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Cigliano A, Zhang S, Ribback S, Steinmann S, Sini M, Ament CE, Utpatel K, Song X, Wang J, Pilo MG, Berger F, Wang H, Tao J, Li X, Pes GM, Mancarella S, Giannelli G, Dombrowski F, Evert M, Calvisi DF, Chen X, Evert K. Correction: The Hippo pathway efector TAZ induces intrahepatic cholangiocarcinoma in mice and is ubiquitously activated in the human disease. J Exp Clin Cancer Res 2023; 42:124. [PMID: 37194029 DOI: 10.1186/s13046-023-02709-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023] Open
Affiliation(s)
- Antonio Cigliano
- Institute of Pathology, University of Regensburg, Franz-Josef-Strauß-Allee 11, Regensburg, Germany
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Shanshan Zhang
- Department of Bioengineering and Therapeutic Sciences and Liver Center, University of California, 513 Parnassus Avenue, San Francisco, CA, USA
- Department of Pathology, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Silvia Ribback
- Institute of Pathology, University of Greifswald, Greifswald, Germany
| | - Sara Steinmann
- Institute of Pathology, University of Regensburg, Franz-Josef-Strauß-Allee 11, Regensburg, Germany
| | - Marcella Sini
- Experimental Pathology Unit, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Cindy E Ament
- Institute of Pathology, University of Regensburg, Franz-Josef-Strauß-Allee 11, Regensburg, Germany
| | - Kirsten Utpatel
- Institute of Pathology, University of Regensburg, Franz-Josef-Strauß-Allee 11, Regensburg, Germany
| | - Xinhua Song
- Department of Bioengineering and Therapeutic Sciences and Liver Center, University of California, 513 Parnassus Avenue, San Francisco, CA, USA
- School of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Jingxiao Wang
- Department of Bioengineering and Therapeutic Sciences and Liver Center, University of California, 513 Parnassus Avenue, San Francisco, CA, USA
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
| | - Maria G Pilo
- Institute of Pathology, University of Greifswald, Greifswald, Germany
| | - Fabian Berger
- Institute of Pathology, University of Regensburg, Franz-Josef-Strauß-Allee 11, Regensburg, Germany
| | - Haichuan Wang
- Department of Bioengineering and Therapeutic Sciences and Liver Center, University of California, 513 Parnassus Avenue, San Francisco, CA, USA
- Liver Transplantation Division, Department of Liver Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Junyan Tao
- Department of Bioengineering and Therapeutic Sciences and Liver Center, University of California, 513 Parnassus Avenue, San Francisco, CA, USA
| | - Xiaolei Li
- Department of Bioengineering and Therapeutic Sciences and Liver Center, University of California, 513 Parnassus Avenue, San Francisco, CA, USA
- Department of Thyroid and Breast Surgery, The 960Th Hospital of the PLA, Jinan, 250031, China
| | - Giovanni M Pes
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Serena Mancarella
- National Institute of Gastroenterology, IRCCS- Saverio de Bellis Research Hospital, Castellana Grotte, Italy
| | - Gianluigi Giannelli
- National Institute of Gastroenterology, IRCCS- Saverio de Bellis Research Hospital, Castellana Grotte, Italy
| | - Frank Dombrowski
- Institute of Pathology, University of Greifswald, Greifswald, Germany
| | - Matthias Evert
- Institute of Pathology, University of Regensburg, Franz-Josef-Strauß-Allee 11, Regensburg, Germany
| | - Diego F Calvisi
- Institute of Pathology, University of Regensburg, Franz-Josef-Strauß-Allee 11, Regensburg, Germany
| | - Xin Chen
- Department of Bioengineering and Therapeutic Sciences and Liver Center, University of California, 513 Parnassus Avenue, San Francisco, CA, USA
- University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Katja Evert
- Institute of Pathology, University of Regensburg, Franz-Josef-Strauß-Allee 11, Regensburg, Germany.
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Mancarella S, Serino G, Gigante I, Cigliano A, Ribback S, Sanese P, Grossi V, Simone C, Armentano R, Evert M, Calvisi DF, Giannelli G. Correction: CD90 is regulated by notch1 and hallmarks a more aggressive intrahepatic cholangiocarcinoma phenotype. J Exp Clin Cancer Res 2023; 42:88. [PMID: 37069577 PMCID: PMC10111764 DOI: 10.1186/s13046-023-02661-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023] Open
Affiliation(s)
- Serena Mancarella
- National Institute of Gastroenterology, IRCCS- Saverio de Bellis Research Hospital, Via Turi 27, 70013, Castellana Grotte, Italy
| | - Grazia Serino
- National Institute of Gastroenterology, IRCCS- Saverio de Bellis Research Hospital, Via Turi 27, 70013, Castellana Grotte, Italy
| | - Isabella Gigante
- National Institute of Gastroenterology, IRCCS- Saverio de Bellis Research Hospital, Via Turi 27, 70013, Castellana Grotte, Italy
| | - Antonio Cigliano
- Institute of Pathology, University of Regensburg, 93053, Regensburg, Germany
| | - Silvia Ribback
- Institute of Pathology, University of Greifswald, 17489, Greifswald, Germany
| | - Paola Sanese
- National Institute of Gastroenterology, IRCCS- Saverio de Bellis Research Hospital, Via Turi 27, 70013, Castellana Grotte, Italy
| | - Valentina Grossi
- National Institute of Gastroenterology, IRCCS- Saverio de Bellis Research Hospital, Via Turi 27, 70013, Castellana Grotte, Italy
| | - Cristiano Simone
- National Institute of Gastroenterology, IRCCS- Saverio de Bellis Research Hospital, Via Turi 27, 70013, Castellana Grotte, Italy
| | - Raffaele Armentano
- National Institute of Gastroenterology, IRCCS- Saverio de Bellis Research Hospital, Via Turi 27, 70013, Castellana Grotte, Italy
| | - Matthias Evert
- Institute of Pathology, University of Regensburg, 93053, Regensburg, Germany
| | - Diego F Calvisi
- Institute of Pathology, University of Regensburg, 93053, Regensburg, Germany
| | - Gianluigi Giannelli
- National Institute of Gastroenterology, IRCCS- Saverio de Bellis Research Hospital, Via Turi 27, 70013, Castellana Grotte, Italy.
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3
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Mancarella S, Gigante I, Serino G, Pizzuto E, Dituri F, Valentini MF, Wang J, Chen X, Armentano R, Calvisi DF, Giannelli G. Crenigacestat blocking notch pathway reduces liver fibrosis in the surrounding ecosystem of intrahepatic CCA viaTGF-β inhibition. J Exp Clin Cancer Res 2022; 41:331. [PMID: 36443822 PMCID: PMC9703776 DOI: 10.1186/s13046-022-02536-6] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 11/09/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Intrahepatic cholangiocarcinoma (iCCA) is a highly malignant tumor characterized by an intensive desmoplastic reaction due to the exaggerated presence of the extracellular (ECM) matrix components. Liver fibroblasts close to the tumor, activated by transforming growth factor (TGF)-β1 and expressing high levels of α-smooth muscle actin (α-SMA), become cancer-associated fibroblasts (CAFs). CAFs are deputed to produce and secrete ECM components and crosstalk with cancer cells favoring tumor progression and resistance to therapy. Overexpression of Notch signaling is implicated in CCA development and growth. The study aimed to determine the effectiveness of the Notch inhibitor, Crenigacestat, on the surrounding microenvironment of iCCA. METHODS We investigated Crenigacestat's effectiveness in a PDX model of iCCA and human primary culture of CAFs isolated from patients with iCCA. RESULTS In silico analysis of transcriptomic profiling from PDX iCCA tissues treated with Crenigacestat highlighted "liver fibrosis" as one of the most modulated pathways. In the iCCA PDX model, Crenigacestat treatment significantly (p < 0.001) reduced peritumoral liver fibrosis. Similar results were obtained in a hydrodynamic model of iCCA. Bioinformatic prediction of the upstream regulators related to liver fibrosis in the iCCA PDX treated with Crenigacestat revealed the involvement of the TGF-β1 pathway as a master regulator gene showing a robust connection between TGF-β1 and Notch pathways. Consistently, drug treatment significantly (p < 0.05) reduced TGF-β1 mRNA and protein levels in tumoral tissue. In PDX tissues, Crenigacestat remarkably inhibited TGF-β signaling and extracellular matrix protein gene expression and reduced α-SMA expression. Furthermore, Crenigacestat synergistically increased Gemcitabine effectiveness in the iCCA PDX model. In 31 iCCA patients, TGF-β1 and α-SMA were upregulated in the tumoral compared with peritumoral tissues. In freshly isolated CAFs from patients with iCCA, Crenigacestat significantly (p < 0.001) inhibited Notch signaling, TGF-β1 secretion, and Smad-2 activation. Consequently, Crenigacestat also inactivated CAFs reducing (p < 0.001) α-SMA expression. Finally, CAFs treated with Crenigacestat produced less (p < 005) ECM components such as fibronectin, collagen 1A1, and collagen 1A2. CONCLUSIONS Notch signaling inhibition reduces the peritumoral desmoplastic reaction in iCCA, blocking the TGF-β1 canonical pathway.
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Affiliation(s)
- Serena Mancarella
- grid.489101.50000 0001 0162 6994National Institute of Gastroenterology “S. De Bellis” Research Hospital, Via Turi 27, 70013 Castellana Grotte, BA Italy
| | - Isabella Gigante
- grid.489101.50000 0001 0162 6994National Institute of Gastroenterology “S. De Bellis” Research Hospital, Via Turi 27, 70013 Castellana Grotte, BA Italy
| | - Grazia Serino
- grid.489101.50000 0001 0162 6994National Institute of Gastroenterology “S. De Bellis” Research Hospital, Via Turi 27, 70013 Castellana Grotte, BA Italy
| | - Elena Pizzuto
- grid.489101.50000 0001 0162 6994National Institute of Gastroenterology “S. De Bellis” Research Hospital, Via Turi 27, 70013 Castellana Grotte, BA Italy
| | - Francesco Dituri
- grid.489101.50000 0001 0162 6994National Institute of Gastroenterology “S. De Bellis” Research Hospital, Via Turi 27, 70013 Castellana Grotte, BA Italy
| | - Maria F. Valentini
- grid.7644.10000 0001 0120 3326Department of Emergency and Organ Transplant, University of Bari Medical School, Bari, Italy
| | - Jingxiao Wang
- grid.266102.10000 0001 2297 6811Department of Bioengineering and Therapeutic Sciences and Liver Center, University of California, San Francisco, CA 94143 USA
| | - Xin Chen
- grid.266102.10000 0001 2297 6811Department of Bioengineering and Therapeutic Sciences and Liver Center, University of California, San Francisco, CA 94143 USA
| | - Raffaele Armentano
- grid.489101.50000 0001 0162 6994National Institute of Gastroenterology “S. De Bellis” Research Hospital, Via Turi 27, 70013 Castellana Grotte, BA Italy
| | - Diego F. Calvisi
- grid.7727.50000 0001 2190 5763Institute of Pathology, University of Regensburg, 93053 Regensburg, Germany
| | - Gianluigi Giannelli
- grid.489101.50000 0001 0162 6994National Institute of Gastroenterology “S. De Bellis” Research Hospital, Via Turi 27, 70013 Castellana Grotte, BA Italy
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Critelli R, Milosa F, Romanzi A, Lasagni S, Marcelli G, Di Marco L, Pivetti A, Schepis F, Romagnoli D, Mancarella S, Dituri F, Martinez‑Chantar ML, Giannelli G, Villa E. Upregulation of the oestrogen target gene SIX1 is associated with higher growth speed and decreased survival in HCV‑positive women with hepatocellular carcinoma. Oncol Lett 2022; 24:395. [DOI: 10.3892/ol.2022.13515] [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] [Received: 04/15/2022] [Accepted: 07/07/2022] [Indexed: 11/05/2022] Open
Affiliation(s)
- Rosina Critelli
- Department of Medical Specialties, Gastroenterology Unit, University of Modena and Reggio Emilia and University Hospital of Modena, I‑41124 Modena, Italy
| | - Fabiola Milosa
- Department of Medical Specialties, Gastroenterology Unit, University of Modena and Reggio Emilia and University Hospital of Modena, I‑41124 Modena, Italy
| | - Adriana Romanzi
- Department of Medical Specialties, Gastroenterology Unit, University of Modena and Reggio Emilia and University Hospital of Modena, I‑41124 Modena, Italy
| | - Simone Lasagni
- Department of Medical Specialties, Gastroenterology Unit, University of Modena and Reggio Emilia and University Hospital of Modena, I‑41124 Modena, Italy
| | - Gemma Marcelli
- Department of Medical Specialties, Gastroenterology Unit, University of Modena and Reggio Emilia and University Hospital of Modena, I‑41124 Modena, Italy
| | - Lorenza Di Marco
- Department of Medical Specialties, Gastroenterology Unit, University of Modena and Reggio Emilia and University Hospital of Modena, I‑41124 Modena, Italy
| | - Alessandra Pivetti
- Department of Medical Specialties, Gastroenterology Unit, University of Modena and Reggio Emilia and University Hospital of Modena, I‑41124 Modena, Italy
| | - Filippo Schepis
- Department of Medical Specialties, Gastroenterology Unit, University of Modena and Reggio Emilia and University Hospital of Modena, I‑41124 Modena, Italy
| | - Dante Romagnoli
- Department of Medical Specialties, Gastroenterology Unit, University of Modena and Reggio Emilia and University Hospital of Modena, I‑41124 Modena, Italy
| | - Serena Mancarella
- National Institute of Gastroenterology ‘Saverio de Bellis’, Research Hospital, I‑70013 Castellana Grotte, Italy
| | - Francesco Dituri
- National Institute of Gastroenterology ‘Saverio de Bellis’, Research Hospital, I‑70013 Castellana Grotte, Italy
| | - Maria-Luz Martinez‑Chantar
- Liver Disease Laboratory, Centre for Cooperative Research in Biosciences (CIC bioGUNE), 48160 Derio, Spain
| | - Gianluigi Giannelli
- National Institute of Gastroenterology ‘Saverio de Bellis’, Research Hospital, I‑70013 Castellana Grotte, Italy
| | - Erica Villa
- Department of Medical Specialties, Gastroenterology Unit, University of Modena and Reggio Emilia and University Hospital of Modena, I‑41124 Modena, Italy
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5
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Lasagni S, Leonardi F, Pivetti A, Di Marco L, Ravaioli F, Serenari M, Gitto S, Critelli RM, Milosa F, Romanzi A, Mancarella S, Dituri F, Riefolo M, Catellani B, Magistri P, Romagnoli D, Celsa C, Enea M, de Maria N, Schepis F, Colecchia A, Cammà C, Cescon M, d’Errico A, di Benedetto F, Giannelli G, Martinez-Chantar ML, Villa E. Endothelial angiopoietin-2 overexpression in explanted livers identifies subjects at higher risk of recurrence of hepatocellular carcinoma after liver transplantation. Front Oncol 2022; 12:960808. [PMID: 36158651 PMCID: PMC9493368 DOI: 10.3389/fonc.2022.960808] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
Background Though the precise criteria for accessing LT are consistently being applied, HCC recurrence (HCC-R_LT) still affects more than 15% of the patients. We analyzed the clinical, histopathological, and biological features of patients with HCC to identify the predictive factors associated with cancer recurrence and survival after LT. Methods We retrospectively analyzed 441 patients with HCC who underwent LT in our center. Overall, 70 (15.8%) of them developed HCC-R_LT. We matched them by age at transplant and etiology with 70 non-recurrent patients. A comparable cohort from the Liver Transplant Centre of Bologna served as validation. The clinical and biochemical characteristics and pre-LT criteria (Milan, Metroticket, Metroticket_AFP, and AFP model) were evaluated. Histological analysis and immunohistochemistry for angiopoietin-2 in the tumor and non-tumor tissue of explanted livers were performed. Patients’ follow-up was until death, last clinical evaluation, or 31 December 2021. In patients with HCC-R_LT, the date of diagnosis of recurrence and anatomical site has been reported; if a biopsy of recurrence was available, histologic and immunohistochemical analyses were also performed. Results Patients were followed up for a mean period of 62.7 ± 54.7 months (median, 39 months). A higher risk of HCC-R_LT was evident for factors related indirectly (AFP) or directly (endothelial angiopoietin-2, microvascular invasion) to biological HCC aggressiveness. In multivariate analysis, only angiopoietin-2 expression was independently associated with recurrence. Extremely high levels of endothelial angiopoietin-2 expression were also found in hepatic recurrence and all different metastatic locations. In univariate analysis, MELD, Metroticket_AFP Score, Edmondson–Steiner grade, microvascular invasion, and endothelial angiopoietin-2 were significantly related to survival. In multivariate analysis, angiopoietin-2 expression, Metroticket_AFP score, and MELD (in both training and validation cohorts) independently predicted mortality. In time-dependent area under receiver operating characteristic curve analysis, the endothelial angiopoietin-2 expression had the highest specificity and sensitivity for recurrence (AUC 0.922, 95% CI 0.876–0.962, p < 0.0001). Conclusions Endothelial angiopoietin-2 expression is a powerful independent predictor of post-LT tumor recurrence and mortality, highlighting the fundamental role of tumor biology in defining the patients’ prognosis after liver transplantation. The great advantage of endothelial angiopoietin-2 is that it is evaluable in HCC biopsy before LT and could drive a patient’s priority on the waiting list.
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Affiliation(s)
- Simone Lasagni
- Gastroenterology Unit, Department of Medical Specialties, University of Modena and Reggio Emilia and Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Filippo Leonardi
- Gastroenterology and Transplant Hepatology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Alessandra Pivetti
- Gastroenterology Unit, Department of Medical Specialties, University of Modena and Reggio Emilia and Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Lorenza Di Marco
- Gastroenterology Unit, Department of Medical Specialties, University of Modena and Reggio Emilia and Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Federico Ravaioli
- Gastroenterology Unit, Department of Medical Specialties, University of Modena and Reggio Emilia and Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Matteo Serenari
- Liver Transplant Center, University of Bologna, Balogna, Italy
| | - Stefano Gitto
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Rosina Maria Critelli
- Gastroenterology Unit, Department of Medical Specialties, University of Modena and Reggio Emilia and Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Fabiola Milosa
- Gastroenterology Unit, Department of Medical Specialties, University of Modena and Reggio Emilia and Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Adriana Romanzi
- Gastroenterology Unit, Department of Medical Specialties, University of Modena and Reggio Emilia and Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Serena Mancarella
- National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Castellana Grotte, Italy
| | - Francesco Dituri
- National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Castellana Grotte, Italy
| | - Mattia Riefolo
- Pathology Unit, Istituto di ricovero e cura a carattere scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Barbara Catellani
- Liver Transplant Center, University of Modena and Reggio Emilia and Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Paolo Magistri
- Liver Transplant Center, University of Modena and Reggio Emilia and Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Dante Romagnoli
- Gastroenterology Unit, Department of Medical Specialties, University of Modena and Reggio Emilia and Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Ciro Celsa
- Section of Gastroenterology and Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Palermo, Italy
| | - Marco Enea
- Internal Medicine and Medical Specialties, Department of Health Promotion, Mother and Child Care (PROMISE) University of Palermo, Palermo, Spain
| | - Nicola de Maria
- Gastroenterology Unit, Department of Medical Specialties, University of Modena and Reggio Emilia and Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Filippo Schepis
- Gastroenterology Unit, Department of Medical Specialties, University of Modena and Reggio Emilia and Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Antonio Colecchia
- Gastroenterology Unit, Department of Medical Specialties, University of Modena and Reggio Emilia and Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Calogero Cammà
- Section of Gastroenterology and Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Matteo Cescon
- Liver Transplant Center, University of Bologna, Balogna, Italy
| | - Antonietta d’Errico
- Pathology Unit, Istituto di ricovero e cura a carattere scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Fabrizio di Benedetto
- Liver Transplant Center, University of Modena and Reggio Emilia and Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Gianluigi Giannelli
- National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Castellana Grotte, Italy
| | - Maria Luz Martinez-Chantar
- Liver Disease Laboratory, Center for Cooperative Research in Biosciences (CIC bioGUNE), Basque Research and Technology Alliance (BRTA), Derio, Spain
- Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBERehd “Instituto de Salud Carlos III”), Derio, Spain
| | - Erica Villa
- Gastroenterology Unit, Department of Medical Specialties, University of Modena and Reggio Emilia and Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
- *Correspondence: Erica Villa,
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6
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Cigliano A, Zhang S, Ribback S, Steinmann S, Sini M, Ament CE, Utpatel K, Song X, Wang J, Pilo MG, Berger F, Wang H, Tao J, Li X, Pes GM, Mancarella S, Giannelli G, Dombrowski F, Evert M, Calvisi DF, Chen X, Evert K. The Hippo pathway effector TAZ induces intrahepatic cholangiocarcinoma in mice and is ubiquitously activated in the human disease. J Exp Clin Cancer Res 2022; 41:192. [PMID: 35655220 PMCID: PMC9164528 DOI: 10.1186/s13046-022-02394-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 05/16/2022] [Indexed: 12/31/2022]
Abstract
Background Intrahepatic cholangiocarcinoma (iCCA) is a highly aggressive primary liver tumor with increasing incidence worldwide, dismal prognosis, and few therapeutic options. Mounting evidence underlines the role of the Hippo pathway in this disease; however, the molecular mechanisms whereby the Hippo cascade contributes to cholangiocarcinogenesis remain poorly defined. Methods We established novel iCCA mouse models via hydrodynamic transfection of an activated form of transcriptional coactivator with PDZ-binding motif (TAZ), a Hippo pathway downstream effector, either alone or combined with the myristoylated AKT (myr-AKT) protooncogene, in the mouse liver. Hematoxylin and eosin staining, immunohistochemistry, electron microscopy, and quantitative real-time RT-PCR were applied to characterize the models. In addition, in vitro cell line studies were conducted to address the growth-promoting roles of TAZ and its paralog YAP. Results Overexpression of TAZ in the mouse liver triggered iCCA development with very low incidence and long latency. In contrast, co-expression of TAZ and myr-AKT dramatically increased tumor frequency and accelerated cancer formation in mice, with 100% iCCA incidence and high tumor burden by 10 weeks post hydrodynamic injection. AKT/TAZ tumors faithfully recapitulated many of the histomolecular features of human iCCA. At the molecular level, the development of the cholangiocellular lesions depended on the binding of TAZ to TEAD transcription factors. In addition, inhibition of the Notch pathway did not hamper carcinogenesis but suppressed the cholangiocellular phenotype of AKT/TAZ tumors. Also, knockdown of YAP, the TAZ paralog, delayed cholangiocarcinogenesis in AKT/TAZ mice without affecting the tumor phenotype. Furthermore, human preinvasive and invasive iCCAs and mixed hepatocellular carcinoma/iCCA displayed widespread TAZ activation and downregulation of the mechanisms protecting TAZ from proteolysis. Conclusions Overall, the present data underscore the crucial role of TAZ in cholangiocarcinogenesis Supplementary Information The online version contains supplementary material available at 10.1186/s13046-022-02394-2.
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Affiliation(s)
- Antonio Cigliano
- Institute of Pathology, University of Regensburg, Franz-Josef-Strauß-Allee 11, Regensburg, Germany.,Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Shanshan Zhang
- Department of Bioengineering and Therapeutic Sciences and Liver Center, University of California, 513 Parnassus Avenue, San Francisco, CA, USA.,Department of Pathology, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Silvia Ribback
- Institute of Pathology, University of Greifswald, Greifswald, Germany
| | - Sara Steinmann
- Institute of Pathology, University of Regensburg, Franz-Josef-Strauß-Allee 11, Regensburg, Germany
| | - Marcella Sini
- Experimental Pathology Unit, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Cindy E Ament
- Institute of Pathology, University of Regensburg, Franz-Josef-Strauß-Allee 11, Regensburg, Germany
| | - Kirsten Utpatel
- Institute of Pathology, University of Regensburg, Franz-Josef-Strauß-Allee 11, Regensburg, Germany
| | - Xinhua Song
- Department of Bioengineering and Therapeutic Sciences and Liver Center, University of California, 513 Parnassus Avenue, San Francisco, CA, USA.,School of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Jingxiao Wang
- Department of Bioengineering and Therapeutic Sciences and Liver Center, University of California, 513 Parnassus Avenue, San Francisco, CA, USA.,School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
| | - Maria G Pilo
- Institute of Pathology, University of Greifswald, Greifswald, Germany
| | - Fabian Berger
- Institute of Pathology, University of Regensburg, Franz-Josef-Strauß-Allee 11, Regensburg, Germany
| | - Haichuan Wang
- Department of Bioengineering and Therapeutic Sciences and Liver Center, University of California, 513 Parnassus Avenue, San Francisco, CA, USA.,Liver Transplantation Division, Department of Liver Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Junyan Tao
- Department of Bioengineering and Therapeutic Sciences and Liver Center, University of California, 513 Parnassus Avenue, San Francisco, CA, USA
| | - Xiaolei Li
- Department of Bioengineering and Therapeutic Sciences and Liver Center, University of California, 513 Parnassus Avenue, San Francisco, CA, USA.,Department of Thyroid and Breast Surgery, The 960th Hospital of the PLA, Jinan, 250031, China
| | - Giovanni M Pes
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Serena Mancarella
- National Institute of Gastroenterology "S. de Bellis", Research Hospital, Castellana Grotte, Italy
| | - Gianluigi Giannelli
- National Institute of Gastroenterology "S. de Bellis", Research Hospital, Castellana Grotte, Italy
| | - Frank Dombrowski
- Institute of Pathology, University of Greifswald, Greifswald, Germany
| | - Matthias Evert
- Institute of Pathology, University of Regensburg, Franz-Josef-Strauß-Allee 11, Regensburg, Germany
| | - Diego F Calvisi
- Institute of Pathology, University of Regensburg, Franz-Josef-Strauß-Allee 11, Regensburg, Germany
| | - Xin Chen
- Department of Bioengineering and Therapeutic Sciences and Liver Center, University of California, 513 Parnassus Avenue, San Francisco, CA, USA.,University of Hawaii Cancer Center, Honolulu, Hawaii, USA
| | - Katja Evert
- Institute of Pathology, University of Regensburg, Franz-Josef-Strauß-Allee 11, Regensburg, Germany.
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7
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Dituri F, Gigante G, Scialpi R, Mancarella S, Fabregat I, Giannelli G. Proteoglycans in Cancer: Friends or Enemies? A Special Focus on Hepatocellular Carcinoma. Cancers (Basel) 2022; 14:cancers14081902. [PMID: 35454809 PMCID: PMC9024587 DOI: 10.3390/cancers14081902] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 03/10/2022] [Revised: 04/04/2022] [Accepted: 04/08/2022] [Indexed: 12/16/2022] Open
Abstract
Simple Summary Proteoglycans affect multiple molecular and cellular processes during the progression of solid tumors with a highly desmoplastic stroma, such as HCC. Due to their role in enhancing or limiting the traits of cancer cells underlying their aggressiveness, such as proliferation, angiogenesis, epithelial to mesenchymal transition (EMT), and stemness, these macromolecules could be exploited as molecular targets or therapeutic agents. Proteoglycans, such as biglycan, versican, syndecan-1, glypican-3, and agrin, promote HCC cell proliferation, EMT, and angiogenesis, while endostatin and proteoglycan 4 were shown to impair cancer neovascularization or to enhance the sensitivity of HCC cells to drugs, such as sorafenib and regorafenib. Based on this evidence, interventional strategies involving the use of humanized monoclonal antibodies, T cells engineered with chimeric antigen receptors, or recombinant proteins mimicking potentially curative proteoglycans, are being employed or may be adopted in the near future for the treatment of HCC. Abstract Proteoglycans are a class of highly glycosylated proteins expressed in virtually all tissues, which are localized within membranes, but more often in the pericellular space and extracellular matrix (ECM), and are involved in tissue homeostasis and remodeling of the stromal microenvironment during physiological and pathological processes, such as tissue regeneration, angiogenesis, and cancer. In general, proteoglycans can perform signaling activities and influence a range of physical, chemical, and biological tissue properties, including the diffusivity of small electrolytes and nutrients and the bioavailability of growth factors. While the dysregulated expression of some proteoglycans is observed in many cancers, whether they act as supporters or limiters of neoplastic progression is still a matter of controversy, as the tumor promoting or suppressive function of some proteoglycans is context dependent. The participation of multiple proteoglycans in organ regeneration (as demonstrated for the liver in hepatectomy mouse models) and in cancer suggests that these molecules actively influence cell growth and motility, thus contributing to key events that characterize neoplastic progression. In this review, we outline the main roles of proteoglycans in the physiology and pathology of cancers, with a special mention to hepatocellular carcinoma (HCC), highlighting the translational potential of proteoglycans as targets or therapeutic agents for the treatment of this disease.
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Affiliation(s)
- Francesco Dituri
- National Institute of Gastroenterology Saverio de Bellis, IRCCS Research Hospital, Castellana Grotte, 70013 Bari, Italy; (G.G.); (R.S.); (S.M.); (G.G.)
- Correspondence:
| | - Gianluigi Gigante
- National Institute of Gastroenterology Saverio de Bellis, IRCCS Research Hospital, Castellana Grotte, 70013 Bari, Italy; (G.G.); (R.S.); (S.M.); (G.G.)
| | - Rosanna Scialpi
- National Institute of Gastroenterology Saverio de Bellis, IRCCS Research Hospital, Castellana Grotte, 70013 Bari, Italy; (G.G.); (R.S.); (S.M.); (G.G.)
| | - Serena Mancarella
- National Institute of Gastroenterology Saverio de Bellis, IRCCS Research Hospital, Castellana Grotte, 70013 Bari, Italy; (G.G.); (R.S.); (S.M.); (G.G.)
| | - Isabel Fabregat
- Oncobell Program, Bellvitge Biomedical Research Institute (IDIBELL), CIBEREHD and University of Barcelona, L’Hospitalet de Llobregat, 08908 Barcelona, Spain;
| | - Gianluigi Giannelli
- National Institute of Gastroenterology Saverio de Bellis, IRCCS Research Hospital, Castellana Grotte, 70013 Bari, Italy; (G.G.); (R.S.); (S.M.); (G.G.)
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8
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Mancarella S, Serino G, Gigante I, Cigliano A, Ribback S, Sanese P, Grossi V, Simone C, Armentano R, Evert M, Calvisi DF, Giannelli G. CD90 is regulated by notch1 and hallmarks a more aggressive intrahepatic cholangiocarcinoma phenotype. J Exp Clin Cancer Res 2022; 41:65. [PMID: 35172861 PMCID: PMC8851853 DOI: 10.1186/s13046-022-02283-8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 02/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intrahepatic Cholangiocarcinoma (iCCA) is characterized by a strong stromal reaction playing a role in tumor progression. Thymus cell antigen 1 (THY1), also called Cluster of Differentiation 90 (CD90), is a key regulator of cell-cell and cell-matrix interaction. In iCCA, CD90 has been reported to be associated with a poor prognosis. In an iCCA PDX model, we recently found that CD90 was downregulated in mice treated with the Notch γ-secretase inhibitor Crenigacestat. The study aims to investigate the role of CD90 in relation to the NOTCH pathway. METHODS THY1/CD90 gene and protein expression was evaluated in human iCCA tissues and xenograft models by qRT-PCR, immunohistochemistry, and immunofluorescence. Notch1 inhibition was achieved by siRNA. THY1/CD90 functions were investigated in xenograft models built with HuCCT1 and KKU-M213 cell lines, engineered to overexpress or knockdown THY1, respectively. RESULTS CD90 co-localized with EPCAM, showing its epithelial origin. In vitro, NOTCH1 silencing triggered HES1 and THY1 down-regulation. RBPJ, a critical transcriptional regulator of NOTCH signaling, exhibited putative binding sites on the THY1 promoter and bound to the latter, implying CD90 as a downstream NOTCH pathway effector. In vivo, Crenigacestat suppressed iCCA growth and reduced CD90 expression in the PDX model. In the xenograft model, Crenigacestat inhibited tumor growth of HuCCT1 cells transfected to overexpress CD90 and KKU-M213 cells constitutively expressing high levels of CD90, while not affecting the growth of HuCCT1 control cells and KKU-M213 depleted of CD90. In an iCCA cohort, patients with higher expression levels of NOTCH1/HES1/THY1 displayed a significantly shorter survival. CONCLUSIONS iCCA patients with higher NOTCH1/HES1/THY1 expression have the worst prognosis, but they are more likely to benefit from Notch signaling inhibition. These findings represent the scientific rationale for testing NOTCH1 inhibitors in clinical trials, taking the first step toward precision medicine for iCCA.
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Affiliation(s)
- Serena Mancarella
- National Institute of Gastroenterology "S. de Bellis", Research Hospital, Via Turi 27, 70013, Castellana Grotte, Italy
| | - Grazia Serino
- National Institute of Gastroenterology "S. de Bellis", Research Hospital, Via Turi 27, 70013, Castellana Grotte, Italy
| | - Isabella Gigante
- National Institute of Gastroenterology "S. de Bellis", Research Hospital, Via Turi 27, 70013, Castellana Grotte, Italy
| | - Antonio Cigliano
- Institute of Pathology, University of Regensburg, 93053, Regensburg, Germany
| | - Silvia Ribback
- Institute of Pathology, University of Greifswald, 17489, Greifswald, Germany
| | - Paola Sanese
- National Institute of Gastroenterology "S. de Bellis", Research Hospital, Via Turi 27, 70013, Castellana Grotte, Italy
| | - Valentina Grossi
- National Institute of Gastroenterology "S. de Bellis", Research Hospital, Via Turi 27, 70013, Castellana Grotte, Italy
| | - Cristiano Simone
- National Institute of Gastroenterology "S. de Bellis", Research Hospital, Via Turi 27, 70013, Castellana Grotte, Italy
| | - Raffaele Armentano
- National Institute of Gastroenterology "S. de Bellis", Research Hospital, Via Turi 27, 70013, Castellana Grotte, Italy
| | - Matthias Evert
- Institute of Pathology, University of Regensburg, 93053, Regensburg, Germany
| | - Diego F Calvisi
- Institute of Pathology, University of Regensburg, 93053, Regensburg, Germany
| | - Gianluigi Giannelli
- National Institute of Gastroenterology "S. de Bellis", Research Hospital, Via Turi 27, 70013, Castellana Grotte, Italy.
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9
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Dituri F, Scialpi R, Schmidt TA, Frusciante M, Mancarella S, Lupo LG, Villa E, Giannelli G. Proteoglycan-4 is correlated with longer survival in HCC patients and enhances sorafenib and regorafenib effectiveness via CD44 in vitro. Cell Death Dis 2020; 11:984. [PMID: 33199679 PMCID: PMC7669886 DOI: 10.1038/s41419-020-03180-8] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 10/27/2020] [Accepted: 10/27/2020] [Indexed: 12/13/2022]
Abstract
Sorafenib and regorafenib administration is among the preferential approaches to treat hepatocellular carcinoma (HCC), but does not provide satisfactory benefits. Intensive crosstalk occurring between cancer cells and other multiple non-cancerous cell subsets present in the surrounding microenvironment is assumed to affect tumor progression. This interplay is mediated by a number of soluble and structural extracellular matrix (ECM) proteins enriching the stromal milieu. Here we assess the HCC tumor expression of the ECM protein proteoglycan 4 (PRG4) and its potential pharmacologic activity either alone, or in combination with sorafenib and regorafenib. PRG4 mRNA levels resulted strongly correlated with increased survival rate of HCC patients (p = 0.000) in a prospective study involving 78 HCC subjects. We next showed that transforming growth factor beta stimulates PRG4 expression and secretion by primary human HCC cancer-associated fibroblasts, non-invasive HCC cell lines, and ex vivo specimens. By functional tests we found that recombinant human PRG4 (rhPRG4) impairs HCC cell migration. More importantly, the treatment of HCC cells expressing CD44 (the main PRG4 receptor) with rhPRG4 dramatically enhances the growth-limiting capacity of sorafenib and regorafenib, whereas not significantly affecting cell proliferation per se. Conversely, rhPRG4 only poorly potentiates drug effectiveness on low CD44-expressing or stably CD44-silenced HCC cells. Overall, these data suggest that the physiologically-produced compound PRG4 may function as a novel tumor-suppressive agent by strengthening sorafenib and regorafenib effects in the treatment of HCC.
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Affiliation(s)
- Francesco Dituri
- National Institute of Gastroenterology "S. De Bellis" Research Hospital, 70013, Castellana Grotte, Italy.
| | - Rosanna Scialpi
- National Institute of Gastroenterology "S. De Bellis" Research Hospital, 70013, Castellana Grotte, Italy
| | - Tannin A Schmidt
- Biomedical Engineering Department, University of Connecticut Health Centre, Farmington, CT, USA
| | - Martina Frusciante
- National Institute of Gastroenterology "S. De Bellis" Research Hospital, 70013, Castellana Grotte, Italy
| | - Serena Mancarella
- National Institute of Gastroenterology "S. De Bellis" Research Hospital, 70013, Castellana Grotte, Italy
| | - Luigi Giovanni Lupo
- University of Bari, Department of General Surgery and Liver Transplantation, Policlinico - piazza Giulio Cesare 14, 70125, Bari, Italy
| | - Erica Villa
- Gastroenterology Unit, Department of Internal Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Gianluigi Giannelli
- National Institute of Gastroenterology "S. De Bellis" Research Hospital, 70013, Castellana Grotte, Italy
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10
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Chaoul N, Mancarella S, Lupo L, Giannelli G, Dituri F. Impaired Anti-Tumor T cell Response in Hepatocellular Carcinoma. Cancers (Basel) 2020; 12:cancers12030627. [PMID: 32182707 PMCID: PMC7139707 DOI: 10.3390/cancers12030627] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 02/19/2020] [Accepted: 03/05/2020] [Indexed: 02/08/2023] Open
Abstract
Different subsets of lymphocytes have the capacity to promote or counteract the progression of solid cancers, including hepatocellular carcinoma (HCC). Therefore, to determine the infiltrative ability and functional status of major immune cell subtypes into tumor may lead to novel insights from the perspective of immunotherapy. After obtaining single cell suspensions from freshly collected specimens of HCC tumor, along with paired peritumor tissues and peripheral blood mononuclear cells (PBMCs) from 14 patients, we flow-cytometrically identified and quantified the relative frequencies of lymphocyte subsets within the tissues of origin. We found that the recruitment in the tumor of cytotoxic cells, namely the terminally differentiated CD4+ and CD8+ T cells (TEFF), is impaired, whereas the effector memory CD4+ T cells (TEM) are more attracted in this site. Concerning the other subsets, the frequency of NK CD56hi and NKT CD56hi cells infiltration in the tumor is increased, whereas that of NKT CD56low is reduced. Although CD4+ and CD8+ T cells settled in the tumor show a higher degree of activation than the circulating counterpart, they occur with a more exhausted phenotype. Overall, these data demonstrate the prevalently immunosuppressive nature of HCC microenvironment, and prompt us to search for strategies to enhance the activity of anti-tumor immune cell subsets.
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Affiliation(s)
- Nada Chaoul
- Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, 70124 Bari, Italy
| | - Serena Mancarella
- National Institute of Gastroenterology "S. De Bellis," Research Hospital, 70013 Castellana Grotte, Italy
| | - Luigi Lupo
- General Surgery and Liver Transplantation Unit, University of Bari Medical School, 70124 Bari, Italy
| | - Gianluigi Giannelli
- National Institute of Gastroenterology "S. De Bellis," Research Hospital, 70013 Castellana Grotte, Italy
| | - Francesco Dituri
- National Institute of Gastroenterology "S. De Bellis," Research Hospital, 70013 Castellana Grotte, Italy
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11
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Modica TME, Dituri F, Mancarella S, Pisano C, Fabregat I, Giannelli G. Calcium Regulates HCC Proliferation as well as EGFR Recycling/Degradation and Could Be a New Therapeutic Target in HCC. Cancers (Basel) 2019; 11:cancers11101588. [PMID: 31635301 PMCID: PMC6826902 DOI: 10.3390/cancers11101588] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 09/30/2019] [Accepted: 10/13/2019] [Indexed: 01/08/2023] Open
Abstract
Calcium is the most abundant element in the human body. Its role is essential in physiological and biochemical processes such as signal transduction from outside to inside the cell between the cells of an organ, as well as the release of neurotransmitters from neurons, muscle contraction, fertilization, bone building, and blood clotting. As a result, intra- and extracellular calcium levels are tightly regulated by the body. The liver is the most specialized organ of the body, as its functions, carried out by hepatocytes, are strongly governed by calcium ions. In this work, we analyze the role of calcium in human hepatoma (HCC) cell lines harboring a wild type form of the Epidermal Growth Factor Receptor (EGFR), particularly its role in proliferation and in EGFR downmodulation. Our results highlight that calcium is involved in the proliferative capability of HCC cells, as its subtraction is responsible for EGFR degradation by proteasome machinery and, as a consequence, for EGFR intracellular signaling downregulation. However, calcium-regulated EGFR signaling is cell line-dependent. In cells responding weakly to the epidermal growth factor (EGF), calcium seems to have an opposite effect on EGFR internalization/degradation mechanisms. These results suggest that besides EGFR, calcium could be a new therapeutic target in HCC.
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Affiliation(s)
- Teresa Maria Elisa Modica
- Department of Biomedical Science and Human Oncology, Università degli Studi di Bari Aldo Moro, 70121 Bari, Italy.
- Biogem S.C.A.R.L., 83031 Ariano Irpino (AV), Italy.
| | | | | | | | - Isabel Fabregat
- Bellvitge Biomedical Research Institute (IDIBELL) L'Hospitalet, 08907 Barcelona, Spain.
- Faculty of Medicine and Health Sciences, University of Barcelona, 08907 Barcelona, Spain.
- Oncology Program, CIBEREHD, Instituto de Salud Carlos III, 28029 Madrid, Spain.
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12
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Mancarella S, Krol S, Crovace A, Leporatti S, Dituri F, Frusciante M, Giannelli G. Validation of Hepatocellular Carcinoma Experimental Models for TGF-β Promoting Tumor Progression. Cancers (Basel) 2019; 11:cancers11101510. [PMID: 31600917 PMCID: PMC6826694 DOI: 10.3390/cancers11101510] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 08/29/2019] [Revised: 09/27/2019] [Accepted: 09/29/2019] [Indexed: 02/07/2023] Open
Abstract
Transforming growth factor beta (TGF-β) is a pleiotropic cytokine with dual role in hepatocellular carcinoma (HCC). It acts as tumor-suppressor and tumor-promoter in the early and late stage respectively. TGF-β influences the tumor-stroma cross-talk affecting the tumoral microenvironment. Therefore, inhibiting the TGF- β mediated pathway alone and/or in combination with chemotherapeutics represents an important therapeutic option. Experimental models to dissect the role of TGF-β in HCC tumor progression as well as the effectiveness of specific inhibitors are tricky. HCC cell lines respond to TGF-β according to their epithelial phenotype. However, the mesenchymal and more aggressive HCC cell lines in vitro, do not develop tumors when transplanted in vivo, thus hampering the understanding of molecular pathways that dictate outcome. In addition, in this model the native immune system is abolished, therefore the contribution of inflammation in hepatocarcinogenesis is unreliable. Different strategies have been set up to engineer HCC animal models, including genetically modified mice, chemically induced HCC, or hydrodynamic techniques. Patient-derived xenograft is currently probably the most fascinating model, keeping in mind that models cannot mirror all the reality. In this context, we discuss the different available HCC mouse models including our experimental model treated with inhibitor of TGF-β receptor Type I kinase (Galunisertib) and a potential role of exosomes in TGF-β moderated tumor progression of HCC. Unfortunately, no positive results were obtained in our treated orthotopic model because it does not reproduce the critical tumor-stroma interactions of the HCC.
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Affiliation(s)
- Serena Mancarella
- National Institute of Gastroenterology, "S. de Bellis" Research Hospital, Castellana Grotte, Bari 70013, Italy.
| | - Silke Krol
- National Institute of Gastroenterology, "S. de Bellis" Research Hospital, Castellana Grotte, Bari 70013, Italy.
| | - Alberto Crovace
- National Institute of Gastroenterology, "S. de Bellis" Research Hospital, Castellana Grotte, Bari 70013, Italy.
| | | | - Francesco Dituri
- National Institute of Gastroenterology, "S. de Bellis" Research Hospital, Castellana Grotte, Bari 70013, Italy.
| | - Martina Frusciante
- National Institute of Gastroenterology, "S. de Bellis" Research Hospital, Castellana Grotte, Bari 70013, Italy.
| | - Gianluigi Giannelli
- National Institute of Gastroenterology, "S. de Bellis" Research Hospital, Castellana Grotte, Bari 70013, Italy.
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13
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Dituri F, Cossu C, Mancarella S, Giannelli G. The Interactivity between TGFβ and BMP Signaling in Organogenesis, Fibrosis, and Cancer. Cells 2019; 8:E1130. [PMID: 31547567 PMCID: PMC6829314 DOI: 10.3390/cells8101130] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 09/16/2019] [Accepted: 09/17/2019] [Indexed: 12/12/2022] Open
Abstract
The Transforming Growth Factor beta (TGFβ) and Bone Morphogenic Protein (BMP) pathways intersect at multiple signaling hubs and cooperatively or counteractively participate to bring about cellular processes which are critical not only for tissue morphogenesis and organogenesis during development, but also for adult tissue homeostasis. The proper functioning of the TGFβ/BMP pathway depends on its communication with other signaling pathways and any deregulation leads to developmental defects or diseases, including fibrosis and cancer. In this review we explore the cellular and physio-pathological contexts in which the synergism or antagonism between the TGFβ and BMP pathways are crucial determinants for the normal developmental processes, as well as the progression of fibrosis and malignancies.
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Affiliation(s)
- Francesco Dituri
- National Institute of Gastroenterology "S. De Bellis", Research Hospital, Castellana Grotte, 70013 Bari, Italy.
| | - Carla Cossu
- National Institute of Gastroenterology "S. De Bellis", Research Hospital, Castellana Grotte, 70013 Bari, Italy.
| | - Serena Mancarella
- National Institute of Gastroenterology "S. De Bellis", Research Hospital, Castellana Grotte, 70013 Bari, Italy.
| | - Gianluigi Giannelli
- National Institute of Gastroenterology "S. De Bellis", Research Hospital, Castellana Grotte, 70013 Bari, Italy.
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14
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Fouassier L, Marzioni M, Afonso MB, Dooley S, Gaston K, Giannelli G, Rodrigues CMP, Lozano E, Mancarella S, Segatto O, Vaquero J, Marin JJG, Coulouarn C. Signalling networks in cholangiocarcinoma: Molecular pathogenesis, targeted therapies and drug resistance. Liver Int 2019; 39 Suppl 1:43-62. [PMID: 30903728 DOI: 10.1111/liv.14102] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/25/2019] [Accepted: 02/27/2019] [Indexed: 12/13/2022]
Abstract
Cholangiocarcinoma (CCA) is a deadly disease. While surgery may attain cure in a minor fraction of cases, therapeutic options in either the adjuvant or advanced setting are limited. The possibility of advancing the efficacy of therapeutic approaches to CCA relies on understanding its molecular pathogenesis and developing rational therapies aimed at interfering with oncogenic signalling networks that drive and sustain cholangiocarcinogenesis. These efforts are complicated by the intricate biology of CCA, which integrates not only the driving force of tumour cell-intrinsic alterations at the genetic and epigenetic level but also pro-tumorigenic cues conveyed to CCA cells by different cell types present in the rich tumour stroma. Herein, we review our current understanding of the mechanistic bases underpinning the activation of major oncogenic pathways causative of CCA pathogenesis. We subsequently discuss how this knowledge is being exploited to implement rationale-based and genotype-matched therapeutic approaches that predictably will radically transform CCA clinical management in the next decade. We conclude by highlighting the mechanisms of therapeutic resistance in CCA and reviewing innovative approaches to combat resistance at the preclinical and clinical level.
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Affiliation(s)
- Laura Fouassier
- Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine (CRSA), Paris, France
| | - Marco Marzioni
- Clinic of Gastroenterology and Hepatology, Università Politecnica delle Marche, Ospedali Riuniti - University Hospital, Ancona, Italy
| | - Marta B Afonso
- Research Institute for Medicines (iMed.ULisboa), Universidade de Lisboa, Lisbon, Portugal
| | - Steven Dooley
- Department of Medicine II, Molecular Hepatology Section, Heidelberg University, Mannheim, Germany
| | - Kevin Gaston
- Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Gianluigi Giannelli
- National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Bari, Italy
| | - Cecilia M P Rodrigues
- Research Institute for Medicines (iMed.ULisboa), Universidade de Lisboa, Lisbon, Portugal
| | - Elisa Lozano
- Experimental Hepatology and Drug Targeting (HEVEFARM), IBSAL, University of Salamanca, Salamanca, Spain
| | - Serena Mancarella
- National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Bari, Italy
| | - Oreste Segatto
- Unit of Oncogenomics and Epigenetics, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Javier Vaquero
- Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine (CRSA), Paris, France.,Sorbonne Université, CNRS, Ecole Polytech., Univ. Paris-Sud, Observatoire de Paris, Université Paris-Saclay, PSL Research University, Paris, France
| | - Jose J G Marin
- Experimental Hepatology and Drug Targeting (HEVEFARM), IBSAL, University of Salamanca, Salamanca, Spain
| | - Cédric Coulouarn
- Inserm, Univ Rennes, Inra, Institut NuMeCan (Nutrition Metabolisms and Cancer), Rennes, France
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15
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Dituri F, Mancarella S, Cigliano A, Chieti A, Giannelli G. TGF-β as Multifaceted Orchestrator in HCC Progression: Signaling, EMT, Immune Microenvironment, and Novel Therapeutic Perspectives. Semin Liver Dis 2019; 39:53-69. [PMID: 30586675 DOI: 10.1055/s-0038-1676121] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Therapeutic attempts to treat hepatocellular carcinoma (HCC) frequently result in a poor response or treatment failure. The efficacy of approved drugs and survival expectancies is affected by an ample degree of variability that can be explained at least in part by the enormous between-patient cellular and molecular heterogeneity of this neoplasm. Transforming growth factor-β (TGF-β) is hyperactivated in a large fraction of HCCs, where it influences complex interactive networks covering multiple cell types and a plethora of other local soluble ligands, ultimately establishing several malignancy traits. This cytokine boosts the invasiveness of cancerous epithelial cells through promoting the epithelial-to-mesenchymal transition program, but also skews the phenotype of immune cells toward a tumor-supporting status. Here, we discuss recent strategies pursued to offset TGF-β-dependent processes that promote metastatic progression and immune surveillance escape in solid cancers, including HCC. Moreover, we report findings indicating that TGF-β reduces the expression of the proinflammatory factors CCL4 and interleukin-1β (IL-1β in human ex vivo treated HCC tissues. While this is consistent with the anti-inflammatory properties of TGF-β, whether it is an outright tumor promoter or suppressor is still a matter of some debate. Indeed, IL-1β has also been shown to support angiogenesis and cell invasiveness in some cancers. In addition, we describe an inhibitory effect of TGF-β on the secretion of CCL2 and CXCL1 by HCC-derived fibroblasts, which suggests the existence of an indirect stroma-mediated functional link between TGF-β and downstream immunity.
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Affiliation(s)
- Francesco Dituri
- National Institute of Gastroenterology "S. de Bellis," Research Hospital, Castellana Grotte, Italy
| | - Serena Mancarella
- National Institute of Gastroenterology "S. de Bellis," Research Hospital, Castellana Grotte, Italy
| | - Antonio Cigliano
- National Institute of Gastroenterology "S. de Bellis," Research Hospital, Castellana Grotte, Italy
| | - Annarita Chieti
- National Institute of Gastroenterology "S. de Bellis," Research Hospital, Castellana Grotte, Italy
| | - Gianluigi Giannelli
- National Institute of Gastroenterology "S. de Bellis," Research Hospital, Castellana Grotte, Italy
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16
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Abstract
Transforming growth factor-β (TGF-β) is a cytokine essential for the induction of the fibrotic response and for the activation of the cancer stroma. Strong evidence suggests that a strong cross-talk exists among TGF-β and the tissue extracellular matrix components. TGF-β is stored in the matrix as part of a large latent complex bound to the latent TGF-β binding protein (LTBP) and matrix binding of latent TGF-β complexes, which is required for an adequate TGF-β function. Once TGF-β is activated, it regulates extracellular matrix remodelling and promotes a fibroblast to myofibroblast transition, which is essential in fibrotic processes. This cytokine also acts on other cell types present in the fibrotic and tumour microenvironment, such as epithelial, endothelial cells or macrophages and it contributes to the cancer-associated fibroblast (CAF) phenotype. Furthermore, TGF-β exerts anti-tumour activity by inhibiting the host tumour immunosurveillance. Aim of this review is to update how TGF-β and the tissue microenvironment cooperate to promote the pleiotropic actions that regulate cell responses of different cell types, essential for the development of fibrosis and tumour progression. We discuss recent evidences suggesting the use of TGF-β chemical inhibitors as a new line of defence against fibrotic disorders or cancer.
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Affiliation(s)
- Laia Caja
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Biomedical Center, Uppsala University, Box 582, 75123 Uppsala, Sweden.
| | - Francesco Dituri
- National Institute of Gastroenterology, "S. de Bellis" Research Hospital, Castellana Grotte, 70013 Bari, Italy.
| | - Serena Mancarella
- National Institute of Gastroenterology, "S. de Bellis" Research Hospital, Castellana Grotte, 70013 Bari, Italy.
| | - Daniel Caballero-Diaz
- TGF-β and Cancer Group, Oncobell Program, Bellvitge Biomedical Research Institute (IDIBELL), Gran Via de l'Hospitalet, 199, 08908 Barcelona, Spain.
- Oncology Program, CIBEREHD, National Biomedical Research Institute on Liver and Gastrointestinal Diseases, Instituto de Salud Carlos III, 28029 Madrid, Spain.
| | - Aristidis Moustakas
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Biomedical Center, Uppsala University, Box 582, 75123 Uppsala, Sweden.
| | - Gianluigi Giannelli
- National Institute of Gastroenterology, "S. de Bellis" Research Hospital, Castellana Grotte, 70013 Bari, Italy.
| | - Isabel Fabregat
- TGF-β and Cancer Group, Oncobell Program, Bellvitge Biomedical Research Institute (IDIBELL), Gran Via de l'Hospitalet, 199, 08908 Barcelona, Spain.
- Oncology Program, CIBEREHD, National Biomedical Research Institute on Liver and Gastrointestinal Diseases, Instituto de Salud Carlos III, 28029 Madrid, Spain.
- Department of Physiological Sciences, Faculty of Medicine and Health Sciences, University of Barcelona, L'Hospitalet, 08907 Barcelona, Spain.
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Caja L, Dituri F, Mancarella S, Caballero-Diaz D, Moustakas A, Giannelli G, Fabregat I. TGF-β and the Tissue Microenvironment: Relevance in Fibrosis and Cancer. Int J Mol Sci 2018; 19:ijms19051294. [PMID: 29701666 PMCID: PMC5983604 DOI: 10.3390/ijms19051294] [Citation(s) in RCA: 207] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 04/17/2018] [Accepted: 04/24/2018] [Indexed: 12/14/2022] Open
Abstract
Transforming growth factor-β (TGF-β) is a cytokine essential for the induction of the fibrotic response and for the activation of the cancer stroma. Strong evidence suggests that a strong cross-talk exists among TGF-β and the tissue extracellular matrix components. TGF-β is stored in the matrix as part of a large latent complex bound to the latent TGF-β binding protein (LTBP) and matrix binding of latent TGF-β complexes, which is required for an adequate TGF-β function. Once TGF-β is activated, it regulates extracellular matrix remodelling and promotes a fibroblast to myofibroblast transition, which is essential in fibrotic processes. This cytokine also acts on other cell types present in the fibrotic and tumour microenvironment, such as epithelial, endothelial cells or macrophages and it contributes to the cancer-associated fibroblast (CAF) phenotype. Furthermore, TGF-β exerts anti-tumour activity by inhibiting the host tumour immunosurveillance. Aim of this review is to update how TGF-β and the tissue microenvironment cooperate to promote the pleiotropic actions that regulate cell responses of different cell types, essential for the development of fibrosis and tumour progression. We discuss recent evidences suggesting the use of TGF-β chemical inhibitors as a new line of defence against fibrotic disorders or cancer.
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Affiliation(s)
- Laia Caja
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Biomedical Center, Uppsala University, Box 582, 75123 Uppsala, Sweden.
| | - Francesco Dituri
- National Institute of Gastroenterology, "S. de Bellis" Research Hospital, Castellana Grotte, 70013 Bari, Italy.
| | - Serena Mancarella
- National Institute of Gastroenterology, "S. de Bellis" Research Hospital, Castellana Grotte, 70013 Bari, Italy.
| | - Daniel Caballero-Diaz
- TGF-β and Cancer Group, Oncobell Program, Bellvitge Biomedical Research Institute (IDIBELL), Gran Via de l'Hospitalet, 199, 08908 Barcelona, Spain.
- Oncology Program, CIBEREHD, National Biomedical Research Institute on Liver and Gastrointestinal Diseases, Instituto de Salud Carlos III, 28029 Madrid, Spain.
| | - Aristidis Moustakas
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Biomedical Center, Uppsala University, Box 582, 75123 Uppsala, Sweden.
| | - Gianluigi Giannelli
- National Institute of Gastroenterology, "S. de Bellis" Research Hospital, Castellana Grotte, 70013 Bari, Italy.
| | - Isabel Fabregat
- TGF-β and Cancer Group, Oncobell Program, Bellvitge Biomedical Research Institute (IDIBELL), Gran Via de l'Hospitalet, 199, 08908 Barcelona, Spain.
- Oncology Program, CIBEREHD, National Biomedical Research Institute on Liver and Gastrointestinal Diseases, Instituto de Salud Carlos III, 28029 Madrid, Spain.
- Department of Physiological Sciences, Faculty of Medicine and Health Sciences, University of Barcelona, L'Hospitalet, 08907 Barcelona, Spain.
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De Lena M, Caruso ML, Marzullo F, Mancarella S, Armentano R, Ventrella V, Guida M. Complete Response to Chemotherapy in Intra-Abdominal Desmoplastic Small round Cell Carcinoma. A Case Report. Tumori 2018; 84:412-6. [PMID: 9678628 DOI: 10.1177/030089169808400320] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 11/17/2022]
Abstract
Aims and background The authors report the case of a 23-year-old woman affected by intra-abdominal desmoplastic small round cell tumor (DSRCT) who obtained a complete response to multiagent chemotherapy. DSRCT is a rare, highly aggressive neoplasm generally arising in young people and seldom in females (about 20 cases described in the literature). Methods The patient underwent surgical resection of a large 15 × 15 cm mass located in the right lower abdominal quadrant, but after only 2 months later, two liver metastasis were noted. Thus, she was subjected to an aggressive antineoplastic treatment consisting of three groups of alternating non-cross resistant multiagent regimens administered every 21 days (cis-platin-etoposide-adriamycin-bleomicin; gemcitabine-ifosfamide-dacarbazine; methotrexate-5-fluorouracilfolinic acid) for a total of 9 administrations. Results After one cycle of treatment including the administration of all the three alternated schemes of chemotherapy, a complete disappearance of liver disease was noted. The treatment was relatively well-tolerated and the toxicity was acceptable. At present, after 15 months from diagnosis and 12 months after starting chemotherapy, the patient is disease-free and in good health. Conclusions Even though this study regards only a single patient, it is noteworthy because of the rarity of this neoplasm and because of the infrequent complete responses reported in the literature. The efficacy and manageability of the treatment, suggests that both the timing and schedule used could constitute an important therapeutical option for this aggressive and poorly chemo-responsive tumor.
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Affiliation(s)
- M De Lena
- Medical Oncology Division, IRCCS Istituto Oncologico, Bari, Italy
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Comella P, Lorusso V, Casaretti R, De Lucia L, Cartení G, Manzione L, Mancarella S, De Lena M, Comella G. Concurrent Modulation of 5-Fluorouracil with Methotrexate and L-leucovorin: An Effective and Moderately Toxic Regimen for the Treatment of Advanced Colorectal Carcinoma a Multicenter Phase II Study of the Southern Italy Cooperative Oncology Group. Tumori 2018; 85:465-72. [PMID: 10774567 DOI: 10.1177/030089169908500608] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and Background Methotrexate (MTX) and leucovorin (LV) can enhance the cytotoxicity of 5-fluorouracil (5FU) by modifying its metabolic pathway inside target cells. Some preclinical studies and clinical trials have suggested that the concurrent or sequential double modulation of 5FU by means of MTX and LV may give a higher activity than single biochemical modulations. The purpose of our phase II study was to assess the activity and toxicity of a biweekly regimen including MTX, levo-LV and 5FU in colorectal cancer patients. Methods From July 1994 to May 1997, 100 consecutive patients affected by advanced or metastatic colorectal carcinoma were given MTX, 750 mg/m2 iv (2-h infusion) on day 1, and levo-LV, 250 mg/m2 iv (2-h infusion) followed by 5FU, 800 mg/m2 iv bolus on day 2, every two weeks. Patients were treated until complete response or progressive disease was documented, or for a maximum of 16 courses. Results Among 97 eligible patients, 5 complete and 25 partial responses were obtained, giving an overall response rate of 31% (95% exact confidence limits, 22-41%). Response rate was significantly higher in patients with a good (ECOG scale 0) than with a poor (ECOG scale 1 or 2) performance status (40% versus 17%, P <0.02). Median time to treatment failure was 27 weeks, median survival time was 63 (95% confidence limits, 54-71) weeks, and 2- and 3-year probability of survival were 34% and 12%, respectively. Performance status was the only pretreatment characteristic significantly affecting the outcome of patients. Indeed, median survival time was 94 weeks for patients with a performance status = 0 and 37 weeks for patients with a performance status ≥ 1 (P < 0.05). Toxicity of the treatment was low and manageable; grade 3 to 4 leukopenia affected 8% of patients, whereas grade 3 diarrhea and mucositis occurred in 5% and 4%, respectively. Conclusions The double biochemical modulation of 5FU by MTX and levo-LV is at least as effective as, and probably more effective than, the single modulation by MTX or by LV. It may therefore represent a therapeutic option for the palliative treatment of patients with advanced colorectal carcinoma.
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Affiliation(s)
- P Comella
- Division of Medical Oncology A, National Tumor Institute, Naples, Italy
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Rani B, Malfettone A, Dituri F, Soukupova J, Lupo L, Mancarella S, Fabregat I, Giannelli G. Galunisertib suppresses the staminal phenotype in hepatocellular carcinoma by modulating CD44 expression. Cell Death Dis 2018. [PMID: 29515105 PMCID: PMC5841307 DOI: 10.1038/s41419-018-0384-5] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Cancer stem cells (CSCs) niche in the tumor microenvironment is
responsible for cancer recurrence and therapy failure. To better understand its
molecular and biological involvement in hepatocellular carcinoma (HCC) progression,
one can design more effective therapies and tailored then to individual patients.
While sorafenib is currently the only approved drug for first-line treatment of
advanced stage HCC, its role in modulating the CSC niche is estimated to be small.
By contrast, transforming growth factor (TGF)-β
pathway seems to influence the CSC and thus may impact hallmarks of HCC, such as
liver fibrosis, cirrhosis, and tumor progression. Therefore, blocking this pathway
may offer an appealing and druggable target. In our study, we have used galunisertib
(LY2157299), a selective ATP-mimetic inhibitor of TGF-β receptor I (TGFβI/ALK5)
activation, currently under clinical investigation in HCC patients. Because the drug
resistance is mainly mediated by CSCs, we tested the effects of galunisertib on
stemness phenotype in HCC cells to determine whether TGF-β signaling modulates CSC
niche and drug resistance. Galunisertib modulated the expression of stemness-related
genes only in the invasive (HLE and HLF) HCC cells inducing a decreased expression
of CD44 and THY1. Furthermore, galunisertib also reduced the stemness-related
functions of invasive HCC cells decreasing the formation of colonies, liver
spheroids and invasive growth ability. Interestingly, CD44 loss of function mimicked
the galunisertib effects on HCC stemness-related functions. Galunisertib treatment
also reduced the expression of stemness-related genes in ex vivo human HCC
specimens. Our observations are the first evidence that galunisertib effectiveness
overcomes stemness-derived aggressiveness via decreased expression CD44 and
THY1.
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Affiliation(s)
- Bhavna Rani
- School of Medicine, University of Bari, Bari, Italy
| | - Andrea Malfettone
- Oncobell Program, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet, Barcelona, Spain
| | - Francesco Dituri
- National Institute of Gastroenterology "S. de Bellis" Research Hospital, Castellana Grotte, Bari, Italy
| | - Jitka Soukupova
- Oncobell Program, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet, Barcelona, Spain
| | - Luigi Lupo
- School of Medicine, University of Bari, Bari, Italy
| | - Serena Mancarella
- National Institute of Gastroenterology "S. de Bellis" Research Hospital, Castellana Grotte, Bari, Italy
| | - Isabel Fabregat
- Oncobell Program, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet, Barcelona, Spain.,Department of Physiological Sciences, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Gianluigi Giannelli
- National Institute of Gastroenterology "S. de Bellis" Research Hospital, Castellana Grotte, Bari, Italy.
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De Giorgi D, Poti' O, Schirinzi M, De Maria G, Galante M, Mancarella S. MTHFR, TSER and DPYD gene mutation is associated with toxicity and response in pre-operative chemo-radiotherapy for local advanced rectal cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx422.040] [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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22
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Mancarella S, Schirinzi M, Potì O, De Giorgi D, De Maria G, Olla C, Imbriglio G, Martiriggiano A, Rizzo A. Docetaxel and ifosfamide as salvage treatment in EGFR, ALK wilde type non small cell lung cancer (NSCLC). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx426.032] [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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23
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Azzariti A, Mancarella S, Porcelli L, Quatrale AE, Caligiuri A, Lupo L, Dituri F, Giannelli G. Hepatic stellate cells induce hepatocellular carcinoma cell resistance to sorafenib through the laminin-332/α3 integrin axis recovery of focal adhesion kinase ubiquitination. Hepatology 2016; 64:2103-2117. [PMID: 27639064 DOI: 10.1002/hep.28835] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 08/04/2016] [Accepted: 08/17/2016] [Indexed: 12/19/2022]
Abstract
UNLABELLED In patients with hepatocellular carcinoma (HCC) receiving sorafenib, drug resistance is common. HCC develops in a microenvironment enriched with extracellular matrix proteins including laminin (Ln)-332, produced by hepatic stellate cells (HSCs). Ln-332 is the ligand of α3β1 and α6β4 integrins, differently expressed on the HCC cell surface, that deliver intracellular pathways. The aim of this study was to investigate the effect of Ln-332 on sorafenib's effectiveness. HCC cells were challenged with sorafenib in the presence of Ln-332 and of HSC conditioned medium (CM). Sorafenib impaired HCC cell proliferation and induced apoptosis. HSC-CM or Ln-332 inhibited sorafenib's effectiveness in HCC cells expressing both α3β1 and α6β4. Inhibiting α3 but not α6 integrin subunit using blocking antibodies or small interfering RNA abrogated the protection induced by Ln-332 and HSC-CM. Hep3B cells expressing α6β4 but lacking the α3 integrin were insensitive to Ln-332 and HSC-CM protective effects. Hep3B α3-positive, but not wild-type and scramble transfected, cells acquired protection by sorafenib when plated on Ln-332-CM or HSCs. Sorafenib dephosphorylated focal adhesion kinase (FAK) and extracellular signal-regulated kinases 1/2, whereas Ln-332 and HSC-CM partially restored the pathways. Silencing FAK, but not extracellular signal-regulated kinases 1/2, abrogated the protection induced by Ln-332 and HSC-CM, suggesting a specific role for FAK. Sorafenib down-regulated total FAK, inducing its proteasomal degradation, while Ln-332 and HSC-CM promoted the escape of FAK from ubiquitination, probably inducing a preferential membrane localization. CONCLUSION This study unveils a novel mechanism of sorafenib resistance depending on the α3β1/Ln-332 axis and requiring FAK ubiquitination, providing new insights into personalizing therapy for patients with HCC. (Hepatology 2016;64:2103-2117).
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Affiliation(s)
- Amalia Azzariti
- National Cancer Institute, Istituto Tumori G. Paolo II, Bari, Italy
| | - Serena Mancarella
- National Institute of Gastroenterology, IRCCS "S. De Bellis", Castellana Grotte Bari, Italy
| | - Letizia Porcelli
- National Cancer Institute, Istituto Tumori G. Paolo II, Bari, Italy
| | | | | | - Luigi Lupo
- University of Bari Medical School, Bari, Italy
| | - Francesco Dituri
- National Institute of Gastroenterology, IRCCS "S. De Bellis", Castellana Grotte Bari, Italy
| | - Gianluigi Giannelli
- National Institute of Gastroenterology, IRCCS "S. De Bellis", Castellana Grotte Bari, Italy
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Schirinzi M, Poti' O, De Giorgi D, Olla C, Mancarella S, De Maria G. Docetaxel and stealth liposomal doxorubicin in relapsed breast cancer as salvage treatment. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw337.59] [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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25
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Mancarella S, De Giorgi D, Poti ' O, Galante M, Trisolini M, De Maria G, Schirinzi M, Rizzo A. Observational study for MTHFR, TSER and DPYD gene mutation-associated toxicity and response in patients with rectal cancer receiving pre-operative chemo-radiotherapy. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw335.39] [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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26
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Mancarella S, Greco V, Baldassarre F, Vergara D, Maffia M, Leporatti S. Frontispiece. Macromol Biosci 2015. [DOI: 10.1002/mabi.201570037] [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)
- Serena Mancarella
- CNR NANOTEC - Istituto di Nanotecnologia; Polo di Nanotecnologia c/o Campus Ecotekne via Monteroni 73100 Lecce Italy
| | - Valentina Greco
- CNR NANOTEC - Istituto di Nanotecnologia; Polo di Nanotecnologia c/o Campus Ecotekne via Monteroni 73100 Lecce Italy
| | - Francesca Baldassarre
- CNR NANOTEC - Istituto di Nanotecnologia; Polo di Nanotecnologia c/o Campus Ecotekne via Monteroni 73100 Lecce Italy
- Dipartimento di Beni Culturali; Università del Salento; via Dalmazio Birago 64 73100 Lecce Italy
| | - Daniele Vergara
- Department of Biological and Environmental Sciences and Technologies (DiSTeBA); University of Salento; Campus Ecotekne, S.P. 6 Lecce-Monteroni Lecce Italy
- Laboratory of Clinical Proteomic; “Giovanni Paolo II” Hospital; ASL-Lecce Italy
| | - Michele Maffia
- Department of Biological and Environmental Sciences and Technologies (DiSTeBA); University of Salento; Campus Ecotekne, S.P. 6 Lecce-Monteroni Lecce Italy
- Laboratory of Clinical Proteomic; “Giovanni Paolo II” Hospital; ASL-Lecce Italy
| | - Stefano Leporatti
- CNR NANOTEC - Istituto di Nanotecnologia; Polo di Nanotecnologia c/o Campus Ecotekne via Monteroni 73100 Lecce Italy
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Mancarella S, Poti O, De Giorgi D, Schirinzi M, De Maria G, Rizzo A, De Benedittis A, Galante M. Safety and efficacy of modified schedula of anti-EGFR monoclonal antibodies plus chemotherapy as first line treatment in metastatic colorectal cancer patients. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv340.52] [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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28
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De Giorgi D, Mancarella S, Poti O, Schirinzi M, Durante C, Pagano A, Trisolini M. Safety and efficacy of gemcitabine plus prednisone for previously treated metastatic kaposi sarcoma: a monoistitutional experience. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv338.12] [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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29
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Mancarella S, Greco V, Baldassarre F, Vergara D, Maffia M, Leporatti S. Polymer-Coated Magnetic Nanoparticles for Curcumin Delivery to Cancer Cells. Macromol Biosci 2015; 15:1365-74. [DOI: 10.1002/mabi.201500142] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 05/27/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Serena Mancarella
- CNR NANOTEC - Istituto di Nanotecnologia; Polo di Nanotecnologia c/o Campus Ecotekne via Monteroni 73100 Lecce Italy
| | - Valentina Greco
- CNR NANOTEC - Istituto di Nanotecnologia; Polo di Nanotecnologia c/o Campus Ecotekne via Monteroni 73100 Lecce Italy
| | - Francesca Baldassarre
- CNR NANOTEC - Istituto di Nanotecnologia; Polo di Nanotecnologia c/o Campus Ecotekne via Monteroni 73100 Lecce Italy
- Dipartimento di Beni Culturali; Università del Salento; via Dalmazio Birago 64 73100 Lecce Italy
| | - Daniele Vergara
- Department of Biological and Environmental Sciences and Technologies (DiSTeBA); University of Salento; Campus Ecotekne, S.P. 6 Lecce-Monteroni Lecce Italy
- Laboratory of Clinical Proteomic; “Giovanni Paolo II” Hospital; ASL-Lecce Italy
| | - Michele Maffia
- Department of Biological and Environmental Sciences and Technologies (DiSTeBA); University of Salento; Campus Ecotekne, S.P. 6 Lecce-Monteroni Lecce Italy
- Laboratory of Clinical Proteomic; “Giovanni Paolo II” Hospital; ASL-Lecce Italy
| | - Stefano Leporatti
- CNR NANOTEC - Istituto di Nanotecnologia; Polo di Nanotecnologia c/o Campus Ecotekne via Monteroni 73100 Lecce Italy
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del Mercato LL, Ferraro MM, Baldassarre F, Mancarella S, Greco V, Rinaldi R, Leporatti S. Biological applications of LbL multilayer capsules: from drug delivery to sensing. Adv Colloid Interface Sci 2014; 207:139-54. [PMID: 24625331 DOI: 10.1016/j.cis.2014.02.014] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 02/15/2014] [Accepted: 02/15/2014] [Indexed: 11/24/2022]
Abstract
Polyelectrolyte multilayer (PEM) capsules engineered with active elements for targeting, labeling, sensing and delivery hold great promise for the controlled delivery of drugs and the development of new sensing platforms. PEM capsules composed of biodegradable polyelectrolytes are fabricated for intracellular delivery of encapsulated cargo (for example peptides, enzymes, DNA, and drugs) through gradual biodegradation of the shell components. PEM capsules with shells responsive to environmental or physical stimuli are exploited to control drug release. In the presence of appropriate triggers (e.g., pH variation or light irradiation) the pores of the multilayer shell are unlocked, leading to the controlled release of encapsulated cargos. By loading sensing elements in the capsules interior, PEM capsules sensitive to biological analytes, such as ions and metabolites, are assembled and used to detect analyte concentration changes in the surrounding environment. This Review aims to evaluate the current state of PEM capsules for drug delivery and sensing applications.
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Comella P, Lorusso V, Maiorino L, Casaretti R, Cannone M, Massidda B, Farris A, Leo S, Roselli M, Sandomenico C, Mancarella S. Oxaliplatin, irinotecan, and 5-fluorouracil/leucovorin in advanced gastric adenocarcinoma: A phase II trial. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.4542] [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: 11/20/2022] Open
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32
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Chahine M, Qu Y, Mancarella S, Boutjdir M. Protein kinase C activation inhibits alpha1D L-type Ca channel: a single-channel analysis. Pflugers Arch 2007; 455:913-9. [PMID: 17909852 DOI: 10.1007/s00424-007-0342-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2007] [Revised: 08/24/2007] [Accepted: 09/05/2007] [Indexed: 10/22/2022]
Abstract
The recently reported alpha1D Ca channel in the heart is known to be regulated by protein kinase C (PKC) at the whole cell level and has been implicated in atrial fibrillation. The biophysical basis of this regulation at the single-channel level is not known. Therefore, the effect of PKC activation was studied on alpha1D Ca channel expressed in tsA201 cells using cell-attached configuration. Unitary currents were recorded in the presence of 70 mM Ba2+ as the charge carrier at room temperature. Under basal condition, channel activity was rare and infrequent; however, Bay K 8644 (1 microM) induced channel openings with a conductance of 22.3 pS. Single channel analysis of open and closed time distributions were best fitted with a single exponential. PKC activation by 4alpha-phorbol 12-myristate 13-acetate (PMA; 10 nM), a phorbol ester derivative, resulted in a decrease in open probability and increase in closed-time without any significant effect on the conductance of the alpha1D Ca channel. This is consistent with a decreased entry of alpha1D Ca channel into open states in the presence of PMA. PMA effects could not be reproduced by 4-alpha Phorbol, an inactive PMA analogue. These data show, for the first time, (1) the alpha1D Ca channel activity at the single-channel level and (2) the biophysical basis by which PKC activation inhibits the alpha1D Ca channel. The shortening of the open-time and the lengthening of the closed-time constants and the increase in blank sweeps may explain the inhibition of the previously reported whole-cell alpha1D Ca current. Altogether, these data are essential for understanding the complex role of alpha1D Ca channel not only in physiological settings but also in pathological settings such as atrial fibrillation.
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Affiliation(s)
- M Chahine
- Le Centre de recherche Université Laval Robert-Giffard, Local F-6539, 2601 chemin de la Canardière, Québec, QC, Canada, G1J 2G3.
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Comella P, Filippelli G, De Cataldis G, Massidda B, Frasci G, Maiorino L, Putzu C, Mancarella S, Palmeri S, Cioffi R, Roselli M, Buzzi F, Milia V, Gambardella A, Natale D, Bianco M, Ghiani M, Masullo P. Efficacy of the combination of cisplatin with either gemcitabine and vinorelbine or gemcitabine and paclitaxel in the treatment of locally advanced or metastatic non-small-cell lung cancer: a phase III randomised trial of the Southern Italy Cooperative Oncology Group (SICOG 0101). Ann Oncol 2007; 18:324-30. [PMID: 17071935 DOI: 10.1093/annonc/mdl396] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [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: 11/14/2022] Open
Abstract
BACKGROUND Triplet regimens were occasionally reported to produce a higher response rate (RR) than doublets in locally advanced or metastatic non-small-cell lung cancer (NSCLC). This trial was conducted to assess (i) whether the addition of cisplatin (CDDP) to either gemcitabine (GEM) and vinorelbine (VNR) or GEM and paclitaxel (PTX) significantly prolongs overall survival (OS) and (ii) to compare the toxicity of PTX-containing and VNR-containing combinations. PATIENTS AND METHODS Stage III or IV NSCLC patients were randomly assigned to (i) GEM 1000 mg/m(2) and VNR 25 mg/m(2) on days 1 and 8 (GV arm); (ii) GEM 1000 mg/m(2) and PTX 125 mg/m(2) on days 1 and 8 (GT arm); (iii) GV plus CDDP 50 mg/m(2) on days 1 and 8 (PGV arm); and (iv) GT plus CDDP 50 mg/m(2) on days 1 and 8 (PGT arm). Treatments were repeated every 3 weeks for a maximum of six cycles. RESULTS A total of 433 (stage III, 160; stage IV, 273) patients were randomly allocated to the study. RR was 48% [95% confidence interval (CI), 42% to 54%] for triplets and 35% (95% CI, 32% to 38%) for doublets (P = 0.004). Median progression-free survival (6.1 versus 5.5 months, P = 0.706) and median OS (10.7 versus 10.5 months, P = 0.379) were similar. CDDP significantly increased the occurrence of severe neutropenia (35% versus 13%), thrombocytopenia (14% versus 4%), anaemia (9% versus 3%), vomiting (6% versus 0.5%), and diarrhoea (6% versus 2%). Conversely, frequency of severe neutropenia (30% versus 17%) and thrombocytopenia (11% versus 6%) was significantly higher with VNR-containing regimens. CONCLUSIONS Adding CDDP to GV or GT significantly increased RR, but did not prolong the OS of patients. Among doublets, the GT regimen should be preferred in view of its better safety profile.
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Affiliation(s)
- P Comella
- Department of Medical Oncology, National Tumor Institute, Naples, Italy.
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Comella P, Massidda B, Filippelli G, Palmeri S, Natale D, Farris A, De Vita F, Buzzi F, Tafuto S, Maiorino L, Mancarella S, Leo S, Lorusso V, De Lucia L, Roselli M. Oxaliplatin plus high-dose folinic acid and 5-fluorouracil i.v. bolus (OXAFAFU) versus irinotecan plus high-dose folinic acid and 5-fluorouracil i.v. bolus (IRIFAFU) in patients with metastatic colorectal carcinoma: a Southern Italy Cooperative Oncology Group phase III trial. Ann Oncol 2005; 16:878-86. [PMID: 15837702 DOI: 10.1093/annonc/mdi185] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [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: 11/14/2022] Open
Abstract
PURPOSE The primary end point of this phase III trial was to compare the response rate (RR) of oxaliplatin (OXA) plus levo-folinic acid (l-FA) and 5-fluorouracil (5-FU) bolus with that of irinotecan (IRI) plus l-FA and 5-FU bolus in advanced colorectal carcinoma. PATIENTS AND METHODS Patients with measurable metastatic colorectal carcinoma were randomly allocated to receive: IRI 200 mg/m(2) on day 1, l-FA 250 mg/m(2) intravenously plus 5-FU 850 mg/m(2) on day 2 (IRIFAFU); or OXA 100 mg/m(2) on day 1, l-FA 250 mg/m(2) plus 5-FU 1050 mg/m(2) on day 2 [OXAFAFU high dose (hd)]. Cycles were given every 2 weeks. After a planned interim analysis, OXA was reduced to 85 mg/m(2) and 5-FU to 850 mg/m(2) [OXAFAFU low dose (ld)]. RESULTS Two hundred and seventy-four patients (IRIFAFU, 135; OXAFAFUhd, 71; OXAFAFUld, 68) were treated. Forty-two confirmed responses were achieved with IRIFAFU, 29 with OXAFAFUhd and 32 with OXAFAFUld. The response rate with OXAFAFU [44%; 95% confidence interval (CI) 35% to 52%] was significantly higher (P=0.029) than that of IRIFAFU (31%; 95% CI 23% to 40%). Occurrence of grade > or =3 neutropenia with OXAFAFUld was similar to that for IRIFAFU (29% versus 31%), while severe diarrhoea was significantly lower (12% versus 24%). Median failure-free survival (7 versus 5.8 months; P=0.046) and overall survival of patients (18.9 versus 15.6 months; P=0.032) were significantly prolonged with OXAFAFU. CONCLUSIONS OXAFAFU was more active and less toxic than IRIFAFU, and it should be preferred in the first-line treatment of advanced colorectal cancer patients.
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Affiliation(s)
- P Comella
- Department of Medical Oncology, National Tumour Institute, Naples, Italy.
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Lorusso V, Crucitta E, Silvestris N, Rosati G, Manzione L, De Lena M, Palmeri S, Gebbia V, Mancarella S, Sobrero A, Pezzella G, Comella P, Mangiameli A, Muci D. Randomised, open-label, phase II trial of paclitaxel, gemcitabine and cisplatin versus gemcitabine and cisplatin as first-line chemotherapy in advanced transitional cell carcinoma of the urothelium. Oncol Rep 2005; 13:283-7. [PMID: 15643512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Abstract
The purpose of the study was to evaluate the antitumor activity and the safety of paclitaxel combined with gemcitabine and cisplatin in patients affected by advanced transitional cell carcinoma of the urothelium (TCC). Eighty-five patients affected by advanced TCC and measurable disease were randomized to receive either paclitaxel at dosage of 70 mg/m2, gemcitabine 1000 mg/m2 and cisplatin 35 mg/m2 on days 1 and 8 every 3 weeks (GCP) or gemcitabine 1000 mg/m2 on days 1, 8, 15 and cisplatin 70 mg/m2 on day 2 every 4 weeks (GC). All enrolled patients were considered evaluable for response and toxicity (intention to treat). The observed response rate was 43% for GCP and 44% for GC combination, respectively. Median time to treatment failure was 32 weeks for GCP and 26 weeks for GC and overall survival 61 vs 49 weeks, respectively (p-value not significant). Grade 3-4 neutropenia was observed in 49% of patients treated with GCP vs 35% of those treated with GC (P=0.05) and grade 3-4 thrombocytopenia was observed in 36% of GCP treated patients as compared to 21% of those treated with GC (P=0.01). Seven patients over 70 years old or with poor PS were removed from the study: 6 patients from GCP group (2 toxic deaths, 2 grade 4 myelotoxicity and 2 grade 3 asthenia) and 1 from GC group was lost to follow-up after the first cycle. The combination of paclitaxel, gemcitabine and cisplatin is effective in the treatment of TCC. However, the addition of paclitaxel to the combination of gemcitabine plus cisplatin seems to increase toxicity, therefore it seems not suitable for poor PS patients and those over 70 years old. Larger and more powered studies are needed to exactly define the role of paclitaxel in this combination.
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Affiliation(s)
- Vito Lorusso
- Operative Unit of Medical Oncology, Oncology Institute of Bari, Via Amendola 209, Bari 70126, Italy
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Comella P, Frasci G, Carnicelli P, Massidda B, Buzzi F, Filippelli G, Maiorino L, Guida M, Panza N, Mancarella S, Cioffi R. Gemcitabine with either paclitaxel or vinorelbine vs paclitaxel or gemcitabine alone for elderly or unfit advanced non-small-cell lung cancer patients. Br J Cancer 2004; 91:489-97. [PMID: 15266334 PMCID: PMC2409832 DOI: 10.1038/sj.bjc.6602011] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The aim of this study was to assess whether a combination of gemcitabine (GEM) with either paclitaxel (PTX) or vinorelbine (VNR) could be more effective than GEM or PTX alone in elderly or unfit advanced non-small-cell lung cancer (NSCLC) patients. A total of 264 NSCLC patients aged >70 years with ECOG performance status (PS)⩽2, or younger with PS=2, were randomly treated with: GEM 1200 mg m−2 on days 1, 8 and 15 every 28 days; PTX 100 mg m−2 on days 1, 8 and 15 every 28 days; GEM 1000 mg m−2 plus PTX 80 mg m−2 (GT) on days 1 and 8 every 21 days; GEM 1000 mg m−2 plus VNR 25 mg m−2 (GV) on days 1 and 8 every 21 days. In all arms, an intra-patients dose escalation was applied over the first three courses, provided that no toxicity of WHO grade ⩾2 had previously occurred. At present time, 217 (82%) patients had died. The median (months) and 1-year survival probability were 5.1 and 29% for GEM, 6.4 and 25% for PTX, 9.2 and 44% for GT, and 9.7 and 32% for GV. Multivariate analysis showed that PS⩽1 (hazard ratio (HR)=0.67; 95% CI 0.51–0.90), and doublet treatments (HR=0.76; 95% CI 0.59–0.99) were significantly associated with longer survival. Doublets produced no more toxicity than single agents. GT should be considered a reference regimen for elderly NSCLC patients with PS⩽1.
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Affiliation(s)
- P Comella
- Division of Medical Oncology A, Department of Medicine, National Tumour Institute, Via M. Semmola, 80131 Naples, Italy.
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Comella P, Massidda B, Filippelli G, De Vita F, Natale D, Farris A, Buzzi F, Maiorino L, Tafuto S, Mancarella S. Oxaliplatin (OXA) plus folinic acid (FA) and 5-fluorouracil (FU) i.v. bolus (OXAFAFU) versus irinotecan (IRI) plus FA and FU i.v. bolus (IRIFAFU) in advanced colorectal carcinoma (ACC): Activity and toxicity results of the SICOG 0103 randomized trial. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.4143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- P. Comella
- National Tumor Institute, Naples, Italy; University Medical School, Cagliari, Italy; City Hospital, Paola, Italy; Second University Medical School, Naples, Italy; City Hospital, Pende, Italy; University Medical School, Sassari, Italy; City Hospital, Terni, Italy; San Gennaro Hospital, Naples, Italy; City Hospital, Pozzuoli, Italy; City Hospital, Campi Salentina, Italy
| | - B. Massidda
- National Tumor Institute, Naples, Italy; University Medical School, Cagliari, Italy; City Hospital, Paola, Italy; Second University Medical School, Naples, Italy; City Hospital, Pende, Italy; University Medical School, Sassari, Italy; City Hospital, Terni, Italy; San Gennaro Hospital, Naples, Italy; City Hospital, Pozzuoli, Italy; City Hospital, Campi Salentina, Italy
| | - G. Filippelli
- National Tumor Institute, Naples, Italy; University Medical School, Cagliari, Italy; City Hospital, Paola, Italy; Second University Medical School, Naples, Italy; City Hospital, Pende, Italy; University Medical School, Sassari, Italy; City Hospital, Terni, Italy; San Gennaro Hospital, Naples, Italy; City Hospital, Pozzuoli, Italy; City Hospital, Campi Salentina, Italy
| | - F. De Vita
- National Tumor Institute, Naples, Italy; University Medical School, Cagliari, Italy; City Hospital, Paola, Italy; Second University Medical School, Naples, Italy; City Hospital, Pende, Italy; University Medical School, Sassari, Italy; City Hospital, Terni, Italy; San Gennaro Hospital, Naples, Italy; City Hospital, Pozzuoli, Italy; City Hospital, Campi Salentina, Italy
| | - D. Natale
- National Tumor Institute, Naples, Italy; University Medical School, Cagliari, Italy; City Hospital, Paola, Italy; Second University Medical School, Naples, Italy; City Hospital, Pende, Italy; University Medical School, Sassari, Italy; City Hospital, Terni, Italy; San Gennaro Hospital, Naples, Italy; City Hospital, Pozzuoli, Italy; City Hospital, Campi Salentina, Italy
| | - A. Farris
- National Tumor Institute, Naples, Italy; University Medical School, Cagliari, Italy; City Hospital, Paola, Italy; Second University Medical School, Naples, Italy; City Hospital, Pende, Italy; University Medical School, Sassari, Italy; City Hospital, Terni, Italy; San Gennaro Hospital, Naples, Italy; City Hospital, Pozzuoli, Italy; City Hospital, Campi Salentina, Italy
| | - F. Buzzi
- National Tumor Institute, Naples, Italy; University Medical School, Cagliari, Italy; City Hospital, Paola, Italy; Second University Medical School, Naples, Italy; City Hospital, Pende, Italy; University Medical School, Sassari, Italy; City Hospital, Terni, Italy; San Gennaro Hospital, Naples, Italy; City Hospital, Pozzuoli, Italy; City Hospital, Campi Salentina, Italy
| | - L. Maiorino
- National Tumor Institute, Naples, Italy; University Medical School, Cagliari, Italy; City Hospital, Paola, Italy; Second University Medical School, Naples, Italy; City Hospital, Pende, Italy; University Medical School, Sassari, Italy; City Hospital, Terni, Italy; San Gennaro Hospital, Naples, Italy; City Hospital, Pozzuoli, Italy; City Hospital, Campi Salentina, Italy
| | - S. Tafuto
- National Tumor Institute, Naples, Italy; University Medical School, Cagliari, Italy; City Hospital, Paola, Italy; Second University Medical School, Naples, Italy; City Hospital, Pende, Italy; University Medical School, Sassari, Italy; City Hospital, Terni, Italy; San Gennaro Hospital, Naples, Italy; City Hospital, Pozzuoli, Italy; City Hospital, Campi Salentina, Italy
| | - S. Mancarella
- National Tumor Institute, Naples, Italy; University Medical School, Cagliari, Italy; City Hospital, Paola, Italy; Second University Medical School, Naples, Italy; City Hospital, Pende, Italy; University Medical School, Sassari, Italy; City Hospital, Terni, Italy; San Gennaro Hospital, Naples, Italy; City Hospital, Pozzuoli, Italy; City Hospital, Campi Salentina, Italy
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Comella P, Farris A, Lorusso V, Palmeri S, Maiorino L, De Lucia L, Buzzi F, Mancarella S, De Vita F, Gambardella A. Irinotecan plus leucovorin-modulated 5-fluorouracil I.V. bolus every other week may be a suitable therapeutic option also for elderly patients with metastatic colorectal carcinoma. Br J Cancer 2003; 89:992-6. [PMID: 12966414 PMCID: PMC2376956 DOI: 10.1038/sj.bjc.6601214] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The aim of this study was to assess the safety and efficacy of biweekly irinotecan plus leucovorin-modulated 5-fluorouracil i.v. bolus in metastatic colorectal carcinoma according to the age of patients. For this purpose, we have analysed 108 patients randomly allocated to receive irinotecan 200 mg m(-2) i.v. (1-h infusion) on day 1, and L-leucovorin 250 mg m(-2) i.v. (1-h infusion) plus 5-fluorouracil 850 mg m(-2) i.v. bolus on day 2 every 2 weeks (IRIFAFU) in our previous SICOG 9801 trial. According to age, patients were retrospectively divided into three groups: younger (</=54 years, n=37), middle-aged (55-69 years, n=64), and elderly (>/=70 years, n=17). Apart from gender, pretreatment characteristics were well balanced across the three groups. WHO grade >/=3 neutropenia and diarrhoea affected on the whole 46 and 16 patients, respectively, without any significant difference according to age-grouping. Patients aged </=54 years stayed on therapy for a longer time (median 24 vs 14-15 weeks), and received more cycles (median 9 vs 7), than the older ones. Only one patient in the young group withdrew consent to therapy as opposed to four patients each in the aged and elderly one. Response rate was 38% for younger patients, 34% for aged, and 35% for the elderly ones. Median time to progression was 7.4, 8.0, and 5.3 months, and median survival time was 13.4, 15.3, and 13.9 months, respectively. We conclude that IRIFAFU given every other week may represent a suitable therapeutic option also for elderly patients with metastatic colorectal carcinoma.
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Affiliation(s)
- P Comella
- Division of Medical Oncology, National Tumour Institute, Via M. Semmola, 80131 Naples, Italy.
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Lorusso V, Crucitta E, Panza N, Silvestris N, Guida M, Carpagnano F, Mancarella S, Sambiasi D, De Lena M. Phase I/II study of paclitaxel, gemcitabine and vinorelbine as first-line chemotherapy of non-small-cell lung cancer. Ann Oncol 2002; 13:1862-7. [PMID: 12453853 DOI: 10.1093/annonc/mdf308] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The aim of our study was to determine the maximum tolerated dose of paclitaxel combined with a fixed dose of gemcitabine and vinorelbine in the treatment of non-small-cell lung cancer (NSCLC) and to evaluate in a phase II trial the efficacy of this combination. PATIENTS AND METHODS Sixty-two patients with stage IIIB/IV NSCLC were treated with paclitaxel in escalating doses from 40-80 mg/m(2) combined with gemcitabine and vinorelbine at fixed doses of 1000 mg/m(2) and 25 mg/m(2), respectively. All drugs were given intravenously on day 1 and 8 every 3 weeks. RESULTS In a phase I trial, carried out on 21 patients, grade 4 neutropenia, as dose-limiting toxicity, occurred at the dosage level of paclitaxel 80 mg/m(2). In a phase II trial, with paclitaxel administered at 70 mg/m(2), 27 out of 41 (66%) assessable patients responded (10% complete responses and 56% partial responses). Objective response was observed in 13 of 16 patients (81%) with stage IIIB disease and in 14 of 25 (56%) with stage IV disease. The median time to treatment failure was 26 weeks (range 3-72 weeks; 32 weeks and 20 weeks for stages IIIB and IV, respectively) and median survival 62 weeks (range 4-176 weeks; 72 weeks and 56 weeks for stages IIIB and IV, respectively). One-year survival was 64% for all patients (72% for patients with stage IIIB and 52% for those with stage IV). Grade 3 and 4 neutropenia were observed in 11 (27%) and seven (17%) cases, respectively; grade 3 thrombocytopenia was observed in three patients (7%) and grade 3 anemia in four patients (10%). The most relevant non-hematological toxicity was grade 2/3 asthenia, which was observed in 12 patients (29%). Alopecia was almost universal, whereas nausea and vomiting were absent. CONCLUSIONS The combination of paclitaxel, gemcitabine and vinorelbine is effective and tolerable in the treatment of NSCLC. The high activity and low toxicity of this regimen warrant randomized studies with platinum-containing combinations.
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Affiliation(s)
- V Lorusso
- Operative Unit of Medical Oncology, Oncology Institute of Bari, Italy.
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Comella P, Crucitta E, De Vita F, De Lucia L, Farris A, Del Gaizo F, Palmeri S, Lannelli A, Mancarella S, Tafuto S, Maiorino L, Buzzi F, De Cataldis G. Addition of either irinotecan or methotrexate to bolus 5-fluorouracil and high-dose folinic acid every 2 weeks in advanced colorectal carcinoma: a randomised study by the Southern Italy Cooperative Oncology Group. Ann Oncol 2002; 13:866-73. [PMID: 12123331 DOI: 10.1093/annonc/mdf133] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [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: 11/13/2022] Open
Abstract
PURPOSE The purpose of this study was to compare the activity and toxicity of the combination of irinotecan (IRI) plus folinic acid (FA)-modulated 5-fluorouracil (5-FU) i.v. bolus with a regimen of double modulation of 5-FU with methotrexate (MTX) and FA in patients with advanced colorectal carcinoma. PATIENTS AND METHODS Two-hundred and thirty-four patients were enrolled: 118 patients received IRI 200 mg/m2 (90-min i.v. infusion) on day 1, followed by levo-FA 250 mg/m2 (2-h i.v. infusion) and 5-FU 850 mg/m2 (i.v. bolus) on day 2 (IRIFAFU), and 116 patients received MTX 750 mg/m2 (2-h i.v. infusion) on day 1, followed by levo-FA 250 mg/m2 (2-h i.v. infusion) and FU 800 mg/m2 (i.v. bolus) on day 2 (MTXFAFU). Both cycles were repeated every 2 weeks until progression or to a maximum of 16 cycles. Response rate (RR) was the main end point of the study; responses were assessed every four cycles and confirmed after 2 additional months of treatment. RESULTS RR was significantly greater with IRIFAFU (36%) than with MTXFAFU (20%) (P <0.001). Multivariate analysis showed that IRIFAFU was significantly associated with a greater activity (P = 0.028). Median progression-free survival was longer with IRIFAFU than with MTXFAFU (7.2 months compared with 4.8 months; P = 0.048). Median survival time (MST) did not differ between the two arms (14.7 months compared with 14.8 months, respectively). Patients not receiving second-line chemotherapy, however, lived longer when treated in the first-line with IRIFAFU (MST 11.9 months compared with 6.4 months; P = 0.038). IRIFAFU caused a significantly greater occurrence of grade 3 or 4 neutropenia (40% compared with 9%; P = 0.001) and diarrhoea (13% compared with 4%; P = 0.024), but a significantly lower incidence of stomatitis (3% compared with 12%; P = 0.007), than the comparative regimen. CONCLUSIONS IRIFAFU appeared comparable in terms of activity and toxicity with other weekly or biweekly bolus or infusional combination regimens. IRIFAFU, however, seems easier to administer, because it does not require infusional catheter or pump devices, and it is less expensive. It may represent a new option for treating advanced colorectal carcinoma.
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Affiliation(s)
- P Comella
- Division of Medical Oncology A, National Tumour Institute, Naples, Italy.
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Crucitta E, Lorusso V, Mancarella S, Panza N, Catino A, Guida M, Latorre A, Frasci G, Caporusso L, De Lena M. Taxol, gemcitabine and vinorelbine, a very active platinum free triplet in naive patients with Non Small Cell Lung Cancer. Eur J Cancer 2001. [DOI: 10.1016/s0959-8049(01)80691-2] [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: 10/26/2022]
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Gaetano C, Catalano A, Illi B, Felici A, Minucci S, Palumbo R, Facchiano F, Mangoni A, Mancarella S, Mühlhauser J, Capogrossi MC. Retinoids induce fibroblast growth factor-2 production in endothelial cells via retinoic acid receptor alpha activation and stimulate angiogenesis in vitro and in vivo. Circ Res 2001; 88:E38-47. [PMID: 11230116 DOI: 10.1161/01.res.88.4.e38] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The effect of retinoic acid (RA) on endothelial cells is still controversial and was examined in the present study. In bovine aortic endothelial cells (BAECs), all-trans RA (ATRA) and 9-cis RA (9CRA), but not 13-cis RA (13CRA), induced fibroblast growth factor-2 (FGF-2) production and exhibited a biphasic dose-dependent effect to enhance BAEC proliferation and differentiation into tubular structures on reconstituted basement membrane proteins (Matrigel); both processes were inhibited by FGF-2-neutralizing antibody. The pan RA receptor (RAR)-selective ligand (E)-4-[2-(5,5,8,8,-tetramethyl-5,6,7,8-tetrahydro-2-naphtalenyl)-1-propenyl] benzoic acid and the RARalpha-selective ligand 4-[1-(3,5,5,8,8-pentamethyl-5,6,7,8-tetrahydro-2-naphtyl)-ethenyl] benzoic acid stimulated the production of FGF-2, whereas the addition of the RARalpha-antagonist RO 41-5253 inhibited this effect. In BAECs, the forced expression of RARalpha, but not RARbeta or RARgamma, enhanced FGF-2 production, whereas the RARalpha-dominant negative, Delta403, blocked this effect. Furthermore, RARalpha overexpression directly stimulated BAEC differentiation on Matrigel and potentiated the effects of ATRA in this assay. Finally, ATRA-treated BAECs coinjected with Matrigel subcutaneously in mice induced neovascularization within the Matrigel plug, and ATRA also enhanced angiogenesis in the chicken chorioallantoic membrane assay. In conclusion, RA can stimulate endothelial cell proliferation and differentiation in vitro via enhanced RARalpha-dependent FGF-2 production, and it can also induce angiogenesis in vivo. The full text of this article is available at http://www.circresaha.org.
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Affiliation(s)
- C Gaetano
- Laboratorio di Patologia Vascolare, Istituto Dermopatico dell'Immacolata, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy.
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Berruti A, Sperone P, Bottini A, Gorzegno G, Lorusso V, Brunelli A, Botta M, Tampellini M, Donadio M, Mancarella S, De Lena M, Alquati P, Dogliotti L. Phase II study of vinorelbine with protracted fluorouracil infusion as a second- or third-line approach for advanced breast cancer patients previously treated with anthracyclines. J Clin Oncol 2000; 18:3370-7. [PMID: 11013277 DOI: 10.1200/jco.2000.18.19.3370] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [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: 11/20/2022] Open
Abstract
PURPOSE To evaluate the feasibility and activity of vinorelbine in association with protracted infusional fluorouracil in patients with advanced breast cancer who were previously treated with anthracycline-containing regimens. PATIENTS AND METHODS Eighty-three consecutive patients were entered onto the study. Forty-three patients experienced treatment failure or relapse after anthracycline-based, first-line chemotherapy for advanced disease and 29 experienced treatment failure or relapse after first- and second-line approaches; 11 patients experienced progressive disease within 6 months of completion of adjuvant anthracycline therapy. Sites of involvement were as follows: liver involvement, 42 patients (50.6%); lung 24 (28.9%); bone, 49 (59.0%); and skin/lymph nodes, 21 (25.3%). Treatment consisted of vinorelbine 30 mg/m(2) administered on days 1 and 15 every 28 days and fluorouracil 200 mg/m(2)/d given continuously over a 24-hour period. RESULTS Toxicity was recorded for 441 cycles. The scheme was well tolerated: grade 1/2 nausea/vomiting occurred in 13 patients (15.6%), grade 1/2 diarrhea in nine (10.8%), and grade 2/3 stomatitis in six (7.2%). Three patients (3.6%) experienced grade 3/4 leukopenia and four (4.8%) experienced grade 2/3 anemia. Grade 2/3 neurologic toxicity was observed in three cases (3.6%), and grade 2/3 hand-foot syndrome was observed in three (3.6%). The median relative dose-intensity was 92% and 100% for vinorelbine and fluorouracil, respectively. Six patients (7.2%) attained a complete clinical response and 45 (54.2%) attained a partial response, for an overall response rate of 61.4% (95% confidence interval, 50.9% to 71.9%). Twenty-one patients (25.3%) obtained disease stabilization, and 11 (13.3%) experienced disease progression. Median time to progression in responding patients was 15 months; median overall survival of the entire population was 22 months. CONCLUSION Vinorelbine associated with protracted infusional fluorouracil is an active and manageable scheme in advanced breast cancer patients previously treated with anthracyclines. The response obtained is durable.
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Affiliation(s)
- A Berruti
- Dipartimento di Scienze Cliniche e Biologiche, Università di Torino, and Oncologia Medica, Azienda Ospedaliera San Giovanni, Molinette, Torino, Italy
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Comella P, De Vita F, Mancarella S, De Lucia L, Biglietto M, Casaretti R, Farris A, Ianniello GP, Lorusso V, Avallone A, Cartenì G, Leo SS, Catalano G, De Lena M, Comella G. Biweekly irinotecan or raltitrexed plus 6S-leucovorin and bolus 5-fluorouracil in advanced colorectal carcinoma: a Southern Italy Cooperative Oncology Group phase II-III randomized trial. Ann Oncol 2000; 11:1323-33. [PMID: 11106123 DOI: 10.1023/a:1008375705484] [Citation(s) in RCA: 23] [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: 11/12/2022] Open
Abstract
PURPOSE The aim of this randomised trial was to evaluate the activity and toxicity of a biweekly regimen including 6S-leucovorin-modulated 5-fluorouracil (LFA-5-FU), combined with either irinotecan (CPT-11 + LFA 5-FU) or raltitrexed (Tomudex) (TOM + LFA-5-FU), in advanced colorectal cancer patients, and to make a preliminary comparison of both these experimental regimens with a biweekly administration of LFA-5-FU modulated by methotrexate (MTX + LFA-5-FU). PATIENTS AND METHODS One hundred fifty-nine patients with advanced colorectal carcinoma previously untreated for the metastatic disease (34 of them previously exposed to adjuvant 5-FU) were randomly allocated to receive: CPT-11, 200 mg/m2 i.v. on day 1, followed on day 2 by LFA, 250 mg/m2 i.v. infusion and 5-FU, 850 mg/m2 s i.v. bolus (arm A); TOM, 3 mg/m2 i.v. on day 1, followed on day 2 by LFA, 250 mg/m2 i.v. infusion and 5-FU, 1050 mg/m2 i.v. bolus (arm B); or MTX, 750 mg/m2 i.v. on day 1, followed on day 2 by LFA, 250 mg/m2 i.v. infusion and 5-FU, 800 mg/m2 i.v. bolus (arm C). Courses were repeated every two weeks in all arms of the trial. Response rate (RR) was evaluated after every four courses. The sample size was defined to have an 80% power to detect a 35% RR for each experimental treatment, and to show a difference of at least 4% in RR with the standard treatment if the true difference is 15% or more. RESULTS The RRs were: 34% (95% confidence interval (95%, CI): 21%-48%) in arm A, including 3 complete responses (CRs) and 15 partial responses (PRs), 24% (95% CI: 14%-38%) in arm B, including 2 CRs and 11 PRs, and 24% (95% CI: 14%-38%), with 2 CRs and 11 PRs, in arm C. After a median follow-up time of 62 (range 18-108) weeks, the median time to progression was 38, 25, and 27 weeks for arm A, B, and C, respectively. With 94 patients still alive, the one-year probability of survival was 61%, 54%, and 59%, respectively. WHO grade 3 or 4 neutropenia and diarrhoea affected 46% and 16%, respectively, of patients treated with CPT-11 + LFA 5-FU. Median relative dose intensity over eight cycles (DI8) was 78% for CPT-11 and 82% for 5-FU. Severe toxicities of TOM + LFA-5-FU were neutropenia (16%) and diarrhoea (16%), but median relative DI8 was 93% for TOM, and 82% for 5-FU. CONCLUSIONS CPT-11 + LFA-5-FU compares favorably in term of activity and toxicity with other combination regimens including CPT-11 and continuous infusional 5-FU. The hypothesis of a RR 15% higher than the MTX + LFA-5-FU treatment can not be ruled out after this interim analysis. The TOM + LFA 5-FU regimen showed a RR and a toxicity profile very close to the MTX + LFA 5-FU combination, and dose not deserve further evaluation in advanced colorectal cancer patients.
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Affiliation(s)
- P Comella
- Division of Medical Oncology A. National Tumor Institute, Naples, Italy.
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Comella P, Panza N, Manzione L, De Cataldis G, Cioffi R, Maiorino L, Lorusso V, Lamberti A, Micillo E, Natale M, Bilancia D, Nicolella G, Di Nota A, Mancarella S, Frasci G, Comella G. Interim Analysis of a Phase III Trial Comparing Cisplatin, Gemcitabine, and Vinorelbine vs. Either Cisplatin and Gemcitabine or Cisplatin and Vinorelbine in Advanced Non–Small-Cell Lung Cancer. A Southern Italy Cooperative Oncology Group Study. Clin Lung Cancer 2000; 1:202-7; discussion 208. [PMID: 14733645 DOI: 10.3816/clc.2000.n.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In a previous phase II randomized study, a cisplatin/gemcitabine/vinorelbine (PGV) regimen produced a 50-week median survival time (MST) in advanced non small-cell lung cancer (NSCLC) patients. The present trial was planned to randomly compare the outcome of patients treated with this new triplet regimen with those of patients receiving either cisplatin plus vinorelbine (PV) or cisplatin plus gemcitabine (PG) doublet combinations. One hundred eighty patients with stage IIIB (76) or IV (104) disease, aged <or= 70 years, and with Eastern Cooperative Oncology Group performance status (ECOG PS) <or= 1, were randomly allocated to receive: cisplatin, 50 mg/m2 plus gemcitabine, 1000 mg/m2 plus vinorelbine, 25 mg/m2 (PGV) on days 1 and 8 every 3 weeks; cisplatin, 100 mg/m2 on day 1 plus gemcitabine, 1000 mg/m2 (PG) on days 1, 8, and 15 every 4 weeks; cisplatin, 120 mg/m2 on days 1 and 29 plus vinorelbine, 30 mg/m2/week (PV). At the planned interim analysis, the MST of patients in the PGV, PG, and PV arms was 51, 42, and 35 weeks, respectively. The hazard of death (Cox analysis) for patients receiving PGV compared with those receiving PV was 0.35 (95% confidence index [CI], 0.16-0.77, P = 0.0058). The response rate was 47% in the PGV arm, 30% in the PG arm, and 25% in the PV arm. Severe neutropenia (75% vs. 45%), and vomiting (50% vs. 15%) significantly affected more patients in the PV than in the PGV arm. Since the difference in survival met early stopping rules, accrual to the PV arm was suspended. Enrollment still continues in the PGV and PG arms to ascertain whether the triplet regimen has a more significant effect on survival than that produced with the PG regimen.
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Affiliation(s)
- P Comella
- Medical Oncology A, National Tumor Institute, Naples, Italy.
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Mancarella S, Lorusso V, Manzione L, Antimi M, De Vita F, Santoro A, Maiorino L, Mattioli R, Luporini G, Bilancia D, De Lena M. Gemcitabine/cisplatin in advanced transitional cell carcinoma of the urinary tract (TCC): a phase II multicenter trial. Eur J Cancer 1999. [DOI: 10.1016/s0959-8049(99)81821-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lorusso V, Catino A, Mancarella S, D'Amico C, Latrorre A, Guida M, Sambiasi D, De Lena M. Phase I/II study of gemcitabine plus mitoxantrone in advanced breast cancer (ABC). Eur J Cancer 1999. [DOI: 10.1016/s0959-8049(99)81690-6] [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: 10/27/2022]
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Lorusso V, Mancarella S, Catino A, Brandi M, Paradiso A, Latorre A, Mastria A, De Mitrio A, Guida M, De Lena M. Mitoxantrone, L-Leucovorin and 5-Fluorouracil: An Effective and Well Tolerated First-Line Treatment for Advanced Breast Cancer. Tumori 1999; 85:60-4. [PMID: 10228500 DOI: 10.1177/030089169908500113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and background The combination of mitoxantrone plus leucovorin/fluorouracil in heavily pretreated patients with advanced breast cancer has shown significant activity and extremely good tolerability. The aim of this study was to evaluate the activity of this combination in patients not previously submitted to chemotherapy. Methods From May 1993 to December 1995 we treated 80 patients with advanced breast cancer with a combination of mitoxantrone, l-leucovorin and 5-fluorouracil. All patients had histologically or cytologically proven breast cancer, WHO performance status 0–3, normal hematological parameters and normal serum bilirubin. Prior chemotherapy for metastatic disease was not allowed, whereas adjuvant CMF (cyclophosphamide, methotrexate and 5-fluorouracil) or adjuvant anthracycline (doxorubicin or epirubicin) therapy was allowed; a single prior hormone treatment was permitted. Chemotherapy consisted of mitoxantrone 12 mg/m2 i.v. day 1, l-leucovorin 150 mg/m2 i.v. days 1, 2 and 3 and 5-fluorouracil 350 mg/m2 i.v. days 1, 2 and 3. The courses were repeated every 3 weeks. Results Objective response (CR + PR) was observed in 46/80 (57%) patients (95% CI, 46%–68%). Complete response (CR) was observed in 21/80 cases (26%). Response was observed in 14/24 (58%) patients with soft tissues as the dominant site of disease, in 22/34 (65%) patients with visceral involvement and in 10/22 (45%) of those with bone as the dominant site of disease. The median duration of response and survival was 9 months (range, 3–16) and 22 months (range, 2–48+), respectively. Toxicity was very manageable, with grade 4 leukopenia and thrombocytopenia in 6/80 (7.5%) and 1/80 (1.25%) patients, respectively, and negligible non-hematological toxicity. Conclusions The combination of mitoxantrone, 5-fluorouracil and high-dose l-leucovorin is a safe and effective regimen for first-line treatment of advanced breast cancer.
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Affiliation(s)
- V Lorusso
- Medical Oncology Operative Unit, Oncology Institute of Bari, Italy.
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Lorusso V, Mancarella S, Carpagnano F, Di Rienzo G, Oisternino L, Napoli G, Orlando S, De Lena M. Phase III study of gemcitabine (GEM) plus vinorelbine (NAV) in patients with stage IIIB-IV non-small cell lung cancer (NSCLC). Lung Cancer 1998. [DOI: 10.1016/s0169-5002(98)90121-0] [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: 10/26/2022]
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Secchi MB, Bettazzi L, Mancarella S, Loche G, Wu SC. [Coexistence of renovascular hypertension and pheochromocytoma. Description of 2 clinical cases]. Ann Ital Med Int 1994; 9:107-10. [PMID: 7917763] [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: 01/27/2023]
Abstract
The two unusual clinical cases described here illustrate the importance of correct application of clinical methodology. Two patients, a 55-year-old man and a 50-year-old woman, presented with severe hypertension due to the coexistence of renal artery stenosis and pheochromocytoma. Their symptoms were indicative of renovascular hypertension which was verified by the finding of extremely elevated plasma renin activity and angiographic detection of critical renal artery stenosis. Further consideration of specific clinical findings led to the suspicion of coexisting pathologies: the detection of elevated plasma catecholamine levels and abdominal computed tomography and iodobenzylguanidine imaging confirmed the presence of pheochromocytoma. The first patient repeatedly refused surgical treatment and died after 9 months; the second patient recovered after undergoing combined nephrectomy and tumor removal. These cases underscore the importance of a carefully planned sequence of studies in patients presenting with uncommon or equivocal clinical manifestations, particularly when conclusive diagnosis is essential to successful treatment.
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Affiliation(s)
- M B Secchi
- Centro per l'Ipertensione Arteriosa, Divisione di Medicina Interna. Ospedale Bassini, Cinisello Balsamo MI
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