1
|
Nero C, Duranti S, Giacomini F, Minucci A, Giacò L, Piermattei A, Genuardi M, Pasciuto T, Urbani A, Daniele G, Lorusso D, Pignataro R, Tortora G, Normanno N, Scambia G. Integrating a Comprehensive Cancer Genome Profiling into Clinical Practice: A Blueprint in an Italian Referral Center. J Pers Med 2022; 12:jpm12101746. [PMID: 36294885 PMCID: PMC9605534 DOI: 10.3390/jpm12101746] [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: 09/23/2022] [Revised: 10/13/2022] [Accepted: 10/19/2022] [Indexed: 11/23/2022] Open
Abstract
The implementation of cancer molecular characterization in clinical practice has improved prognostic re-definition, extending the eligibility to a continuously increasing number of targeted treatments. Broad molecular profiling technologies better than organ-based approaches are believed to serve such dynamic purposes. We here present the workflow our institution adopted to run a comprehensive cancer genome profiling in clinical practice. This article describes the workflow designed to make a comprehensive cancer genome profiling program feasible and sustainable in a large-volume referral hospital.
Collapse
Affiliation(s)
- Camilla Nero
- Dipartimento per le Scienze Della Salute Della Donna, del Bambino e di Sanità Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
- Faculty of Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Simona Duranti
- Direzione Scientifica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
- Correspondence:
| | - Flavia Giacomini
- Direzione Scientifica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
| | - Angelo Minucci
- Genomics Core Facility, Gemelli Science and Technology Park (G-STeP), Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
| | - Luciano Giacò
- Bioinformatics Core Facility, Gemelli Science and Technology Park (G-STeP), Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
| | - Alessia Piermattei
- Dipartimento per le Scienze Della Salute Della Donna, del Bambino e di Sanità Pubblica, UOC Anatomia Patologica Generale, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
| | - Maurizio Genuardi
- Faculty of Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
- Dipartimento per le Scienze di Laboratorio e Infettivologiche, UOC Genetica Medica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
| | - Tina Pasciuto
- Data Collection Core Facility, Gemelli Science and Technology Park (G-STeP), Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
| | - Andrea Urbani
- Faculty of Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
- Dipartimento per le Scienze di Laboratorio e Infettivologiche, UOC Chimica, Biochimica e Biologia Molecolare Clinica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
| | - Gennaro Daniele
- UOC Fase 1, Direzione Scientifica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
| | - Domenica Lorusso
- Dipartimento per le Scienze Della Salute Della Donna, del Bambino e di Sanità Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
- Faculty of Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Raffaele Pignataro
- Direzione Sanitaria, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
| | - Giampaolo Tortora
- Faculty of Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
- Dipartimento di Scienze Mediche e Chirurgiche, UOC Oncologica Medica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
| | - Nicola Normanno
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori “Fondazione Giovanni Pascale”, IRCCS, 80131 Napoli, Italy
| | - Giovanni Scambia
- Dipartimento per le Scienze Della Salute Della Donna, del Bambino e di Sanità Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
- Faculty of Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| |
Collapse
|
2
|
Fuso P, Muratore M, D’Angelo T, Paris I, Carbognin L, Tiberi G, Pavese F, Duranti S, Orlandi A, Tortora G, Scambia G, Fabi A. PI3K Inhibitors in Advanced Breast Cancer: The Past, The Present, New Challenges and Future Perspectives. Cancers (Basel) 2022; 14:2161. [PMID: 35565291 PMCID: PMC9103982 DOI: 10.3390/cancers14092161] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [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: 03/22/2022] [Revised: 04/19/2022] [Accepted: 04/21/2022] [Indexed: 12/24/2022] Open
Abstract
Breast cancer is the leading cause of death in the female population and despite significant efforts made in diagnostic approaches and treatment strategies adopted for advanced breast cancer, the disease still remains incurable. Therefore, development of more effective systemic treatments constitutes a crucial need. Recently, several clinical trials were performed to find innovative predictive biomarkers and to improve the outcome of metastatic breast cancer through innovative therapeutic algorithms. In the pathogenesis of breast cancer, the phosphatidylinositol 3-kinase (PI3K)-protein kinase B (PKB/AKT)-mammalian target of rapamycin (mTOR) axis is a key regulator of cell proliferation, growth, survival, metabolism, and motility, making it an interest and therapeutic target. Nevertheless, the PI3K/AKT/mTOR cascade includes a complex network of biological events, needing more sophisticated approaches for their use in cancer treatment. In this review, we described the rationale for targeting the PI3K pathway, the development of PI3K inhibitors and the future treatment directions of different breast cancer subtypes in the metastatic setting.
Collapse
Affiliation(s)
- Paola Fuso
- Department of Woman and Child Health and Public Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (M.M.); (I.P.); (L.C.); (G.T.); (F.P.); (G.S.)
| | - Margherita Muratore
- Department of Woman and Child Health and Public Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (M.M.); (I.P.); (L.C.); (G.T.); (F.P.); (G.S.)
| | - Tatiana D’Angelo
- Comprehensive Cancer Center, Unit of Medical Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (T.D.); (A.O.); (G.T.)
| | - Ida Paris
- Department of Woman and Child Health and Public Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (M.M.); (I.P.); (L.C.); (G.T.); (F.P.); (G.S.)
| | - Luisa Carbognin
- Department of Woman and Child Health and Public Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (M.M.); (I.P.); (L.C.); (G.T.); (F.P.); (G.S.)
| | - Giordana Tiberi
- Department of Woman and Child Health and Public Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (M.M.); (I.P.); (L.C.); (G.T.); (F.P.); (G.S.)
| | - Francesco Pavese
- Department of Woman and Child Health and Public Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (M.M.); (I.P.); (L.C.); (G.T.); (F.P.); (G.S.)
| | - Simona Duranti
- Scientific Directorate, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
| | - Armando Orlandi
- Comprehensive Cancer Center, Unit of Medical Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (T.D.); (A.O.); (G.T.)
| | - Giampaolo Tortora
- Comprehensive Cancer Center, Unit of Medical Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (T.D.); (A.O.); (G.T.)
- Medical Oncology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Giovanni Scambia
- Department of Woman and Child Health and Public Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (M.M.); (I.P.); (L.C.); (G.T.); (F.P.); (G.S.)
- Scientific Directorate, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
- Istituto di Ginecologia e Ostetricia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Alessandra Fabi
- Precision Medicine in Breast Cancer Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
| |
Collapse
|
3
|
Duranti S, Fabi A, Filetti M, Falcone R, Lombardi P, Daniele G, Franceschini G, Carbognin L, Palazzo A, Garganese G, Paris I, Scambia G, Pietragalla A. Breast Cancer Drug Approvals Issued by EMA: A Review of Clinical Trials. Cancers (Basel) 2021; 13:cancers13205198. [PMID: 34680350 PMCID: PMC8533780 DOI: 10.3390/cancers13205198] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/07/2021] [Accepted: 10/10/2021] [Indexed: 11/19/2022] Open
Abstract
Simple Summary Considering the high incidence and mortality of breast cancer, a lot of trials evaluating new drugs for the treatment of this disease are currently ongoing. However, few drugs show a statistically and clinically significant improvement in the outcomes leading to the Competent Authority approval. In this review we analyzed the European Medicines Agency breast cancer drug indications issued between January 2015 and June 2021 and we evaluated the clinical trials results leading to the approval and their update. Abstract Breast cancer represents the first cause of cancer worldwide and the leading cause of cancer mortality for women. Therefore, new therapies are needed to improve the prognosis of women diagnosed with this disease. In this review, we summarize the new drug indications for the treatment of breast cancer approved by European Medicines Agency between January 2015 and June 2021. In particular, we analyzed the clinical trials results leading to approvals and their update (when available), according to setting (localized and locally advanced or metastatic) and clinical features (hormone receptor positive, HER2 positive, triple negative, BRCA 1/2 mutation). The aim of this paper is to describe the clinical benefit obtained with the new indications.
Collapse
Affiliation(s)
- Simona Duranti
- Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.F.); (G.D.); (G.S.); (A.P.)
- Correspondence: ; Tel.: +39-06-3015-8729
| | - Alessandra Fabi
- Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.F.); (G.D.); (G.S.); (A.P.)
- Unit of Precision Medicine in Breast Cancer, Scientific Directorate, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Marco Filetti
- Phase 1 Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.F.); (R.F.); (P.L.)
| | - Rosa Falcone
- Phase 1 Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.F.); (R.F.); (P.L.)
| | - Pasquale Lombardi
- Phase 1 Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.F.); (R.F.); (P.L.)
| | - Gennaro Daniele
- Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.F.); (G.D.); (G.S.); (A.P.)
- Phase 1 Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.F.); (R.F.); (P.L.)
| | - Gianluca Franceschini
- Multidisciplinary Breast Center, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Luisa Carbognin
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (L.C.); (I.P.)
| | - Antonella Palazzo
- Comprehensive Cancer Center, UOC di Oncologia Medica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Giorgia Garganese
- Gynecology and Breast Care Center, Mater Olbia Hospital, 07026 Olbia, Italy;
- Department of Life Science and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Ida Paris
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (L.C.); (I.P.)
| | - Giovanni Scambia
- Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.F.); (G.D.); (G.S.); (A.P.)
- Department of Life Science and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Antonella Pietragalla
- Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.F.); (G.D.); (G.S.); (A.P.)
| |
Collapse
|
4
|
Nero C, Ciccarone F, Pietragalla A, Duranti S, Daniele G, Scambia G, Lorusso D. Adjuvant Treatment Recommendations in Early-Stage Endometrial Cancer: What Changes With the Introduction of The Integrated Molecular-Based Risk Assessment. Front Oncol 2021; 11:612450. [PMID: 34540651 PMCID: PMC8442623 DOI: 10.3389/fonc.2021.612450] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 09/30/2020] [Accepted: 07/29/2021] [Indexed: 11/13/2022] Open
Abstract
Adjuvant therapy recommendations for endometrial cancer were historically based on the individual patient's risk of disease recurrence using clinicopathologic factors such as age, stage, histologic subtype, tumor grade, and lymphovascular space invasion. Despite the excellent prognosis for early stages, considerable under- and overtreatment remains. Integrated genomic characterization by the Cancer Genome Atlas (TCGA) in 2013 defined four distinct endometrial cancer subgroups (POLE mutated, microsatellite instability, low copy number, and high copy number) with possible prognostic value. The validation of surrogate markers (p53, Mismatch repair deficiency, and POLE) to determine these subgroups and the addition of other molecular prognosticators (CTNNB1, L1CAM) resulted in a practical and clinically useful molecular classification tool. The incorporation of such molecular alterations into established clinicopathologic risk factors resulted in a refined, improved risk assessment. Thus, the ESGO/ESTRO/ESP consensus in 2020 defined for the first time different prognostic risk groups integrating molecular markers. Finally, the feasibility and clinical utility of molecular profiling for tailoring adjuvant therapy in the high-intermediate-risk group is currently under investigation (NCT03469674).
Collapse
Affiliation(s)
- Camilla Nero
- Direzione Scientifica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Dipartimento di Scienze della vita e sanità pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesca Ciccarone
- Direzione Scientifica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonella Pietragalla
- Direzione Scientifica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Simona Duranti
- Direzione Scientifica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gennaro Daniele
- Direzione Scientifica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giovanni Scambia
- Direzione Scientifica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Dipartimento di Scienze della vita e sanità pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Domenica Lorusso
- Direzione Scientifica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Dipartimento di Scienze della vita e sanità pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
5
|
Duranti S, Pietragalla A, Daniele G, Nero C, Ciccarone F, Scambia G, Lorusso D. Role of Immune Checkpoint Inhibitors in Cervical Cancer: From Preclinical to Clinical Data. Cancers (Basel) 2021; 13:cancers13092089. [PMID: 33925884 PMCID: PMC8123488 DOI: 10.3390/cancers13092089] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/20/2021] [Accepted: 04/24/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary Cervical cancer represents one of the main leading causes of cancer-related mortality in women worldwide. In contrast to patients with early-stage disease, those with advanced, recurrent, or metastatic cervical cancer have a poor prognosis and new treatment strategies are needed. Immunotherapy has recently modified the natural course of different tumors, such as melanoma and lung cancer. The aim of this review is to evaluate the possible role of immune checkpoint inhibitors in cervical cancer treatment. Abstract Human papillomavirus (HPV) infection is the recognized cause of almost all cervical cancers. Despite the reduction in incidence due to a wide use of screening programs and a specific vaccine, the prognosis of cervical cancer remains poor, especially for late-stage and relapsed disease. Considering the elevated rates of PD-L1 expression in up to 80% of cervical cancers, a strong rationale supports the use of immunotherapy to restore the immune response against tumor. The aim of this review is to analyze the possible role of immune checkpoint inhibitors in cervical cancer treatment, with a particular focus on the rationale and on the results of phase I and II clinical trials. An overview of ongoing phase III studies with possible future areas of development is also provided.
Collapse
Affiliation(s)
- Simona Duranti
- Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (S.D.); (A.P.); (G.D.); (C.N.); (G.S.)
| | - Antonella Pietragalla
- Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (S.D.); (A.P.); (G.D.); (C.N.); (G.S.)
| | - Gennaro Daniele
- Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (S.D.); (A.P.); (G.D.); (C.N.); (G.S.)
| | - Camilla Nero
- Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (S.D.); (A.P.); (G.D.); (C.N.); (G.S.)
- Department Woman and Child Health and Public Health, Division of Gynaecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Francesca Ciccarone
- Department Woman and Child Health and Public Health, Division of Gynaecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Giovanni Scambia
- Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (S.D.); (A.P.); (G.D.); (C.N.); (G.S.)
- Department of Life Science and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Domenica Lorusso
- Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (S.D.); (A.P.); (G.D.); (C.N.); (G.S.)
- Department of Life Science and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Correspondence: ; Tel.: +39-06-30157336
| |
Collapse
|
6
|
Pietragalla A, Duranti S, Daniele G, Nero C, Ciccarone F, Lorusso D, Fagotti A, Scambia G. Oregovomab: an investigational agent for the treatment of advanced ovarian cancer. Expert Opin Investig Drugs 2021; 30:103-110. [PMID: 33423551 DOI: 10.1080/13543784.2021.1868436] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 01/19/2023]
Abstract
Introduction: Ovarian cancer (OC) represents the leading cause of death among gynecological cancers. Despite novel compound classes like vascular endothelial growth factor (VEGF) inhibitors or poly-ADP ribose polymerase (PARP) inhibitors are available, which improve significantly efficacy of platinum-based chemotherapy, OC prognosis remains poor and innovative strategies are needed. The induction of tumor specific immune response with a therapeutic intent is a very challenging approach. Oregovomab is a murine monoclonal antibody direct to the tumor-associated antigen CA125 that stimulate a host cytotoxic immune response against tumor cells expressing CA125. Areas covered: This paper reviews the preclinical and clinical published data underlying the use of oregovomab in advanced OC. A literature search was performed in PubMed for oregovomab, ovarian cancer, anti-CA125, and on ClinicalTrials.gov for currently ongoing trials. Expert opinion: Oregovomab demonstrated a significant improvement in progression-free and overall survival in advanced OC treatment when administered simultaneously with first-line chemotherapy. This promising schedule is currently investigated in a phase III trial. Since oral treatments as PARP-inhibitors have recently been approved in the OC first-line setting, the possible role of oregovomab needs still to be defined, also considering the intravenous route of administration. The easy to manage toxicity profile makes oregovomab an ideal candidate for association strategies.
Collapse
Affiliation(s)
- Antonella Pietragalla
- Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome, Italy
| | - Simona Duranti
- Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome, Italy
| | - Gennaro Daniele
- Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome, Italy
| | - Camilla Nero
- Division of Gynaecologic Oncology, Department Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome, Italy
| | - Francesca Ciccarone
- Division of Gynaecologic Oncology, Department Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome, Italy
| | - Domenica Lorusso
- Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome, Italy.,Department of Life Science and Public Health, Università Cattolica Del Sacro Cuore , Rome, Italy
| | - Anna Fagotti
- Division of Gynaecologic Oncology, Department Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome, Italy.,Department of Life Science and Public Health, Università Cattolica Del Sacro Cuore , Rome, Italy
| | - Giovanni Scambia
- Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome, Italy.,Department of Life Science and Public Health, Università Cattolica Del Sacro Cuore , Rome, Italy
| |
Collapse
|
7
|
Gori S, Turazza M, Modena A, Duranti S, Zamboni G, Alongi F, Carbognin G, Massocco A, Salgarello M, Inno A. When and how to treat women with HER2-positive, small (pT1a-b), node-negative breast cancer? Crit Rev Oncol Hematol 2018; 128:130-138. [DOI: 10.1016/j.critrevonc.2018.03.010] [Citation(s) in RCA: 3] [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] [Received: 11/20/2017] [Revised: 01/30/2018] [Accepted: 03/21/2018] [Indexed: 01/06/2023] Open
|
8
|
Sabbatini R, Galli L, Pignata S, Lo Re G, Valcamonico F, Defferrari C, Spada M, Santini D, Masini C, Ciuffreda L, Ruggeri E, Chioni A, Livi L, Fagnani D, Bonetti A, Giustini L, Duranti S, Procopio G, Caserta C, Cartenì G. Efficacy and safety data in elderly patients (pts) with metastatic renal cell carcinoma (mRCC) included in the nivolumab expanded access program (EAP) in Italy. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx371.051] [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
|
9
|
Foglietta J, Inno A, de Iuliis F, Sini V, Duranti S, Turazza M, Tarantini L, Gori S. Cardiotoxicity of Aromatase Inhibitors in Breast Cancer Patients. Clin Breast Cancer 2017; 17:11-17. [DOI: 10.1016/j.clbc.2016.07.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 07/10/2016] [Accepted: 07/18/2016] [Indexed: 11/26/2022]
|
10
|
Milani C, Ferrario C, Turroni F, Duranti S, Mangifesta M, van Sinderen D, Ventura M. The human gut microbiota and its interactive connections to diet. J Hum Nutr Diet 2016; 29:539-46. [PMID: 27161433 DOI: 10.1111/jhn.12371] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [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: 12/22/2022]
Abstract
The microbiota of the gastrointestinal tract plays an important role in human health. In addition to their metabolic interactions with dietary constituents, gut bacteria may also be involved in more complex host interactions, such as modulation of the immune system. Furthermore, the composition of the gut microbiota may be important in reducing the risk of contracting particular gut infections. Changes in the microbiota during an individual's lifespan are accompanied by modifications in multiple health parameters, and such observations have prompted intense scientific efforts aiming to understand the complex interactions between the microbiota and its human host, as well as how this may be influenced by diet.
Collapse
Affiliation(s)
- C Milani
- Laboratory of Probiogenomics, Department of Life Sciences, University of Parma, Parma, Italy
| | - C Ferrario
- Laboratory of Probiogenomics, Department of Life Sciences, University of Parma, Parma, Italy
| | - F Turroni
- Laboratory of Probiogenomics, Department of Life Sciences, University of Parma, Parma, Italy
| | - S Duranti
- Laboratory of Probiogenomics, Department of Life Sciences, University of Parma, Parma, Italy
| | | | - D van Sinderen
- APC Microbiome Institute and School of Microbiology, National University of Ireland, Cork, Ireland
| | - M Ventura
- Laboratory of Probiogenomics, Department of Life Sciences, University of Parma, Parma, Italy.
| |
Collapse
|
11
|
Magarotto R, Micheloni B, Lunardi G, Duranti S, Inno A, Valerio M, Bustaggi M, Castagna S, Dalle Vedove A, Duma M, Mignolli L, Oliosi L, Platano M, Residori G, Righetti P, Ronconi A, Unguru C, Zivelonghi S, Gori S. Systematic pain evaluation in hospitalized cancer patients in a Medical Oncology Unit: feasibility and utility of pain monitoring by Numeric Rating Scale in cancer pain management. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw344.09] [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
|
12
|
Inno A, Bogina G, Turazza M, Bortesi L, Duranti S, Massocco A, Zamboni G, Carbognin G, Alongi F, Salgarello M, Gori S. Neuroendocrine Carcinoma of the Breast: Current Evidence and Future Perspectives. Oncologist 2015; 21:28-32. [PMID: 26659223 DOI: 10.1634/theoncologist.2015-0309] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [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: 08/04/2015] [Accepted: 10/27/2015] [Indexed: 01/30/2023] Open
Abstract
UNLABELLED : Neuroendocrine carcinoma of the breast is considered a rare entity, and for this reason there are no data from prospective clinical trials on its optimal management. Early stage tumors are usually treated with the same strategy used for the other types of invasive breast cancer. Anthracycline- and taxane-based regimens represent the most frequently administered chemotherapy in neoadjuvant and adjuvant setting, as well as for metastatic disease, although combinations of platinum compounds and etoposide have been widely used, in particular for small-cell histology and tumors with a high proliferation index. For metastatic disease, a multimodality therapeutic strategy can be considered on an individual basis, with chemotherapy, endocrine therapy, peptide receptor radionuclide therapy, radiation therapy, surgery, or a combination of the above. In the near future, a better knowledge of the biology of these tumors will hopefully provide new therapeutic targets for personalized treatment. In this review, we discuss the current evidence and the future perspectives on diagnosis and treatment of neuroendocrine carcinoma of the breast. IMPLICATIONS FOR PRACTICE Neuroendocrine carcinoma of the breast (NECB) is a distinct entity of breast cancer. Clinical features and morphology are not helpful to distinguish NECB from other subtypes of breast cancer; therefore, immunohistochemistry markers for neuroendocrine differentiation, mainly chromogranin and synaptophysin, should be routinely used to confirm the diagnosis, especially in cases of mucinous or solid papillary carcinoma in which the suspicion of NECB may be relevant. Adjuvant treatment should be offered according to the same recommendations given for the other types of invasive breast cancer. An accurate diagnosis of NECB is also important in the metastatic setting, in which a multimodality approach including specific therapies such as peptide receptor radionuclide therapy can be considered.
Collapse
Affiliation(s)
- Alessandro Inno
- Department of Medical Oncology, Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Giuseppe Bogina
- Department of Pathology, Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Monica Turazza
- Department of Medical Oncology, Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Laura Bortesi
- Department of Pathology, Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Simona Duranti
- Department of Medical Oncology, Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Alberto Massocco
- Department of Surgery, Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Giuseppe Zamboni
- Department of Pathology, Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Giovanni Carbognin
- Department of Radiology, Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Filippo Alongi
- Department of Radiotherapy, Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Matteo Salgarello
- Department of Nuclear Medicine, Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Stefania Gori
- Department of Medical Oncology, Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| |
Collapse
|
13
|
Bogina G, Munari E, Marconi M, Bortesi L, Turazza M, Cassandrini P, Cirillo M, Duranti S, Inno A, Magarotto R, Nicodemo M, Picece V, Lunardi G, Gori S. Neuroendocrine differentiation in breast carcinoma: clinicopathological features and outcome. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv348.17] [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
|
14
|
Lunardi G, Magarotto R, Inno A, Cassandrini P, Cirillo M, Duranti S, Nicodemo M, Picece V, Turazza M, Marchetti F, Micheloni B, Valerio M, Zenari L, Gori S. Association between patient reported outcomes and vibratory perception threshold test for measuring neurotoxicity in patients with chemotherapy induced peripheral neuropathy. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv348.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
15
|
Duranti S, Inno A, Rossi V, Turazza M, Fiorio E, Fabi A, Bisagni G, Foglietta J, Santini D, Pavese I, Zambelli A, Vici P, Leonardi V, Barni S, Saracchini S, Bogina G, Lunardi G, Marchetti F, Montemurro F, Gori S. Clinical and pathological factors predicting long-term disease control with lapatinib and capecitabine for patients with HER2 positive metastastic breast cancer: results from a multicenter retrospective study. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv336.32] [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: 11/13/2022] Open
|
16
|
Inno A, Lunardi G, Turazza M, Pasetto S, Severi F, Gorgoni G, Bogina G, Bortesi L, Russo A, Alongi F, Fiorentino A, Duranti S, Massocco A, Marchetti F, Valerio M, Salgarello M, Gori S. FDG-PET/CT as a predictor of pathological complete response (pCR) in breast cancer (BC) patients (pts) treated with neoadjuvant chemotherapy (NAC): a single center retrospective study. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv336.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
17
|
Gori S, Inno A, Fiorio E, Foglietta J, Ferro A, Gulisano M, Pinotti G, Gubiotti M, Cavazzini MG, Turazza M, Duranti S, De Simone V, Iezzi L, Bisagni G, Spazzapan S, Cavanna L, Saggia C, Bria E, Cretella E, Vici P, Santini D, Fabi A, Garrone O, Frassoldati A, Amaducci L, Saracchini S, Evangelisti L, Barni S, Gamucci T, Mentuccia L, Laudadio L, Zoboli A, Marchetti F, Bogina G, Lunardi G, Boni L. Correction: The Promher Study: An Observational Italian Study on Adjuvant Therapy for HER2-Positive, pT1a-b pN0 Breast Cancer. PLoS One 2015; 10:e0139650. [PMID: 26406908 PMCID: PMC4583491 DOI: 10.1371/journal.pone.0139650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
18
|
Gori S, Inno A, Fiorio E, Foglietta J, Ferro A, Gulisano M, Pinotti G, Gubiotti M, Cavazzini MG, Turazza M, Duranti S, De Simone V, Iezzi L, Bisagni G, Spazzapan S, Cavanna L, Saggia C, Bria E, Cretella E, Vici P, Santini D, Fabi A, Garrone O, Frassoldati A, Amaducci L, Saracchini S, Evangelisti L, Barni S, Gamucci T, Mentuccia L, Laudadio L, Zoboli A, Marchetti F, Bogina G, Lunardi G, Boni L. The Promher Study: An Observational Italian Study on Adjuvant Therapy for HER2-Positive, pT1a-b pN0 Breast Cancer. PLoS One 2015; 10:e0136731. [PMID: 26340098 PMCID: PMC4560419 DOI: 10.1371/journal.pone.0136731] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Accepted: 08/08/2015] [Indexed: 01/03/2023] Open
Abstract
Background The management of pT1a-b pN0 HER2-positive breast cancer is controversial and no data about the efficacy of trastuzumab in this setting are available from randomized clinical trials. The aims of this retrospective study were to assess how patients are managed in clinical practice in Italy, which clinical or biological characteristics influenced the choice of adjuvant systemic therapy and the outcome of patients. Methods Data of consecutive patients who underwent surgery from January 2007 to December 2012 for HER2-positive, pT1a-b pN0 M0 breast cancer were retrospectively collected from 28 Italian centres. Analysis of contingency tables and multivariate generalized logit models were used to investigate the association between the baseline clinical and biological features and the treatment strategy adopted. Results Among 303 enrolled patients, 204 received adjuvant systemic therapy with trastuzumab, 65 adjuvant systemic therapy without trastuzumab and 34 did not receive adjuvant systemic therapy. At the multivariate analysis age, tumor size, proliferation index and hormone receptor status were significantly associated with the treatment choice. Five-year disease-free survival (DFS) probability was 95%, 94.3% and 69.6% for patients treated with adjuvant systemic therapy and trastuzumab, with adjuvant systemic therapy without trastuzumab and for patients who did not receive adjuvant systemic therapy, respectively (p<0.001). Conclusions The majority of patients (66%) with pT1a-b pN0 HER2-positive breast cancer enrolled in this retrospective study received adjuvant systemic therapy with trastuzumab, whereas only 11% patients did not receive any adjuvant systemic therapy. The choice of treatment type seems to be mainly influenced by tumor size, proliferation index, hormone receptor status and age. The 5-year DFS probability was significantly higher for patients receiving adjuvant systemic therapy with trastuzumab compared with patients not receiving adjuvant systemic therapy or receiving adjuvant systemic therapy without trastuzumab.
Collapse
MESH Headings
- Adjuvants, Pharmaceutic/therapeutic use
- Adult
- Age Factors
- Aged
- Antineoplastic Agents/therapeutic use
- Breast Neoplasms/diagnosis
- Breast Neoplasms/drug therapy
- Breast Neoplasms/mortality
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/surgery
- Chemotherapy, Adjuvant
- Disease Management
- Female
- Gene Expression
- Humans
- Middle Aged
- Multivariate Analysis
- Neoplasm Proteins/genetics
- Neoplasm Proteins/metabolism
- Prognosis
- Receptor, ErbB-2/genetics
- Receptor, ErbB-2/metabolism
- Retrospective Studies
- Survival Analysis
- Trastuzumab/therapeutic use
- Tumor Burden
Collapse
Affiliation(s)
- Stefania Gori
- Department of Oncology, Ospedale Sacro Cuore don Calabria, Negrar–Verona, Italy
- * E-mail:
| | - Alessandro Inno
- Department of Oncology, Ospedale Sacro Cuore don Calabria, Negrar–Verona, Italy
| | - Elena Fiorio
- Unit of Oncology, Ospedale Civile Maggiore, Verona, Italy
| | | | | | | | - Graziella Pinotti
- Department of Oncology, Ospedale di Circolo and University of Insubria, Varese, Italy
| | - Marta Gubiotti
- Medical Oncology, Ospedale Civile di Macerata, Macerata, Italy
| | | | - Monica Turazza
- Department of Oncology, Ospedale Sacro Cuore don Calabria, Negrar–Verona, Italy
| | - Simona Duranti
- Department of Oncology, Ospedale Sacro Cuore don Calabria, Negrar–Verona, Italy
| | | | - Laura Iezzi
- Medical Oncology, Ospedale SS Annunziata, Chieti, Italy
| | - Giancarlo Bisagni
- Medical Oncology, Breast Unit, Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | - Simon Spazzapan
- Medical Oncology, C.R.O.–I.R.C.C.S., Aviano–Pordenone, Italy
| | - Luigi Cavanna
- Department of Oncology and Hematology, Ospedale Guglielmo da Saliceto, Piacenza, Italy
| | - Chiara Saggia
- Medical Oncology, Ospedale Maggiore della Carità, Novara, Italy
| | - Emilio Bria
- Department of Medicine, Medical Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Patrizia Vici
- Division of Medical Oncology B, Regina Elena National Cancer Institute, Roma, Italy
| | - Daniele Santini
- Department of Medical Oncology, Campus Bio-Medico University, Roma, Italy
| | - Alessandra Fabi
- Division of Medical Oncology A, Regina Elena National Cancer Institute, Roma, Italy
| | - Ornella Garrone
- Division of Medical Oncology, Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy
| | | | - Laura Amaducci
- Medical Oncology, Ospedale per gli Infermi, Faenza–Ravenna, Italy
| | | | | | - Sandro Barni
- Medical Oncology, Azienda Ospedaliera Treviglio, Treviglio–Bergamo, Italy
| | | | | | - Lucio Laudadio
- Department of Oncology, Ospedale Floraspe Renzetti, Lanciano–Chieti, Italy
| | - Alessandra Zoboli
- Medical Oncology, Ospedale San Sebastiano, Correggio–Reggio Emilia, Italy
| | - Fabiana Marchetti
- Department of Oncology, Ospedale Sacro Cuore don Calabria, Negrar–Verona, Italy
| | - Giuseppe Bogina
- Pathology, Ospedale Sacro Cuore don Calabria, Negrar–Verona, Italy
| | - Gianluigi Lunardi
- Department of Oncology, Ospedale Sacro Cuore don Calabria, Negrar–Verona, Italy
| | - Luca Boni
- Azienda Ospedaliero–Universitaria Careggi, Firenze, Italy
| |
Collapse
|
19
|
Gori S, Turazza M, Duranti S, Fiorio E, Foglietta J, Gulisano M, Marcon I, Gubbiotti M, Cavazzini MG, Spazzapan S, De Simone V, Bisagni G, Saggia C, Cavanna L, Bria E, Iezzi L, Cretella E, Vici P, Santini D, Fabi A, Garrone O, Ferro A, Saracchini S, Evangelisti L, Barni S, Mentuccia L, Laudadio L, Inno A, Lunardi G, Coati F, Boni L. Abstract P5-18-05: The Promher Study: An observational Italian study on HER2+ve, pT1a-b, pN0, M0 breast cancer (BC) patients (pts). Cancer Res 2015. [DOI: 10.1158/1538-7445.sabcs14-p5-18-05] [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 management of small (≤ 1 cm), node-negative, HER2+ve BC is controversial, since data from randomized clinical trials specifically addressing the benefit of adjuvant systemic treatment with or without Trastuzumab in this setting are still lacking. The aims of this retrospective study are to assess how pts are managed in routinary clinical practice in Italy, whether clinical or biological features may influence the choice of adjuvant systemic therapy and if there is any difference in the outcome between treated and not treated pts.
Patients and methods. Data of 268 consecutive pts who underwent surgery from January 2007 to December 2012 for HER2+ve, pT1a-b pN0 BC, were collected from 25 Italian centres. Descriptive statistical analyses and multivariate logistic regression models were used, with the aim of investigating the relationship between the baseline clinical and biological features and the adjuvant treatment strategy.
Results. Pts characteristics were: median age 57, 69% postmenopausal status, 77% had conservative surgery, 32% pT1a, 68% pT1b, 48% G3, 66% ER+ve, 75% Ki67 ≥14%. Ninety percent of pts received adjuvant systemic therapy: 19% hormone therapy (HT) alone, 3% chemotherapy (CT) +/- HT, 64% Trastuzumab + CT +/- HT and 4% Trastuzumab + HT. At the multivariate analysis, the odds of being treated with adjuvant systemic therapy with or without Trastuzumab, resulted higher in presence of conservative surgery (p=0.002), pT1b (p<0.001) and positivity of hormone receptors status (p<0.001). Among the patients treated with adjuvant systemic therapy, the administration of Trastuzumab appeared to be more frequently associated with pT1b (p=0.010) and negative hormone receptors (p=0.004). After 37 months of median follow-up, local and/or distant recurrence were 4/29 (14%) for pts who did not receive any systemic treatment, 2/59 (4%) for pts receiving systemic treatment without Trastuzumab and 2/180 (1%) for pts receiving Trastuzumab.
Conclusion. This preliminary analysis shows that in Italy the majority of these pts received systemic adjuvant treatment and about 2/3 were treated with Trastuzumab. Pathological tumor size (pT1b) and negative hormone receptor status represent the main factors influencing the choice of including Trastuzumab in the adjuvant treatment. Survival data are still not mature to drive definitive conclusions about outcome.
Citation Format: Stefania Gori, Monica Turazza, Simona Duranti, Elena Fiorio, Jennifer Foglietta, Marcella Gulisano, Ilaria Marcon, Marta Gubbiotti, Maria Giovanna Cavazzini, Simon Spazzapan, Valeria De Simone, Giancarlo Bisagni, Chiara Saggia, Luigi Cavanna, Emilio Bria, Laura Iezzi, Elisabetta Cretella, Patrizia Vici, Daniele Santini, Alessandra Fabi, Ornella Garrone, Antonella Ferro, Silvana Saracchini, Lucia Evangelisti, Sandro Barni, Lucia Mentuccia, Lucio Laudadio, Alessandro Inno, Gianluigi Lunardi, Francesca Coati, Luca Boni. The Promher Study: An observational Italian study on HER2+ve, pT1a-b, pN0, M0 breast cancer (BC) patients (pts) [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P5-18-05.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Emilio Bria
- 13AO Universitaria Integrata – Policlinico GB Rossi
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Luca Boni
- 25Istituto Toscano Tumori AOU Careggi
| |
Collapse
|
20
|
Gori S, Rossi V, Turazza M, Fiorio E, Fabi A, Bisagni G, Foglietta J, Santini D, Pavese I, Zambelli A, Vici P, Leonardi V, Barni S, Saracchini S, Bogina G, Duranti S, Inno A, Lunardi G, Montemurro F. Abstract P5-19-25: Multi-institutional retrospective analysis of clinical and pathological factors predicting resistance to lapatinib-based therapy in HER2 positive metastatic breast cancer (HER2+ MBC). Cancer Res 2015. [DOI: 10.1158/1538-7445.sabcs14-p5-19-25] [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 combination of the dual HER1/HER2 inhibitor lapatinib (L) and capecitabine (C) is a therapeutic option for patients (pts) with HER2+MBC whose disease progresses after treatment with the monoclonal antibody trastuzumab. At present time, no clinical or pathological factors except HER2 status are clearly recognized as predictors of the activity of LC. We conducted a retrospective analysis of pts with HER2-positive metastatic breast cancer receiving LC after trastuzumab failure to identify factors associated with resistance to LC.
Materials and methods
We collected clinical and pathological data from 151 pts with HER2+ MBC receiving LC after failing a prior trastuzumab-based treatment (either adjuvant or for metastatic disease) treated at 13 Italian Institutions between March 2007 and December 2013. Time to progression (TTP) and overall survival (OS), calculated by the Kaplan Meier (KM) method, were from LC treatment beginning to disease progression or to death in the absence of progression (TTP), and to the date of death or to the date of last follow-up (OS), respectively. LC resistance was defined as TTP from treatment initiation lower or equal to the median TTP for the overall population. KM curves were compared by the Log-rank test. Logistic regression analysis was used to study predictors of TTP below the median value for patients receiving LC. Analyses were performed using SPSS version 17.0 (SPSS Inc., Chicago, IL).
Results
At a median follow-up of 41 months (IQR 23-62), median TTP to LC therapy was 7 months (IQR 5.5-8.5) and median OS was 18 months (IQR 10-28). Fifteen pts were excluded because of short follow-up (i.e. on LC treatment and <7 months of fu). Of the remaining 136, a total of 74 pts with a PFS≤7 months were defined LC-resistant (LC-R) and a total of 62 pts were defined LC-sensitive (LC-S). All clinical and pathological variables analyzed resulted evenly distributed between the two groups, except best tumor response (CR+PR) to LC, which was higher in patients with LC-S disease (72% vs 29%, p<0.001). Conversely, best tumor response in LC-R patients showed higher rates of PD (43% vs 2%, p<0.001). Median OS was 14 months (IC 95% 11.4-22.6) and 26 months (IC 95% 22.5-29.5) in LC-R and LC-S pts, respectively (p<0.001). Although we could not find independent predictors of LC-R, factors indicating failure of the first-line trastuzumab based therapy, as PD as best tumor response and short duration of first-line trastuzumab, were associated to LC-R.
Conclusions
A short time to progression during capecitabine and lapatinib (LC-R) is associated with reduced OS in patients failing prior trastuzumab based therapy for HER2+ MBC. Patients who had modest clinical benefit from previous trastuzumab-based therapy could experience LC-R indicating the possibility of primary resistance to anti HER2-treatment. For these patients, alternative targeting strategies are urgently needed.
Citation Format: Stefania Gori, Valentina Rossi, Monica Turazza, Elena Fiorio, Alessandra Fabi, Giancarlo Bisagni, Jennifer Foglietta, Daniele Santini, Ida Pavese, Alberto Zambelli, Patrizia Vici, Vita Leonardi, Sandro Barni, Silvana Saracchini, Giuseppe Bogina, Simona Duranti, Alessandro Inno, Gianluigi Lunardi, Filippo Montemurro. Multi-institutional retrospective analysis of clinical and pathological factors predicting resistance to lapatinib-based therapy in HER2 positive metastatic breast cancer (HER2+ MBC) [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P5-19-25.
Collapse
Affiliation(s)
- Stefania Gori
- 1Medical Oncology – Sacro Cuore Don Calabria Hospital
| | - Valentina Rossi
- 2Medical Oncology – Institute for Cancer Research and Treatment IRCCS
| | | | | | - Alessandra Fabi
- 4Medical Oncology A – Istituto Nazionale Tumori Regina Elena
| | | | | | | | - Ida Pavese
- 8Medical Oncology – S. Pietro Fatebenefratelli Hospital
| | | | - Patrizia Vici
- 13Medical Oncology B – Istituto Nazionale Tumori Regina Elena
| | | | - Sandro Barni
- 11Medical Oncology – Azienda Ospedaliera di Treviglio
| | | | | | | | | | | | | |
Collapse
|
21
|
Gori S, Lunardi G, Inno A, Magarotto R, Duranti S, Messa MG, Mucchino C, Cirillo M. Pharmacokinetics of oxaliplatin in a hemodialyzed patient: chemotherapy dose adjustment and timing of dialysis. Clin Colorectal Cancer 2014; 13:260-3. [PMID: 25314931 DOI: 10.1016/j.clcc.2014.09.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 09/10/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Stefania Gori
- Medical Oncology Department, Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy
| | - Gianluigi Lunardi
- Medical Oncology Department, Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy
| | - Alessandro Inno
- Medical Oncology Department, Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy.
| | - Roberto Magarotto
- Medical Oncology Department, Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy
| | - Simona Duranti
- Medical Oncology Department, Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy
| | | | - Claudio Mucchino
- Chemistry Department, Università degli Studi di Parma, Parma, Italy
| | - Massimo Cirillo
- Medical Oncology Department, Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy
| |
Collapse
|
22
|
Chiari R, Duranti S, Ludovini V, Bellezza G, Pireddu A, Minotti V, Bennati C, Crinò L. Long-term response to gefitinib and crizotinib in lung adenocarcinoma harboring both epidermal growth factor receptor mutation and EML4-ALK fusion gene. J Clin Oncol 2014; 32:e30-2. [PMID: 24419120 DOI: 10.1200/jco.2012.47.7141] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [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)
- Rita Chiari
- Santa Maria della Misericordia Hospital, Perugia, Italy
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Metro G, Chiari R, Duranti S, Siggillino A, Fischer MJ, Giannarelli D, Ludovini V, Bennati C, Marcomigni L, Baldi A, Giansanti M, Minotti V, Crinò L. Impact of specific mutant KRAS on clinical outcome of EGFR-TKI-treated advanced non-small cell lung cancer patients with an EGFR wild type genotype. Lung Cancer 2012; 78:81-6. [PMID: 22770374 DOI: 10.1016/j.lungcan.2012.06.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 05/28/2012] [Accepted: 06/09/2012] [Indexed: 12/20/2022]
Abstract
INTRODUCTION This retrospective study was undertaken to investigate the impact of specific mutant KRAS on clinical outcome to either gefitinib or erlotinib (EGFR tyrosine kinase inhibitor, EGFR-TKI) in patients with EGFR wild type (WT) advanced non-small cell lung cancer (NSCLC). METHODS Patients with an EGFR WT genotype who were treated with an EGFR-TKI for advanced disease at our Institution were identified. Simultaneous availability of KRAS mutation status was required for study inclusion. RESULTS Sixty-seven patients were eligible. Median age was 60 years (39-84), and 10 patients (14.9%) had received an EGFR-TKI as upfront therapy. Overall, the median progression-free survival (PFS) and overall survival (OS) were 2.9 months and 18.0 months, respectively. KRAS mutant patients (n=18) experienced a significantly shorter PFS compared with those carrying a KRAS WT genotype (n=49) (1.6 months vs 3.0 months, respectively, P=0.04; HR=1.92). However, within the KRAS mutant group a great variability in terms of sensitivity to treatment was noted (PFS ranging from 0.7 months to 38.7 months). KRAS codon 13 mutant patients (n=4) experienced the worse outcome when compared with KRAS codon 12 mutants (n=14) and KRAS WT patients (P<0.0001 and P=0.01 for PFS and OS, respectively). CONCLUSIONS Though we found that EGFR WT/KRAS mutant advanced NSCLC patients are associated with an increased resistance to treatment, specific mutant KRAS may account for differential sensitivity to an EGFR-TKI. KRAS codon 13 mutants are those who seem to experience the worse clinical outcome.
Collapse
Affiliation(s)
- Giulio Metro
- Medical Oncology, Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia, Perugia, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Metro G, Duranti S, Chiari R, Bennati C, Molica C, Currà MF, Scafati C, Siggillino A, Flacco A, Marcomigni L, Ludovini V, Minotti V, Crinò L. KRAS mutational status and sensitivity to a reversible epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) in EGFR wild type (WT) advanced non-small cell lung cancer (NSCLC) patients (pts). J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.e18023] [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
e18023 Background: Treatment with a reversible EGFR-TKI may benefit pts with EGFR WT advanced NSCLC, though to a much lesser extent than pts carrying an activating mutation in the EGFR gene. We assessed whether KRAS mutational status would help predict sensitivity to gefitinib or erlotinib in EGFR WT advanced NSCLC pts. Methods: Sixty-seven EGFR WT, advanced NSCLC pts treated with a reversible EGFR-TKI in any line setting were included. Pts were treated from May 2005 to March 2011 at the Medical Oncology of the Perugia Hospital. EGFR (exons 18 to 21) and KRAS (codons 12, 13 and 61) genes were amplified by nested PCR and sequenced in both sense and antisense directions. Results: Median age was 60 years (39-84); 52 pts (77.6%) were PS 0 or 1; 58 pts (86.6%) belonged to the non-squamous subtype and 22 pts (32.8%) were never-smokers. Eighteen pts (26.8%) were KRAS mutant (MUT), of which 14 pts at codon 12 (COD 12 MUT) and 4 pts at codon 13 (COD 13 MUT). Overall, 11 pts (16.4%) responded to treatment and 8 pts (11.9%) achieved stable disease, for a disease control rate of 28.3%. At a median follow-up of 25.2 months, median progression-free survival (PFS) and overall survival (OS) were 2.9 and 29.5 months, respectively. When analyzed according to KRAS status, a significantly shorter PFS was noted for the EGFR WT/KRAS MUT subgroup (N=18) compared with the EGFR WT/KRAS WT population (N=49) (1.6 vs. 3.0 months, respectively, p=0.04). However, no significant difference was observed between the two groups in terms of OS (18.0 vs. 34.8 months, respectively, p=0.42). Within the EGFR WT/KRAS MUT subrgoup a significantly longer PFS was reported for COD 12 MUT pts compared with COD 13 MUT pts (1.7 vs 0.7 months, respectively, p=0.04). Similarly, KRAS COD 12 MUT pts experienced a statistically significant superior OS compared with COD 13 MUT pts (36.2 vs 7.4 months, respectively, p=0.003). Conclusions: EGFR WT/KRAS MUT pts appear to be more resistant to treatment with a reversible EGFR-TKI, the greatest resistance occurring in COD 13 MUT pts. KRAS COD 12 MUT pts may represent a clinically distinct subgroup of KRAS mutants with a particularly favorable prognosis.
Collapse
Affiliation(s)
- Giulio Metro
- Department of Medical Oncology, Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia, Perugia, Italy
| | - Simona Duranti
- Department of Medical Oncology, Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia, Perugia, Italy
| | - Rita Chiari
- Department of Medical Oncology, Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia, Perugia, Italy
| | - Chiara Bennati
- Department of Medical Oncology, Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia, Perugia, Italy
| | - Carmen Molica
- Department of Medical Oncology, Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia, Perugia, Italy
| | - Maria Francesca Currà
- Department of Medical Oncology, Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia, Perugia, Italy
| | - Chiara Scafati
- Department of Medical Oncology, Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia, Perugia, Italy
| | - Annamaria Siggillino
- Department of Medical Oncology, Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia, Perugia, Italy
| | - Antonella Flacco
- Department of Medical Oncology, Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia, Perugia, Italy
| | - Luca Marcomigni
- Department of Medical Oncology, Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia, Perugia, Italy
| | - Vienna Ludovini
- Department of Medical Oncology, Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia, Perugia, Italy
| | - Vincenzo Minotti
- Department of Medical Oncology, Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia, Perugia, Italy
| | - Lucio Crinò
- Department of Medical Oncology, Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia, Perugia, Italy
| |
Collapse
|
25
|
Bennati C, Currà MF, Chiari R, De Angelis V, Minotti V, Metro G, Duranti S, Molica C, Scafati C, Paglialunga L, Pistola L, Flacco A, Tofanetti FR, Siggillino A, Baldelli E, Ludovini V, Crinò L. Response to afatinib in patients with advanced NSCLC previously treated with reversible EGFR inhibitors in a mono-institutional experience. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.e18101] [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
e18101 Background: All mutated non-small cell lung cancer (NSCLC) patients (pts) previously treated with an EGFR reversibile inhibitor, develop, soon or later, resistance. Afatinib is a potent irreversible HER family inhibitor, with preclinical data suggesting activity against the resistance mutation EGFR T790M. From August 2005 to January 2011, in a retrospective observational study at our Division of Medical Oncology, we have evaluated 22 advanced NSCLC pts, who have been treated with Afatinib, after disease progression with Erlotinib or Gefitinib. Methods: 22 advanced NSCLC pts who have previously received a reversible EGFR-TKI (gefitinib or erlotinib), and subsequently have been treated with Afatinib in a different setting of their medical history, were included in the analysis. Afatinib was provided in an expanded access program by Boehringer. Results: Patients characteristics: median age 64 ys (34-85); PS 0-1; most of pts were never smokers (82%) with non-squamous histology. 12 pts (54%) had multi-metastatic sites at diagnosis, 4 of which (33%) had brain lesions. Nineteen pts (86%) were found to be EGFR mutated (15 patients with EGFR-sensitizing mutations at exon 19 and 21). No one was K-RAS mutated. Eighteen pts (82%) received Afatinib in a second line TKI setting and 4 pts (18%) in a third line. Overall, 4 pts (18%), 2 of which had a multi-metastatic disease at diagnosis, had a partial response to Afatinib and 11 pts (50%) achieved a stable disease. Of the 16 pts evaluable for response in the second line setting, median progression-free survival (PFS) was 5,2 months. Diarrhea and skin rash were the most common adverse events but a dose-limiting toxicity was observed in only three patients. Conclusions: Our experience confirmed Afatinib clinical activity in patients with acquired resistance to prior reversible TKI. The treatment has been well tolerated and there were no new or unexpected safety findings.
Collapse
Affiliation(s)
- Chiara Bennati
- Division of Medical Oncology, S. Maria della Misericordia Hospital, Perugia, Italy
| | | | - Rita Chiari
- Division of Medical Oncology, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Verena De Angelis
- Division of Medical Oncology, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Vincenzo Minotti
- Division of Medical Oncology, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Giulio Metro
- Division of Medical Oncology, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Simona Duranti
- Division of Medical Oncology, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Carmen Molica
- Division of Medical Oncology, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Chiara Scafati
- Division of Medical Oncology, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Luca Paglialunga
- Division of Medical Oncology, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Lorenza Pistola
- Division of Medical Oncology, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Antonella Flacco
- Division of Medical Oncology, S. Maria della Misericordia Hospital, Perugia, Italy
| | | | - Annamaria Siggillino
- Division of Medical Oncology, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Elisa Baldelli
- Division of Medical Oncology, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Vienna Ludovini
- Division of Medical Oncology, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Lucio Crinò
- Division of Medical Oncology, S. Maria della Misericordia Hospital, Perugia, Italy
| |
Collapse
|
26
|
Abstract
INTRODUCTION Small cell lung cancer (SCLC) is a biologically complex tumor whose medical treatment has remained largely unchanged over the last 30 years. The frustration for the invariably negative results reported in the early 2000s in clinical studies investigating new agents for this disease have contributed to the little interest shown by pharmaceutical industries in funding SCLC research. However, recent advances in the molecular understanding of the oncogenic mechanisms underlying SCLC have renewed the attraction for the clinical development of novel active drugs for the treatment of this challenging disease. AREAS COVERED The authors briefly touch on the most promising agents under clinical development for the treatment of SCLC, either chemotherapeutic or targeted drugs. Relevant and recent (2 years) studies obtained through Pubmed literature research or released at International scientific meetings are presented. EXPERT OPINION The data discussed herein provide evidence in support of the fact that only rationally designed clinical trials including relevant translational research may lead to successful results. Therefore, a thoughtful change in trial construction is crucial for the approval of new active drugs for this orphan disease.
Collapse
Affiliation(s)
- Giulio Metro
- Division of Medical Oncology, Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia, Via Dottori, 1, 06156 Perugia, Italy.
| | | | | | | | | |
Collapse
|
27
|
Chiari R, De Angelis V, Bennati C, Molica C, Metro G, Duranti S, Tofanetti FR, Ludovini V, Minotti V, Crino L. Clinical outcome of KRAS-mutated advanced non-small cell lung cancer (NSCLC) patients (pts): A mono-institutional analysis. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.7580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|