Feasibility of cabazitaxel in octogenarian prostate cancer patients

Background

To evaluate the effectiveness and safety of cabazitaxel in castration-resistant prostate cancer patients aged ≥80 years, we performed a retrospective study on a sample of patients from 11 Italian cancer centers.

Materials and methods

Fifty-seven patients aged ≥80 years were treated with cabazitaxel after previous failure with docetaxel; 39 completed a comprehensive geriatric assessment questionnaire (34 fit and 5 vulnerable) and 8 patients (14%) had an Eastern Cooperative Oncology Group performance status (PS) ≥2, while most had a PS of 0-1 (86%). Cabazitaxel was administered at a dose of 25 mg/m2 in 30 (52%) patients and 20 mg/m2 or adapted schedules in 27 (48%) patients. These schedules were adopted mainly in patients ≥85 years (75%), with a PS ≥2 (87.5%), and those classified as vulnerable (100%).

Results

The duration of treatment was 4.8 months and was comparable in all subgroups; disease control rate was reported in 36 patients (63%); prostate-specific antigen response was recorded in 18 patients (31.5%). Median overall survival was 13.1 months regardless of age (<85/≥85 years), but overall survival was reduced in vulnerable (7.2 months) and PS ≥ 2 patients (6.8 months). The most frequently documented grade 3-4 toxicities were neutropenia (14%) and diarrhea (10.5%). Six patients (10.5%) dropped out due to severe toxicity.

Conclusions

Octogenarian patients can be treated with cabazitaxel with reduced doses or alternative schedules that are associated with less toxicity and fewer treatment interruptions. Comprehensive geriatric assessment could facilitate more appropriate patient selection.

Clinicians' and Patients' Perceptions and Use of the Word "Cured" in Cancer Care: An Italian Survey

BACKGROUND

The words "hope" and "cure" were used in a greater number of articles and sentences in narrative and editorial papers than in primary research. Despite concomitant improvements in cancer outcomes, the related reluctance to use these terms in more scientifically oriented original reports may reflect a bias worthy of future exploration. This study aims to survey a group of physicians and cancer patients regarding their perception and use of the word cure.

MATERIALS AND METHOD

An anonymous online and print survey was conducted to explore Italian clinicians' (the sample includes medical oncologists, radiotherapists, and oncological surgeons) and cancer patients' approach to the perception and use of the word "cure" in cancer care. The participants received an email informing them of the study's purpose and were invited to participate in the survey via a linked form. A portion, two-thirds, of questionnaires were also administered to patients in the traditional paper form.

RESULTS

The survey was completed by 224 clinicians (54 oncologists, 78 radiotherapists, and 92 cancer surgeons) and 249 patients. The results indicate a favourable attitude for patients in favour of a new language ("cured" vs. "complete remission") of the disease experience.

CONCLUSIONS

The use of the word cured is substantially accepted and equally shared by doctors and patients. Its use can facilitate the elimination of metaphoric implications and toxic cancer-related connotations registered in all cultures that discourage patients from viewing cancer as a disease with varied outcomes, including cure.

Genome-wide analyses reveal the regions involved in the phenotypic diversity in Sicilian pigs

Nero Siciliano (Sicilian Black, SB) is a local pig breed generally of uniform black color. In addition to this officially recognized breed, there are animals showing morphological characteristics resembling the SB but with gray hair (Sicilian Grey, SG). The SG, compared with the SB, also shows a more compact structure with greater transverse diameters, higher average daily gains and lower thickness of the back fat. In this study, using the Illumina PorcineSNP60 BeadChip, we run genome-wide analyses to identify regions that may explain the phenotypic differences between SB (n = 21) and SG (n = 27) individuals. Combining the results of the two case-control approaches (GWAS and F_ST ), we identified two significant regions, one on SSC5 (95 401 083 bp) and one on SSC15 (55 051 435 bp), which contains several candidate genes related to growth traits in pig. The results of the Bayesian population differentiation approach identified a marker near the MGAT4C, a gene associated with average daily gain in pigs. Finally, scanning the genome for runs of homozygosity islands, we found that the two groups have different runs of homozygosity islands, with several candidate genes involved in coat color (in SG) or related to different pig performance traits (in SB). In summary, the two analyzed groups differed for several phenotypic traits, and genes involved in these traits (growth, meat traits and coat color) were detected. This study provided another contribution to the identification of genomic regions involved in phenotypic variability in local pig populations.

Hematologic toxicity of radium-223 in elderly patients with metastatic Castration Resistant Prostate Cancer: a real-life experience

Background

Treatment with radium-223 has been shown to increase survival and to delay skeletal events related to bone metastases of patients with metastatic Castration Resistant Prostate Cancer (mCRPC). This treatment has also proved to be well tolerated, and hematological toxicity, in particular anemia, represents the most represented adverse event.

Materials and methods

We evaluated the hematologic toxicity of Ra-223 treatment in a real-life experience of 38 patients from two Italian cancer centers, with bone metastases from mCRPC. The main endpoint of the study was the evaluation of the efficacy and tolerability of treatment with radium-223, with greater reference to hematological toxicity (especially anemia) as the cause of interruption of treatment, specifically in the elderly patient.

Results

From August 2016 to October 2017, a total of 38 consecutive nonselected patients, 20 of them aged >75 years, with mCRPC symptomatic bone metastases, were enrolled for radium-223 at standard doses. Hematologic adverse events were recorded more frequently (72.4% with AE), and 36.8% had anemia. The most frequent cause of treatment discontinuation due to AEs was anemia [8/10 patients (80%)], followed by thrombocytopenia (2 patients) and neutropenia (1 patient). Hematologic AEs were more represented in elderly patients with greater disease burden and previously treated with docetaxel.

Conclusions

Anemia is the most represented AE related to radium-223 treatment in elderly patients with greater disease burden and previously treated with docetaxel, besides representing the main reason for interruption of treatment. Correct patient selection, appropriate timing, and adequate supportive care are elements that could facilitate successful treatment with radium-223, preventing premature interruption of the same. The results of this experience support the opportunity to propose treatment with radium-223 mostly in patients in the earliest stages.

Cause of radium 223 treatment discontinuation in elderly mCRPC patients

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Background: Prostate cancer is the most common cancer among adult men. Bones are the main metastatic site of prostate cancer. Radium-223 is indicated to treat metastatic castrate-resistant prostate cancer ( mCRPC) with symptomatic skeletal metastases. We evaluate the tolerability of Ra223 treatment in real life setting. Methods: We reported the cases of 38 consecutive non-selected patients with mCRPC symptomatic bone metastases treated in two Italian hospital cancer center from August 2016 to October 2017. The cause of Ra 223 treatment discontinuation in elderly prostate cancer patients were evaluated. Results: due bones metastases, 38 patients were treated with Radium-223; 20 were ≥75 years old (range 75-85 yrs). Patients characteristics and main toxicity are reported (Table). Regarding the elderly patients, hematologic toxicity were the most common adverse events reported. Anemia G2-G3 was observed in 10 pts (50%), thrombocytopoenia G3 in 2 patients (10%) and neutropenia G3 in 4 patients (20%); 12/20 patients interrupted the treatment, of which 10 were ECOG PS2. The number of patients who discontinued the drug because of hematologic adverse events was higher than ALSYMPCA clinical trial. Fatigue G1-G2 incidence was 32%. Unexpectedly we did not record any cases of gastrointestinal toxicity (diarrhea, nausea or constipation). Conclusions: In patients ≥75 years old, anemia G2-G3 was more frequent than data reported in literature, while diarrhea is not found. The data of this experience suggest that elderly vulnerable patients are more exposed to hematologic toxicity that may compromise the outcome of the treatment. For these patients surveillance for early supportive care is relevant. Characteristics of patients with ≥75y. [Table: see text]

Physical Needs of Long-term Cancer Patients

The enormous success in the therapeutic area of oncology has allowed achieving a number of long-term survival patients unthinkable until a few decades ago. The number of cancer survivors in the world has, in fact, almost tripled in the last decade alone. Anticancer therapies, including those of the latest generation, aimed at targeting also the chronicity of the disease, are not free from side-effects, especially when used in the long term. This scenario should lead to development of follow-up programs with the purpose of assessing long-term effects related to cancer treatments, in addition to the early detection of any relapse or a second tumor. Oncologists who take care of cancer survivors cannot ignore these effects; it is, therefore, essential to start a program of prevention and treatment of these sequelae, to meet patients' health needs.

The Real Impact of Target Therapy in Breast Cancer Patients: Between Hope and Reality

Over the last 15 years, we have seen a huge expansion of the development of drugs directed against biomolecular targets within breast cancer cells. The over-expression of certain receptors (ER, PgR, HER-2, VEGF-R), as well as alteration of several intracellular signal transduction pathways (the PI3K-AKT-mTOR pathway, MEK-MAPK pathway, loss of PTEN, etc ...) has a great impact on the likelihood of recurrence and progression of the disease, influencing the natural history of breast cancer. The recent biomolecular classification of breast cancer (Luminal A / B, HER2- driven, Basal Like) allowed finally to identify specific treatments against molecular target to associate or not to traditional chemotherapy, and to use in relation to the prognosis of the disease. In the following paragraphs, we will set out the major targeted drug that have received indications in breast cancer, both in the localized and in advanced disease, referring to the specific target (hormonal receptors, HER2, VEGF, m-TOR, PARP etc ...).

Chemotherapy in frail elderly patients with hormone-refractory prostate cancer: A "real world" experience

BACKGROUND

In elderly patients affected by metastatic castration-resistant prostate cancer (mCRPC) chemotherapic treatment may be the choice if one considers not only the chronological age, but also the clinical status, the functional reserve, and the vulnerability of patients. Several studies have confirmed the survival benefit of docetaxel and vinorelbine among every class of age. Most CRP elderly patients are defined as frail, maybe due to comorbidities: these patients, who are unable to be candidates for a standard treatment, should be candidates for a more tolerable treatment.

METHODS

Twenty-six elderly, frail patients were evaluated. The patients were affected by mCRPC and were receiving chemotherapy with intravenous weekly docetaxel (12 patients) or oral metronomic vinorelbine (14 patients). Safety and efficacy were investigated evaluating clinical and objective response and tolerability. The level of patient satisfaction with treatment was assessed through a questionnaire.

RESULTS

No significant difference was found between groups in terms of 6-month progression-free survival: 57.1% for patients treated with oral metronomic vinorelbine versus 58.3% for patients treated with docetaxel. Median progression free survival was 8.6 months (95% confidence interval: 7.1-9.4 months), and 8.2 months (95% confidence interval: 6.9-9.3 months) for patients treated with oral metronomic vinorelbine and socetaxel, respectively. Oral metronomic vinorelbine was associated with increased patient satisfaction with respect to docetaxel administration. The most frequent side effect associated with oral metronomic vinorelbine was anemia and vomiting, with similar frequency compared to patients treated with docetaxel.

CONCLUSION

Weekly docetaxel and oral metronomic vinorelbine are equally effective and well tolerated in elderly unfit and frail patients affected by mCRPC. Metronomic vinorelbine treatment is associated with higher patient compliance and satisfaction.

Survivors preferences about the role of the oncologist and primary care provider

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Background: Oncologist and Primary Care Provider are both involved in cancer patients follow-up. Patient's preference is an important issue. Aims This observational study was made to investigate: a) if and how long after the diagnosis the patient prefers to be followed by PCPs, Oncologist or both; b) if they prefer to be followed in the same institute where they received acute phase care; c) if it's important to receive recommendations about their lifestyle. Methods: 150 patients were recruited between May and June 2015 in the transient phase. They were affected by different tumors (breast, colon, prostate, melanoma, gynecological cancers and lymphoma disease) 53 pts under 3 years, 38 pts 5 years, 59 pts 7 years since the diagnosis. A questionnaire investigating the aims of the study was administered. Results: Among the pts on 3 years follow-up, only one preferred to be followed by the PCPs for logistical reasons; 24/53 patients after 5 years follow-up preferred PCPs and 18/53 preferred to be followed only by the oncologist because of more competence. In the 5 and 7 years follow-up 80/97 pts preferred to be exclusively followed by the oncologist for these reasons: A) poor PCPs involvement during the acute phase. B) oncologist expertise in acute phase, follow-up and possible relapse; c) lack of interest shown by the PCPs for survivorship care plan. All pts (150) gave positive response on receiving advices about their lifestyle (diet, sport activities, etc...). For 63% of the patients a unique structure would be suitable for receiving follow-up too. Conclusions: The preferences of patients, followed in the transient phase, suggest that fear of relapse guides patient's choice and the relationship with the oncologist offers security.

Effect of a structured, active, home-based cancer-treatment program for the management of patients on oral chemotherapy

INTRODUCTION

The advent of oral chemotherapy agents has had a strong impact on several aspects of the management of cancer patients, including survival rates, health-care expenditure, and health-related quality of life. However, access to care and adherence to oral chemotherapy are central to optimal outcomes.

PATIENTS AND METHODS

In this multicenter observational study, we assessed the effect of the "Active Home Care" initiative - a structured, active, home-based cancer-treatment program - on quality of life, health-care utilization, and patient adherence and satisfaction using self-administered questionnaires. Sixty-two patients treated with oral chemotherapy (capecitabine, vinorelbine, imatinib, sunitinib, sorafenib, temozolomide, ibandronate) were enrolled in the program. Weekly home visits were scheduled, each one with a trained nurse who delivered the home-based chemotherapy and reviewed patients' compliance and treatment toxicity. An oncologist evaluated patients and modified the dosage of oral chemotherapy based on toxicity reported during the previous cycle at bi-weekly visits.

RESULTS

A total of 460 home visits were performed between April 2012 and February 2013. The Active Home Care initiative was associated with significant improvements in physical functioning and symptoms, and reductions in the access to cancer facilities. Satisfaction with oral chemotherapy and care received was high. All patients reported having taken their medications according to their prescription, and no patient reported difficulties in managing the oral chemotherapy regimen.

CONCLUSION

The Active Home Care program was associated with improvements in the quality of life of patients and caregivers, better adherence to treatment, and the effective management of therapy and cancer-related symptoms. Home-based cancer treatment may also optimize the utilization of health-care resources.

The mathematical modeling of the lactation curve for dairy traits of the donkey (Equus asinus)

In recent years, an increase in the number of donkeys farmed in Italy as a consequence of the growing demand for donkey milk for direct consumption has been observed. Some research has been carried out on jenny milk composition and on its nutritional properties, whereas milk production features are scarcely described for this species. In this work, the lactation curve shape of donkeys for milk yield and composition was investigated. A total of 453 test-day records for milk yield, fat and protein percentage, and somatic cell count of 62 lactations measured on 46 multiparous jennies of the Ragusano breed were considered. Effects of herd, age, and foaling season were assessed by using a mixed model analysis. Average and individual lactation curves were fitted using the Wood incomplete gamma function, the Cappio-Borlino modified gamma, and a third-order Legendre orthogonal polynomial model. Donkeys foaling between 6- and 10-yr-old had the highest test-day milk yield (about 1.85 kg/d). Donkeys foaling in winter and autumn had a higher daily milk yield compared with those foaling in summer and spring. Less defined results were obtained for composition traits. The general pattern of the donkey lactation curve is similar to the standard shape reported for the main dairy ruminant species, with a peak yield occurring at about 5 wk from parturition. Younger jennies tended to have lower production peaks and higher lactation persistency. Similarly to what is reported for dairy cattle, a large variability in individual patterns has been observed. No differences in goodness of fit have been observed between the models in the case of average lactation curves, whereas orthogonal polynomials were more efficient in fitting individual patterns.

Active home-based cancer treatment

Background

Active home-based treatment represents a new model of health care. Chronic treatment requires continuous access to facilities that provide cancer care, with considerable effort, particularly economic, on the part of patients and caregivers. Oral chemotherapy could be limited as a consequence of poor compliance and adherence, especially by elderly patients.

Methods

We selected 30 cancer patients referred to our department and treated with oral therapy (capecitabine, vinorelbine, imatinib, sunitinib, sorafenib, temozolomide, ibandronate). This pilot study of oral therapy in the patient’s home was undertaken by a doctor and two nurses with experience in clinical oncology. The instruments used were clinical diaries recording home visits, hospital visits, need for caregiver support, and a questionnaire specially developed by the European Organization for Research and Treatment of Cancer (EORTC), known as the QLQ-C30 version 2.0, concerning the acceptability of oral treatment from the patient’s perspective.

Results

This program decreased the need to access cancer facilities by 98.1%, promoted better quality of life for patients, as reflected in increased EORTC QLQ-C30 scores over time, allowing for greater adherence to oral treatment as a result of control of drug administration outside the hospital. This model has allowed treatment of patients with difficult access to care (elderly, disabled or otherwise needed caregivers) that in the project represent the majority (78% of these).

Conclusions

This model of active home care improves quality of life and adherence with oral therapy, reduces the need to visit the hospital, and consequently decreases the number of lost hours of work on the part of carers. Management of the service by the professionals involved revealed excellent control of the process by nursing staff, with minimal visits involving doctors.

Qol and adherence to i.v. or oral chemotherapy treatment in elderly patients with advanced NSCLC

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Background: In elderly patients with advanced stage NSCLC the identification of the best treatment-related quality of life becomes the main discriminating endpoint. Methods: In this multicentre study, 53 elderly (≥ 70 yrs) patients with advanced (IIIB-IV) NSCLC were randomly allocated to receive as first-line treatment either Gemcitabine intravenously (1000 mg/m2) or oral Vinorelbine (60 mg/m2) both on days 1 and 8, every 21 days. The primary objective was the evaluation of the QoL, while the secondary one was the assessment of treatment adherence. The EORTC QLQ-C30 v 2.0 and QLQ-LC13 questionnaires have been used to evaluate the quality of life and an “ad hoc” questionnaire for the estimate of adherence/compliance to treatment in patients receiving oral Vinorelbine. The questionnaires were filled in at baseline and every 3 cycles. Results: Forty-one patients (thirty-six males), median age of 75.7 years, have been considered suitable for evaluation. All patients filled in the QoL questionnaires at baseline, 18 of them after three cycles of treatment. Differences of mean score values of items recorded at each assessment were calculated. Referring to QLQ-C30, patients enrolled in the Vinorelbine arm displayed higher mean scores as compared to those of Gemcitabine. There was a gain of 5.6 points as regards Physical Function and 16.9 points for Social Function in the Vinorelbine arm as compared to 3 and 1.6 points in the Gemcitabine arm. A higher improvement of the symptoms Nausea and Vomiting and Sleep Disturbance in the Vinorelbine arm in comparison with Gemcitabine (- 7 vs. + 3.2 and – 21.3 vs. + 7.7, respectively) was also observed. Patients treated with oral Vinorelbine showed improvements of the majority of QLQ-LC13 scores and completed a higher number of cycles as compared to Gemcitabine. Most patients (93.5%) responded positively to the satisfaction questionnaire of oral Vinorelbine. Conclusions: Oral Vinorelbine may provide an advantage in terms of patient preference since, without reducing the effectiveness, is able to maintain an acceptable toxicity profile which results in a gain of the level of quality of life.

Psychological and sexual disorders in long-term breast cancer survivors

Background

The progressive increase in the number of patients surviving long term after a diagnosis of malignant disease has led to a focus on the early and late complications of the disease and its treatment. The aim of this study was to investigate the prevalence of complications which may worsen quality of life and shorten long-term survival.

Methods

We identified 306 cancer patients who had been disease-free without treatment for at least three years. Of these, 167 with breast cancer were enrolled in this study. A detailed questionnaire-based interview was undertaken to investigate the characteristics of the patients (age, gender, marital status, education), the tumor (date of diagnosis, histology), and treatment. We also used the Beck Depression Inventory to screen for depression, Spitzer’s Quality of Life Index to assess quality of life, and the International Index of Erectile Function and the Female Sexual Function Index to get precise information on sexual function.

Results

Psychological effects were reported by 121 (72.4%) subjects. Sexual disorders were identified in 60 (35.9%) subjects. A correlation between frequency of psychological disorders and severity of sexual disorders was reported. The proportion of psychological disorders was higher in younger patients, those who were married, and those with low education.

Conclusion

In survivors of breast cancer, the incidences of psychological and sexual affective disorders are significant and frequently correlated, resulting in diminished quality of life.

Analysis of genetic diversity and the determination of relationships among western Mediterranean horse breeds using microsatellite markers

The distribution of genetic diversity and the genetic relationships among western Mediterranean horse breeds were investigated using microsatellite markers. The examined sample included seven Spanish and three Italian local horse breeds and populations, plus a Spanish Thoroughbred outgroup. The total number of animals examined was 682 (on average 62 animals per breed; range 20-122). The microsatellite marker set analysed provided 128 alleles (10.7 alleles per locus). Within-breed genetic diversity was always high (>0.70), with breeds contributing about 8% of the total genetic variability. The mean molecular coancestry of the entire population examined was 0.205, Losino being the breed that contributed most. In addition to Nei's standard and Reynolds' genetic distances, pair-wise kinship distance and molecular coancestry were estimated. Remarkably similar breed rankings were obtained with all methods. Clustering analysis provided an accurate representation of the current genetic relationships among the breeds. Determining coancestry is useful for analysing genetic diversity distribution between and within breeds and provides a good framework for jointly analysing molecular markers and pedigree information. An integrated analysis was undertaken to obtain information on the population dynamics in western Mediterranean native horse populations, and to better determine conservation priorities.

Effect of sustained-release somatotropin on performance and grazing behavior of ewes housed at different stocking rates

This study evaluated the effects of recombinant bovine somatotropin (bST; one injection of 320 mg per ewe) on milk production and composition and on the grazing behavior of multiparous ewes in the third to fourth lactation. Forty Comisana lactating ewes were divided into four groups: 1) untreated, grazing on natural pasture (botanical composition: 35% of Graminaceae, 49% of Fabaceae, 6% of Cruciferae, 10% of other families) at a low stocking rate (16 m2/d); 2) untreated, grazing at a high stocking rate (8 m2/d); 3) treated with bST, grazing at a low stocking rate; and 4) treated with bST, grazing at a high stocking rate. The diets of the ewes were supplemented with vetch and oat hay (500 g/d) and with concentrate (500 g/d). Treatment increased milk production (923.8 vs. 669.5 g/d) but had little effect on fat and protein contents. Administration of bST significantly increased herbage intake; the effect on intake was more marked at the high stocking rate. Under these grazing conditions, the treated ewes reduced selective intake behavior and, thus, achieved good feed intake despite the low biomass availability.