Oncology, IRCCS, Giovanni Paolo II Hospital, Bari, Italy
| | - Alessandra Cassano
- Department of Medical Oncology, Catholic University of Sacred Heart, Rome, Italy
| | - Francesca Aroldi
- Department of Medical Oncology, Catholic University of Sacred Heart, Rome, Italy
| | - Armando Orlandi
- Department of Medical Oncology, Catholic University of Sacred Heart, Rome, Italy
| | - Luca Moscetti
- Division of Medical Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Domenico Sergi
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | - Giuseppe Tonini
- Department of Oncology, University Campus Biomedico of Rome, Rome, Italy
| | - Daniele Santini
- Department of Oncology, University Campus Biomedico of Rome, Rome, Italy
| | - Valentina Sini
- Oncology Unit, ASL Roma 1, Santo Spirito Hospital, Rome, Italy
| | - Enzo Veltri
- Division of Medical Oncology, Ospedale S. Maria Goretti, Latina, Italy
| | - Angela Vaccaro
- Medical Oncology Unit, SS Trinità Hospital, Loc. San MarcianoHospital, Sora, Frosinone, Italy
| | - Laura Ferrari
- Medical Oncology Unit, SS Trinità Hospital, Loc. San MarcianoHospital, Sora, Frosinone, Italy
| | - Michele De Tursi
- Department of Medical, Oral and Biotechnological Sciences, Centro Scienze Dell'Invecchiamento e Medicina Traslazionale-CeSI-MeT, Chieti, Italy
| | - Nicola Tinari
- Department of Medical, Oral and Biotechnological Sciences, Centro Scienze Dell'Invecchiamento e Medicina Traslazionale-CeSI-MeT, Chieti, Italy
| | - Antonino Grassadonia
- Department of Medical, Oral and Biotechnological Sciences, Centro Scienze Dell'Invecchiamento e Medicina Traslazionale-CeSI-MeT, Chieti, Italy
| | - Filippo Greco
- ASST Fatebenefratelli Sacco PO Fatebenefratelli, Department of Oncology, Milan, Italy
| | - Andrea Botticelli
- Department of Clinical and Molecular Medicine, "Sapienza" University of Rome, Azienda Ospedaliera Sant'Andrea, Rome, Italy
| | - Nicla La Verde
- Department of Oncology, ASST Fatebenefratelli Sacco PO Fatebenefratelli, Milan, Italy
| | - Claudio Zamagni
- SSD Oncologia Medica "Addarii", S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Daniela Rubino
- SSD Oncologia Medica "Addarii", S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Enrico Cortesi
- Medical Oncology, Policlinico Umberto I, Sapienza, University of Rome, Rome, Italy
| | - Valentina Magri
- Medical Oncology, Policlinico Umberto I, Sapienza, University of Rome, Rome, Italy
| | - Giulia Pomati
- Medical Oncology, Policlinico Umberto I, Sapienza, University of Rome, Rome, Italy
| | - Simone Scagnoli
- Medical Oncology, Policlinico Umberto I, Sapienza, University of Rome, Rome, Italy
| | | | - Ramy Kayal
- Department of Radiology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | - Domenico Corsi
- Medical Oncology Unit, Ospedale San Pietro Fatebenefratelli, Rome, Italy
| | | | | | | | - Maria Mancini
- Medical Oncology, Ospedale F. Renzetti, Lanciano, Italy
| | - Luisa Carbognin
- Department of Pathology, Surgery and Oncology, "Mater Salutis" Hospital, ULSS21, Verona, Italy
| | - Patrizia Seminara
- Department of Clinical and Molecular Medicine, A Oncology Division, "Sapienza" University of Rome, Rome, Italy
| | - Sandro Barni
- Department of Oncology, Oncology Unit, ASST Bergamo Ovest, Treviglio, Italy
| | | | - Mario Roselli
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata Clinical Center University Hospital, Tor Vergata University Hospital, Rome, Italy
| | - Ilaria Portarena
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata Clinical Center University Hospital, Tor Vergata University Hospital, Rome, Italy
| | - Antonio Russo
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - Corrado Ficorella
- Medical Oncology Department, S. Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | - Katia Cannita
- Medical Oncology Department, S. Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | - Silvia Carpano
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Mirco Pistelli
- Azienda Ospedaliero Universitaria Ospedali Riuniti Clinica di Oncologia, Università Politecnica delle Marche, Ancona, Italy
| | - Rossana Berardi
- Azienda Ospedaliero Universitaria Ospedali Riuniti Clinica di Oncologia, Università Politecnica delle Marche, Ancona, Italy
| | - Ruggero De Maria
- Institute of General Pathology, Catholic University of the Sacred Heart, Rome, Italy
| | - Isabella Sperduti
- Bio-statistics Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Gennaro Ciliberto
- Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Patrizia Vici
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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Petrelli F, Ghidini A, Cabiddu M, Tomasello G, De Stefani A, Bruschieri L, Vitali E, Ghilardi M, Borgonovo K, Barni S, Trevisan F. Addition of radiotherapy to the primary tumour in oligometastatic NSCLC: A systematic review and meta-analysis. Lung Cancer 2018; 126:194-200. [PMID: 30527187 DOI: 10.1016/j.lungcan.2018.11.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 10/07/2018] [Revised: 11/01/2018] [Accepted: 11/11/2018] [Indexed: 12/19/2022]
Abstract
Oligometastatic non-small cell lung cancer (NSCLC) has a discrete number of distant lesions (<5) that can be amenable to radical treatment. The treatment of the primary lung tumour in such stage IV cases is still debated. We conducted a systematic review and meta-analysis to evaluate the outcome of these patients and the added benefit in terms of overall survival (OS) and progression-free survival (PFS) when radical treatment of the primary tumour with radiotherapy (RT) was delivered. PubMed, EMBASE and Cochrane Library were systematically searched to identify relevant studies published up to July 2018. Prospective trials and retrospective series comparing RT vs no RT to the primary NSCLC in the presence of oligometastases were included. Hazard ratios (HRs) for OS and PFS were aggregated according to a fixed or random effect model. Twenty-one studies for a total of 924 synchronous oligometastatic NSCLC were analysed. Median OS and PFS were 20.4 and 12 months. Pooled 1-2-3 and 5-year OS were 70.3%, 43.5%, 29.3% and 20.2% respectively. Overall survival was improved with the addition of thoracic RT (HR = 0.44, 95%CI 0.32-0.6; P < 0.001). Similarly, RT added to the primary tumour increased PFS (HR = 0.42, 95%CI 0.33-0.55; P < 0.001). The only variable associated with the median OS was the year of publication with most recent series associated with a better outcome. In patients with oligometastatic NSCLC and disease controlled with ablative therapy of distant metastases, a consolidation with radical RT to the primary tumour is associated with better survival and could be considered as a treatment modality in selected cases.
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Affiliation(s)
- Fausto Petrelli
- Medical oncology unit, ASST Bergamo Ovest, Treviglio, BG, Italy.
| | | | - Mary Cabiddu
- Medical oncology unit, ASST Bergamo Ovest, Treviglio, BG, Italy
| | | | | | | | | | - Mara Ghilardi
- Medical oncology unit, ASST Bergamo Ovest, Treviglio, BG, Italy
| | - Karen Borgonovo
- Medical oncology unit, ASST Bergamo Ovest, Treviglio, BG, Italy
| | - Sandro Barni
- Medical oncology unit, ASST Bergamo Ovest, Treviglio, BG, Italy
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40
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Barni S, Livraghi L, Morritti M, Vici P, Michelotti A, Cinieri S, Fontanella C, Porcu L, Del Mastro L, Puglisi F. Eribulin in the treatment of advanced breast cancer: real-world scenario from 39 Italian centers - ESEMPiO study. Future Oncol 2018; 15:33-44. [PMID: 30411979 DOI: 10.2217/fon-2018-0324] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
AIM We performed a multicenter retrospective cohort study of eribulin mesylate (EM) use in Italy, to describe the current practice for metastatic breast cancer patients (ESEMPiO) in the real-world. PATIENTS & METHODS Baseline characteristics, treatment administration and safety were summarized using descriptive statistics. RESULTS No safety concerns were raised in the population enrolled in the ESEMPiO database and treated in a real-life practice. Median progression-free survival and overall survival were 3.2 and 10.1 months, respectively. EM activity was similar between breast cancer subtypes. CONCLUSION In metastatic breast cancer patients treated with EM in 'real-world' setting, the clinician-registered outcomes were comparable to those reported in pivotal trials. Furthermore, EM maintained clinical activity and a tolerable safety profile.
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Affiliation(s)
- Sandro Barni
- Oncology Unit, Medical Department, ASST Bergamo Ovest, 24047, Treviglio, Italy
| | - Luca Livraghi
- Medical Oncology Unit, ASST Papa Giovanni XXIII, 24127, Bergamo, Italy
| | - Maria Morritti
- Oncology Unit, Ospedale Casa Sollievo della Sofferenza, 71013, San Giovanni Rotondo, Foggia, Italy
| | - Patrizia Vici
- Division of Medical Oncology 2, "Regina Elena" National Cancer Institute, 00128, Rome, Italy
| | - Andrea Michelotti
- Oncology Unit 1, Azienda Ospedaliera Universitaria Pisana, 56126, Pisa, Italy
| | - Saverio Cinieri
- Medical Oncology Division and Breast Unit, "Senatore Antonio Perrino" Hospital, 72100, Brindisi, Italy
| | - Caterina Fontanella
- Unit of Medical Oncology and Cancer Prevention, IRCCS Centro di Riferimento Oncologico Aviano-National Cancer Institute, 33081, Aviano, Italy
| | - Luca Porcu
- Laboratory of Methodology for Clinical Research, Oncology Department, IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, 20156, Milan, Italy
| | - Lucia Del Mastro
- Department of Internal Medicine, University of Genova, Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Fabio Puglisi
- Unit of Medical Oncology and Cancer Prevention, IRCCS Centro di Riferimento Oncologico Aviano-National Cancer Institute, 33081, Aviano, Italy.,Medical Oncology, Department of Medicine, University of Udine, 33100, Udine, Italy
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Gamucci T, Pizzuti L, Natoli C, Mentuccia L, Sperduti I, Barba M, Sergi D, Iezzi L, Maugeri-Saccà M, Vaccaro A, Magnolfi E, Gelibter A, Barchiesi G, Magri V, D'Onofrio L, Cassano A, Rossi E, Botticelli A, Moscetti L, Omarini C, Fabbri MA, Scinto AF, Corsi D, Carbognin L, Mazzotta M, Bria E, Foglietta J, Samaritani R, Garufi C, Mariani L, Barni S, Mirabelli R, Sarmiento R, Graziano V, Santini D, Marchetti P, Tonini G, Di Lauro L, Sanguineti G, Paoletti G, Tomao S, De Maria R, Veltri E, Paris I, Giotta F, Latorre A, Giordano A, Ciliberto G, Vici P. A multicenter REtrospective observational study of first-line treatment with PERtuzumab, trastuzumab and taxanes for advanced HER2 positive breast cancer patients. RePer Study. Cancer Biol Ther 2018; 20:192-200. [PMID: 30403909 PMCID: PMC6343690 DOI: 10.1080/15384047.2018.1523095] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
We carried out a retrospective observational study of 264 HER2-positive advanced breast cancer (ABC) patients to explore the efficacy of first-line treatment with pertuzumab/trastuzumab/taxane in real-world setting. Survival data were analyzed by Kaplan Meier curves and log rank test. Median follow-up, length of pertuzumab/trastuzumab/taxane treatment and of pertuzumab, trastuzumab maintenance were 21, 4 and 15 months, respectively. The response rate was 77.3%, and the clinical benefit rate 93.6%. Median progression-free survival (mPFS) was 21 months, and median overall survival (mOS) was not reached. When comparing patients by trastuzumab-pretreatment, similar PFS were observed, although a longer OS was reached in trastuzumab-naïve patients (p = 0.02). Brain metastases at baseline and their development in course of therapy were associated with significantly shorter PFS (p = 0.0006) and shorter OS, although at a not fully statistically relevant extent (p = 0.06). The addition of maintenance endocrine therapy (ET) to pertuzumab/trastuzumab maintenance was associated with longer PFS (p = 0.0001), although no significant differences were detected in OS (p = 0.31). Results were confirmed by propensity score analysis (p = 0.003 and p = 0.46, respectively). In multivariate models, longer PFS was related to lower Performance Status (PS) (p = 0.07), metastatic stage at diagnosis (p = 0.006) and single metastatic site (p < 0.0001). An OS advantage was observed with lower PS (p < 0.0001), single metastatic site (p = 0.004), no prior exposure to trastuzumab (p = 0.004) and response to pertuzumab-based treatment (p = 0.003). Our results confirm that trastuzumab/pertuzumab/taxane is the standard of care as first-line treatment of patients with HER2-positive ABC even in the real-world setting. Moreover, the double-maintenance therapy (HER2 block and ET) is strongly recommended when feasible.
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Affiliation(s)
- Teresa Gamucci
- a Medical Oncology Unit , ASL Frosinone , Frosinone , Italy.,b Medical Oncology , Sandro Pertini Hospital , Roma , Italy
| | - Laura Pizzuti
- c Division of Medical Oncology 2 , IRCCS Regina Elena National Cancer Institute , Rome , Italy
| | - Clara Natoli
- d Department of Medical, Oral and Biotechnological Sciences , Centro Scienze dell'Invecchiamento e Medicina Traslazionale -CeSI-MeT , Chieti , Italy
| | | | - Isabella Sperduti
- e Bio-Statistics Unit , IRCCS Regina Elena National Cancer Institute , Rome , Italy
| | - Maddalena Barba
- c Division of Medical Oncology 2 , IRCCS Regina Elena National Cancer Institute , Rome , Italy.,f Scientific Direction , IRCCS Regina Elena National Cancer Institute , Rome , Italy
| | - Domenico Sergi
- c Division of Medical Oncology 2 , IRCCS Regina Elena National Cancer Institute , Rome , Italy
| | - Laura Iezzi
- d Department of Medical, Oral and Biotechnological Sciences , Centro Scienze dell'Invecchiamento e Medicina Traslazionale -CeSI-MeT , Chieti , Italy
| | - Marcello Maugeri-Saccà
- c Division of Medical Oncology 2 , IRCCS Regina Elena National Cancer Institute , Rome , Italy.,f Scientific Direction , IRCCS Regina Elena National Cancer Institute , Rome , Italy
| | - Angela Vaccaro
- a Medical Oncology Unit , ASL Frosinone , Frosinone , Italy
| | | | - Alain Gelibter
- g Medical Oncology Unit , Policlinico Umberto I , Rome , Italy
| | | | - Valentina Magri
- g Medical Oncology Unit , Policlinico Umberto I , Rome , Italy
| | - Loretta D'Onofrio
- h Department of Oncology , University Campus Biomedico of Rome , Rome , Italy
| | - Alessandra Cassano
- i Department of Medical Oncology , Policlinico Universitario "A. Gemelli" , Rome , Italy
| | - Ernesto Rossi
- i Department of Medical Oncology , Policlinico Universitario "A. Gemelli" , Rome , Italy
| | - Andrea Botticelli
- j Department of Clinical and Molecular Medicine , "Sapienza" University of Rome, Azienda Ospedaliera Sant'Andrea , Rome , Italy
| | - Luca Moscetti
- k Division of Medical Oncology, Department of Oncology and Hematology , University Hospital of Modena , Modena , Italy
| | - Claudia Omarini
- k Division of Medical Oncology, Department of Oncology and Hematology , University Hospital of Modena , Modena , Italy
| | | | | | - Domenico Corsi
- m Medical Oncology Unit , San Pietro Fatebenefratelli Hospital , Rome , Italy
| | - Luisa Carbognin
- n U.O.C. Oncology , University of Verona, Azienda Ospedaliera Universitaria Integrata , Verona , Italy
| | - Marco Mazzotta
- j Department of Clinical and Molecular Medicine , "Sapienza" University of Rome, Azienda Ospedaliera Sant'Andrea , Rome , Italy
| | - Emilio Bria
- n U.O.C. Oncology , University of Verona, Azienda Ospedaliera Universitaria Integrata , Verona , Italy
| | - Jennifer Foglietta
- o Department of Medical Oncology , University of Perugia, Santa Maria della Misericordia Hospital , Perugia , Italy
| | | | - Carlo Garufi
- q Division of Medical Oncology , Pescara Hospital , Pescara , Italy
| | - Luciano Mariani
- r HPV Unit, Department of Gynaecologic Oncology , IRCCS Regina Elena National Cancer Institute , Rome , Italy
| | - Sandro Barni
- s Department of Oncology, Oncology Unit , ASST Bergamo Ovest , Treviglio , Italy
| | - Rosanna Mirabelli
- t Department of Hematology & Oncology , Azienda Ospedaliera Pugliese-Ciaccio , Catanzaro , Italy
| | | | - Vincenzo Graziano
- v Medical Oncology Unit , SS Annunziata Hospital , Chieti , Italy.,w Breast Medical Oncology Unit , G. Bernabeo Hospital , Ortona , Italy
| | - Daniele Santini
- h Department of Oncology , University Campus Biomedico of Rome , Rome , Italy
| | - Paolo Marchetti
- j Department of Clinical and Molecular Medicine , "Sapienza" University of Rome, Azienda Ospedaliera Sant'Andrea , Rome , Italy
| | - Giuseppe Tonini
- h Department of Oncology , University Campus Biomedico of Rome , Rome , Italy
| | - Luigi Di Lauro
- c Division of Medical Oncology 2 , IRCCS Regina Elena National Cancer Institute , Rome , Italy
| | - Giuseppe Sanguineti
- x Department of Radiation Oncology , IRCCS Regina Elena National Cancer Institute , Rome , Italy
| | - Giancarlo Paoletti
- c Division of Medical Oncology 2 , IRCCS Regina Elena National Cancer Institute , Rome , Italy
| | - Silverio Tomao
- g Medical Oncology Unit , Policlinico Umberto I , Rome , Italy
| | - Ruggero De Maria
- y Institute of General Pathology , Catholic University of the Sacred Heart , Rome , Italy
| | - Enzo Veltri
- z Oncology Unit , S. Maria Goretti Hospital , Latina , Italy
| | - Ida Paris
- aa Gynecology Oncology Unit , Catholic University of the Sacred Heart , Rome , Italy
| | - Francesco Giotta
- ab Department of Medical Oncology , "Giovanni Paolo II" Institute , Bari , Italy
| | - Agnese Latorre
- ab Department of Medical Oncology , "Giovanni Paolo II" Institute , Bari , Italy
| | - Antonio Giordano
- ac Center for Biotechnology , Sbarro Institute for Cancer Research and Molecular Medicine, College of Science and Technology, Temple University , Philadelphia , PA , USA
| | - Gennaro Ciliberto
- f Scientific Direction , IRCCS Regina Elena National Cancer Institute , Rome , Italy
| | - Patrizia Vici
- c Division of Medical Oncology 2 , IRCCS Regina Elena National Cancer Institute , Rome , Italy
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Garassino MC, Kawaguchi T, Gregorc V, Rulli E, Ando M, Marsoni S, Isa SI, Novello S, Farina G, Barni S, Torri V, Cinquini M. Chemotherapy versus erlotinib as second-line treatment in patients with advanced non-small cell lung cancer and wild-type epidermal growth factor receptor: an individual patient data (IPD) analysis. ESMO Open 2018; 3:e000327. [PMID: 30555723 PMCID: PMC6267321 DOI: 10.1136/esmoopen-2018-000327] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 03/15/2018] [Accepted: 03/19/2018] [Indexed: 11/28/2022] Open
Abstract
The efficacy of second-line treatment in patients with epidermal growth factor receptor (EGFR) wild-type tumours is still debatable. We assessed the efficacy of a standard second-line chemotherapy compared with erlotinib in an individual patient data approach for meta-analysis. The primary endpoint was overall survival (OS), and secondary endpoint was progression-free survival (PFS). Both were compared by log-rank test. The 'restricted mean survival time' (RMST) was estimated in each study and the difference in mean survival time up to the last available time point was calculated. The Cox proportional hazards model was used on survival analyses to provide HRs, to adjust for confounding variables and to test possible interaction with selected factors. Three randomised trials comparing chemotherapy versus erlotinib were analysed, including 587 randomised patients. Overall, 74% of patients included in the original trials were considered. 464 deaths and 570 progressions or deaths were observed. Compared with erlotinib, chemotherapy was associated to a decreased risk of progression (29%; HR: 0.71, 95% CI: 0.60 to 0.84, p< 0.0001;) but with no statistical significant reduction in OS (HR: 0.89, 95% CI: 0.74 to 1.06; p<0.20). No heterogeneity was found in both analyses. Patients treated with chemotherapy gained an absolute 1.5 and 1.6 months, respectively, in PFS and lifetime (RMST 95% CI: PFS 0.49 to 2.44; OS 95% CI: -1.04 to 4.25). These results showed that patients without a constitutively activated EGFR had better PFS with chemotherapy rather than with erlotinib while no statistical difference was observed in OS.
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Affiliation(s)
| | - Tomoya Kawaguchi
- Osaka City University, Graduate School of Medicine, Osaka, Japan
| | - Vanesa Gregorc
- Ospedale San Raffaele Scientific Institute, Vimodrone, Italy
| | - Eliana Rulli
- Oncology Department, IRCCS-Mario Negri Institute for Pharmacological Research, Milano, Italy
| | - Masahiko Ando
- Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan
| | - Silvia Marsoni
- Istituto di Candiolo, Fondazione del Piemonte per l’Oncologia-IRCCS, Candiolo, Italy
| | - Shun-ichi Isa
- National Hospital Organization, Kinki-Chuo Chest Medical Center, Osaka, Japan
| | - Silvia Novello
- Azienda Ospedaliero-Universitaria S. Luigi Gonzaga, Orbassano, Italy
| | - Gabriella Farina
- O.U. Medical Oncology, A.O. Fatebenefratelli e Oftalmico, Milan, Italy
| | - Sandro Barni
- Division of Oncology, Azienda Ospedaliera Treviglio, Treviglio, Italy
| | - Valter Torri
- Oncology Department, IRCCS-Mario Negri Institute for Pharmacological Research, Milano, Italy
| | - Michela Cinquini
- Oncology Department, IRCCS-Mario Negri Institute for Pharmacological Research, Milano, Italy
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Petrelli F, Ardito R, Borgonovo K, Lonati V, Cabiddu M, Ghilardi M, Barni S. Haematological toxicities with immunotherapy in patients with cancer: a systematic review and meta-analysis. Eur J Cancer 2018; 103:7-16. [DOI: 10.1016/j.ejca.2018.07.129] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 06/20/2018] [Accepted: 07/24/2018] [Indexed: 01/20/2023]
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Lissoni P, Meregalli S, Fossati V, Paolorossi F, Barni S, Tancini G, Frigerio F. A Randomized Study of Immunotherapy with Low-Dose Subcutaneous Interleukin-2 plus Melatonin Vs Chemotherapy with Cisplatin and Etoposide as First-Line Therapy for Advanced Non-Small Cell Lung Cancer. Tumori 2018; 80:464-7. [PMID: 7900237 DOI: 10.1177/030089169408000611] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [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 The theraputic role of chemotherapy in advanced non-small cell lung cancer (NSCLC) is controversial because of its potentially detrimental action on host anticancer defenses. On the contrary, IL-2 would seem to prolong survival time by improving the immune status, even though it is generally less effective in determining tumor regression in NSCLC. Our previous studies have suggested the possibility of increasing tumor sensitivity to IL-2 by concomitant administration of immunomodulating neurohormones, such as the pineal hormone melatonin (MLT). On this basis, a study was carried out to evaluate the efficacy of immunotherapy with low-dose IL-2 plus MLT versus chemotherapy in advanced NSCLC. Methods The study included 60 patients with locally advanced or metastatic NSCLC, who were randomized to receive immunotherapy or chemotherapy. The immunotherapy consisted of IL-2 (3 million IU/day subcutaneously for 6 days/week for 4 weeks) and MLT (40 mg/day orally every day, starting 7 days before IL-2); in nonprogressing patients, a second cycle was repeated after a 21-day rest period, then they underwent a maintenance period consisting of one week of therapy every month until progression. Chemotherapy consisted of cisplatin (20 mg/m2) and etoposide (100 mg/m2)/day intravenously for 3 days; cycles of chemotherapy were repeated every 21 days until progression. Results No complete response was obtained. A partial response was achieved in 7/29 patients treated with chemotherapy and in 6/31 patients receiving chemotherapy. The difference was not significant. In contrast, the mean progression-free period and the percentage survival at 1 year was significantly higher in patients treated with immunotherapy than in those treated with chemotherapy. Toxicity was substantially lower in patients receiving immunotherapy than in those given chemotherapy. Conclusions This randomized study showed that immunotherapy with low-dose IL-2 plus MLT is a better tolerated and more effective therapy in terms of survival time than chemotherapy containing cisplatin in patients affected by advanced NSCLC.
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Affiliation(s)
- P Lissoni
- Divisione di Radioterapia Oncologica, Ospedale San Gerardo, Monza, Milano, Italia
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Abstract
In order to investigate the production of interleukin-2 (IL-2) in human neoplasms, we determined IL-2 and soluble IL-2 receptors (sIL-2R) in serum from 18 patients with lymphoma and 28 patients with solid tumors, with (15 cases) or without (13 cases) metastases. As controls, 58 healthy subjects were evaluated. Low levels of IL-2 were not observed in patients with lymphoma or limited solid tumor but abnormally low concentrations of IL-2 were seen in 4/15 metastatic solid tumors, associated with abnormally high values of sIL-2R. This preliminary study confirms in vivo the reduced IL-2 production in metastatic solid neoplasms, previously documented in vitro
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Affiliation(s)
- P Lissoni
- Division of Radiation Oncology, Ospedale San Gerardo, Monza, Italy
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Barni S, Curtit E, Cognetti F, Bourgeois D, Masetti R, Zilberman S, Naso G, Gligorov J. Real-life utilization of genomic testing for invasive breast cancer patients in Italy and France reduces chemotherapy recommendations. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy270.189] [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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47
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Barni S, Rosati G, Zagonel V, Pella N, Banzi M, Zampino M, Di Bartolomeo M, Rimassa L, Marchetti P, Maiello E, Artioli F, Ferrari D, Labianca R, Bidoli P, Zaniboni A, Sobrero A, Iaffaioli V, de Placido S, Frassineti L, Galli F, Petrelli F. Thromboembolic risk and survival with Khorana score in resected colorectal cancer patients: Subgroup analysis from the adjuvant TOSCA trial. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy281.129] [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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48
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Petrelli F, Rosati G, Banzi M, Zampino M, Pella N, Di Bartolomeo M, Maiello E, Bidoli P, Ferrari D, Rimassa L, Labianca R, Scartozzi M, Lonardi S, de Placido S, Zaniboni A, Sobrero A, Frassineti L, Silvestris N, Corsi D, Galli F, Barni S. Prognostic value of neutrophil-lymphocite ratio in resected high risk colorectal cancer: An analysis of adjuvant TOSCA trial. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy281.069] [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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Santini D, Brandi G, Aprile G, Russano M, Cereda S, Leone F, Lonardi S, Fornaro L, Scartozzi M, Silvestris N, Barni S, Pantano F, Vincenzi B, Palloni A, Frega G, Casagrande M, Ferrari L, Dadduzio V, Intini R, Filippi R, Vasile E, Vivaldi C, Faloppi L, Brunetti O, Reni M, Aglietta M, Tonini G. Bone metastases in biliary cancers: A multicenter retrospective survey. J Bone Oncol 2018; 12:33-37. [PMID: 30042924 PMCID: PMC6054714 DOI: 10.1016/j.jbo.2017.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 11/18/2017] [Accepted: 11/24/2017] [Indexed: 10/24/2022] Open
Abstract
•Natural history of biliary cancers metastatic to bone•The role of skeletal events in patients with biliary cancer•Biliary cancer and bone metastases: role of bisphosphonates.
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Affiliation(s)
- D Santini
- Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
| | - G Brandi
- Department of Experimental, Diagnostic and Speciality Medicine, Sant'Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - G Aprile
- Department of Oncology, San Bortolo Hospital, ULSS8 Berica–East District, Vicenza, Italy
- Department of Oncology, University and General Hospital, Udine, Italy
| | - M Russano
- Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
| | - S Cereda
- Department of Medical Oncology, San Raffaele Scientific Institute, Milan, Italy
| | - F Leone
- Department of Oncology, University of Turin Medical School/Piedmont Foundation for Oncology, Candiolo Cancer Institute - FPO, IRCCS, Candiolo, Italy
| | - S Lonardi
- Medical Oncology Unit 1, Department of Clinical and Experimental Oncology, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - L Fornaro
- Unit of Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126, Italy
| | - M Scartozzi
- Medical Oncology, Hospital & University of Cagliari, Italy
| | - N Silvestris
- Medical Oncology Unit, Cancer Institute ``Giovanni Paolo II'', 70124 Bari, Italy
| | - S Barni
- Medical Oncology Unit, ASST Bergamo Ovest, Piazzale Ospedale 1, 24047 Treviglio, Bergamo, Italy
| | - F Pantano
- Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
| | - B Vincenzi
- Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
| | - A Palloni
- Department of Experimental, Diagnostic and Speciality Medicine, Sant'Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - G Frega
- Department of Experimental, Diagnostic and Speciality Medicine, Sant'Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - M Casagrande
- Department of Oncology, University and General Hospital, Udine, Italy
| | - L Ferrari
- Department of Oncology, University and General Hospital, Udine, Italy
| | - V Dadduzio
- Medical Oncology Unit 1, Department of Clinical and Experimental Oncology, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - R Intini
- Medical Oncology Unit 1, Department of Clinical and Experimental Oncology, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - R Filippi
- Department of Oncology, University of Turin Medical School/Piedmont Foundation for Oncology, Candiolo Cancer Institute - FPO, IRCCS, Candiolo, Italy
| | - E Vasile
- Unit of Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126, Italy
| | - C Vivaldi
- Unit of Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126, Italy
| | - L Faloppi
- Medical Oncology, Hospital of Macerata, Macerata, Italy & Medical Oncology, University of Cagliari, Italy
| | - O Brunetti
- Medical Oncology Unit, Cancer Institute ``Giovanni Paolo II'', 70124 Bari, Italy
| | - M Reni
- Department of Medical Oncology, San Raffaele Scientific Institute, Milan, Italy
| | - M Aglietta
- Department of Oncology, University of Turin Medical School/Piedmont Foundation for Oncology, Candiolo Cancer Institute - FPO, IRCCS, Candiolo, Italy
| | - G Tonini
- Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
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Mori F, Angelucci C, Cianferoni A, Barni S, Indolfi G, Casini A, Mangone G, Materassi M, Pucci N, Azzari C, Novembre E. Increase of natural killer cells in children with liver transplantation-acquired food allergy. Allergol Immunopathol (Madr) 2018; 46:447-453. [PMID: 29456038 DOI: 10.1016/j.aller.2017.09.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 09/14/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Transplantation-acquired food allergies (TAFA) are frequently reported and considered to be caused by immunosuppressive therapy. The aim of this study was to investigate the allergic and immunologic responses in children who had liver or kidney transplantations. METHODS Twelve children receiving liver transplantations and 10 children receiving kidney transplantations were investigated. All children underwent the allergy work-up and in most of them, lymphocyte screening and serum cytokine measurements were also performed. RESULTS TAFA were found in 7/12 (58%) children with liver transplantations and in none of the 10 children with kidney transplantations. The mean age at transplantation was significantly lower in children who underwent liver transplantations (p<0.001). The immunosuppressive therapy administered to children with liver transplantation was tacrolimus in 11 patients and cyclosporine in one patient, while all 10 children with kidney transplantation received tacrolimus plus mycophenolate. The most common antigenic food was egg. The natural killer (NK) cell numbers were significantly higher in liver-transplant children than in kidney-transplant children. No significant differences were found in the serum cytokine levels. CONCLUSIONS This study confirms that liver-transplant children treated with tacrolimus alone have a higher risk of developing TAFA than kidney-transplant children treated with tacrolimus plus mycophenolate. NK cells might be involved in this difference.
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Affiliation(s)
- F Mori
- Allergy Unit, Department of Paediatrics, Anna Meyer Children's University Hospital, Florence, Italy
| | - C Angelucci
- Allergy Unit, Department of Paediatrics, Anna Meyer Children's University Hospital, Florence, Italy
| | - A Cianferoni
- Allergy and Immunology Division, Children's Hospital of Philadelphia, PA, USA
| | - S Barni
- Allergy Unit, Department of Paediatrics, Anna Meyer Children's University Hospital, Florence, Italy.
| | - G Indolfi
- Pediatric and Liver Unit, Meyer Children's University Hospital of Florence, Florence, Italy
| | - A Casini
- Division of Immunology, Section of Paediatrics, Department of Health Sciences, Anna Meyer Children's University Hospital, Florence, Italy
| | - G Mangone
- Division of Immunology, Section of Paediatrics, Department of Health Sciences, Anna Meyer Children's University Hospital, Florence, Italy
| | - M Materassi
- Pediatric Nephrology Unit, Meyer Children's University Hospital, Florence, Italy
| | - N Pucci
- Allergy Unit, Department of Paediatrics, Anna Meyer Children's University Hospital, Florence, Italy
| | - C Azzari
- Pediatric and Liver Unit, Meyer Children's University Hospital of Florence, Florence, Italy
| | - E Novembre
- Allergy Unit, Department of Paediatrics, Anna Meyer Children's University Hospital, Florence, Italy
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