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Crucitta S, Cucchiara F, Marconcini R, Bulleri A, Manacorda S, Capuano A, Cioni D, Nuzzo A, de Jonge E, Mathjissen RHJ, Neri E, van Schaik RHN, Fogli S, Danesi R, Del Re M. TGF-β mRNA levels in circulating extracellular vesicles are associated with response to anti-PD1 treatment in metastatic melanoma. Front Mol Biosci 2024; 11:1288677. [PMID: 38633217 PMCID: PMC11021649 DOI: 10.3389/fmolb.2024.1288677] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 02/27/2024] [Indexed: 04/19/2024] Open
Abstract
Introduction: Immune checkpoint inhibitors (ICIs) represent the standard therapy for metastatic melanoma. However, a few patients do not respond to ICIs and reliable predictive biomarkers are needed. Methods: This pilot study investigates the association between mRNA levels of programmed cell death-1 (PD-1) ligand 1 (PD-L1), interferon-gamma (IFN-γ), and transforming growth factor-β (TGF-β) in circulating extracellular vesicles (EVs) and survival in 30 patients with metastatic melanoma treated with first line anti-PD-1 antibodies. Blood samples were collected at baseline and RNA extracted from EVs; the RNA levels of PD-L1, IFN-γ, and TGF-β were analysed by digital droplet PCR (ddPCR). A biomarker-radiomic correlation analysis was performed in a subset of patients. Results: Patients with high TGF-β expression (cut-off fractional abundance [FA] >0.19) at baseline had longer median progression-free survival (8.4 vs. 1.8 months; p = 0.006) and overall survival (17.9 vs. 2.63 months; p = 0.0009). Moreover, radiomic analysis demonstrated that patients with high TGF-β expression at baseline had smaller lesions (2.41 ± 3.27 mL vs. 42.79 ± 101.08 mL, p < 0.001) and higher dissimilarity (12.01 ± 28.23 vs. 5.65 ± 8.4; p = 0.018). Discussion: These results provide evidence that high TGF-β expression in EVs is associated with a better response to immunotherapy. Further investigation on a larger patient population is needed to validate the predictive power of this potential biomarker of response to ICIs.
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Affiliation(s)
- Stefania Crucitta
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Federico Cucchiara
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Riccardo Marconcini
- Unit of Medical Oncology 2, Department of Medicine and Oncology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Alessandra Bulleri
- Unit of Radiodiagnostics 1, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Simona Manacorda
- Unit of Medical Oncology 2, Department of Medicine and Oncology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Annalisa Capuano
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Section of Pharmacology, Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Napoli, Italy
| | - Dania Cioni
- Unit of Radiodiagnostics 1, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Amedeo Nuzzo
- Unit of Medical Oncology 2, Department of Medicine and Oncology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Evert de Jonge
- Department of Clinical Chemistry, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Ron H. J. Mathjissen
- Department of Medical Oncology, Erasmus University Medical Center Cancer Institute, Rotterdam, Netherlands
| | - Emanuele Neri
- Unit of Radiodiagnostics 1, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Ron H. N. van Schaik
- Department of Clinical Chemistry, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Stefano Fogli
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Romano Danesi
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Department of Oncology and Hemato-Oncology, University of Milano, Milano, Italy
| | - Marzia Del Re
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Manacorda S, Carmena MDT, Malone C, Linh Le HM, Furness AJS, Larkin J, Schmitt AM. Ipilimumab plus nivolumab in patients with symptomatic melanoma brain metastasis requiring corticosteroids. Eur J Cancer 2023; 188:98-107. [PMID: 37229837 DOI: 10.1016/j.ejca.2023.04.018] [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: 12/08/2022] [Revised: 04/17/2023] [Accepted: 04/25/2023] [Indexed: 05/27/2023]
Abstract
STUDY AIM To investigate the efficacy of PD-1-directed antibody-based therapy in patients with symptomatic melanoma brain metastases (MBM) and concurrent treatment with corticosteroids. METHODS This retrospective cohort study included patients with cutaneous melanoma with symptomatic MBM and concurrent treatment with corticosteroids who received PD-1-directed antibody-based treatment at the Royal Marsden Hospital London between 2016 and 2021. The primary outcome was overall survival (OS), secondary outcomes were intracranial response rate (ORR) and duration of response (DOR). We used the Kaplan-Meier method to describe survival. RESULTS Between 2016 and 2021, 256 patients presented with metastatic melanoma, of whom 29 were eligible with symptomatic MBM requiring corticosteroids and receiving ipilimumab plus nivolumab. Median age was 54 (interquartile range 44, 66). Median OS was 5.45months (95% confidence interval (CI) 2.89, 29.40), with 21% of patients (95% CI 9%, 47%) alive after 3years. ORR was 28% (8/29) and DOR was 7.85months (95% CI 7.85, not estimably [NE]). Responding patients had a median OS of 56.4months (95% CI 46.03, NE). Elevated lactate dehydrogenase and Eastern Cooperative Oncology Group PS> 2 were associated with poorer outcomes (median OS 29.4 versus 3.12months and 6.44 versus 5.13months), no such association was observed for corticosteroid dose, number of lesions, or line of treatment. CONCLUSION Patients with symptomatic MBM derive only modest benefit from combination immunotherapy treatment. Nevertheless, those with disease response have the potential to derive long-term benefit, justifying ipilimumab plus nivolumab in this group in the absence of other more effective treatment options.
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Affiliation(s)
- Simona Manacorda
- Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Santa Chiara Hospital, Pisa, Italy; Division of Medical Oncology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Maria De Toro Carmena
- Unit of Medical Oncology, Hospital Universitario Infanta Leonor, Madrid, Spain; Division of Medical Oncology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Ciara Malone
- Department of Medical Oncology, Addenbrookes Hospital NHS Trust, Cambridge, UK; Division of Medical Oncology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Ha Mo Linh Le
- Division of Medical Oncology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Andrew J S Furness
- Division of Medical Oncology, The Royal Marsden NHS Foundation Trust, London, UK
| | - James Larkin
- Division of Medical Oncology, The Royal Marsden NHS Foundation Trust, London, UK.
| | - Andreas M Schmitt
- Division of Medical Oncology, The Royal Marsden NHS Foundation Trust, London, UK; Department of Medical Oncology, University Hospital Basel, Basel, Switzerland
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Marconcini R, Fava P, Nuzzo A, Manacorda S, Ferrari M, De Rosa F, De Tursi M, Tanda ET, Consoli F, Minisini A, Pimpinelli N, Morgese F, Bersanelli M, Tucci M, Saponara M, Parisi A, Ocelli M, Bazzurri S, Massaro G, Morganti R, Ciardetti I, Stanganelli I. Comparison Between First Line Target Therapy and Immunotherapy in Different Prognostic Categories of BRAF Mutant Metastatic Melanoma Patients: An Italian Melanoma Intergroup Study. Front Oncol 2022; 12:917999. [PMID: 36046043 PMCID: PMC9421680 DOI: 10.3389/fonc.2022.917999] [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: 04/11/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundBRAF and MEK inhibitors target therapies (TT) and AntiPD1 immunotherapies (IT) are available first-line treatments for BRAF v600 mutant metastatic melanoma patients. ECOG PS (E), baseline LDH (L), and baseline number of metastatic sites (N) are well-known clinical prognostic markers that identify different prognostic categories of patients. Direct comparison between first-line TT and IT in different prognostic categories could help in first line treatment decision.MethodsThis is a retrospective analysis conducted in 14 Italian centers on about 454 metastatic melanoma patients, divided in 3 groups: group A—patients with E = 0, L within normal range, and N less than 3; group B—patients not included in group A or C; group C—patients with E > 0, L over the normal range, and N more than 3. For each prognostic group, we compared TT and IT in terms of progression free survival (PFS), overall survival (OS), and disease control rate (DCR).ResultsIn group A, results in 140 TT and 36 IT-treated patients were, respectively, median PFS 35.5 vs 11.6 months (HR (95% CI) 1.949 (1.180–3.217) p value 0.009); median OS not reached vs 55 months (HR (95% CI) 1.195 (0.602–2.373) p value 0.610); DCR 99% vs 75% p value <0.001). In group B, results in 196 TT and 38 IT-treated patients were, respectively, median PFS 11.5 vs 5 months (HR 1.535 (1.036–2.275) p value 0.033); median OS 19 vs 20 months (HR 0.886 (0.546–1.437) p value 0.623); DCR 85% vs 47% p value <0.001). In group C, results in 41 TT and 3 IT-treated patients were, respectively, median PFS 6.4 vs 1.8 months (HR 4.860 (1.399–16) p value 0.013); median OS 9 vs 5 months (HR 3.443 (0.991–11.9) p value 0.052); DCR 66% vs 33% p value 0.612).ConclusionsIn good prognosis, group A—TT showed statistically significant better PFS than IT, also in a long-term period, suggesting that TT can be a good first line option for this patient category. It is only in group B that we observed a crossing of the survival curves after the 3rd year of observation in favor of IT. Few patients were enrolled in group C, so few conclusions can be made on it.
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Affiliation(s)
- Riccardo Marconcini
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
- *Correspondence: Riccardo Marconcini,
| | - Paolo Fava
- Struttura Complessa (S.C.) Dermatologia Azienda Ospedaliero Universitaria (AOU) Città della Salute e della Scienza di Torino, Torino, Italy
| | - Amedeo Nuzzo
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Simona Manacorda
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Marco Ferrari
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Francesco De Rosa
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Romagnolo per lo studio dei Tumori “Dino Amadori”, Meldola, Italy
| | - Michele De Tursi
- Dipartimento di Tecnologie Innovative in Medicina & Odontoiatria Sezione di Oncologia Università G. D’Annunzio Chieti-Pescara, Chieti-Pescara, Italy
| | - Enrica Teresa Tanda
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genoa, Italy
- Genetics of Rare Cancers, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, Italy
| | - Francesca Consoli
- Unitá Operativa (U.O.) Oncologia Medica, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili, Brescia, Italy
| | - Alessandro Minisini
- Dipartimento di Oncologia Azienda Sanitaria Universitaria del Friuli Centrale P.le Santa Maria (SM) della Misericordia, Udine, Italy
| | - Nicola Pimpinelli
- Dipartimento Di Scienze Della Salute (DSS), Sezione Dermatologia, Università di Firenze, Melanoma & Skin Cancer Unit Area Vasta Centro, Firenze, Italy
| | - Francesca Morgese
- Clinica Oncologica, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, G.M. Lancisi, G. Salesi di Ancona, Ancona, Italy
| | - Melissa Bersanelli
- Unità Operativa di Oncologia Medica, Azienda Ospedaliero-Universitaria di Parma e Dipartimento di Medicina e Chirurgia, Università degli Studi di Parma, Parma, Italy
| | - Marco Tucci
- Medical Oncology Unit, Department of interdisciplinary Medicine (DIM), University of Bari ‘Aldo Moro’, Bari, Italy
| | | | | | | | - Serena Bazzurri
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Giulia Massaro
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | | | - Isabella Ciardetti
- Dipartimento Di Scienze Della Salute (DSS), Sezione Dermatologia, Università di Firenze, Melanoma & Skin Cancer Unit Area Vasta Centro, Firenze, Italy
| | - Ignazio Stanganelli
- Skin Cancer Unit, Scientific Institute of Romagna for the Study of Cancer, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto per La Ricerca Scientifica e Tecnologica (IRST), Meldola, Italy
- Department of Dermatology, University of Parma, Parma, Italy
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Nuzzo A, Manacorda S, Sammarco E, Sbrana A, Bazzurri S, Paolieri F, Manfredi F, Mercinelli C, Ferrari M, Massaro G, Bonato A, Salfi A, Galli L, Morganti R, Antonuzzo A, Cremolini C, Masi G. Safety and Tolerability of COVID-19 Vaccines in Patients with Cancer: A Single Center Retrospective Analysis. Vaccines (Basel) 2022; 10:vaccines10060892. [PMID: 35746500 PMCID: PMC9227366 DOI: 10.3390/vaccines10060892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 05/28/2022] [Accepted: 05/31/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Severe acute respiratory syndrome coronavirus 2 disease (COVID-19) has caused a worldwide challenging and threatening pandemic. Multinational, placebo-controlled, observer-blinded trials were conducted since the beginning of pandemic because safe and effective vaccines were needed urgently. In most trials of COVID-19 vaccines patients affected by malignancies or on treatment with immunosuppressive drugs were excluded. Patients and methods: A retrospective monocentric study was conducted at Medical Oncological Unit of Santa Chiara Hospital (Pisa, Italy) in this subset of population to investigate safety and tolerability of COVID-19 vaccines; 377 patients with solid tumor on treatment were enrolled. Vaccine-related adverse events were recorded using a face-to-face questionnaire including a toxicity grading scale. Most of the patients (94%) received mRNA vaccine as indicated by Italian health ministry guidelines. Mean age was 66 years (range 27–87), 62% of the patients were older than 65 years and 68% had at least one additional comorbidity. The majority (86%) of patients were in a metastatic setting and 29% received immunotherapy-based treatment. For statistical analysis, multivariate binary logistic regression models were performed and linear regression models were applied. Results: Adverse events were mild and transient and ended in a few days without any sequelae. No severe or uncommon adverse events were recorded. In multivariate analysis, we found that the female sex was associated with a greater risk of more severe and longer lasting adverse events, and a higher risk of adverse events was found for patients treated with immunotherapy. Conclusions: Our results demonstrate that COVID-19 vaccines were safe and well-tolerated in this population of patients being treated for solid tumors.
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Affiliation(s)
- Amedeo Nuzzo
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Santa Chiara Hospital, 56125 Pisa, Italy; (S.M.); (E.S.); (S.B.); (F.P.); (F.M.); (C.M.); (M.F.); (G.M.); (A.B.); (A.S.); (L.G.); (C.C.); (G.M.)
- Correspondence: ; Tel.: +39-050992466; Fax: +39-050992928
| | - Simona Manacorda
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Santa Chiara Hospital, 56125 Pisa, Italy; (S.M.); (E.S.); (S.B.); (F.P.); (F.M.); (C.M.); (M.F.); (G.M.); (A.B.); (A.S.); (L.G.); (C.C.); (G.M.)
| | - Enrico Sammarco
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Santa Chiara Hospital, 56125 Pisa, Italy; (S.M.); (E.S.); (S.B.); (F.P.); (F.M.); (C.M.); (M.F.); (G.M.); (A.B.); (A.S.); (L.G.); (C.C.); (G.M.)
| | - Andrea Sbrana
- Department of Surgical, Medical and Molecular Pathology and Critical Area Medicine, Azienda Ospedaliero-Universitaria Pisana, 56125 Pisa, Italy;
| | - Serena Bazzurri
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Santa Chiara Hospital, 56125 Pisa, Italy; (S.M.); (E.S.); (S.B.); (F.P.); (F.M.); (C.M.); (M.F.); (G.M.); (A.B.); (A.S.); (L.G.); (C.C.); (G.M.)
| | - Federico Paolieri
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Santa Chiara Hospital, 56125 Pisa, Italy; (S.M.); (E.S.); (S.B.); (F.P.); (F.M.); (C.M.); (M.F.); (G.M.); (A.B.); (A.S.); (L.G.); (C.C.); (G.M.)
| | - Fiorella Manfredi
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Santa Chiara Hospital, 56125 Pisa, Italy; (S.M.); (E.S.); (S.B.); (F.P.); (F.M.); (C.M.); (M.F.); (G.M.); (A.B.); (A.S.); (L.G.); (C.C.); (G.M.)
| | - Chiara Mercinelli
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Santa Chiara Hospital, 56125 Pisa, Italy; (S.M.); (E.S.); (S.B.); (F.P.); (F.M.); (C.M.); (M.F.); (G.M.); (A.B.); (A.S.); (L.G.); (C.C.); (G.M.)
| | - Marco Ferrari
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Santa Chiara Hospital, 56125 Pisa, Italy; (S.M.); (E.S.); (S.B.); (F.P.); (F.M.); (C.M.); (M.F.); (G.M.); (A.B.); (A.S.); (L.G.); (C.C.); (G.M.)
| | - Giulia Massaro
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Santa Chiara Hospital, 56125 Pisa, Italy; (S.M.); (E.S.); (S.B.); (F.P.); (F.M.); (C.M.); (M.F.); (G.M.); (A.B.); (A.S.); (L.G.); (C.C.); (G.M.)
| | - Adele Bonato
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Santa Chiara Hospital, 56125 Pisa, Italy; (S.M.); (E.S.); (S.B.); (F.P.); (F.M.); (C.M.); (M.F.); (G.M.); (A.B.); (A.S.); (L.G.); (C.C.); (G.M.)
| | - Alessia Salfi
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Santa Chiara Hospital, 56125 Pisa, Italy; (S.M.); (E.S.); (S.B.); (F.P.); (F.M.); (C.M.); (M.F.); (G.M.); (A.B.); (A.S.); (L.G.); (C.C.); (G.M.)
| | - Luca Galli
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Santa Chiara Hospital, 56125 Pisa, Italy; (S.M.); (E.S.); (S.B.); (F.P.); (F.M.); (C.M.); (M.F.); (G.M.); (A.B.); (A.S.); (L.G.); (C.C.); (G.M.)
| | - Riccardo Morganti
- Section of Statistics, University Hospital of Pisa, 56125 Pisa, Italy;
| | - Andrea Antonuzzo
- Unit of Medical Oncology 1, Azienda Ospedaliero-Universitaria Pisana, Santa Chiara Hospital, 56125 Pisa, Italy;
| | - Chiara Cremolini
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Santa Chiara Hospital, 56125 Pisa, Italy; (S.M.); (E.S.); (S.B.); (F.P.); (F.M.); (C.M.); (M.F.); (G.M.); (A.B.); (A.S.); (L.G.); (C.C.); (G.M.)
| | - Gianluca Masi
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Santa Chiara Hospital, 56125 Pisa, Italy; (S.M.); (E.S.); (S.B.); (F.P.); (F.M.); (C.M.); (M.F.); (G.M.); (A.B.); (A.S.); (L.G.); (C.C.); (G.M.)
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Marconcini R, Fava P, F. de Rosa, De Tursi M, Tanda E, Consoli F, Targato G, Pimpinelli N, Morgese F, Bersanelli M, Tucci M, Saponara M, Cortellini A, Ocelli M, Morganti R, Manacorda S, Bazzurri S, Nuzzo A, Ferrari M, Falcone A. 1045P Comparison between first-line target therapy and immunotherapy in different prognostic categories of BRAF mutant metastatic melanoma patients. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1430] [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: 10/20/2022] Open
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Nuzzo A, Manacorda S, Paolieri F, Sbrana A, Bazzurri S, Sammarco E, Bloise F, Ferrari M, Manfredi F, Mercinelli C, Bonato A, Massaro G, Salfi A, Galli L, Antonuzzo A, Cosio S, Gadducci A. 750P Safety and efficacy of platinum desensitization treatment in patients with ovarian cancer and platinum hypersensitivity. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1192] [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: 11/30/2022] Open
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Fornarini G, Rebuzzi SE, Banna GL, Calabrò F, Scandurra G, De Giorgi U, Masini C, Baldessari C, Naglieri E, Caserta C, Manacorda S, Maruzzo M, Milella M, Buttigliero C, Tambaro R, Ermacora P, Morelli F, Nolè F, Astolfi C, Sternberg CN. Immune-inflammatory biomarkers as prognostic factors for immunotherapy in pretreated advanced urinary tract cancer patients: an analysis of the Italian SAUL cohort. ESMO Open 2021; 6:100118. [PMID: 33984678 PMCID: PMC8134706 DOI: 10.1016/j.esmoop.2021.100118] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [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: 01/15/2021] [Revised: 03/04/2021] [Accepted: 03/17/2021] [Indexed: 12/18/2022] Open
Abstract
Background Reliable and affordable prognostic and predictive biomarkers for urothelial carcinoma treated with immunotherapy may allow patients' outcome stratification and drive therapeutic options. The SAUL trial investigated the safety and efficacy of atezolizumab in a real-world setting on 1004 patients with locally advanced or metastatic urothelial carcinoma who progressed to one to three prior systemic therapies. Patients and methods Using the SAUL Italian cohort of 267 patients, we investigated the prognostic role of neutrophil-to-lymphocyte ratio (NLR) and systemic immune-inflammation index (SII) and the best performing one of these in combination with programmed death-ligand 1 (PD-L1) with or without lactate dehydrogenase (LDH). Previously reported cut-offs (NLR >3 and NLR >5; SII >1375) in addition to study-defined ones derived from receiver operating characteristic (ROC) analysis were used. Results The cut-off values for NLR and SII by the ROC analysis were 3.65 (sensitivity 60.4; specificity 63.0) and 884 (sensitivity 64.4; specificity 67.5), respectively. The median overall survival (OS) was 14.7 months for NLR <3.65 [95% confidence interval (CI) 9.9-not reached (NR)] versus 6.0 months for NLR ≥3.65 (95% CI 3.9-9.4); 14.7 months for SII <884 (95% CI 10.6-NR) versus 6.0 months for SII ≥884 (95% CI 3.7-8.6). The combination of SII, PD-L1, and LDH stratified OS better than SII plus PD-L1 through better identification of patients with intermediate prognosis (77% versus 48%, respectively). Multivariate analyses confirmed significant correlations with OS and progression-free survival for both the SII + PD-L1 + LDH and SII + PD-L1 combinations. Conclusion The combination of immune-inflammatory biomarkers based on SII, PD-L1, with or without LDH is a potentially useful and easy-to-assess prognostic tool deserving validation to identify patients who may benefit from immunotherapy alone or alternative therapies. Reliable biomarkers for immunotherapy may assist in treatment decision making and clinical trial design and interpretation. Immune-inflammatory biomarkers were investigated for their prognostic role within the Italian SAUL study cohort. ROC-based cut-offs were 3.65 for NLR and 884 for SII. Both NLR and SII were prognostic with SII performing slightly better than NLR. The combination of SII, PD-L1, and LDH stratified OS better than SII + PD-L1; both were independent prognostic factors.
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Affiliation(s)
- G Fornarini
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - S E Rebuzzi
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Internal Medicine and Medical Specialties, University of Genoa, Genoa, Italy
| | - G L Banna
- Department of Oncology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - F Calabrò
- Medical Oncology, Azienda Ospedaliera S. Camillo-Forlanini, Rome, Italy
| | - G Scandurra
- Medical Oncology, Azienda Ospedaliera Cannizzaro di Catania, Catania, Italy
| | - U De Giorgi
- Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) - IRCCS, Meldola, Italy
| | - C Masini
- Medical Oncology, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - C Baldessari
- Oncology, Azienda Ospedaliero - Universitaria di Modena, Modena, Italy
| | - E Naglieri
- Division of Medical Oncology, IRCCS Istituto Tumori Bari Giovanni Paolo II - IRCCS, Bari, Italy
| | - C Caserta
- Medical Oncology Unit, Azienda Ospedaliera S. Maria, Terni, Italy
| | - S Manacorda
- Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - M Maruzzo
- Medical Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto, IOV-IRCCS, Padua, Italy
| | - M Milella
- Dipartimento di Oncologia, Policlinico Universitario G.B. Rossi Borgo Roma, Verona, Italy
| | - C Buttigliero
- Medical Oncology, Università degli Studi di Torino, Turin, Italy
| | - R Tambaro
- U.O.C di Oncologia Sperimentale Uroginecologica, I.N.T. IRCCS Fondazione G. Pascale, Naples, Italy
| | - P Ermacora
- Dipartimento di Oncologia, Azienda Ospedaliero Universitaria di Udine, Udine, Italy
| | - F Morelli
- Casa Sollievo della Sofferenza, S. Giovanni Rotondo, Foggia, Italy
| | - F Nolè
- IEO, Istituto Europeo di Oncologia IRCCS, Milan, Italy
| | - C Astolfi
- Medical Affairs & Clinical Operation, Roche S.p.A., Monza, Italy
| | - C N Sternberg
- Hematology and Oncology, Englander Institute for Precision Medicine Weill Cornell Medicine, New York-Presbyterian, New York, USA.
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Sbrana A, Paolieri F, Bloise F, Nuzzo A, Manacorda S, Sammarco E, Manfredi F, Mercinelli C, Gadducci G, Giannini N, Antonuzzo A, Paiar F, Falcone A, Pasqualetti F, Galli L. 1711P SARS-CoV-2 infection in prostate cancer patients: Data from a high-incidence area in Italy. Ann Oncol 2020. [PMCID: PMC7506440 DOI: 10.1016/j.annonc.2020.08.1775] [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: 11/22/2022] Open
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9
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Sbrana A, Paolieri F, Bloise F, Manacorda S, Nuzzo A, Sammarco E, Galli L, Falcone A. Dedifferentiated liposarcoma: when eribulin can make the difference. Future Oncol 2019; 16:21-24. [PMID: 31872768 DOI: 10.2217/fon-2019-0598] [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] [Indexed: 01/02/2023] Open
Abstract
We describe the case of a male subject affected by retroperitoneal advanced, anthracycline-pretreated liposarcoma, who experienced a long, beneficial clinical effect from eribulin treatment. In March 2013, a left, paraortic, retroperitoneal mass was surgically removed and diagnosed as Mdm2-positive dedifferentiated liposarcoma. In June 2015, a CT scan revealed disease progression and first-line epirubicin/ifosfamide treatment was started, followed by epirubicin in monotherapy. In January 2017, following a new disease progression, the patient started a second-line eribulin treatment that went on for about 1 year with no major adverse events. The CT scans performed every 3-4 months showed stable disease. After 13 months of treatment, a CT scan revealed disease progression and 10 days later, the patient died of bowel perforation and peritonitis.
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Affiliation(s)
- Andrea Sbrana
- Medical Oncology Unit 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.,Department of Translational Research & New Technologies in Medicine & Surgery, University of Pisa, Pisa, Italy
| | - Federico Paolieri
- Medical Oncology Unit 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.,Department of Translational Research & New Technologies in Medicine & Surgery, University of Pisa, Pisa, Italy
| | - Francesco Bloise
- Medical Oncology Unit 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.,Department of Translational Research & New Technologies in Medicine & Surgery, University of Pisa, Pisa, Italy
| | - Simona Manacorda
- Medical Oncology Unit 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.,Department of Translational Research & New Technologies in Medicine & Surgery, University of Pisa, Pisa, Italy
| | - Amedeo Nuzzo
- Medical Oncology Unit 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.,Department of Translational Research & New Technologies in Medicine & Surgery, University of Pisa, Pisa, Italy
| | - Enrico Sammarco
- Medical Oncology Unit 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.,Department of Translational Research & New Technologies in Medicine & Surgery, University of Pisa, Pisa, Italy
| | - Luca Galli
- Medical Oncology Unit 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.,Department of Translational Research & New Technologies in Medicine & Surgery, University of Pisa, Pisa, Italy
| | - Alfredo Falcone
- Medical Oncology Unit 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.,Department of Translational Research & New Technologies in Medicine & Surgery, University of Pisa, Pisa, Italy
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10
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Marconcini R, Nuzzo A, Manacorda S, de rosa F, Fava P, Astrua C, Di Guardo L, Raimondi A, Stucci S, Todisco A, Cortellini A, Bersanelli M, Nigro O, Palla M, Palmieri G, Falcone A. Prognostic factors for efficacy of Ipilimumab used after anti-PD1 and/or BRAF+MEK inhibitors in melanoma patients: An Italian melanoma intergroup study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz255.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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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11
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Marconcini R, Tanda E, Di Guardo L, Nigro O, Fava P, Todisco A, Morgese F, Cortellini A, Stroppa E, Gallizzi G, Festino L, Grego E, Quadrini S, Orlandini C, Nuzzo A, Manacorda S, Bloise F, Indini A, Astrua C, Falcone A. Baseline predictive factors for efficacy of anti-PD1 used in first line in melanoma patients: An Italian melanoma intergroup study. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy289.014] [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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12
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Gadducci A, Cosio S, Fanucchi A, Tana R, Manacorda S, Pistolesi S, Strigini FL. Prognosis of Patients with Gestational Trophoblastic Neoplasia and Obstetric Outcomes of Those Conceiving After Chemotherapy. Anticancer Res 2016; 36:3477-3482. [PMID: 27354611] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 05/25/2016] [Indexed: 06/06/2023]
Abstract
AIM To assess prognosis of gestational trophoblastic neoplasia (GTN) and obstetric outcome after chemotherapy. PATIENTS AND METHODS Sixty-six patients had diagnosis of hydatiform mole on curettage and 18 developed GTN. Two patients were referred with pathological diagnosis of GTN. Chemotherapy was tailored according to International Federation of Gynecology and Obstetrics risk scoring system. RESULTS All patients with GTN but one, were recovered by chemotherapy and had no evidence of disease after a median follow-up of 80 months. Only the patient with epithelioid trophoblastic tumor died of disease. Seven out of the eight women who tried to conceive after chemotherapy became pregnant. Ten conceptions occurred, resulting in no molar pregnancy, three miscarriages and seven term-live healthy births (70.0%). All seven babies showed normal development and growth after a median follow-up of 38 months. CONCLUSION The prognosis of women with GTN is very good, and obstetric outcomes of those who conceive after chemotherapy are similar to those of the general population.
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Affiliation(s)
- Angiolo Gadducci
- Division of Gynecology and Obstetrics, Department of Clinical and Experimental Medicine, Division of Pathology, University of Pisa, Pisa, Italy
| | - Stefania Cosio
- Division of Gynecology and Obstetrics, Department of Clinical and Experimental Medicine, Division of Pathology, University of Pisa, Pisa, Italy
| | - Antonio Fanucchi
- Division of Gynecology and Obstetrics, Department of Clinical and Experimental Medicine, Division of Pathology, University of Pisa, Pisa, Italy
| | - Roberta Tana
- Division of Gynecology and Obstetrics, Department of Clinical and Experimental Medicine, Division of Pathology, University of Pisa, Pisa, Italy
| | - Simona Manacorda
- Division of Gynecology and Obstetrics, Department of Clinical and Experimental Medicine, Division of Pathology, University of Pisa, Pisa, Italy
| | - Sabina Pistolesi
- Translational Research and New Technologies in Medicine and Surgery, Division of Pathology, University of Pisa, Pisa, Italy
| | - Francesca Letizia Strigini
- Division of Gynecology and Obstetrics, Department of Clinical and Experimental Medicine, Division of Pathology, University of Pisa, Pisa, Italy
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