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Bavaro DF, Pizzutilo P, Catino A, Signorile F, Pesola F, Di Gennaro F, Cassiano S, Marech I, Lamorgese V, Angarano G, Monno L, Saracino A, Galetta D. Incidence of Infections and Predictors of Mortality During Checkpoint Inhibitor Immunotherapy in Patients With Advanced Lung Cancer: A Retrospective Cohort Study. Open Forum Infect Dis 2021; 8:ofab187. [PMID: 34141817 PMCID: PMC8204890 DOI: 10.1093/ofid/ofab187] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 04/09/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs) have revolutionized nonsmall cell lung cancer (NSCLC) treatment and significantly increased overall survival of patients. However, the incidence of concurrent infections and their management is still debated. METHODS From August 2015 to October 2019, all consecutive patients with NSCLC who received nivolumab or pembrolizumab as first- or second-line therapy were retrospectively evaluated. At the time of analysis all patients had died. Clinical characteristics of patients, type of infections, and predictors of mortality were analyzed. RESULTS A total of 118 patients were identified: 74 in the nivolumab group and 44 in the pembrolizumab group. At least 1 infection was recorded in 22% of the nivolumab-group versus 27% of the pembrolizumab-group (P = .178). In both groups, the main infection was pneumonia, followed by skin and soft tissue infections, urinary tract infections, and gastroenteritis. Crude mortality for first infection was 10.7%, followed by 25% and 40% for the second and third recurrence, respectively (p for trend = .146). No opportunistic infections were recorded. It is notable that, by Cox-regression model, the independent predictor of mortality was a higher Eastern Cooperative Oncology Group performance status at baseline (P < .001), whereas the multidisciplinary diagnosis and treatment of concurrent infections was associated with a reduced probability of mortality (adjusted hazard ratio = 0.50; 95% confidence interval = 0.30-0.83; P < .001). CONCLUSIONS In patients with NSCLC treated with ICIs, multidisciplinary management of concurrent infections may reduce the risk of mortality. Further studies to investigate risk factors for infections, as well as appropriate management strategies and preventive measures in this setting, are warranted.
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Affiliation(s)
- Davide Fiore Bavaro
- University of Bari “Aldo Moro,” Department of Biomedical Sciences and Human Oncology, Clinic of Infectious Diseases, Bari, Italy
| | - Pamela Pizzutilo
- Thoracic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari, Italy
| | - Annamaria Catino
- Thoracic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari, Italy
| | - Fabio Signorile
- University of Bari “Aldo Moro,” Department of Biomedical Sciences and Human Oncology, Clinic of Infectious Diseases, Bari, Italy
| | - Francesco Pesola
- Thoracic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari, Italy
| | - Francesco Di Gennaro
- University of Bari “Aldo Moro,” Department of Biomedical Sciences and Human Oncology, Clinic of Infectious Diseases, Bari, Italy
| | - Sandro Cassiano
- Thoracic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari, Italy
| | - Ilaria Marech
- Thoracic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari, Italy
| | - Vito Lamorgese
- Thoracic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari, Italy
| | - Gioacchino Angarano
- University of Bari “Aldo Moro,” Department of Biomedical Sciences and Human Oncology, Clinic of Infectious Diseases, Bari, Italy
| | - Laura Monno
- University of Bari “Aldo Moro,” Department of Biomedical Sciences and Human Oncology, Clinic of Infectious Diseases, Bari, Italy
| | - Annalisa Saracino
- University of Bari “Aldo Moro,” Department of Biomedical Sciences and Human Oncology, Clinic of Infectious Diseases, Bari, Italy
| | - Domenico Galetta
- Thoracic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari, Italy
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Bafunno D, Catino A, Lamorgese V, Longo V, Montrone M, Pesola F, Pizzutilo P, Petrillo P, Varesano N, Zacheo A, Del Bene G, Lapadula V, Mastrandrea A, Ricci D, Di Lauro A, Cassiano S, Galetta D. Smoking Prevalence, Knowledge and Perceptions on Tobacco Control Among Healthcare Professionals: A Survey in an Italian Cancer Center. J Community Health 2021; 46:597-602. [PMID: 32789714 DOI: 10.1007/s10900-020-00907-8] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Smoking is recognized as the major cause of lung cancer. Healthcare professionals play an important role in lung cancer prevention policies, as they act as a source of guidance for patients and advocates. The following survey evaluated prevalence, knowledge, and attitudes toward tobacco smoking among a sample of workers in "IRCCS Istituto Tumori "Giovanni Paolo II" of Bari, an Italian cancer hospital. An anonymous questionnaire was completed by 104 healthcare professionals to collect personal and occupational data about smoking status, knowledge about the harms of smoking, current legislation in place, Second-Hand Smoke (SHS) awareness, and, for ex-smokers, the reasons for quitting. Among participants, 17.8% were current smokers, 26.2% former smokers, and 56% never smoked. Only 40% acknowledged that the smoking ban is generally respected, and 63.2% reported that they smoke during working hours. Most of the participants perceived tobacco control policy as an efficient way to protect public health. Currently, the implementation of Italian anti-smoking legislation has so far improved neither smoking cessation rates nor the will to quit smoking completely. Our experience highlights that to date the anti-smoking strategies have limited efficacy even in a cancer center; in fact, there is still a large prevalence of smokers among hospital personnel. Therefore, it is strongly suggested that interventions be shared with all healthcare workers, specifically aimed at developing a culture of health promotion.
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Affiliation(s)
- Daniela Bafunno
- IRCCS Istituto Tumori "Giovanni Paolo II" 65, Viale Orazio Flacco, 70124, Bari, Italy
| | - Annamaria Catino
- IRCCS Istituto Tumori "Giovanni Paolo II" 65, Viale Orazio Flacco, 70124, Bari, Italy.
| | - Vito Lamorgese
- IRCCS Istituto Tumori "Giovanni Paolo II" 65, Viale Orazio Flacco, 70124, Bari, Italy
| | - Vito Longo
- IRCCS Istituto Tumori "Giovanni Paolo II" 65, Viale Orazio Flacco, 70124, Bari, Italy
| | - Michele Montrone
- IRCCS Istituto Tumori "Giovanni Paolo II" 65, Viale Orazio Flacco, 70124, Bari, Italy
| | - Francesco Pesola
- IRCCS Istituto Tumori "Giovanni Paolo II" 65, Viale Orazio Flacco, 70124, Bari, Italy
| | - Pamela Pizzutilo
- IRCCS Istituto Tumori "Giovanni Paolo II" 65, Viale Orazio Flacco, 70124, Bari, Italy
| | - Patrizia Petrillo
- IRCCS Istituto Tumori "Giovanni Paolo II" 65, Viale Orazio Flacco, 70124, Bari, Italy
| | - Niccolò Varesano
- IRCCS Istituto Tumori "Giovanni Paolo II" 65, Viale Orazio Flacco, 70124, Bari, Italy
| | - Antonella Zacheo
- IRCCS Istituto Tumori "Giovanni Paolo II" 65, Viale Orazio Flacco, 70124, Bari, Italy
| | - Gabriella Del Bene
- IRCCS Istituto Tumori "Giovanni Paolo II" 65, Viale Orazio Flacco, 70124, Bari, Italy
| | - Vittoria Lapadula
- IRCCS Istituto Tumori "Giovanni Paolo II" 65, Viale Orazio Flacco, 70124, Bari, Italy
| | - Angelica Mastrandrea
- IRCCS Istituto Tumori "Giovanni Paolo II" 65, Viale Orazio Flacco, 70124, Bari, Italy
| | - Donata Ricci
- IRCCS Istituto Tumori "Giovanni Paolo II" 65, Viale Orazio Flacco, 70124, Bari, Italy
| | - Alessandra Di Lauro
- IRCCS Istituto Tumori "Giovanni Paolo II" 65, Viale Orazio Flacco, 70124, Bari, Italy
| | - Sandro Cassiano
- IRCCS Istituto Tumori "Giovanni Paolo II" 65, Viale Orazio Flacco, 70124, Bari, Italy
| | - Domenico Galetta
- IRCCS Istituto Tumori "Giovanni Paolo II" 65, Viale Orazio Flacco, 70124, Bari, Italy
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Bavaro D, Pizzutilo P, Signorile F, Pesola F, Cassiano S, Marech I, Lamorgese V, Angarano G, Monno L, Saracino A, Catino A, Galetta D. P75.21 Impact of Diagnosis and Treatment of Concurrent Infections during Immunotherapy in Advanced Lung Cancer: A Retrospective Cohort Study. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.1656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Catino A, Perrotti P, Cassiano S, Montrone M, Longo V, Galetta D. [RET rearrangements in advanced lung cancer: a target to always look for.]. Recenti Prog Med 2021; 112:33e-36e. [PMID: 33624634 DOI: 10.1701/3559.35382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Introduction . RET rearrangements have been recently aroused growing interest, due to the availability of target therapies increasingly active and safe. The search for these oncogenic alterations in patients with advanced lung adenocarcinoma has become an integral part of the biomolecular tumoral assessment, in order to possibly provide a selective therapeutical option also for rare subgroups of patients, but belonging to lung cancer that is considered a "big killer", representing the most frequent cause of cancer-related death worldwide. Following to the introduction of modern biomolecular techniques, such as the comprehensive genome profiling (CGP), that has been added to the immunohistochemistry (IHC) and the "in situ fluorescent ibridation" (FISH), the availability of techniques based on genomic sequencing such as the next generation sequencing (NGS), achievable either on tumoral tissue or on plasma, has made it easier to identify oncogenic alterations that, although rare, are potentially treatable with molecularly targeted drugs. A complete molecular assessment should preferable be obtained at the first diagnosis, in order not to neglect the possibility of using target drugs if indicated, but it is possible and desiderable to complete or to re-determine the biomolecular profile also during the clinical course, due to the possibility of spontaneous or drug-induced resistance mechanisms that can modify the biomolecular tumoral characteristics; this reassessment is achievable both through tissutal rebiopsy and by plasma test, the so-called "liquid biopsy". Clinical case . In this report, we describe the case of a patient with advanced lung adenocarcinoma, pretreated with multiple chemo- and immuno-therapic lines of treatment; at baseline, the biomolecular profile was not complete, as well as during the clinical course through repeated re-biopsies. Conclusions . At the time of further disease progression, a liquid biopsy with NGS revealed the presence of a RET rearrangement. This clinical case underscores the importance of a complete biomolecolar assessment in order to identify target linked to effective and innovative treatment options; it is also highlighted the usefulness of the modern CGP techniques, applicable to tumoral tissue and plasma.
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Affiliation(s)
- Annamaria Catino
- SSD Oncologia Medica per la Patologia Toracica, IRCCS Istituto Tumori "Giovanni Paolo II", Bari
| | - Pia Perrotti
- SSD Oncologia Medica per la Patologia Toracica, IRCCS Istituto Tumori "Giovanni Paolo II", Bari
| | - Sandro Cassiano
- SSD Oncologia Medica per la Patologia Toracica, IRCCS Istituto Tumori "Giovanni Paolo II", Bari
| | - Michele Montrone
- SSD Oncologia Medica per la Patologia Toracica, IRCCS Istituto Tumori "Giovanni Paolo II", Bari
| | - Vito Longo
- SSD Oncologia Medica per la Patologia Toracica, IRCCS Istituto Tumori "Giovanni Paolo II", Bari
| | - Domenico Galetta
- SSD Oncologia Medica per la Patologia Toracica, IRCCS Istituto Tumori "Giovanni Paolo II", Bari
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Bafunno D, Catino A, Lamorgese V, Del Bene G, Longo V, Montrone M, Pesola F, Pizzutilo P, Cassiano S, Mastrandrea A, Ricci D, Petrillo P, Varesano N, Zacheo A, Galetta D. Impact of tobacco control interventions on smoking initiation, cessation, and prevalence: a systematic review. J Thorac Dis 2020; 12:3844-3856. [PMID: 32802466 PMCID: PMC7399441 DOI: 10.21037/jtd.2020.02.23] [Citation(s) in RCA: 14] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article investigates the effects of tobacco control policies on smoking initiation, cessation and prevalence by examining the papers published in the last 5 years. Twenty-one articles have been selected by two authors and sorted by four types of tobacco control: tobacco prices, anti-smoking campaigns for young people, mass media intervention and public smoking bans. Price/tax increase has deterrent effect on smoking initiation but does not promote smoking cessation; intervention on young people could reduce the smoking initiation if carried out at an early age and if acted on social skills and with peer-led approach, as opposed to restraining measures which hare generally easily circumvented by young people. The mass media campaigns showed positive effect on attempts to quit among smokers if carried forward over time and by involving multiple communication channels (TV, internet, radio). The bans in public have little effect on smoking cessation but could improve the overall well-being of non-smokers. Heterogeneous results have been described by different studies probably because of different research methodologies, cultural aspects and the really effective implementation of the rules for each country. In conclusion, comprehensive tobacco control interventions to reduce smoking prevalence and modify the smoking behavior are recommended. Moreover, the use of e-cigarettes and heat-not-burn (HnB) products, as possible helping tool for smoke cessation, currently remains controversial.
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Affiliation(s)
- Daniela Bafunno
- Thoracic Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Annamaria Catino
- Thoracic Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Vito Lamorgese
- Thoracic Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Gabriella Del Bene
- Thoracic Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Vito Longo
- Thoracic Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Michele Montrone
- Thoracic Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Francesco Pesola
- Thoracic Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Pamela Pizzutilo
- Thoracic Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Sandro Cassiano
- Thoracic Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | | | - Donata Ricci
- Thoracic Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Patrizia Petrillo
- Thoracic Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Niccolò Varesano
- Thoracic Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Antonella Zacheo
- Thoracic Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Domenico Galetta
- Thoracic Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
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