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Petrelli F, Cherri S, Ghidini M, Tomasello G, Ghidini A, Zaniboni A. Efficacy of different maintenance strategies for RAS wild-type colorectal cancer: A network meta-analysis. Dig Liver Dis 2024; 56:242-247. [PMID: 37369616 DOI: 10.1016/j.dld.2023.06.008] [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: 04/03/2023] [Revised: 06/05/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023]
Abstract
INTRODUCTION In metastatic RAS wild-type colorectal cancer (CRC), induction combination chemotherapy doublets (CT) with an anti-EGFR agent are considered the primary treatment. We performed a network meta-analysis (NMA) to compare the relative efficacy of different maintenance treatments for advanced RAS wild-type CRC. MATERIALS AND METHODS PubMed, EMBASE and Cochrane, from database inception until December 2021 were used. Randomized clinical trials enrolling adults with advanced RAS wild-type CRC and providing overall survival (OS) and/or progression-free survival (PFS) data PRISMA guidelines for NMA were followed. Between-group comparisons were estimated using hazard ratios (HRs) with 95% credible intervals (95% CrIs). Agents were ranked using surface under the cumulative ranking (SUCRA) probabilities. RESULTS A total of 7 randomized phase 2 trials were included (for a total of 1286 patients). Compared to depotentiation treatments, continuous CT + anti-EGFR was not significantly superior to other maintenance regimens for OS and was ranked as the best option for NMA (SUCRA p-score=0.69). Conversely, in the PFS analysis, single-agent fluoropyrimidines + anti-EGFR was ranked as the best treatment (SUCRA p-score=0.60). CONCLUSIONS Maintaining chemotherapy doublet + anti-EGFR until progression appears to be the best first-line strategy in terms of OS for advanced unresectable RAS wild-type mCRC treatment. However, fluoropyrimidines single-agent + cetuximab or panitumumab represent a reasonable choice regarding PFS.
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Affiliation(s)
| | - Sara Cherri
- Oncology Unit, Fondazione Poliambulanza, Brescia, Italy
| | - Michele Ghidini
- Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Gianluca Tomasello
- Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
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2
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Cherri S, Oneda E, Zanotti L, Zaniboni A. Optimizing the first-line treatment for metastatic colorectal cancer. Front Oncol 2023; 13:1246716. [PMID: 37909027 PMCID: PMC10614157 DOI: 10.3389/fonc.2023.1246716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 10/02/2023] [Indexed: 11/02/2023] Open
Abstract
Colorectal cancer represents an important oncological challenge both for its incidence, which makes it an important health problem, and for its biological complexity, which has made clinical results very difficult in terms of outcome for this category of patients. To date these diseases should not be treated as a single entity but it is necessary to distinguish colorectal cancers based on characteristics that nowadays are essential to have greater therapeutic benefits. These include the sideness of the disease, the state of microsatellites, the presence of prognostic and predictive mutations of response to treatments currently available in clinical practice, which are associated with new therapeutic targets. The greatest challenge in the future will be to circumvent the resistance mechanisms that make this disease very difficult to treat with good long-term results by studying effective combination treatments with a good toxicity profile. Once such combinations or targeted treatments are consolidated, it will be desirable to shift the best therapies to the first line treatment to make them immediately accessible to the patient. It will also be essential to refine the selection of patients who can benefit from these treatments.
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Affiliation(s)
- Sara Cherri
- Department of Clinical Oncology, Fondazione Poliambulanza, Brescia, Italy
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Alzayer R, Barakat M, Jirjees F, Alhamdan A, Aloraifej S, Cherri S, Mansour S, El Khatib S, Kharaba Z, Rahal M, Hallit S, Malaeb D, Hosseini H. Knowledge and awareness of stroke and associated factors in the Saudi general population: a cross-sectional study. Front Neurol 2023; 14:1225980. [PMID: 37808501 PMCID: PMC10552853 DOI: 10.3389/fneur.2023.1225980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 08/29/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction Stroke is a major cause of death and disability globally and in Saudi Arabia as well. Prevention and management of stroke depend highly on raising knowledge and awareness about the disease. Purpose The purpose of this study was to evaluate Saudi adult's knowledge and awareness about stroke and determine the associated factors. Materials and methods A cross-sectional online survey was conducted in May-July 2022 among Saudi citizens. Assessments of stroke knowledge about risk factors, symptoms, and response to stroke symptoms were evaluated. Logistic regression was conducted to assess the association between the socio-demographic characteristics and knowledge. Results A total of 389 participants were enrolled with the majority (81.7%) being male participants. Less than half of the study subjects (43.3%) identified four out of five correct answers related to general knowledge about stroke. Almost all the participants were able to identify at least one risk factor associated with stroke. The majority of the participants (81.2%) believed that physical inactivity was the most common risk factor associated with stroke. Approximately three-quarters of participants considered difficulty speaking and understanding speech, followed by the sudden loss of consciousness as the most common stroke manifestation. Participants with a history of hypertension, dyslipidemia, and obesity had significantly higher odds of identifying at least one early stroke symptom (OR 2.271 [95% CI 1.402 3.677], 2.059 [95% CI 1.273 3.328], and 2.665 [95% CI 1.431 4.963], respectively). Conclusion Our study revealed that participants have good knowledge about stroke. Nonetheless, further efforts are required to raise awareness and educate the public to optimize and ensure better treatment outcomes.
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Affiliation(s)
- Reem Alzayer
- Clinical Pharmacy Practice, Mohammed Al-Mana College for Medical Sciences (MACHS), Dammam, Saudi Arabia
| | - Muna Barakat
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
- MEU Research Unit, Middle East University, Amman, Jordan
| | - Feras Jirjees
- Clinical Pharmacy and Pharmacy Practice, University of Sharjah, Sharjah, United Arab Emirates
| | | | - Shatha Aloraifej
- Clinical Pharmacy Practice, Mohammed Al-Mana College for Medical Sciences (MACHS), Dammam, Saudi Arabia
| | - Sara Cherri
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Sara Mansour
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Sami El Khatib
- Department of Biomedical Sciences, Lebanese International University, Bekaa, Lebanon
- Center for Applied Mathematics and Bioinformatics (CAMB), Gulf University for Science and Technology, Mubarak Al-Abdullah, Kuwait
| | - Zelal Kharaba
- Department of Clinical Pharmacy, College of Pharmacy, Al Ain University, Abu Dhabi, United Arab Emirates
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Mohamad Rahal
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon
- Research Department, Psychiatric Hospital of the Cross, Jal El Dib, Lebanon
| | - Diana Malaeb
- College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates
| | - Hassan Hosseini
- Neurology Department, Henri Mondor Hospital, AP-HP, Créteil, France
- INSERM U955-E01, Institut Mondor de Recherche Biomedicale (IMRB), UPEC-Universite Paris-Est, Créteil, France
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Cherri S, Oneda E, Noventa S, Melocchi L, Zaniboni A. Microsatellite instability and chemosensitivity in solid tumours. Ther Adv Med Oncol 2022; 14:17588359221099347. [PMID: 35620236 PMCID: PMC9127927 DOI: 10.1177/17588359221099347] [Citation(s) in RCA: 1] [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: 02/13/2022] [Accepted: 04/21/2022] [Indexed: 01/01/2023] Open
Abstract
The use of biomarkers that influence a targeted choice in cancer treatments is the future of medical oncology. Within this scenario, in recent years, an important role has been played by knowledge of microsatellite instability (MSI), a molecular fingerprint that identifies defects in the mismatch repair system. This knowledge has changed clinical practice in the adjuvant setting of colon cancer, and its role in the neoadjuvant setting in gastric tumours is becoming increasingly interesting, as well as in endometrial cancers in both early and advanced diseases. Furthermore, it has undoubtedly conditioned the first lines of treatment in the metastatic setting in different types of cancers. The incidence of MSI is different in different cancer types, as well as in early cancers versus metastatic disease. Knowing the incidence of MSI in the various histologies can provide insight into the potential use of this biomarker considering its prognostic value, especially in the early stages, and its predictive role with respect to treatment response. In particular, MSI can guide the choice of chemotherapy treatments in the adjuvant setting of colon and perioperative setting in gastric tumours, which could lead to immunotherapy treatments in these patients in both the early stages of the disease and the metastatic setting where the response to immunotherapy drugs in diseases with MSI is now well established. In this review, we focus on colon, gastric and endometrial cancers, and we briefly discuss other cancer types where MSI could have a potential role in oncological treatment decisions.
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Affiliation(s)
- Sara Cherri
- Department of Clinical Oncology, Fondazione Poliambulanza, Via bissolati 57, 25124, Brescia, Italy
| | - Ester Oneda
- Department of Clinical Oncology, Fondazione Poliambulanza, Brescia, Italy
| | - Silvia Noventa
- Department of Clinical Oncology, Fondazione Poliambulanza, Brescia, Italy
| | - Laura Melocchi
- Department of Anatomical Pathology, Fondazione Poliambulanza, Brescia, Italy
| | - Alberto Zaniboni
- Department of Clinical Oncology, Fondazione Poliambulanza, Brescia, Italy
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5
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Petrelli F, Luciani A, Ghidini A, Cherri S, Gamba P, Maddalo M, Bossi P, Zaniboni A. Treatment de-escalation for HPV+ oropharyngeal cancer: A systematic review and meta-analysis. Head Neck 2022; 44:1255-1266. [PMID: 35238114 DOI: 10.1002/hed.27019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 02/13/2022] [Accepted: 02/17/2022] [Indexed: 12/12/2022] Open
Abstract
Human Papillomavirus (HPV) related oropharyngeal carcinoma (OPC) carries a better prognosis compared with HPV-counterparts, thereby pushing the adoption of de-intensification treatment approaches as new strategies to preserve superior oncologic outcomes while minimizing toxicity. We evaluated the effect of treatment de-intensification in terms of overall survival (OS), progression-free survival (PFS), locoregional and distant control (LRC and DM) by selecting prospective or retrospective studies, providing outcome data with reduced intensification versus standard curative treatment in HPV+ OPC patients, with a systematic analysis till September 2020. The primary outcome of interest was OS. Secondary endpoints were PFS, LRC, and DM expressed as HR. A total of 55 studies (from 1393 screened references) were employed for quantitative synthesis for 38 929 patients. Among n = 48 studies with data available, de-intensified treatments reduced OS in HPV+ OPCs (HR = 1.33, 95% CI 1.17-1.52; p < 0.01). In de-escalated treatments, PFS was also decreased (HR = 2.11, 95% CI 1.65-2.69; p < 0.01). Compared with standard treatments, reduced intensity approaches were associated with reduced locoregional and distant disease control (HR = 2.51, 95% CI 1.75-3.59; p < 0.01; and HR = 1.9, 95% CI 1.25-2.9; p < 0.01). Chemoradiation improved survival in a definitive curative setting compared with radiotherapy alone (HR = 1.42, 95% CI 1.16-1.75; p < 0.01). When adjuvant treatments were compared, standard and de-escalation strategies provided similar OS. In conclusion, in patients with HPV+ OPC, de-escalation treatments should not be widely and agnostically adopted in clinical practice, as therein lies a concrete risk of offering a sub-optimal treatment to patients.
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Affiliation(s)
| | | | | | - Sara Cherri
- Oncology Unit, Fondazione Poliambulanza, Brescia, Italy
| | - Paolo Gamba
- Otolaryngology Unit, Fondazione Poliambulanza, Brescia, Italy
| | - Marta Maddalo
- Department of Radiation Oncology, University of Brescia and Spedali Civili, Brescia, Italy
| | - Paolo Bossi
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences, Public Health, University of Brescia, Brescia, Italy
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Cherri S, Libertini M, Zaniboni A. New drugs for the treatment of metastatic colorectal cancer. World J Gastrointest Oncol 2021; 13:1551-1560. [PMID: 34853636 PMCID: PMC8603451 DOI: 10.4251/wjgo.v13.i11.1551] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 07/01/2021] [Accepted: 09/08/2021] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer (CRC) represents one of the most frequent malignancies in terms of incidence and mortality, thus representing the third leading cause of cancer death worldwide. In the last decade, few drugs have enriched the treatment landscape of metastatic CRC and have significantly affected prognosis. Unlike other neoplasms, metastatic CRC patients who have exhausted treatment options often still maintain a good performance status. There are many challenges to increasing potential treatment options, notably a better understanding of disease biology and the mechanisms of resistance underlying cancer treatment failure. The development of new drugs for metastatic CRC certainly represents one of the most important challenges in medical oncology. This article discusses the main limitations in the development of new drugs and potential future scenarios. In particular, we addressed three questions: (1) The main limitations of targeted therapy in the treatment of metastatic CRC (mCRC); (2) New target armamentarium that could escape primary and secondary resistance and lead to more personalized mCRC therapy; and (3) Future directions.
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Affiliation(s)
- Sara Cherri
- Department of Oncology, Fondazione Poliambulanza, Brescia 25124, Italy
| | - Michela Libertini
- Department of Oncology, Fondazione Poliambulanza, Brescia 25124, Italy
| | - Alberto Zaniboni
- Department of Oncology, Fondazione Poliambulanza, Brescia 25124, Italy
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Lemmers DHL, Cherri S, van Etten-Jamaludin FS, Noventa S, Zaniboni A, Wilmink JW, Besselink MG, Abu Hilal M. Adjuvant chemotherapy following curative-intent resection for ampullary adenocarcinoma. Hippokratia 2021. [DOI: 10.1002/14651858.cd014749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Daniel HL Lemmers
- Department of Surgery, Hepato-Biliary and Pancreatic Unit; Instituto Fondazione Poliambulanza; Brescia Italy
- Department of Surgery; Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam; Amsterdam Netherlands
| | - Sara Cherri
- Department of Medical Oncology; Instituto Fondazione Poliambulanza; Brescia Italy
| | | | - Silvia Noventa
- Department of Medical Oncology; Instituto Fondazione Poliambulanza; Brescia Italy
| | - Alberto Zaniboni
- Department of Medical Oncology; Instituto Fondazione Poliambulanza; Brescia Italy
| | - Johanna W Wilmink
- Department of Medical Oncology; Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam; Amsterdam Netherlands
| | - Marc G Besselink
- Department of Surgery; Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam; Amsterdam Netherlands
| | - Mohammed Abu Hilal
- Department of Surgery, Hepato-Biliary and Pancreatic Unit; Instituto Fondazione Poliambulanza; Brescia Italy
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8
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Lai E, Murgioni S, Ziranu P, Basile D, Cherri S, Madeddu C, Bergamo F, Piacentini G, Smiroldo V, Squadroni M, De Grandis M, Mascia L, Rosati G, Zampino M, Spallanzani A, Conca V, Palladino M, Flaminio V, Di Bella S, Scartozzi M. 467P Monocyte to red blood cells ratio (MRR): an innovative haematologic prognostic parameter in FOLFIRI-aflibercept treated patients: A subgroup analysis from the DISTINCTIVE trial. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.988] [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: 11/16/2022] Open
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9
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Petrelli F, Cherri S, Ghidini M, Perego G, Ghidini A, Zaniboni A. Tocilizumab as treatment for COVID-19: A systematic review and meta-analysis. World J Methodol 2021; 11:95-109. [PMID: 34026583 PMCID: PMC8127418 DOI: 10.5662/wjm.v11.i3.95] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/02/2020] [Accepted: 03/28/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The majority of patients with coronavirus disease 2019 (COVID-19) have good prognoses, but some develop a critical illness that can lead to death. Evidence shows severe acute respiratory syndrome is closely related to the induced cytokine storm. Interleukin-6 is a key player; its role in systemic inflammation is well known. AIM To evaluate the effect of tocilizumab (TCZ), an interleukin-6 receptor antagonist, on the outcomes for patients with COVID-19 pneumonia. METHODS PubMed, EMBASE, SCOPUS, Web of Science, MedRxiv, Science Direct, and the Cochrane Library were searched from inception to 9th June 2020 for observational or prospective studies reporting results of hospitalized adult patients with COVID-19 infection treated with TCZ. Effect sizes were reported as odds ratios (ORs) with 95% confidence intervals (CIs), and an OR less than 1 was associated with a better outcome in those treated with TCZ. RESULTS Overall 13476 patients (33 studies; n = 3264 received TCZ) with COVID-19 pneumonia and various degree of severity were included. Outcome was improved with TCZ. In the primary analysis (n = 19 studies reporting data), mortality was reduced in patients treated with TCZ (OR = 0.64, 95%CI: 0.47-0.87; P < 0.01). In 9 studies where risk of death with TCZ use was controlled for other variables mortality was reduced by 57% (OR = 0.43, 95%CI: 0.27-0.7; P < 0.01). Intensive care need (mechanical ventilation) was also reduced (OR = 0.36, 95%CI: 0.14-0.89; P = 0.02). CONCLUSION In COVID-19-infected patients treated with TCZ, outcome may be improved compared to those not treated with TCZ.
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Affiliation(s)
| | - Sara Cherri
- Department of Clinical Oncology, Fondazione Poliambulanza, Brescia 25124, Italy
| | - Michele Ghidini
- Medical Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Antonio Ghidini
- Department of Medicine, Casa di Cura Igea, Milano 20100, Italy
| | - Alberto Zaniboni
- Department of Oncology, Fondazione Poliambulanza, Brescia 25124, Italy
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Abstract
Pancreatic cancer is considered one of the most aggressive cancers, with an increasing incidence in recent years. To date, chemotherapy is still the standard of care for advanced metastatic disease, unfortunately providing only a slight advantage in terms of survival. The molecular and cellular characteristics of pancreatic cancer cells, as well as the cells that characterize the pancreatic tumour microenvironment, are the basis of the mechanisms of resistance to treatment. After progression during first-line treatment, few patients are eligible for second-line treatment due to the loss of performance status. To date, a clear survival advantage has not yet been demonstrated for second-line chemotherapy. Precision medicine could be the key to increasing responses to cancer treatment and finally impacting survival in this difficult-to-treat disease. In this review, we analyze current recommendations in the second-line setting and potential future prospects.
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Affiliation(s)
- Sara Cherri
- Department of Oncology, Fondazione Poliambulanza, Brescia 25124, Italy
| | - Silvia Noventa
- Department of Oncology, Fondazione Poliambulanza, Brescia 25124, Italy
| | - Alberto Zaniboni
- Department of Oncology, Fondazione Poliambulanza, Brescia 25124, Italy
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11
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Francini E, Ou FS, Lazzi S, Petrioli R, Multari AG, Pesola G, Messuti L, Colombo E, Livellara V, Bazzurri S, Cherri S, Miano ST, Wolfe EG, Alberts SR, Hubbard JM, Yoon HH, Francini G. The prognostic value of CD3+ tumor-infiltrating lymphocytes for stage II colon cancer according to use of adjuvant chemotherapy: A large single-institution cohort study. Transl Oncol 2020; 14:100973. [PMID: 33338878 PMCID: PMC7750416 DOI: 10.1016/j.tranon.2020.100973] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/18/2020] [Accepted: 11/20/2020] [Indexed: 11/28/2022] Open
Abstract
Low CD3+ TILs rate was associated with shorter OS in those with stage II colon cancer who did not receive adjuvant therapy. CD3+ TILs rate was not prognostic for patients with stage II colon cancer who had adjuvant therapy. Low CD3+ TILs rate may be an additional risk factor for stage II colon cancer patients who did not have adjuvant therapy yet.
Background High tumor infiltrating lymphocytes (TILs) density was previously shown to be associated with favorable prognosis for patients with colon cancer (CC). However, the impact of TILs on overall survival (OS) of stage II CC patients who received adjuvant chemotherapy (ADJ) or not (no-ADJ) is unknown. We assessed the prognostic value of CD3+ TILs in stage II CC patients according to whether they had ADJ or not. Methods Patients treated with curative surgery for stage II CC (2002–2013) were selected from the Santa Maria alle Scotte Hospital registry. TILs at the invasive front, center of tumor, and stroma were determined by immunohistochemistry and manually quantified as the rate of TILs/total tissue areas. High TILs (H-TILs) was defined as >20%. Patients were categorized as high or low TILs (L-TILs) and ADJ or no-ADJ. Results Of the 678 patients included, 137 (20%) received ADJ and 541 (80%) did not. The distribution of the 4 groups were: 16% (L-TIL/ADJ), 64% (L-TIL/no-ADJ), 5% (H-TIL/ADJ), 15% (H-TIL/no-ADJ). Compared to H-TILs/no-ADJ, ADJ patients showed a significantly increased OS (P<.01) regardless of the TILs rate whereas L-TILs/no-ADJ had significantly decreased OS and higher risk of death (HR=1.41; 95% CI, 1.06–1.88; P<.0001). On multivariable analysis, the unfavorable prognostic value of L-TILs (vs. H-TILs) for no-ADJ patients was confirmed (HR=1.36; 95% CI 1.02, 1.82; P=.0373). Conclusion Low CD3+ TILs rate was associated with shorter OS in those with stage II colon cancer who did not receive adjuvant therapy. Low CD3+ TILs could be considered an additional risk factor for still ADJ-untreated stage II CC patients, which could facilitate clinical decision making.
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Affiliation(s)
- Edoardo Francini
- Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Italy.
| | | | - Stefano Lazzi
- Department of Human Pathology and Oncology, University of Siena, Siena, Italy
| | | | | | | | | | | | | | | | - Sara Cherri
- Santa Maria Alle Scotte Hospital, Siena, Italy
| | | | | | | | | | | | - Guido Francini
- Department of Medical and Surgical Sciences and Neuroscience, University of Siena, Siena, Italy
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Cherri S, Lemmers DHL, Noventa S, Abu Hilal M, Zaniboni A. Outcome of oncological patients admitted with COVID-19: experience of a hospital center in northern Italy. Ther Adv Med Oncol 2020; 12:1758835920962370. [PMID: 33062065 PMCID: PMC7533930 DOI: 10.1177/1758835920962370] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/04/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Recent literature regarding the outcome of cancer patients infected with COVID-19 are not encouraging. Nevertheless, current evidence on the risk and benefits of continuing oncological treatment of cancer patients during the pandemic remains insufficient. We provide our experience in a center with high access for patients with COVID-19-associated pneumonia in Lombardy, Italy. We conducted a retrospective study using a prospectively maintained database of patients admitted to our hospital between 25 February 2020 and 9 April 2020 with a confirmed diagnosis of COVID-19 pneumonia. RESULTS A total of 53 patients with a history or current oncological disease were included in this study. Sixteen oncological patients (30.2%) died during hospitalization. Multivariable logistic regression analysis found that age (Odds ratio [OR]: 1.17, p = 0.009), diabetes (OR: 15.05, p = 0.028) and active oncological disease (OR 13.60, p = 0.015) were independently associated with in-hospital mortality. The mortality rate of the total number of cancer patients is about twice as high as that of non-oncological patients admitted to our hospital with a diagnosis of COVID-19. CONCLUSION The presence of active oncological disease is independently related to mortality as well as age and diabetes. The majority of patients who died were frail. Careful evaluation of the risks and benefits of treatment in frail patients is needed, considering that difficult access to intensive care may have affected the mortality rate.
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Affiliation(s)
- Sara Cherri
- Department of Clinical Oncology, Fondazione Poliambulanza, Brescia, Italy
| | - Daniel H. L. Lemmers
- Department of Surgery, Fondazione Poliambulanza, Brescia, Italy
- Department of Surgery, Amsterdam UMC, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - Silvia Noventa
- Department of Oncology, Fondazione Poliambulanza, Brescia, Italy
| | | | - Alberto Zaniboni
- Department of Oncology, Fondazione Poliambulanza, Brescia, Italy
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13
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Cherri S, Prochilo T, Rota L, Mutti S, Garatti M, Liserre B, Zaniboni A. Neutropenic Enterocolitis in the Treatment of Solid Tumors: A Case Report and Review of the Literature. Case Rep Oncol 2020; 13:442-448. [PMID: 32399014 PMCID: PMC7204860 DOI: 10.1159/000506896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Received: 02/27/2020] [Accepted: 02/27/2020] [Indexed: 12/14/2022] Open
Abstract
Neutropenic enterocolitis is a clinical condition characterized by inflammation of the colic mucosa, usually the caecum, associated with bowel wall thickening in patients with compromised immune system due to chemotherapy treatments. It can occur as well in other clinical conditions that lead to immunosuppression. Clinically, patients present with abdominal pain, fever, and neutropenia on blood tests. A number of major and minor criteria have been suggested for the clinical diagnosis of typhlitis. The most sensitive radiological investigation is represented by a computed tomography scan. There are no guidelines for treatment, but some factors may lead the clinician to medical treatments or prompt surgery as the best choice in that particular patient. The most implicated chemotherapeutic regimens are those based on taxanes. Here, we present a clinical case of a young patient with breast cancer and a review of the state of the art of knowledge regarding neutropenic enterocolitis in adult patients undergoing chemotherapy for the treatment of solid tumors.
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Affiliation(s)
- Sara Cherri
- Department of Oncology, Fondazione Poliambulanza, Brescia, Italy
| | - Tiziana Prochilo
- Department of Oncology, Fondazione Poliambulanza, Brescia, Italy
| | - Luigina Rota
- Department of Oncology, Fondazione Poliambulanza, Brescia, Italy
| | - Stefano Mutti
- Department of Surgery, Fondazione Poliambulanza, Brescia, Italy
| | - Marco Garatti
- Department of Surgery, Fondazione Poliambulanza, Brescia, Italy
| | - Barbara Liserre
- Department of Pathology, Fondazione Poliambulanza, Brescia, Italy
| | - Alberto Zaniboni
- Department of Oncology, Fondazione Poliambulanza, Brescia, Italy
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Francini E, Ou FS, Lazzi S, Petrioli R, Multari AG, Pesola G, Messuti L, Colombo E, Livellara V, Bazzurri S, Cherri S, Salvatora M, Wolfe E, Alberts SR, Hubbard JM, Yoon HH, Francini G. CD3+ tumor-infiltrating lymphocytes (TILs) as prognostic in patients (pts) with stage II colon cancer (CC) not treated with adjuvant chemotherapy (ADJ). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.4_suppl.167] [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
167 Background: Previous studies have reported high TILs are a favorable prognostic factor in stage II CC. However, whether the impact of TILs on overall survival (OS) differs among pts who did or did not receive ADJ is still to be determined. We assessed the prognostic value of CD3+ TILs in pts with stage II CC according to whether they received ADJ or not (no-ADJ). Methods: Pts treated with curative surgery for stage II CC (2002-2013) were identified through the Santa Maria alle Scotte Hospital database. CD3+ TILs at the invasive front, center of tumor, and stroma, were determined by immunohistochemistry and manually quantified as the rate of TILs/total tissue areas. High TILs (H-TILs) was defined as > 20%. Pts were classified as high or low TILs (L-TILs) and ADJ or no-ADJ. Cox models were used to assess OS with hazard ratio estimates (95% CI). Results: Of the 678 pts included (356 deaths), 137 (20%) received ADJ while 541 (80%) did not. ADJ comprised fluoropyrimidine +/- oxaliplatin. Median follow-up was 8.5 years. The distributions of the 4 groups were: 16% (L-TIL/ADJ), 64% (L-TIL/no-ADJ), 5% (H-TIL/ADJ), 15% (H-TIL/no-ADJ). Compared to H-TILs/no-ADJ, ADJ pts had a significantly longer OS (P < .0001) regardless of the TILS rate while L-TILs/no ADJ had significantly shorter OS and higher risk of death (HR = 1.41; 95% CI, 1.06-1.88; P < .0001) [See table]. On multivariable analysis, adjusting for perforation, obstruction, T-stage, grade, < 12 lymph nodes resected, lymphovascular and perineural invasion, the adverse prognostic impact of L-TILs (vs H-TILs) in no-ADJ pts was confirmed (HR = 1.36; 95% CI 1.02, 1.82; P = .0373). Conclusions: Low CD3+ TILs rate was independently associated with shorter OS in stage II CC pts who did not receive ADJ, but was not prognostic among pts who had ADJ. These data suggest a potentially different impact of TILs in chemo-treated vs -untreated stage II CC which could affect clinical decision making. [Table: see text]
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Affiliation(s)
| | | | - Stefano Lazzi
- Pathological Anatomy Department, Santa Maria alle Scotte Hospital, Siena, Italy
| | - Roberto Petrioli
- Medical Oncology, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | | | - Guido Pesola
- Medical Oncology Unit, Santa Maria alle Scotte Hospital, Siena, Italy
| | - Luciana Messuti
- Medical Oncology Unit, Santa Maria alle Scotte Hospital, Siena, Italy
| | - Elena Colombo
- Medical Oncology Unit, Santa Maria alle Scotte Hospital, Siena, Italy
| | | | - Serena Bazzurri
- Medical Oncology Unit, Santa Maria alle Scotte Hospital, Siena, Italy
| | - Sara Cherri
- Medical Oncology Unit, Santa Maria alle Scotte Hospital, Siena, Italy
| | - Miano Salvatora
- Medical Oncology Unit, Santa Maria alle Scotte Hospital, Siena, Italy
| | | | | | | | | | - Guido Francini
- Medical Oncology, Azienda Ospedaliera Universitaria Senese, Siena, Italy
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15
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Martellucci I, Fanelli M, Cherri S, Multari A, Pesola G, Rosellini P, Ciompi A, Francini G. Pre-graduate internship in the medical oncology department: a good training setting to capture aspects of palliative and simultaneous care. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw336.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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16
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Abstract
In this paper, we extend our previous observation on the mobilization of the ribose moiety from a purine nucleoside to a pyrimidine base, with subsequent pyrimidine nucleotides formation (Cappiello et al., Biochim. Biophys. Acta 1425 (1998) 273-281). The data show that, at least in vitro, also the reverse process is possible. In rat brain extracts, the activated ribose, stemming from uridine as ribose 1-phosphate, can be used to salvage adenine and hypoxanthine to their respective nucleotides. Since the salvage of purine bases is a 5-phosphoribosyl 1-pyrophosphate-dependent process, catalyzed by adenine phosphoribosyltransferase and hypoxanthine guanine phosphoribosyltransferase, our results imply that Rib-1P must be transformed into 5-phosphoribosyl 1-pyrophosphate, via the successive action of phosphopentomutase and 5-phosphoribosyl 1-pyrophosphate synthetase; and,in fact, no adenosine could be found as an intermediate when rat brain extracts were incubated with adenine, Rib-1P and ATP, showing that adenine salvage does not imply adenine ribosylation, followed by adenosine phosphorylation. Taken together with our previous results on the Rib-1P-dependent salvage of pyrimidine nucleotides, our results give a clear picture of the in vitro Rib-1P recycling, for both purine and pyrimidine salvage.
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Affiliation(s)
- L Mascia
- Department of Physiology and Biochemistry, University of Pisa, Via S. Maria 55, 56126, Pisa, Italy
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