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Agnelli L, Villa A, Butt F, Duca M, Guidi A, Carapezza M, Addante M, Lenoci G, O'Regan P, Russo L, Cresta S, Castano A, Ebrahem E, Alfieri S, Patil A, Carter L, Dive C, De Braud FG, Damian S. PROACT 2.0: A new open-source tool to improve patient-doctor communication in clinical trials. Tumori 2024:3008916241248007. [PMID: 38676437 DOI: 10.1177/03008916241248007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
The use of Digital Healthcare Products is leading to significant improvements in clinical practice. Herein, we discuss the development of PROACT 2.0 (Patient Reported Opinions About Clinical Tolerability v2.0), a novel open-source mobile and web application developed at Fondazione IRCCS Istituto Nazionale Tumori in Milan. It was developed in collaboration with The Christie, Manchester, in the context of work package 2 of the UpSMART Accelerator project, involving a consortium of referral cancer centers from the UK, Spain and Italy. PROACT 2.0 enhances communication between patients and healthcare providers in cancer clinical trials, allowing patients to report adverse events and side effects, and healthcare teams to collect valuable patient-reported outcome measures for treatment management. PROACT 2.0 supports text, audio, and video messaging, offering a secure, non-urgent communication channel that integrates with, or replaces, traditional methods. Its user-friendly and multilingual interface provides a new route for patient engagement and streamlines the handling of logistical information. Positive feedback from initial testing warrants future enhancements for broader applicability in cancer research and treatment.
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Affiliation(s)
- Luca Agnelli
- Department of Diagnostic Innovation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andrea Villa
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Fouziah Butt
- Digital Cancer Research , Cancer Research UK National Biomarker Centre, University of Manchester, Manchester, UK
| | - Matteo Duca
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandro Guidi
- Department of Diagnostic Innovation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marcello Carapezza
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Michele Addante
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Gaetano Lenoci
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paul O'Regan
- Digital Cancer Research , Cancer Research UK National Biomarker Centre, University of Manchester, Manchester, UK
| | - Laura Russo
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Women's and Maternal-Children's Area Department, Ospedale San Gerardo dei Tintori, University of Milano Bicocca, Monza, Italy
| | - Sara Cresta
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandra Castano
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elisabella Ebrahem
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sara Alfieri
- Clinical Psychology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Akshita Patil
- Digital Cancer Research , Cancer Research UK National Biomarker Centre, University of Manchester, Manchester, UK
| | | | - Caroline Dive
- Digital Cancer Research , Cancer Research UK National Biomarker Centre, University of Manchester, Manchester, UK
| | | | - Silvia Damian
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Rivoltini L, Camisaschi C, Fucà G, Paolini B, Vergani B, Beretta V, Damian S, Duca M, Cresta S, Magni M, Leone BE, Castelli C, de Braud F, De Santis F, Di Nicola M. Immunological characterization of a long-lasting response in a patient with metastatic triple-negative breast cancer treated with PD-1 and LAG-3 blockade. Sci Rep 2024; 14:3379. [PMID: 38336861 PMCID: PMC10858221 DOI: 10.1038/s41598-024-54041-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 02/07/2024] [Indexed: 02/12/2024] Open
Abstract
In patients with advanced triple-negative breast cancer (TNBC), translational research efforts are needed to improve the clinical efficacy of immunotherapy with checkpoint inhibitors. Here, we report on the immunological characterization of an exceptional, long-lasting, tumor complete response in a patient with metastatic TNBC treated with dual PD-1 and LAG-3 blockade within the phase I/II study CLAG525X2101C (NCT02460224) The pre-treatment tumor biopsy revealed the presence of a CD3+ and CD8+ cell infiltrate, with few PD1+ cells, rare CD4+ cells, and an absence of both NK cells and LAG3 expression. Conversely, tumor cells exhibited positive staining for the three primary LAG-3 ligands (HLA-DR, FGL-1, and galectin-3), while being negative for PD-L1. In peripheral blood, baseline expression of LAG-3 and PD-1 was observed in circulating immune cells. Following treatment initiation, there was a rapid increase in proliferating granzyme-B+ NK and T cells, including CD4+ T cells, alongside a reduction in myeloid-derived suppressor cells. The role of LAG-3 expression on circulating NK cells, as well as the expression of LAG-3 ligands on tumor cells and the early modulation of circulating cytotoxic CD4+ T cells warrant further investigation as exploitable predictive biomarkers for dual PD-1 and LAG-3 blockade.Trial registration: NCT02460224. Registered 02/06/2015.
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Affiliation(s)
- Licia Rivoltini
- Unit of Immunotherapy of Human Tumors, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Chiara Camisaschi
- Unit of Immunotherapy of Human Tumors, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Biomarkers Unit, Department of Applied Research and Technical Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanni Fucà
- Immunotherapy and Innovative Therapeutics Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian,1, 20133, Milan, Italy
| | - Biagio Paolini
- Pathology A Unit, Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Barbara Vergani
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Valeria Beretta
- Unit of Immunotherapy of Human Tumors, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Silvia Damian
- Immunotherapy and Innovative Therapeutics Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian,1, 20133, Milan, Italy
| | - Matteo Duca
- Immunotherapy and Innovative Therapeutics Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian,1, 20133, Milan, Italy
| | - Sara Cresta
- Immunotherapy and Innovative Therapeutics Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian,1, 20133, Milan, Italy
| | - Michele Magni
- Immunotherapy and Innovative Therapeutics Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian,1, 20133, Milan, Italy
| | | | - Chiara Castelli
- Unit of Immunotherapy of Human Tumors, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Filippo de Braud
- Immunotherapy and Innovative Therapeutics Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian,1, 20133, Milan, Italy
- Oncology and Hemato-Oncology Department, University of Milan, Milan, Italy
| | - Francesca De Santis
- Immunotherapy and Innovative Therapeutics Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian,1, 20133, Milan, Italy
| | - Massimo Di Nicola
- Immunotherapy and Innovative Therapeutics Unit, Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian,1, 20133, Milan, Italy.
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Vingiani A, Agnelli L, Duca M, Lorenzini D, Damian S, Proto C, Niger M, Nichetti F, Tamborini E, Perrone F, Piccolo A, Manoukian S, Azzollini J, Brambilla M, Colombo E, Lopez S, Vernieri C, Marra F, Conca E, Busico A, Capone I, Bozzi F, Angelini M, Devecchi A, Salvatori R, De Micheli V, Baggi A, Pasini S, Jommi C, Ladisa V, Apolone G, De Braud F, Pruneri G. Molecular Tumor Board as a Clinical Tool for Converting Molecular Data Into Real-World Patient Care. JCO Precis Oncol 2023; 7:e2300067. [PMID: 37487147 PMCID: PMC10581623 DOI: 10.1200/po.23.00067] [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] [Received: 02/08/2023] [Revised: 03/28/2023] [Accepted: 06/12/2023] [Indexed: 07/26/2023] Open
Abstract
PURPOSE The investigation of multiple molecular targets with next-generation sequencing (NGS) has entered clinical practice in oncology, yielding to a paradigm shift from the histology-centric approach to the mutational model for personalized treatment. Accordingly, most of the drugs recently approved in oncology are coupled to specific biomarkers. One potential tool for implementing the mutational model of precision oncology in daily practice is represented by the Molecular Tumor Board (MTB), a multidisciplinary team whereby molecular pathologists, biologists, bioinformaticians, geneticists, medical oncologists, and pharmacists cooperate to generate, interpret, and match molecular data with personalized treatments. PATIENTS AND METHODS Since May 2020, the institutional MTB set at Fondazione IRCCS Istituto Nazionale Tumori of Milan met weekly via teleconference to discuss molecular data and potential therapeutic options for patients with advanced/metastatic solid tumors. RESULTS Up to October 2021, among 1,996 patients evaluated, we identified >10,000 variants, 43.2% of which were functionally relevant (pathogenic or likely pathogenic). On the basis of functionally relevant variants, 711 patients (35.6%) were potentially eligible to targeted therapy according to European Society of Medical Oncology Scale for Clinical Actionability of Molecular Targets tiers, and 9.4% received a personalized treatment. Overall, larger NGS panels (containing >50 genes) significantly outperformed small panels (up to 50 genes) in detecting actionable gene targets across different tumor types. CONCLUSION Our real-world data provide evidence that MTB is a valuable tool for matching NGS data with targeted treatments, eventually implementing precision oncology in clinical practice.
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Affiliation(s)
- Andrea Vingiani
- Department of Diagnostic Innovation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Luca Agnelli
- Department of Diagnostic Innovation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Matteo Duca
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Daniele Lorenzini
- Department of Diagnostic Innovation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Silvia Damian
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Claudia Proto
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Monica Niger
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Federico Nichetti
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
- Computational Oncology Group, Molecular Precision Oncology Program, National Center for Tumor Diseases (NCT) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Elena Tamborini
- Department of Diagnostic Innovation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Federica Perrone
- Department of Diagnostic Innovation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alberta Piccolo
- Department of Diagnostic Innovation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Siranoush Manoukian
- Unit of Medical Genetics, Department of Medical Oncology and Hematology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Jacopo Azzollini
- Unit of Medical Genetics, Department of Medical Oncology and Hematology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Marta Brambilla
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Elena Colombo
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Salvatore Lopez
- Gynecologic Oncology, Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Claudio Vernieri
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
- IFOM ETS, The AIRC Institute of Molecular Oncology, Milan, Italy
| | - Francesca Marra
- Department of Diagnostic Innovation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elena Conca
- Department of Diagnostic Innovation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Adele Busico
- Department of Diagnostic Innovation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Iolanda Capone
- Department of Diagnostic Innovation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Fabio Bozzi
- Department of Diagnostic Innovation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marta Angelini
- Department of Diagnostic Innovation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andrea Devecchi
- Department of Diagnostic Innovation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Rebecca Salvatori
- Department of Diagnostic Innovation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Precision Cancer Therapeutics Program, Center for Individualized Medicine, Mayo Clinic, Rochester, MN
| | | | - Anna Baggi
- Business Integration Partners S.p.A., Milan, Italy
| | | | - Claudio Jommi
- Department of Pharmaceutical Sciences, Università del Piemonte Orientale, Novara, Italy
| | - Vito Ladisa
- Hospital Pharmacy, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Giovanni Apolone
- Scientific Directorate, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Filippo De Braud
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Giancarlo Pruneri
- Department of Diagnostic Innovation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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4
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Provenzano L, Damian S, Duca M, Della Valle S, Maria De Braud FG. Ascites During Selpercatinib Treatment: Need for a Multidisciplinary Approach. J Thorac Oncol 2023; 18:e9-e10. [PMID: 36682848 DOI: 10.1016/j.jtho.2022.09.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 01/22/2023]
Affiliation(s)
- Leonardo Provenzano
- Medical Oncology 1 Department, Fondazione IRCCS "Istituto Nazionale dei Tumori,", Milan, Italy
| | - Silvia Damian
- Medical Oncology 1 Department, Fondazione IRCCS "Istituto Nazionale dei Tumori,", Milan, Italy
| | - Matteo Duca
- Medical Oncology 1 Department, Fondazione IRCCS "Istituto Nazionale dei Tumori,", Milan, Italy
| | - Serena Della Valle
- Nutritional Department, Fondazione IRCCS "Istituto Nazionale dei Tumori,", Milan, Italy
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Corradini P, Agrati C, Apolone G, Mantovani A, Giannarelli D, Marasco V, Bordoni V, Sacchi A, Matusali G, Salvarani C, Zinzani PL, Mantegazza R, Tagliavini F, Lupo-Stanghellini MT, Ciceri F, Damian S, Uccelli A, Fenoglio D, Silvestris N, Baldanti F, Piaggio G, Ciliberto G, Morrone A, Locatelli F, Sinno V, Rescigno M, Costantini M. Humoral and T-Cell Immune Response After 3 Doses of Messenger RNA Severe Acute Respiratory Syndrome Coronavirus 2 Vaccines in Fragile Patients: The Italian VAX4FRAIL Study. Clin Infect Dis 2022; 76:e426-e438. [PMID: 35607769 PMCID: PMC9213871 DOI: 10.1093/cid/ciac404] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [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: 12/31/2021] [Revised: 05/09/2022] [Accepted: 05/18/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Patients with solid or hematological tumors or neurological and immune-inflammatory disorders are potentially fragile subjects at increased risk of experiencing severe coronavirus disease 2019 and an inadequate response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. METHODS We designed a prospective Italian multicenter study to assess humoral and T-cell responses to SARS-CoV-2 vaccination in patients (n = 378) with solid tumors (ST), hematological malignancies (HM), neurological disorders (ND), and immunorheumatological diseases (ID). A group of healthy controls was also included. We analyzed the immunogenicity of the primary vaccination schedule and booster dose. RESULTS The overall seroconversion rate in patients after 2 doses was 62.1%. Significantly lower rates were observed in HM (52.4%) and ID (51.9%) than in ST (95.6%) and ND (70.7%); a lower median antibody level was detected in HM and ID versus ST and ND (P < .0001). Similar rates of patients with a positive SARS-CoV-2 T-cell response were found in all disease groups, with a higher level observed in ND. The booster dose improved the humoral response in all disease groups, although to a lesser extent in HM patients, whereas the T-cell response increased similarly in all groups. In the multivariable logistic model, independent predictors of seroconversion were disease subgroup, treatment type, and age. Ongoing treatment known to affect the immune system was associated with the worst humoral response to vaccination (P < .0001) but had no effect on T-cell responses. CONCLUSIONS Immunosuppressive treatment more than disease type per se is a risk factor for a low humoral response after vaccination. The booster dose can improve both humoral and T-cell responses.
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Affiliation(s)
| | - Chiara Agrati
- Correspondence: C. Agrati, Cellular Immunology Laboratory, INMI L Spallanzani, Via Portuense 292, 00149, Rome, Italy ()
| | - Giovanni Apolone
- Fondazione IRCCS Istituto Nazionale dei Tumori di, Milano, Italy
| | - Alberto Mantovani
- Humanitas Scientific Directorate, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy,William Harvey Research Institute, Queen Mary University, London, United Kingdom
| | - Diana Giannarelli
- Biostatistical Unit, Istituto Nazionale Tumori Regina Elena IRCCS - IFO, Rome, Italy
| | - Vincenzo Marasco
- Department of Oncology and Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori di, Milano, Italy
| | - Veronica Bordoni
- Cellular Immunology Laboratory, National Institute for Infectious Diseases L Spallanzani – IRCCS, Rome, Italy
| | - Alessandra Sacchi
- Cellular Immunology Laboratory, National Institute for Infectious Diseases L Spallanzani – IRCCS, Rome, Italy
| | - Giulia Matusali
- Virology Laboratory, National Institute for Infectious Diseases L Spallanzani – IRCCS, Rome, Italy
| | - Carlo Salvarani
- Unità di Reumatologia, Azienda USL-IRCCS, Reggio Emilia, Italy,Unità di Reumatologia, Università degli Studi di Modena e Reggio Emilia, Modena
| | - Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli”, Bologna, Italy,Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Renato Mantegazza
- Neuromuscular Diseases and Neuroimmunology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | | | | | - Fabio Ciceri
- IRCSS San Raffaele Scientific Institute, Milano, Italy
| | - Silvia Damian
- Department of Oncology and Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori di, Milano, Italy
| | - Antonio Uccelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) University of Genoa, Genoa, Italy,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Daniela Fenoglio
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy,Centre of Excellence for Biomedical Research and Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Nicola Silvestris
- Medical Oncology Department, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari, Italy,Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, Bari, Italy
| | - Fausto Baldanti
- Molecular Virology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy,Department of Clinical, Surgical, Diagnostics and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Giulia Piaggio
- SAFU Unit IRCCS Regina Elena, National Cancer Institute, Istituti Fisioterapici Ospitalieri (IFO), Rome, Italy
| | - Gennaro Ciliberto
- National Cancer Institute, Istituti Fisioterapici Ospitalieri (IFO), Rome, Italy
| | - Aldo Morrone
- San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Franco Locatelli
- Department of Pediatric Hematology and Oncology and Cell and Gene Therapy, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy,Department of Gynecology-Obstetrics and Pediatrics, University ‘La Sapienza’, Roma, Italy
| | - Valentina Sinno
- Department of Oncology and Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori di, Milano, Italy
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Randon G, Maddalena G, Germani MM, Pagani F, Bergamo F, Giordano M, Pircher C, Sposetti C, Zambelli L, Corti F, Bini M, Rametta A, Spagnoletti A, Montagna A, Fassan M, Boccaccino A, Vetere G, Damian S, Milione M, de Braud F, Cremolini C, Lonardi S, Pietrantonio F. Abstract 1269: Negative ultra-selection of patients with RAS/ BRAF wild-type (wt), microsatellite stable (MSS) metastatic colorectal cancer (mCRC) receiving anti-EGFR-based therapy: The PRESSING2 study. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-1269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Several genomic alterations beyond RAS and BRAFV600E mutations have been preclinically validated as primary resistance drivers to EGFR inhibition in mCRC. We showed that our PRESSING panel (including PIK3CA exon 20/AKT1/PTEN mutations, ERBB2/MET amplification and ALK/ROS1/RET/NTRKs fusions) is useful to promote a new paradigm of negative hyper-selection, since patients with RAS/BRAF wt MSS mCRC and PRESSING alterations achieve significantly worse survival upon anti-EGFRs. With the aim of further refining molecular selection (negative ultra-selection), we investigated the clinical impact of candidate resistance alterations with even lower frequency (PRESSING2 panel) in a cohort of hyper-selected patients.
Methods: A prospective dataset was developed at 3 Italian Academic Hospitals and included 650 mCRC patients with comprehensive genomic profiling of FFPE tumor tissue by means of FoundationOne CDx. We selected those with RAS/BRAF wt, MSS and PRESSING negative treated with anti-EGFRs. Alterations of the PRESSING2 panel were selected based on their actionability and biological value, as follows: ALK, ROS1, NTRKs, ERBB2/3/4, NF1, ARAF, MAP2K1 pathogenic mutations, PTEN loss, KRAS and AKT1-2 amplification, FGFR2 amplification/fusions, EGFR fusions. PRESSING2 status was correlated with progression-free survival (PFS) and overall survival (OS).
Results: 163 molecularly hyper-selected patients with PRESSING negative status were identified; 30 (18%) had PRESSING2 alterations, which were mutually exclusive in 26 (87%) samples. No significant differences in baseline clinical and pathological characteristics - including sidedness - were found in PRESSING2 positive vs negative patients. The median follow-up was 34.6 months (IQR 23.5-49.3). Patients with PRESSING2 positive status had significantly worse PFS and OS vs those with PRESSING2 negative disease (median PFS 7.0 and 13.0 months; HR 3.54, 95%CI 2.26-5.52, P<0.001; median OS 24.5 and 51.2 months; HR 2.91, 95%CI 1.64-5.18, P<0.001). In the multivariable model, the adjusted HRs were 3.40 for PFS and 2.71 for OS, respectively. 121 (74%) patients received an anti-EGFR agent upfront. In this first-line cohort, median PFS were 8.1 vs 13.2 months for PRESSING2 positive and negative subgroups (HR 3.24, 95%CI 1.89-5.57; P<0.001; adjusted HR 2.96), whereas median OS were 26.2 vs 49.9 months, respectively (HR 2.28, 95%CI 1.15-4.54, P=0.018; adjusted HR 2.34).
Conclusions: In the era of comprehensive genomic profiling, several resistance alterations with extremely low prevalence may be detected, especially in CRCs that do not bear other genomic drivers. Negative ultra-selection may represent a relevant step forward in precision medicine in patients with RAS/BRAF wt MSS mCRC potentially eligible for EGFR blockade.
Citation Format: Giovanni Randon, Giulia Maddalena, Marco Maria Germani, Filippo Pagani, Francesca Bergamo, Mirella Giordano, Chiara Pircher, Caterina Sposetti, Luca Zambelli, Francesca Corti, Marta Bini, Alessandro Rametta, Andrea Spagnoletti, Aldo Montagna, Matteo Fassan, Alessandra Boccaccino, Guglielmo Vetere, Silvia Damian, Massimo Milione, Filippo de Braud, Chiara Cremolini, Sara Lonardi, Filippo Pietrantonio. Negative ultra-selection of patients with RAS/BRAF wild-type (wt), microsatellite stable (MSS) metastatic colorectal cancer (mCRC) receiving anti-EGFR-based therapy: The PRESSING2 study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1269.
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Affiliation(s)
- Giovanni Randon
- 1Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | | | | | - Filippo Pagani
- 1Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | | | - Mirella Giordano
- 3Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy, Pisa, Italy
| | - Chiara Pircher
- 1Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Caterina Sposetti
- 1Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Luca Zambelli
- 1Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Francesca Corti
- 1Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Marta Bini
- 1Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | | | | | | | | | | | - Guglielmo Vetere
- 3Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy, Pisa, Italy
| | - Silvia Damian
- 1Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Massimo Milione
- 1Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Filippo de Braud
- 1Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Chiara Cremolini
- 3Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy, Pisa, Italy
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7
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Azzollini J, Vingiani A, Agnelli L, Tamborini E, Perrone F, Conca E, Capone I, Busico A, Peissel B, Rosina E, Ducceschi M, Mantiero M, Lopez S, Raspagliesi F, Niger M, Duca M, Damian S, Proto C, de Braud F, Pruneri G, Manoukian S. Management of BRCA Tumour Testing in an Integrated Molecular Tumour Board Multidisciplinary Model. Front Oncol 2022; 12:857515. [PMID: 35463374 PMCID: PMC9026437 DOI: 10.3389/fonc.2022.857515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/17/2022] [Indexed: 11/13/2022] Open
Abstract
Tumour testing of the BRCA1/2 genes is routinely performed in patients with different cancer histological subtypes. To accurately identify patients with tumour-detected germline pathogenic variants (PVs) is a relevant issue currently under investigation. This study aims at evaluating the performance of the tumour-to-germline diagnostic flowchart model defined at our Institutional Molecular Tumour Board (MTB). Results from tumour BRCA sequencing of 641 consecutive unselected cancer patients were discussed during weekly MTB meetings with the early involvement of clinical geneticists for appropriate referral to genetic counselling. The overall tumour detection rate of BRCA1/2 PVs was 8.7% (56/641), ranging from 24.4% (31/127) in high-grade ovarian cancer to 3.9% (12/304) in tumours not associated with germline BRCA1/2 PVs. Thirty-seven patients with PVs (66%) were evaluated by a clinical geneticist, and in 24 of them (64.9%), germline testing confirmed the presence of the PV in blood. Nine of these patients (37.5%) were not eligible for germline testing according to the criteria in use at our institution. Cascade testing was subsequently performed on 18 relatives. The tumour-to-germline diagnostic pipeline, developed in the framework of our institutional MTB, compared with guideline-based germline testing following genetic counselling, proved to be effective in identifying a higher number of germline BRCA PVs carriers.
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Affiliation(s)
- Jacopo Azzollini
- Unit of Medical Genetics, Department of Medical Oncology and Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andrea Vingiani
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,Oncology and Hemato-oncology Department, University of Milan, Milan, Italy
| | - Luca Agnelli
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elena Tamborini
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Federica Perrone
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elena Conca
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Iolanda Capone
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Adele Busico
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Bernard Peissel
- Unit of Medical Genetics, Department of Medical Oncology and Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Erica Rosina
- Unit of Medical Genetics, Department of Medical Oncology and Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Monika Ducceschi
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Mara Mantiero
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Salvatore Lopez
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Francesco Raspagliesi
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Monica Niger
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Matteo Duca
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Silvia Damian
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Claudia Proto
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Filippo de Braud
- Oncology and Hemato-oncology Department, University of Milan, Milan, Italy.,Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giancarlo Pruneri
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,Oncology and Hemato-oncology Department, University of Milan, Milan, Italy
| | - Siranoush Manoukian
- Unit of Medical Genetics, Department of Medical Oncology and Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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8
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Fucà G, Lecchi M, Ciniselli CM, Ottini A, Spagnoletti A, Mazzeo L, Morelli D, Frati P, Stroscia M, Ebrahem E, Sottotetti E, Galli G, D’Elia MG, Lobefaro R, Ducceschi M, Di Guardo L, Bhoori S, Provenzano S, Platania M, Niger M, Colombo E, Nichetti F, Duca M, Rivoltini L, Mortarini R, Baili P, Apolone G, de Braud F, Verderio P, Damian S. Efficacy of mRNA anti-SARS-CoV-2 vaccination and dynamics of humoral immune response in patients with solid tumors: results from the institutional registry of an Italian tertiary cancer center. Ther Adv Med Oncol 2022; 14:17588359221108687. [PMID: 35923922 PMCID: PMC9340426 DOI: 10.1177/17588359221108687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 06/06/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Systemic immunosuppression characterizing cancer patients represents a concern regarding the efficacy of anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination, and real-world evidence is needed to define the efficacy and the dynamics of humoral immune response to mRNA-based anti-SARS-CoV-2 vaccines. Methods: We conducted an observational study that included patients with solid tumors who were candidates for mRNA anti-SARS-CoV-2 vaccination at the Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. The primary objective was to monitor the immunologic response to the mRNA anti-SARS-CoV-2 vaccination in terms of anti-spike antibody levels. All the patients received two doses of the mRNA-1273 vaccine or the BNT162b2 vaccine. Healthcare workers served as a control group of healthy subjects. Results: Among the 243 patients included in the present analysis, 208 (85.60%) and 238 (97.94%) resulted seroconverted after the first and the second dose of vaccine, respectively. Only five patients (2.06%) had a negative titer after the second dose. No significant differences in the rate of seroconversion after two vaccine doses were observed in patients as compared with the control group of healthy subjects. Age and anticancer treatment class had an independent impact on the antibody titer after the second dose of vaccination. In a subgroup of 171 patients with available data about the third timepoint, patients receiving immunotherapy with immune checkpoint inhibitors seem to have a higher peak of antibodies soon after the second dose (3 weeks after), but a more pronounced decrease at a late timepoint (3 months after). Conclusions: The systemic immunosuppression characterizing cancer patients did not seem to dramatically affect the humoral response to anti-SARS-CoV-2 mRNA vaccines in our population of patients with solid tumors. Further investigation is needed to dissect the interplay between immunotherapy and longitudinal dynamics of humoral response to mRNA vaccines, as well as to analyze the cellular response to mRNA vaccines in cancer patients.
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Affiliation(s)
- Giovanni Fucà
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Mara Lecchi
- Unit of Bioinformatics and Biostatistics, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Chiara Maura Ciniselli
- Unit of Bioinformatics and Biostatistics, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Arianna Ottini
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andrea Spagnoletti
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Laura Mazzeo
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Daniele Morelli
- Unit of Bioinformatics and Biostatistics, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paola Frati
- Unit of Immunotherapy of Human Tumors, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Martina Stroscia
- Unit of Immunotherapy of Human Tumors, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elisabella Ebrahem
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elisa Sottotetti
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giulia Galli
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Maria Grazia D’Elia
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Riccardo Lobefaro
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Monika Ducceschi
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Lorenza Di Guardo
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sherrie Bhoori
- Hepato-Pancreatic-Biliary Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Salvatore Provenzano
- Medical Oncology Unit 2, Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marco Platania
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Monica Niger
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elena Colombo
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Federico Nichetti
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Computational Oncology, Molecular Diagnostics Program, National Center for Tumor Diseases and German Cancer Research Center, Heidelberg, Germany
| | - Matteo Duca
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Licia Rivoltini
- Unit of Immunotherapy of Human Tumors, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberta Mortarini
- Human Tumors Immunobiology Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paolo Baili
- Unit of Bioinformatics and Biostatistics, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Scientific Directorate, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanni Apolone
- Scientific Directorate, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Filippo de Braud
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy Oncology and Hemato-Oncology Department, University of Milan, Milan, Italy
| | | | - Silvia Damian
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, Milan 20133, Italy
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9
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Capone I, Bozzi F, Dagrada GP, Verderio P, Conca E, Busico A, Testi MA, Monti V, Duca M, Proto C, Damian S, Piccolo A, Perrone F, Tamborini E, Devecchi A, Collini P, Lorenzini D, Vingiani A, Agnelli L, Pruneri G. Targeted RNA-sequencing analysis for fusion transcripts detection in tumor diagnostics: assessment of bioinformatic tools reliability in FFPE samples. Exploration of Targeted Anti-tumor Therapy 2022; 3:582-597. [PMCID: PMC9630092 DOI: 10.37349/etat.2022.00102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 08/02/2022] [Indexed: 11/07/2022] Open
Abstract
Aim: Diagnostic laboratories are progressively introducing next-generation sequencing (NGS) technologies in the routine workflow to meet the increasing clinical need for comprehensive molecular characterization in cancer patients for diagnosis and precision medicine, including fusion-transcripts detection. Nevertheless, the low quality of messenger RNA (mRNA) extracted from formalin-fixed paraffin-embedded (FFPE) samples may affect the transition from traditional single-gene testing approaches [like fluorescence in situ hybridization (FISH), immunohistochemistry (IHC), or polymerase chain reaction (PCR)] to NGS. The present study is aimed at assessing the overall accuracy of RNA fusion transcripts detection by NGS analysis in FFPE samples in real-world diagnostics. Methods: Herein, NGS data from 190 soft tissue tumors (STTs) and carcinoma cases, discussed in the context of the institutional Molecular Tumor Board, are reported and analyzed by FusionPlex© Solid tumor kit through the manufacturer’s pipeline and by two well-known fast and accurate open-source tools [Arriba (ARR) and spliced transcripts alignment to reference (STAR)-fusion (SFU)]. Results: The combination of FusionPlex© Solid tumor with ArcherDX® Analysis suite (ADx) analysis package has been proven to be sensitive and specific in STT samples, while partial loss of sensitivity has been found in carcinoma specimens. Conclusions: Albeit ARR and SFU showed lower sensitivity, the use of additional fusion-detection tools can contribute to reinforcing or extending the output obtained by ADx, particularly in the case of low-quality input data. Overall, our results sustain the clinical use of NGS for the detection of fusion transcripts in FFPE material.
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Affiliation(s)
- Iolanda Capone
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Fabio Bozzi
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Gian Paolo Dagrada
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Paolo Verderio
- Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Elena Conca
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Adele Busico
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Maria Adele Testi
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Valentina Monti
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Matteo Duca
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Claudia Proto
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Silvia Damian
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Alberta Piccolo
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Federica Perrone
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Elena Tamborini
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Andrea Devecchi
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Paola Collini
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Daniele Lorenzini
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Andrea Vingiani
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy,Department of Oncology and Hemato-oncology, University of Milan, 20133 Milan, Italy
| | - Luca Agnelli
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy,Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy,Correspondence: Luca Agnelli, Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy.
| | - Giancarlo Pruneri
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy,Department of Oncology and Hemato-oncology, University of Milan, 20133 Milan, Italy
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10
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Pietrantonio F, Lonardi S, Corti F, Infante G, Elez ME, Fakih M, Jayachandran P, Shah AT, Salati M, Fenocchio E, Salvatore L, Curigliano G, Cremolini C, Ambrosini M, Ros J, Intini R, Nappo F, Damian S, Morano F, Fucà G, Overman M, Miceli R. Nomogram to predict the outcomes of patients with microsatellite instability-high metastatic colorectal cancer receiving immune checkpoint inhibitors. J Immunother Cancer 2021; 9:e003370. [PMID: 34429334 PMCID: PMC8386222 DOI: 10.1136/jitc-2021-003370] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The efficacy of immune checkpoint inhibitors (ICIs) in patients with microsatellite instability (MSI)-high metastatic colorectal cancer (mCRC) is unprecedented. A relevant proportion of subjects achieving durable disease control may be considered potentially 'cured', as opposed to patients experiencing primary ICI refractoriness or short-term clinical benefit. We developed and externally validated a nomogram to estimate the progression-free survival (PFS) and the time-independent event-free probability (EFP) in patients with MSI-high mCRC receiving ICIs. METHODS The PFS and EFP were estimated using a cure model fitted on a developing set of 163 patients and validated on a set of 146 patients with MSI-high mCRC receiving anti-programmed death (ligand)1 (PD-(L)1) ± anticytotoxic T-lymphocyte antigen 4 (CTLA-4) agents. A total of 23 putative prognostic factors were chosen and then selected using a random survival forest (RSF). The model performance in estimating PFS probability was evaluated by assessing calibration (internally-developing set and externally-validating set) and quantifying the discriminative ability (Harrell C index). RESULTS RFS selected five variables: ICI type (anti-PD-(L)1 monotherapy vs anti-CTLA-4 combo), ECOG PS (0 vs >0), neutrophil-to-lymphocyte ratio (≤3 vs >3), platelet count, and prior treatment lines. As both in the developing and validation series most PFS events occurred within 12 months, this was chosen as cut-point for PFS prediction. The combination of the selected variables allowed estimation of the 12-month PFS (focused on patients with low chance of being cured) and the EFP (focused on patients likely to be event-free at a certain point of their follow-up). ICI type was significantly associated with disease control, as patients receiving the anti-CTLA-4-combination experienced the best outcomes. The calibration of PFS predictions was good both in the developing and validating sets. The median value of the EFP (46%) allowed segregation of two prognostic groups in both the developing (PFS HR=3.73, 95% CI 2.25 to 6.18; p<0.0001) and validating (PFS HR=1.86, 95% CI 1.07 to 3.23; p=0.0269) sets. CONCLUSIONS A nomogram based on five easily assessable variables including ICI treatment was built to estimate the outcomes of patients with MSI-high mCRC, with the potential to assist clinicians in their clinical practice. The web-based system 'MSI mCRC Cure' was released.
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Affiliation(s)
- Filippo Pietrantonio
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sara Lonardi
- Medical Oncology 3, Istituto Oncologico Veneto IOV-IRCSS, Padua, Italy
| | - Francesca Corti
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Gabriele Infante
- Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Maria Elena Elez
- Department of Medical Oncology, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Institute of Oncology (VHIO), Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Marwan Fakih
- Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Priya Jayachandran
- Division of Medical Oncology, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | | | - Massimiliano Salati
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, PhD Clinical and Experimental Medicine (CEM), University of Modena and Reggio Emilia, Modena, Italy
| | - Elisabetta Fenocchio
- Multidisciplinary Outpatient Oncology Clinic, Candiolo Cancer Institute FPO-IRCCS, Candiolo, Italy
| | - Lisa Salvatore
- Department of Medical Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giuseppe Curigliano
- European Institute of Oncology (IEO), IRCCS, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Chiara Cremolini
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana; Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Margherita Ambrosini
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Javier Ros
- Department of Medical Oncology, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Institute of Oncology (VHIO), Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Rossana Intini
- Medical Oncology 1, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - Floriana Nappo
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Silvia Damian
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Federica Morano
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanni Fucà
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Michael Overman
- Department of Gastrointestinal Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Rosalba Miceli
- Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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11
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Kelley RK, Sangro B, Harris W, Ikeda M, Okusaka T, Kang YK, Qin S, Tai DWM, Lim HY, Yau T, Yong WP, Cheng AL, Gasbarrini A, Damian S, Bruix J, Borad M, Bendell J, Kim TY, Standifer N, He P, Makowsky M, Negro A, Kudo M, Abou-Alfa GK. Safety, Efficacy, and Pharmacodynamics of Tremelimumab Plus Durvalumab for Patients With Unresectable Hepatocellular Carcinoma: Randomized Expansion of a Phase I/II Study. J Clin Oncol 2021; 39:2991-3001. [PMID: 34292792 PMCID: PMC8445563 DOI: 10.1200/jco.20.03555] [Citation(s) in RCA: 232] [Impact Index Per Article: 77.3] [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: 12/13/2022] Open
Abstract
This phase I/II study evaluated tremelimumab (anticytotoxic T-lymphocyte–associated antigen-4 monoclonal antibody) and durvalumab (antiprogrammed death ligand-1 monoclonal antibody) as monotherapies and in combination for patients with unresectable hepatocellular carcinoma (HCC), including a novel regimen featuring a single, priming dose of tremelimumab (ClinicalTrials.gov identifier: NCT02519348).
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Affiliation(s)
| | - Bruno Sangro
- Liver Unit, Clínica Universidad de Navarra, IdiSNA and CIBEREHD, Pamplona, Spain
| | | | | | | | - Yoon-Koo Kang
- Department of Oncology, Asan Medical Center (AMC), University of Ulsan, Seoul, South Korea
| | - Shukui Qin
- Cancer Center of Nanjing, Jinling Hospital, Nanjing, China
| | | | - Ho Yeong Lim
- Samsung Medical Center (SMC), Sungkyunkwan University, Seoul, South Korea
| | - Thomas Yau
- Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Wei-Peng Yong
- National University Cancer Institute Singapore (NCIS), Singapore
| | | | | | - Silvia Damian
- Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Jordi Bruix
- Barcelona Clinic Liver Cancer (BCLC), Hospital Clinic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | | | - Johanna Bendell
- Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN
| | - Tae-You Kim
- Seoul National University Hospital, Seoul, South Korea
| | | | | | | | | | | | - Ghassan K Abou-Alfa
- Memorial Sloan Kettering Cancer Center, New York, NY.,Weill Cornell Medicine, Cornell University, New York, NY
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12
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Mariani G, Galli G, Cavalieri S, Valagussa P, Bianchi GV, Capri G, Cresta S, Ferrari L, Damian S, Duca M, de Braud F, Moliterni A. Single Institution trial of anthracycline- and taxane-based chemotherapy for operable breast cancer: The ASTER study. Breast J 2019; 25:237-242. [PMID: 30810258 DOI: 10.1111/tbj.13197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 07/31/2018] [Accepted: 07/31/2018] [Indexed: 11/29/2022]
Abstract
The efficacy of anthracycline- and taxane-based chemotherapy for perioperative treatment of breast cancer (BC) has been established. No superiority of a cytotoxic regimen has been demonstrated, provided that administration of an anthracycline and a taxane is warranted. The ASTER study was designed to investigate the safety of 6 months of perioperative chemotherapy with Doxorubicin and Paclitaxel, followed by Cyclophosphamide, Methotrexate, and 5-Fluorouracil. ASTER enrolled patients with cT2-3 N0-1 or pT1-2 N1-3 BC, from November 2008 to August 2011. Treatment consisted of Doxorubicin 60 mg/sm, Paclitaxel 200 mg/sm q21 (AT) for three cycles followed by Cyclophosphamide 600 mg/sm, Methotrexate 40 mg/sm, 5-Fluorouracil 600 mg/sm d1,8 q28 (CMF) for three cycles, in either neo-adjuvant or adjuvant setting. All HER-positive patients received targeted therapy with Trastuzumab for 1 year. Disease-free and overall survival (DFS and OS, respectively) were estimated according to Kaplan-Meier method. Three hundred and thirty patients were enrolled, where 77.9% of cases were treated in an adjuvant setting; 65.5% received breast conservative surgery, 72.4% axillary dissection. 75.5% of cases presented estrogen receptor positivity, 66.7% progesterone receptor positivity; 18.5% of patients presented HER2-positive BC, 16.1% triple negative disease. Twenty-eight (8.5%) developed grade III-IV hematologic toxicity; nine patients (2.7%) developed grade III neurological toxicity. Loco-regional DFS was 99.6% at 1 year, 97.1% at 5 years, 95.9% at 7 years. Corresponding distant DFS was 98.4%, 90.2%, and 88.8%. One, 5, and 7-year OS was 99.6%, 94.9%, and 91.2%, respectively. Chemotherapy with ATx3→CMFx3 is confirmed safe and effective at 6.7 years follow-up. These results appear comparable to those reported in regulatory trials of most commonly prescribed anthracycline and taxane-based regimens.
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Affiliation(s)
- Gabriella Mariani
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giulia Galli
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stefano Cavalieri
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Giulia Valeria Bianchi
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giuseppe Capri
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sara Cresta
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Laura Ferrari
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Silvia Damian
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Matteo Duca
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Filippo de Braud
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,Università degli Studi di Milano, Milan, Italy
| | - Angela Moliterni
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Cona M, Lecchi M, Damian S, Del Vecchio M, Cimminiello C, Cresta S, Duca M, Necchi A, Signorelli D, Poggi M, Raggi D, Ratta R, Verderio P, de Braud F, Di Nicola M. Combination of baseline LDH, performance status and age to identify solid tumor patients with higher probability of response to anti-PD1 and PDL1 monoclonal antibodies. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy269.109] [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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14
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Farè E, Sdao S, Damian S, Cresta S, Del Vecchio M, Di Bartolomeo M, Di Guardo L, Duca M, Indini A, Necchi A, Niger M, Prisciandaro M, Procopio G, Raggi D, Verzoni E, Pruneri G, Di Nicola M, de Braud F. Hyperprogression during immuno-checkpoint inhibitors (ICIs): A clinically significant problem? Ann Oncol 2018. [DOI: 10.1093/annonc/mdy288.083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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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15
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Schöffski P, Cresta S, Mayer IA, Wildiers H, Damian S, Gendreau S, Rooney I, Morrissey KM, Spoerke JM, Ng VW, Singel SM, Winer E. A phase Ib study of pictilisib (GDC-0941) in combination with paclitaxel, with and without bevacizumab or trastuzumab, and with letrozole in advanced breast cancer. Breast Cancer Res 2018; 20:109. [PMID: 30185228 PMCID: PMC6125885 DOI: 10.1186/s13058-018-1015-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [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: 09/15/2017] [Accepted: 07/03/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND This phase Ib study (NCT00960960) evaluated pictilisib (GDC-0941; pan-phosphatidylinositol 3-kinase inhibitor) plus paclitaxel, with and without bevacizumab or trastuzumab, or in combination with letrozole, in patients with locally recurrent or metastatic breast cancer. METHODS This was a three-part multischedule study. Patients in parts 1 and 2, which comprised 3 + 3 dose escalation and cohort expansion stages, received pictilisib (60-330 mg) plus paclitaxel (90 mg/m2) with and without bevacizumab (10 mg/kg) or trastuzumab (2-4 mg/kg). In part 3, patients received pictilisib (260 mg) plus letrozole (2.5 mg). Primary objectives were evaluation of safety and tolerability, identification of dose-limiting toxicities (DLTs) and the maximum tolerated dose (MTD) of pictilisib, and recommendation of a phase II dosing regimen. Secondary endpoints included pharmacokinetics and preliminary antitumor activity. RESULTS Sixty-nine patients were enrolled; all experienced at least one adverse event (AE). Grade ≥ 3 AEs, serious AEs, and AEs leading to death were reported in 50 (72.5%), 21 (30.4%), and 2 (2.9%) patients, respectively. Six (8.7%) patients reported a DLT, and the MTD and recommended phase II pictilisib doses were established where possible. There was no pictilisib-paclitaxel drug-drug interaction. Two (3.4%) patients experienced complete responses, and 17 (29.3%) patients had partial responses. CONCLUSIONS Combining pictilisib with paclitaxel, with and without bevacizumab or trastuzumab, or letrozole, had a manageable safety profile in patients with locally recurrent or metastatic breast cancer. The combination had antitumor activity, and the additive effect of pictilisib supported further investigation in a randomized study. TRIAL REGISTRATION ClinicalTrials.gov, NCT00960960 . Registered on August 13, 2009.
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Affiliation(s)
- Patrick Schöffski
- Department of General Medical Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
- Department of Oncology, Faculty of Medicine, Laboratory of Experimental Oncology, KU Leuven, Herestraat 49, B-3000 Leuven, Belgium
| | - Sara Cresta
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Ingrid A. Mayer
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN USA
| | - Hans Wildiers
- Department of General Medical Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Silvia Damian
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Steven Gendreau
- Oncology Biomarker Development, Genentech Inc, South San Francisco, CA USA
| | - Isabelle Rooney
- Product Development Oncology, Genentech Inc, South San Francisco, CA USA
| | | | - Jill M. Spoerke
- Oncology Biomarker Development, Genentech Inc, South San Francisco, CA USA
| | - Vivian W. Ng
- Biostatistics, Genentech Inc, South San Francisco, CA USA
| | - Stina M. Singel
- Product Development Oncology, Genentech Inc, South San Francisco, CA USA
| | - Eric Winer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA USA
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de Braud F, Di Nicola M, Damian S, Cresta S, Duca M, Indini A, Di Bartolomeo M, Galli G, Farè E, Verzoni E. Is “hyper-progression” a relevant clinical item for patient with solid tumours candidate to check-point inhibitor treatment? Ann Oncol 2018. [DOI: 10.1093/annonc/mdy046.018] [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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17
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Mariani G, Galli G, Cavalieri S, Valagussa P, Bianchi G, Capri G, Cresta S, Ferrari L, Damian S, Duca M, de Braud F, Moliterni A. Long term results of ASTER study, a single Institution phase II trial of sequential chemotherapy (CT) for operable breast cancer (BC). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx424.033] [Citation(s) in RCA: 1] [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: 11/13/2022] Open
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18
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Drilon A, Siena S, Ou SHI, Patel M, Ahn MJ, Lee J, Bauer TM, Farago AF, Wheler JJ, Liu SV, Doebele R, Giannetta L, Cerea G, Marrapese G, Schirru M, Amatu A, Bencardino K, Palmeri L, Sartore-Bianchi A, Vanzulli A, Cresta S, Damian S, Duca M, Ardini E, Li G, Christiansen J, Kowalski K, Johnson AD, Patel R, Luo D, Chow-Maneval E, Hornby Z, Multani PS, Shaw AT, De Braud FG. Safety and Antitumor Activity of the Multitargeted Pan-TRK, ROS1, and ALK Inhibitor Entrectinib: Combined Results from Two Phase I Trials (ALKA-372-001 and STARTRK-1). Cancer Discov 2017; 7:400-409. [PMID: 28183697 DOI: 10.1158/2159-8290.cd-16-1237] [Citation(s) in RCA: 550] [Impact Index Per Article: 78.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 01/24/2017] [Accepted: 01/25/2017] [Indexed: 12/14/2022]
Abstract
Entrectinib, a potent oral inhibitor of the tyrosine kinases TRKA/B/C, ROS1, and ALK, was evaluated in two phase I studies in patients with advanced or metastatic solid tumors, including patients with active central nervous system (CNS) disease. Here, we summarize the overall safety and report the antitumor activity of entrectinib in a cohort of patients with tumors harboring NTRK1/2/3, ROS1, or ALK gene fusions, naïve to prior TKI treatment targeting the specific gene, and who were treated at doses that achieved therapeutic exposures consistent with the recommended phase II dose. Entrectinib was well tolerated, with predominantly Grades 1/2 adverse events that were reversible with dose modification. Responses were observed in non-small cell lung cancer, colorectal cancer, mammary analogue secretory carcinoma, melanoma, and renal cell carcinoma, as early as 4 weeks after starting treatment and lasting as long as >2 years. Notably, a complete CNS response was achieved in a patient with SQSTM1-NTRK1-rearranged lung cancer.Significance: Gene fusions of NTRK1/2/3, ROS1, and ALK (encoding TRKA/B/C, ROS1, and ALK, respectively) lead to constitutive activation of oncogenic pathways. Entrectinib was shown to be well tolerated and active against those gene fusions in solid tumors, including in patients with primary or secondary CNS disease. Cancer Discov; 7(4); 400-9. ©2017 AACR.This article is highlighted in the In This Issue feature, p. 339.
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Affiliation(s)
- Alexander Drilon
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York.
| | - Salvatore Siena
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy.,Dipartimento di Oncologia e Emato-Oncologia, Università degli Studi di Milano, Milan, Italy
| | - Sai-Hong Ignatius Ou
- Chao Family Comprehensive Cancer Center, University of California, Irvine, California
| | - Manish Patel
- Sarah Cannon Research Institute/Florida Cancer Specialists, Sarasota, Florida
| | | | | | - Todd M Bauer
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, Tennessee
| | - Anna F Farago
- Massachusetts General Hospital, Boston, Massachusetts
| | | | - Stephen V Liu
- Georgetown Lombardi Comprehensive Cancer Center, Washington, DC
| | | | - Laura Giannetta
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giulio Cerea
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giovanna Marrapese
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Michele Schirru
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alessio Amatu
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Katia Bencardino
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Laura Palmeri
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Angelo Vanzulli
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy.,Dipartimento di Oncologia e Emato-Oncologia, Università degli Studi di Milano, Milan, Italy
| | - Sara Cresta
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Silvia Damian
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Matteo Duca
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Gang Li
- Ignyta, Inc., San Diego, California
| | | | | | | | | | | | | | | | | | - Alice T Shaw
- Massachusetts General Hospital, Boston, Massachusetts
| | - Filippo G De Braud
- Dipartimento di Oncologia e Emato-Oncologia, Università degli Studi di Milano, Milan, Italy.,Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Lazureanu V, Radu D, Vermesan D, Prejbeanu R, Florescu S, Trocan I, Damian S, Inchingolo F, Abbinante A, Dipalma G, Caprio M, Cagiano R, Potenza MA, Haragus H. Drain tip cultures do not predict infections in primary total knee arthroplasty. Clin Ter 2016; 166:e153-7. [PMID: 26152624 DOI: 10.7417/ct.2015.1846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND AIM The possibility to predict surgical site infections development could be of high prognostic value. We aimed to investigate whether cultures obtained from the tip of the closed passive wound drain may provide early signs of progression towards periprosthetic joint infections. MATERIALS AND METHODS We performed an observational study on consecutive primary total knee arthroplasties performed in our department over 4 years by two high volume surgeons (it means they do a lot of arthroplasties/year; it is orthopedics specific). A total of 284 knees in 257 patients were included. Follow up was available for an average of 18.7 months. There were no simultaneous procedures. RESULTS Nineteen (6.69%) drain tips yielded positive cultures, for a mean duration, from surgery to sample collection, of 1.63 (0.5) days. None of the positive drain tip cultures developed clinical signs of infection and all knees were healed at discharge after a mean of 13.78 days (SD= 3.34; range= 8-18). None of the 7 (2.46%) cases who developed deep infections had positive drain tip cultures. A true positive value of 0 led to a positive predictive value of 0, a negative predictive value of 97.34%, sensitivity of 0% and specificity of 93.14. CONCLUSIONS The diagnostic use of passive drain tip cultures to detect early infections after total knee replacement is therefore absolutely useless.
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Affiliation(s)
- V Lazureanu
- Deparments of Second Clinic of Infectious Diseases, University of Medicine and Pharmacy 'Victor Babes' Timisoara, Romania
| | - D Radu
- Department of First Clinic of Surgery, University of Medicine and Pharmacy 'Victor babes' Timisoara, Romania
| | - D Vermesan
- Deparments of Orthopedics and Trauma, University of Medicine and Pharmacy 'Victor Babes' Timisoara, Romania
| | - R Prejbeanu
- Deparments of Orthopedics and Trauma, University of Medicine and Pharmacy 'Victor Babes' Timisoara, Romania
| | - S Florescu
- Deparments of Orthopedics and Trauma, University of Medicine and Pharmacy 'Victor Babes' Timisoara, Romania
| | - I Trocan
- Deparments of Orthopedics and Trauma, University of Medicine and Pharmacy 'Victor Babes' Timisoara, Romania
| | - S Damian
- West University 'Vasile Goldis', Arad, Romania
| | - F Inchingolo
- Departments of Interdisciplinary Medicine, School of Medicine, University of Bari, Italy
| | - A Abbinante
- Departments of Biomedical Sciences and Human Oncology School of Medicine, University of Bari, Italy
| | - G Dipalma
- Departments of Interdisciplinary Medicine, School of Medicine, University of Bari, Italy
| | - M Caprio
- Departments of Biomedical Sciences and Human Oncology, School of Medicine, University of Bari, Italy
| | - R Cagiano
- Departments of Biomedical Sciences and Human Oncology, School of Medicine, University of Bari, Italy
| | - M A Potenza
- Departments of Biomedical Sciences and Human Oncology, School of Medicine, University of Bari, Italy
| | - H Haragus
- Deparments of Orthopedics and Trauma, University of Medicine and Pharmacy 'Victor Babes' Timisoara, Romania
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Niculescu M, Cagiano R, Caprio M, Damian S, Boia E, Vermesan D, Tattoli M, Haragus H. The anxiolitic effects of BTG1640 and BTG1675A on ultrasonic isolation calls and locomotor activity of rat pups. Eur Rev Med Pharmacol Sci 2016; 20:4980-4984. [PMID: 27981534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE The aim of the present study was to evaluate the anxiolytic properties of the new isoxazoline compounds BTG1640 and BTG1675A in comparison with diazepam. MATERIALS AND METHODS We evaluated the ultrasonic distress emission in both sexes of neonatal rat pups (which seems to be a sensitive indicator of the rat emotional reactivity and represents a valuable tool to screen compounds with expected anxiolytic properties) and the locomotor activity in 30-day old rat pups. RESULTS We found a significant reduction in the number of emitted ultrasonic calls only after i.p. administration of diazepam 1 mg/kg, while no significant reduction have been detected after i.p. administration of BTG 1640 and BTG 1675A. Furthermore, we found a significant reduction of locomotor activity in the first 10' of the test, only in the group treated with diazepam 0.1 mg. CONCLUSIONS The tests validating the supposed anxiolytic properties of the new isoxazoline compounds BTG1640 and BTG1675A, in comparison with diazepam, gave negative results.
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Affiliation(s)
- M Niculescu
- Faculty of Medicine, University "Titu Maiorescu", Bucharest, Romania.
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21
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Azaro A, Rodón J, Machiels JP, Rottey S, Damian S, Baird R, Garcia-Corbacho J, Mathijssen RHJ, Clot PF, Wack C, Shen L, de Jonge MJA. A phase I pharmacokinetic and safety study of cabazitaxel in adult cancer patients with normal and impaired renal function. Cancer Chemother Pharmacol 2016; 78:1185-1197. [PMID: 27796539 PMCID: PMC5114328 DOI: 10.1007/s00280-016-3175-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 10/12/2016] [Indexed: 01/13/2023]
Abstract
PURPOSE Limited data are available on cabazitaxel pharmacokinetics in patients with renal impairment. This open-label, multicenter study assessed cabazitaxel in patients with advanced solid tumors and normal or impaired renal function. METHODS Cohorts A (normal renal function: creatinine clearance [CrCL] >80 mL/min/1.73 m2), B (moderate renal impairment: CrCL 30 to <50 mL/min/1.73 m2) and C (severe impairment: CrCL <30 mL/min/1.73 m2) received cabazitaxel 25 mg/m2 (A, B) or 20 mg/m2 (C, could be escalated to 25 mg/m2), once every 3 weeks. Pharmacokinetic parameters and cabazitaxel unbound fraction (F U) were assessed using linear regression and mixed models. Geometric mean (GM) and GM ratios (GMRs) were determined using mean CrCL intervals (moderate and severe renal impairment: 40 and 15 mL/min/1.73 m2) versus a control (90 mL/min/1.73 m2). RESULTS Overall, 25 patients received cabazitaxel (median cycles: 3 [range 1-20]; Cohort A: 5 [2-13]; Cohort B: 3 [1-15]; and Cohort C: 5 [1-20]), of which 24 were eligible for pharmacokinetic analysis (eight in each cohort). For moderate and severe renal impairment versus normal renal function, GMR estimates were: clearance normalized to body surface area (CL/BSA) 0.95 (90% CI 0.80-1.13) and 0.89 (0.61-1.32); area under the curve normalized to dose (AUC/dose) 1.06 (0.88-1.27) and 1.14 (0.76-1.71); and F U 0.99 (0.94-1.04) and 0.97 (0.87-1.09), respectively. Estimated slopes of linear regression of log parameters versus log CrCL (renal impairment) were: CL/BSA 0.06 (-0.15 to 0.28); AUC/dose -0.07 (-0.30 to 0.16); and F U 0.02 (-0.05 to 0.08). Cabazitaxel safety profile was consistent with previous reports. CONCLUSIONS Renal impairment had no clinically meaningful effect on cabazitaxel pharmacokinetics.
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Affiliation(s)
- Analía Azaro
- Molecular Therapeutics Research Unit, Department of Medical Oncology, Vall d'Hebron University Hospital, Barcelona, Spain. .,Pharmacology Department, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
| | - Jordi Rodón
- Molecular Therapeutics Research Unit, Department of Medical Oncology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Jean-Pascal Machiels
- Department of Medical Oncology, Institut Roi Albert II, Cliniques Universitaires Saint-Luc and Institut de Recherche Clinique et Expérimentale (Pole MIRO), Université Catholique de Louvain, Brussels, Belgium
| | - Sylvie Rottey
- Department of Medical Oncology, University Hospital of Ghent and Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium
| | - Silvia Damian
- Department of Medical Oncology, Fondazione IRCCS National Cancer Institute of Milan, Milan, Italy
| | - Richard Baird
- Early Phase Clinical Trials Team, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Javier Garcia-Corbacho
- Early Phase Clinical Trials Team, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Ron H J Mathijssen
- Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | | | | | - Maja J A de Jonge
- Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
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Cona MS, Duca M, Testi A, Cresta S, Dotti KF, Indini A, Signorelli D, Pelosi G, de Braud FG, Damian S. Abstract LB-A08: ALK and ROS-1 status: A retrospective analysis in solid tumors. Mol Cancer Ther 2015. [DOI: 10.1158/1535-7163.targ-15-lb-a08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Tyrosine kinase receptors are important regulators of cellular signal transduction pathways that play a crucial role in development of cancer. Among them, Anaplastic Lymphoma Kinase (ALK) and C-Ros Oncogene-1 (ROS-1) are activated by rearrangement in several tumors. Tailored therapies have been developed according to the status of ALK and ROS-1, successfully used in NSCLC and potentially useful in other solid tumors harboring ALK and ROS-1 aberrations.
Material and methods: ALK and ROS-1 status was evaluated in 666 and 441 patients with solid tumors, respectively, since 2014 at the Pathology Department. ALK and ROS-1 rearrangement and gene copy number variation (CNV) were assayed by fluorescence in situ hybridization (FISH). Gene copy number gain was defined by 3 to 5 fusion signals on average in ≥10% of cells, with amplification being highlighted by the clusters or 10 to 15 fusion signals in 10% or more tumor cells.
Results: ALK status was assessed in 650/666 (97%) cases, while ROS-1 status was evaluable in 426/441 (96%). We identified 15/650 (2.3%) cases with ALK rearrangment, including 13 lung adenocarcinomas (4.1%), 1 colon cancer (0.5%) and 1 myoepithelioma (0.5%). CNV for ALK was documented in 53% lung adenocarcinoma, 50% pancreatic, 41% biliary and 37% colon carcinoma patients. We found 7/426 (1.6%) tumors with ROS-1 rearrangement, corresponding to 5 lung (2.7%) and 2 colon (1.3%) adenocarcinomas. CNV for ROS-1 was more frequent in melanoma (77%), neuroendocrine tumors (39%) and NSCLC (32%, 3/4 cases of ROS-1 amplification were squamous carcinoma). Eight out of the 22 rearranged cases (5 ALK and 3 ROS-1) were tested for both genes: these aberrations were mutually exclusive. Three out of 5 (60%) ALK rearranged tumors showed ROS-1 deletion. No ALK and ROS-1 alterations were documented in 30 pancreatic, 25 H&N, 22 biliary tract, 13 renal, and 13 breast carcinomas, as well as in 13 melanomas and 36 other solid tumors.
Conclusions: ALK and ROS-1 rearrangement was found in 4.1% and 2.7% of NSCLC, respectively, in keeping with literature data. In other solid tumors, the percentage of rearrangements is exceedingly low, but melanoma, neuroendocrine tumors, pancreatic and colon cancer may show significant CNV. We speculate that such aberrations of ALK and ROS-1 could act as potential therapy targets, but additional investigation by immunohistochemistry and next generation sequencing is clinically warranted.
Citation Format: Maria Silvia Cona, matteo Duca, Adele Testi, Sara Cresta, Katia Fiorella Dotti, Alice Indini, Diego Signorelli, Giuseppe Pelosi, Filippo Guglielmo de Braud, Silvia Damian. ALK and ROS-1 status: A retrospective analysis in solid tumors. [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2015 Nov 5-9; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2015;14(12 Suppl 2):Abstract nr LB-A08.
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Affiliation(s)
| | - matteo Duca
- Istituto Nazionale Tumori. Milan, Milan, Italy
| | - Adele Testi
- Istituto Nazionale Tumori. Milan, Milan, Italy
| | - Sara Cresta
- Istituto Nazionale Tumori. Milan, Milan, Italy
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Cona M, Indini A, Testi A, Cresta S, Signorelli D, Garassino M, Sinno V, Sesana S, Pelosi G, de Braud F, Damian S. Druggable aberrations in solid tumors: an overview on ALK and ROS-1 status. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv348.32] [Citation(s) in RCA: 1] [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: 11/13/2022] Open
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De Braud FG, Niger M, Damian S, Bardazza B, Martinetti A, Pelosi G, Marrapese G, Palmeri L, Cerea G, Valtorta E, Veronese S, Sartore-Bianchi A, Ardini E, Isachi A, Martignoni M, Galvani A, Luo D, Yeh L, Senderowicz AM, Siena S. Alka-372-001: First-in-human, phase I study of entrectinib – an oral pan-trk, ROS1, and ALK inhibitor – in patients with advanced solid tumors with relevant molecular alterations. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.2517] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [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)
| | - Monica Niger
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Silvia Damian
- Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | | | | | - Giuseppe Pelosi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Laura Palmeri
- Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Giulio Cerea
- Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan, Italy
| | | | - Silvio Veronese
- Niguarda Cancer Center, Ospedale Niguarda Ca’ Granda, Milan, Italy
| | | | | | | | - Marcella Martignoni
- CLInical Organization for Strategies & Solutions (CLIOSS), NMS Group, Nerviano, Italy
| | | | | | | | | | - Salvatore Siena
- Niguarda Cancer Center, Ospedale Niguarda Ca’ Granda, Milan, Italy
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De Braud F, Pilla L, Niger M, Damian S, Bardazza B, Martinetti A, Pelosi G, Marrapese G, Palmeri L, Cerea G, Valtorta E, Veronese S, Sartore-Bianchi A, Ardini E, Martignoni M, Isacchi A, Pearson P, Luo D, Freddo J, Siena S. Rxdx-101, an Oral Pan-Trk, Ros1, and Alk Inhibitor, in Patients with Advanced Solid Tumors with Relevant Molecular Alterations. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu331.8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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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26
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Azaro A, Rodon J, Machiels J, Rottey S, Damian S, Baird R, Nieuweboer A, Clot P, Wack C, Shen L, Bobilev D, De Jonge M. Pharmacokinetic (Pk) Activity of Cabazitaxel (Cbz) in Patients (Pts) with Renal Impairment (Ri). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu336.32] [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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27
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De Braud FG, Pilla L, Niger M, Damian S, Bardazza B, Martinetti A, Pelosi G, Marrapese G, Palmeri L, Cerea G, Valtorta E, Veronese S, Sartore-Bianchi A, Ardini E, Martignoni M, Galvani A, Pearson P, Luo D, Freddo JL, Siena S. Phase 1 open label, dose escalation study of RXDX101, an oral pan-trk, ROS1, and ALK inhibitor, in patients with advanced solid tumors with relevant molecular alterations. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.2502] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [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)
| | - Lorenzo Pilla
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Monica Niger
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Silvia Damian
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | | | - Giuseppe Pelosi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Laura Palmeri
- Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Giulio Cerea
- Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan, Italy
| | | | - Silvio Veronese
- Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milano, Italy
| | | | | | - Marcella Martignoni
- CLInical Organization for Strategies & Solutions (CLIOSS), NMS Group, Nerviano, Italy
| | | | | | | | | | - Salvatore Siena
- Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan, Italy
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Moliterni A, Mariani G, Carlo Stella G, Mariani L, Bianchi GV, Capri G, Cresta S, Mariani P, Damian S, De Benedictis E, Gelsomino F, Zanardi E, Duca M, Sica L, Tessari A, De Braud FG. Long-term results from INT-HER study: Retrospective evaluation of adjuvant trastuzumab in unselected HER2-positive breast cancer patients—Single institution experience. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e11509] [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)
- Angela Moliterni
- Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Gabriella Mariani
- Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | | | - Luigi Mariani
- Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Giuseppe Capri
- Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Sara Cresta
- Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Paola Mariani
- Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Silvia Damian
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elena De Benedictis
- Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Francesco Gelsomino
- Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Elisa Zanardi
- Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Matteo Duca
- Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Lorenzo Sica
- Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Anna Tessari
- Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
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Mariani G, Galli G, Mariani P, Bianchi GV, Capri G, Cresta S, Damian S, De Benedictis E, Valagussa P, Magazzu' D, De Braud FG, Moliterni A. Abstract P3-12-13: First analysis of ASTER study AT for 3 cycles followed by CMF for 3 cycles as neo or adjuvant chemotherapy in early stage breast cancer. A single institution experience. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p3-12-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The ECTO study demonstrated the efficacy of concurrent doxorubicin and paclitaxel (AT) for 4 cycles followed by cyclophosphamyde/ methotrexate/fluorouracil (CMF) for 4 cycles in the neoadjuvant and adjuvant treatment of operable breast cancer (Gianni L. et al. JCO 2009). With the purpose of ameliorating the tolerability of the regimen, we designed the ASTER study to reduce both the duration and the total dose of treatment with AT followed by CMF. Herein we report on the first data of efficacy of the study and the toxicity.
Methods: A total of 345 patients with operable breast cancer were enrolled between September 2008 and November 2011. Median age was 50 years (range 23-74); 74.5% of patients presented with hormonal receptor positive (HR +) and 23,5% of patients with both hormonal receptor negative (HR-PgR-); 19% of patients presented HER2 over expression/amplification; half patients had Ki67 >14%, almost of patients had pT1 (66%) or pT2 (30%) with 27,5% of pN0. Patients were treated with Adriamycin (60 mg/mq) + Paclitaxel (200 mg/mq) q21 for 3 cycles followed by CMF i.v. 1, 8q28 for 3 cycles (73 as neo-adjuvant and 272 as adjuvant regimen). After chemotherapy in patients with HER2+ trastuzumab was delivered for 1 yr and in patients with HR+ tumors hormonal treatment was recommended for 5 yr. Breast irradiation was mandatory after conserving surgery (64% of cases).
Results: At a median follow-up of 36 months, the relapse free survival (RFS) and overall survival (OS) were 92% and 96% respectively. As expected in patients HR+/HER2- RFS were 95% and OS 99%, in patients HER2+ RFS were 90% and OS 97% and in those HR-/HER2- 83% and 79% respectively.
In the neoadjuvant subset tnpCR, defined as the absence of invasive cells in the primary tumor and in nodes, was obtained in 10% of cases. A tnpCR was achieved in 27% of patients with triple negative cancer and only in 5% of HR positive cancer.
Peripheral neuropathy toxicity was reported in 37% of cases and was essentially mild to moderate. Only 8,7% of patients experienced neutropenia G 3, 4,3% GI toxicity G3 and 2,3% mucositis G3. No cardiotoxicity was documented even in the 65 patients who received postoperative trastuzumab to date.
Conclusions: This results of Aster study AT for 3 cycles followed by CMF for 3 cycles showed similar efficacy and very favorable toxicity compared whit our previous experience of eighth cycle of sequential and non cross resistant chemotherapy in early stage breast cancer.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-12-13.
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Affiliation(s)
- G Mariani
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Fondazione Michelangelo, Milan, Italy
| | - G Galli
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Fondazione Michelangelo, Milan, Italy
| | - P Mariani
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Fondazione Michelangelo, Milan, Italy
| | - GV Bianchi
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Fondazione Michelangelo, Milan, Italy
| | - G Capri
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Fondazione Michelangelo, Milan, Italy
| | - S Cresta
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Fondazione Michelangelo, Milan, Italy
| | - S Damian
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Fondazione Michelangelo, Milan, Italy
| | - E De Benedictis
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Fondazione Michelangelo, Milan, Italy
| | - P Valagussa
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Fondazione Michelangelo, Milan, Italy
| | - D Magazzu'
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Fondazione Michelangelo, Milan, Italy
| | - FG De Braud
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Fondazione Michelangelo, Milan, Italy
| | - A Moliterni
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Fondazione Michelangelo, Milan, Italy
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Damian S, Celio L, De Benedictis E, Mariani P, Agustoni F, Ricchini F, De Braud F. Is a dexamethasone-sparing strategy capable of preventing acute and delayed emesis caused by combined doxorubicin and paclitaxel for breast cancer? Analysis of a phase II trial. Oncology 2013; 84:371-7. [PMID: 23711719 DOI: 10.1159/000348538] [Citation(s) in RCA: 3] [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] [Received: 11/17/2012] [Accepted: 01/27/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The effectiveness of palonosetron without delayed dexamethasone dosing against emesis was investigated in patients scheduled to receive the corticosteroid-containing combination of doxorubicin and paclitaxel (AT) for 3 cycles. METHODS Chemo-naïve women with breast cancer receiving doxorubicin (60 mg/m(2)) and paclitaxel (200 mg/m(2)) were eligible. Patients received palonosetron 0.25 mg intravenously before chemotherapy, however, all patients also received a premedication consisting of prednisone (25 mg orally the evening before therapy) and hydrocortisone (250 mg intravenously just before paclitaxel). The primary end point was complete control (CC; no vomiting, no rescue anti-emetics, and no more than mild nausea) during the overall phase (days 1-5) following cycle 1. RESULTS Seventy-six patients were enrolled and evaluable (median age 50 years). Fifty-six patients (74%; 95% CI 62-83%) achieved overall CC. Acute (day 1) and delayed (days 2-5) CC rates were 78 and 74%, respectively. No vomiting rates for the acute, delayed and overall phases were 85, 85 and 83%, respectively. An exploratory analysis showed only a small decrease in the probability of achieving CC between cycle 1 (74%) and cycle 3 (66%). CONCLUSION The dexamethasone-sparing strategy prevented emesis in more than 70% of breast cancer patients receiving their initial cycle of AT chemotherapy.
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Affiliation(s)
- Silvia Damian
- Medical Oncology Unit 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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31
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Damian S, Tessari A, Capri G, Mariani P, Bianchi GV, Mariani G, Ricchini F, Sica L, De Benedictis E, Cresta S, Lanocita R, Spreafico C. Hepatic trans-arterial chemoembolization (TACE) in metastatic breast cancer. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e12017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e12017 Background: Liver metastasis is one of the most frequent cause of death in breast cancer patients. Among loco-regional approaches available for solid tumor liver metastasis, TACE allows a prolonged intra-lesion exposure to chemotherapeutic agents. Initial studies have highlighted a benefit in terms of response rate (RR) and overall survival (OS) in breast cancer patients treated with TACE versus systemic chemotherapy. Methods: We have retrospectively evaluated 14 patients affected by breast cancer with liver metastasis. Patients had been selected for liver TACE according to the presence of liver metastasis as only site of disease, or in the event of further sites of metastasis that were stable or in response from the previous treatment. All the patients received one or more TACE with DC-Bead (Biocompatibles UK) 100-300 micron, loaded with a chemotherapeutic agent (doxorubicin, paclitaxel).The systemic therapy received by patients before TACE could be confirmed or changed according to disease response. Objective of the study was to evaluate the response rate to TACE and its correlation with the response to the very last treatment performed before it. As surrogate of efficacy, time to progression (TTP) and OS were analyzed. Results: Among the 14 treated patients (5 heavily pretreated, with more than three lines of chemotherapy) only one obtained a complete remission (RC). Four patients presented a partial remission (PR). Three of them were progressing from previous treatment and one had a PR. Stable disease (SD) after TACE was obtained in four cases: two of them had a progressive disease (PD) before TACE and two had a responsive disease. Five patients did not respond to TACE (one with PR from the previous line of therapy). Median TTP observed in responsive patients (CR + PR) was 4.5 times higher than non-responders (PD) (13.2 vs. 2.9 months). Patients with SD had a median TTP of 4.3 months. Median OS of responsive patients was 25.6 months vs. 17.5 and 19.2 months of patients with SD or PD respectively. Conclusions: In our experience, chemoembolization can represent a valid therapeutic option in breast cancer patients with liver metastasis, independently from the response to the previous systemic therapy, and may prolong survival.
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Affiliation(s)
- Silvia Damian
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Anna Tessari
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giuseppe Capri
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paola Mariani
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | | | | | - Lorenzo Sica
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Sara Cresta
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Carlo Spreafico
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Ong M, Del Conte G, Bahleda R, Mateo J, Damian S, Perotti A, Lassau N, Farace F, Lovosgaldeano J, Tunariu N, Hospitel M, Mariani P, Cohen P, Capri G, Soria JC, Gianni L, Molife LR, Sessa C. A phase I study of ombrabulin (O) combined with bevacizumab (B) in patients with advanced solid tumors. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.2535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2535 Background: O, a vascular-disrupting agent derived from combretastatin A4-phosphate, induces rapid tumor vascular shutdown via endothelial cell damage. Resistance to O may occur by surges in circulating endothelial progenitors (CEP) that repopulate the tumor vasculature. Experimental models suggest prolonged and synergistic antitumor activity when O is combined with VEGF-blockade, with reduction in CEP surge. This phase I study was performed to determine the maximum tolerated dose, safety, tolerability, pharmacokinetics (PK), pharmacodynamics (PD) and preliminary antitumor activity of O combined with B. Methods: Patients (pts) with advanced treatment-refractory solid tumors, ECOG PS ≤1, and adequate organ function were eligible. O (mg/m²) was administered intravenously (IV) on day (d)1 with B (mg/kg) IV on d2 in 21d cycles (C). A Bayesian model informed dose escalation steps. PK sampling, dynamic contrast-enhanced ultrasound (DCE-US) for tumor perfusion, and CEP samples were collected. Results: 39 pts (M:F 10:29; median age 51 years [range 25-75]) were treated at 12 dose levels combining O [8 to 50mg/m2] with B [5, 10, or 15mg/kg]. Ovary (16/39, 41%) and colon (4/39, 10%) were the most common primary sites. No C1 dose-limiting toxicities occurred in 37 evaluable pts. Drug-related grade 3-4 treatment emergent adverse events (AE) were hypertension (6/39, 15%), intestinal perforation (2/39, 5%), headache (1/39, 3%), myocardial infarction (1/39, 3%), and pulmonary embolism (1/39, 3%). 36 pts (14 ovarian) were evaluable for response by RECIST 1.1. Antitumor activity was observed at O 20mg/m2+ B 10mg/kg and above, with confirmed partial responses in 2/14 pts with ovarian primary (14%), CA125 responses in 2 further ovary/endometrial cancers lasting ≥ 6 months, and stable disease in 15/36 pts (42%) lasting ≥ 6 months in 3 pts. PK indicated no interactions of O+B. Analyses of CEP levels post O and paired DCE-US data are ongoing. Conclusions: The maximum administered dose (MAD) was O 50mg/m2 with B 15mg/kg, with no dose-limiting toxicities and vascular toxicity that was manageable. Promising antitumor activity was observed at doses below the MAD and warrants further evaluation. Clinical trial information: NCT01193595.
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Affiliation(s)
- Michael Ong
- The Institute of Cancer Research, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | | | | | - Joaquin Mateo
- The Institute of Cancer Research, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Silvia Damian
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | | | | | - Jimena Lovosgaldeano
- The Institute of Cancer Research, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Nina Tunariu
- The Institute of Cancer Research, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | | | - Paola Mariani
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Giuseppe Capri
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Luca Gianni
- San Raffaele Scientific Institute, Milan, Italy
| | - L Rhoda Molife
- The Institute of Cancer Research, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Cristiana Sessa
- Ospedale Regionale Bellinzona e Valli, Bellinzona, Switzerland
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Puma E, Mariani P, Damian S, Dazzani M, De Benedictis E, Parati M, Sica L, Tessari A, De Braud F, Moliterni A. Neoadjuvant Chemotherapy in Operable Breast Cancer: Data From the Aster Study (At for 3 Cycles Followed by CMF for 3 Cycles). Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)32831-3] [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: 10/25/2022] Open
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Del Conte G, Bahleda R, Moreno V, Damian S, Perotti A, Lassau N, Farace F, Ong M, Stimpson SJ, Tunariu N, Micallef S, Demers B, Oprea C, Capri G, Soria JC, Sessa C, Molife LR. A phase I study of ombrabulin (O) combined with bevacizumab (B) in patients with advanced solid tumors (NCT01193595). J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.3080] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3080 Background: O is a vascular-disrupting agent derived from combretastatin A4-phosphate that induces rapid but transient tumor vascular shutdown. In experimental models, the combination of O with VEGF-blockade induced more regressions than O alone. This phase I study was performed to determine the maximum tolerated dose (MTD), and assess the overall safety, pharmacokinetics (PK), pharmacodynamics (PD) and preliminary antitumor activity of O plus B. Trial is funded by sanofi. Methods: Patients (pt) with advanced solid tumors, ECOG PS ≤1, and adequate organ function were eligible. Increasing doses of O (mg/m²) was administered intravenously (IV) on day (d) 1; B (5 or 10mg/kg) was administered IV on d2, in 21d cycles (C). A Bayesian design was applied to determine dose escalation steps and MTD. PK sampling was performed in C1 and C2. PD sampling for circulating endothelial cells (CEC) and progenitors (CEP) were performed throughout. Dynamic contrast-enhanced ultrasound (DCE-US) to assess tumor perfusion was performed before and after C1 and C2 dosing. Results: 25 pts (M:F 6:19; median age 49 years [range 27-75]) have been treated at 8 dose levels of O/B: 8/5 (3), 11.5/5 (4), 11.5/10 (3), 15.5/10 (3), 20/10 (3), 25/10 (3); 35/10 (3) and 42/10 (3). Ovarian cancer was the most frequent tumor type (n=11). Median Cs received was 3 (1 to 14). No DLTs were observed during C1. Drug-related grade (g) 3-4 adverse events (AE) included hypertension in 2 pts (8/5; 11.5/5) and ileal perforation in 1 pt with peritoneal carcinomatosis at laparotomy (11.5/10). A case of duodenal perforation was unlikely related (25/10). Two pts with ovarian cancer (11.5/5; 20/10) had confirmed partial responses (4.4 months (mo) and 7+ mo). 13/23 (57%) pts with ≥ 1 tumor assessment had stable disease (n=8; median 4.3 mo [1.8-9.5]; 5 ongoing). Data from cohorts 1 and 2 demonstrated no evidence of a PK interaction.17/25 patients demonstrated a peak in CEC, and 7/9 patients a peak in CEP. 4/7 DCE-US evaluable pts had >50% drop in tumor perfusion (AUC) at Day 8 of C1. Conclusions: O combined with B is well tolerated with early evidence of clinical activity. The MTD has not been reached (current dose level 50/10); cohorts of O combined with B at 15 mg/kg will be tested.
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Affiliation(s)
| | | | | | | | | | | | | | - Michael Ong
- Royal Marsden Hospital and Institute of Cancer Research, Sutton, United Kingdom
| | - Sarah Jane Stimpson
- Royal Marsden Hospital and Institute of Cancer Research, Sutton, United Kingdom
| | - Nina Tunariu
- The Institute of Cancer Research and Royal Marsden Foundation Trust, Sutton, United Kingdom
| | | | | | | | - Giuseppe Capri
- Montabone Unit for New Drug Development, Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Cristiana Sessa
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - L Rhoda Molife
- Royal Marsden Hospital and Institute of Cancer Research, Sutton, United Kingdom
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Panasci L, Jean-Claude BJ, Vasilescu D, Mustafa A, Damian S, Damian Z, Georges E, Liu Z, Batist G, Leyland-Jones B. Sensitization to doxorubicin resistance in breast cancer cell lines by tamoxifen and megestrol acetate. Biochem Pharmacol 1996; 52:1097-102. [PMID: 8831729 DOI: 10.1016/0006-2952(96)00456-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [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: 02/02/2023]
Abstract
Acquired drug resistance is a major factor in the failure of doxorubicin-based chemotherapy in breast cancer. We determined the ability of megestrol acetate and/or tamoxifen to reverse doxorubicin drug resistance in a doxorubicin-resistant breast cancer line (the human MCF-7/ADR). The cytotoxicity of doxorubicin, megestrol acetate, and/or tamoxifen was determined in the sensitive and resistant cell lines utilizing the sulphorhodamine B assay. Tamoxifen alone produced an IC50 (concentration resulting in 50% inhibition of control growth) of 10.6 microM, whereas megestrol acetate alone resulted in an IC50 of 48.7 microM in the MCF-7/ADR cell line. The IC50 of doxorubicin in MCF-7/ADR was 1.9 microM. Neither megestrol acetate alone nor tamoxifen alone at 1 or 5 microM altered the IC50 of doxorubicin. However, the combination of tamoxifen (1 or 5 microM) and megestrol acetate (1 or 5 microM) synergistically sensitized MCF-7/ADR cells. Additionally, megestrol acetate and tamoxifen inhibited iodoarylazidoprazosin binding to P-glycoprotein, and, in their presence, there was an increased doxorubicin accumulation in the MCF-7/ADR cells. Furthermore, the combination of tamoxifen and megestrol acetate had much less effect on the cytotoxicity of doxorubicin in MCF-7 wild-type cells. Clinically achievable concentrations of tamoxifen and megestrol acetate can largely sensitize MCF-7/ADR to doxorubicin. The combination of these three drugs in a clinical trial may be informative.
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Affiliation(s)
- L Panasci
- Lady Davis Institute, Montreal, Quebec, Canada
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