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De Lisa M, Ballatore Z, Marcantognini G, Pierantoni C, Antognoli S, Pistelli M, Pagliacci A, Berardi R. Irinotecan-Induced Transient Dysarthria: Case Series and Updated Literature Review. Oncol Ther 2020; 8:147-160. [PMID: 32700070 PMCID: PMC7359989 DOI: 10.1007/s40487-019-00106-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Indexed: 12/27/2022] Open
Abstract
Irinotecan-based regimens are used worldwide for the treatment of several recurrent or advanced gastrointestinal malignancies. In this paper we describe the cases of four patients treated in our institution who developed acute dysarthria while receiving intravenous infusion of irinotecan. In all our cases, dysarthria occurred during the infusion of the first course of irinotecan, and then resolved rapidly without any sequelae. Imaging of the brain was performed, but failed to show any evidence of an acute neurological event. We also reviewed the literature on this very uncommon adverse event. The pathogenesis of irinotecan-induced dysarthria is still unknown and is not completely elucidated by the current pharmacodynamic or kinetic explanations; therefore, we could only hypothesize some assumptions.
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Affiliation(s)
- Mariagrazia De Lisa
- Medical Oncology, Azienda Ospedaliero-Universitaria Ospedali Riuniti-Ancona, Università Politecnica delle Marche, Ancona, Italy
| | - Zelmira Ballatore
- Medical Oncology, Azienda Ospedaliero-Universitaria Ospedali Riuniti-Ancona, Università Politecnica delle Marche, Ancona, Italy
| | - Giulia Marcantognini
- Medical Oncology, Azienda Ospedaliero-Universitaria Ospedali Riuniti-Ancona, Università Politecnica delle Marche, Ancona, Italy
| | - Chiara Pierantoni
- Medical Oncology, Azienda Ospedaliero-Universitaria Ospedali Riuniti-Ancona, Università Politecnica delle Marche, Ancona, Italy
| | - Stefania Antognoli
- Medical Oncology, Azienda Ospedaliero-Universitaria Ospedali Riuniti-Ancona, Università Politecnica delle Marche, Ancona, Italy
| | - Mirco Pistelli
- Medical Oncology, Azienda Ospedaliero-Universitaria Ospedali Riuniti-Ancona, Università Politecnica delle Marche, Ancona, Italy
| | - Alessandra Pagliacci
- Medical Oncology, Azienda Ospedaliero-Universitaria Ospedali Riuniti-Ancona, Università Politecnica delle Marche, Ancona, Italy
| | - Rossana Berardi
- Medical Oncology, Azienda Ospedaliero-Universitaria Ospedali Riuniti-Ancona, Università Politecnica delle Marche, Ancona, Italy.
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Meletani T, Cantini L, Lanese A, Nicolini D, Cimadamore A, Agostini A, Ricci G, Antognoli S, Mandolesi A, Guido M, Alaggio R, Giuseppetti GM, Scarpelli M, Vivarelli M, Berardi R. Are liver nested stromal epithelial tumors always low aggressive? World J Gastroenterol 2017; 23:8248-8255. [PMID: 29290661 PMCID: PMC5739931 DOI: 10.3748/wjg.v23.i46.8248] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 07/27/2017] [Accepted: 08/25/2017] [Indexed: 02/06/2023] Open
Abstract
Nested stromal-epithelial tumor (NSET) is a non-hepatocytic and non-biliary tumor of the liver consisting of nests of epithelial and spindled cells with associated myofibroblastic stroma and variable intra-lesional calcification and ossification, which represents a very rare and challenging disease. Most of the reported cases have been treated with surgery, obtaining a long survival outcome. Here, we report the case of a 31-year-old Caucasian man who underwent surgery at our institution for a large, lobulated, multinodular mass of the right hemi-liver. The histological exam confirmed the diagnosis of NSET. After 6 mo from surgery, a liver recurrence was described and a chemo-embolization was performed. After a further disease progression, based on the correlation between the histological features of the disease and those of the hepatoblastoma, a similar chemotherapy regimen (with cisplatin and ifosfamide/mesna chemotherapy, omitting doxorubicin due to liver impairment) was administered. However, infection of the biliary catheter required a dose modification of the treatment. No benefit was noted and a progression of disease was radiologically assessed after only four cycles. The worsening of the clinical status prevented further treatments, and the patient died a few months later. This case report documents how the NSET might have an aggressive and non-preventable behavior. No chemotherapy schedules with a proved efficacy are available, and new data are needed to shed light on this rare neoplasm.
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MESH Headings
- Adult
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Diagnosis, Differential
- Fatal Outcome
- Hepatectomy
- Hepatoblastoma/diagnosis
- Hepatoblastoma/pathology
- Humans
- Liver/diagnostic imaging
- Liver/pathology
- Liver/surgery
- Liver Neoplasms/diagnosis
- Liver Neoplasms/pathology
- Liver Neoplasms/therapy
- Male
- Neoplasm Recurrence, Local/diagnosis
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/therapy
- Neoplasms, Complex and Mixed/diagnosis
- Neoplasms, Complex and Mixed/pathology
- Neoplasms, Complex and Mixed/therapy
- Neoplasms, Glandular and Epithelial/diagnosis
- Neoplasms, Glandular and Epithelial/pathology
- Neoplasms, Glandular and Epithelial/therapy
- Positron-Emission Tomography
- Tomography, X-Ray Computed
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Affiliation(s)
- Tania Meletani
- Medical Oncology, University Hospital and Polytechnic University Ancona, 60126 Marche, Italy
| | - Luca Cantini
- Medical Oncology, University Hospital and Polytechnic University Ancona, 60126 Marche, Italy
| | - Andrea Lanese
- Medical Oncology, University Hospital and Polytechnic University Ancona, 60126 Marche, Italy
| | - Daniele Nicolini
- Hepatobiliary and Transplantation Surgery, Department of Clinical and Experimental Medicine, University Hospital and Polytechnic University Ancona, 60126 Marche, Italy
| | - Alessia Cimadamore
- Section of Pathological Anatomy, Department of Biomedical Sciences and Public Health, University Hospital and Polytechnic University Ancona, 60126 Marche, Italy
| | - Andrea Agostini
- Department of Radiology, University Hospital and Polytechnic University Ancona, 60126 Marche, Italy
| | - Giulia Ricci
- Medical Oncology, University Hospital and Polytechnic University Ancona, 60126 Marche, Italy
| | - Stefania Antognoli
- Medical Oncology, University Hospital and Polytechnic University Ancona, 60126 Marche, Italy
| | - Alessandra Mandolesi
- Section of Pathological Anatomy, Department of Biomedical Sciences and Public Health, University Hospital and Polytechnic University Ancona, 60126 Marche, Italy
| | - Maria Guido
- Pathology Department, Padova University, 35121 Padova, Italy
| | - Rita Alaggio
- Pathology Department, Padova University, 35121 Padova, Italy
| | - Gian Marco Giuseppetti
- Department of Radiology, University Hospital and Polytechnic University Ancona, 60126 Marche, Italy
| | - Marina Scarpelli
- Section of Pathological Anatomy, Department of Biomedical Sciences and Public Health, University Hospital and Polytechnic University Ancona, 60126 Marche, Italy
| | - Marco Vivarelli
- Hepatobiliary and Transplantation Surgery, Department of Clinical and Experimental Medicine, University Hospital and Polytechnic University Ancona, 60126 Marche, Italy
| | - Rossana Berardi
- Medical Oncology, University Hospital and Polytechnic University Ancona, 60126 Marche, Italy
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Faloppi L, Maccaroni E, Giampieri R, Bianconi M, Bittoni A, Del Prete M, Antognoli S, Scartozzi M, Cascinu S. Correlation of biliary stenting with clinical outcome in patients with advanced pancreatic cancer treated with chemotherapy. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.4_suppl.349] [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
349 Background: The head of the pancreas is a common location for primary pancreatic tumour and therefore obstructive jaundice is a common complication deriving from this location. Although very important in the palliative treatment of this setting of patients, endoscopic procedures are an important source of complications, frequently influencing the prognosis. Aim of our analysis was to assess the clinical outcome of pancreatic cancer patients with biliary stent. Methods: We retrospectively analyzed a population of metastatic or locally advanced pancreatic cancer patients receiving at our Institution a first line chemotherapy between 2002 and 2010. Results: 163 patients were eligible for our analysis, 29 (18%) carried a biliary stent before first line treatment. A statistically significant difference in time to progression (TTP) was found in patients with or without biliary stent (respectively 2.77 months vs 4.27 months p=0,03). Clinical characteristics were homogeneous between the two groups (age, sex, performance status, stage, objective response rate, chemotherapy performed, toxicity profile). Overall survival analysis was worse in patients with biliary stent (5.93 months vs 8.33 months). In the group of patients with biliary stent toxicity was worse in patients receiving a combination chemoterapy (GEMOX). Conclusions: In our population placement of biliary stent seems to have a negative prognostic role in advanced pancreatic cancer patients. Our data also show that in patients with biliary stent the toxicity profile of chemotherapy may influence treatment adherence and clinical outcome. These observations seem to suggest that patients with obstructive jaundice even when successfully treated with plastic or metal stent may still represent a group of patients with a worse clinical outcome, not suitable for an intensive first-line approach such as FOLFIRINOX.
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Affiliation(s)
- Luca Faloppi
- Scuola di Specializzazione in Oncologia Medica, Università Politecnica delle Marche, Ancona, Italy; A. O. Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy; Scuola di Specializzazione in Oncologia, Università Politecnica delle Marche, Ancona, Italy; Clinica di Oncologia Medica AOU Ospedali Riuniti Ancona, Ancona, Italy; Clinica di Oncologia Medica, A. O. Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy
| | - Elena Maccaroni
- Scuola di Specializzazione in Oncologia Medica, Università Politecnica delle Marche, Ancona, Italy; A. O. Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy; Scuola di Specializzazione in Oncologia, Università Politecnica delle Marche, Ancona, Italy; Clinica di Oncologia Medica AOU Ospedali Riuniti Ancona, Ancona, Italy; Clinica di Oncologia Medica, A. O. Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy
| | - Riccardo Giampieri
- Scuola di Specializzazione in Oncologia Medica, Università Politecnica delle Marche, Ancona, Italy; A. O. Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy; Scuola di Specializzazione in Oncologia, Università Politecnica delle Marche, Ancona, Italy; Clinica di Oncologia Medica AOU Ospedali Riuniti Ancona, Ancona, Italy; Clinica di Oncologia Medica, A. O. Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy
| | - Maristella Bianconi
- Scuola di Specializzazione in Oncologia Medica, Università Politecnica delle Marche, Ancona, Italy; A. O. Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy; Scuola di Specializzazione in Oncologia, Università Politecnica delle Marche, Ancona, Italy; Clinica di Oncologia Medica AOU Ospedali Riuniti Ancona, Ancona, Italy; Clinica di Oncologia Medica, A. O. Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy
| | - Alessandro Bittoni
- Scuola di Specializzazione in Oncologia Medica, Università Politecnica delle Marche, Ancona, Italy; A. O. Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy; Scuola di Specializzazione in Oncologia, Università Politecnica delle Marche, Ancona, Italy; Clinica di Oncologia Medica AOU Ospedali Riuniti Ancona, Ancona, Italy; Clinica di Oncologia Medica, A. O. Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy
| | - Michela Del Prete
- Scuola di Specializzazione in Oncologia Medica, Università Politecnica delle Marche, Ancona, Italy; A. O. Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy; Scuola di Specializzazione in Oncologia, Università Politecnica delle Marche, Ancona, Italy; Clinica di Oncologia Medica AOU Ospedali Riuniti Ancona, Ancona, Italy; Clinica di Oncologia Medica, A. O. Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy
| | - Stefania Antognoli
- Scuola di Specializzazione in Oncologia Medica, Università Politecnica delle Marche, Ancona, Italy; A. O. Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy; Scuola di Specializzazione in Oncologia, Università Politecnica delle Marche, Ancona, Italy; Clinica di Oncologia Medica AOU Ospedali Riuniti Ancona, Ancona, Italy; Clinica di Oncologia Medica, A. O. Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy
| | - Mario Scartozzi
- Scuola di Specializzazione in Oncologia Medica, Università Politecnica delle Marche, Ancona, Italy; A. O. Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy; Scuola di Specializzazione in Oncologia, Università Politecnica delle Marche, Ancona, Italy; Clinica di Oncologia Medica AOU Ospedali Riuniti Ancona, Ancona, Italy; Clinica di Oncologia Medica, A. O. Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy
| | - Stefano Cascinu
- Scuola di Specializzazione in Oncologia Medica, Università Politecnica delle Marche, Ancona, Italy; A. O. Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy; Scuola di Specializzazione in Oncologia, Università Politecnica delle Marche, Ancona, Italy; Clinica di Oncologia Medica AOU Ospedali Riuniti Ancona, Ancona, Italy; Clinica di Oncologia Medica, A. O. Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy
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Faloppi L, Mandolesi A, Maccaroni E, Giampieri R, Bianconi M, Bittoni A, Del Prete M, Antognoli S, Scartozzi M, Bearzi I, Cascinu S. HER2 expression in patients with advanced pancreatic cancer: Preliminary results from a multifactorial biologic analysis. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.4_suppl.250] [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
250 Background: Pancreatic cancer is the deadliest solid cancer and currently the fourth most frequent cause of cancer-related deaths. Many studies have demonstrated that pancreatic cancer is a group of heterougeneous disease with different therapeutical implications and prognosis. Aim of our analysis was to analyze the HER-family status in pancreatic cancer. Methods: We immunohistochemically assessed surgical specimens and macrobiopses for several biological targets. K-ras, HER-1, HER-2 and HER-3 were analyzed. Results: 62 specimens were analyzed in our centre. 30 samples were K-ras wild-type, 70% of these were EGFR positive. While 32 samples have a mutant form of K-ras, 87.5% were EGFR positive. HER-2 resulted negative in all specimens. In the K-ras wild-type group, 17% have high expression of HER-3, 20% a low one; in mutant K-ras group 16% are high expressing while 34% have a low HER-3. Conclusions: Over the past decades, there has hardly been any substantial therapeutic progress regarding clinical endpoints in pancreatic cancer, thus in the era of target therapies the molecular biological classification of these neoplasms have an ever more important role for developing tailored therapies. Our analysis show a low rate of k-ras mutations (52%) and seems to suggest that anti-EGFR strategies may represent an interesting treatment option in pancreatic cancer as long as a preliminary molecular selection is applied. Numerous international trials are evaluating the role of new drugs targeting HER-2 in association with chemotherapy in metastatic pancreatic cancer. On the contrary, our data suggest that HER-2 directed therapies are not likely to represent a relevant choice in this setting.
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Affiliation(s)
- Luca Faloppi
- Scuola di Specializzazione in Oncologia Medica, Università Politecnica delle Marche, Ancona, Italy; Anatomia Patologica, A. O. Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy; A. O. Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy; Scuola di Specializzazione in Oncologia, Università Politecnica delle Marche, Ancona, Italy; Clinica di Oncologia Medica AOU Ospedali Riuniti Ancona, Ancona, Italy; Clinica di Oncologia Medica, A. O. Ospedali Riuniti-Università
| | - Alessandra Mandolesi
- Scuola di Specializzazione in Oncologia Medica, Università Politecnica delle Marche, Ancona, Italy; Anatomia Patologica, A. O. Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy; A. O. Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy; Scuola di Specializzazione in Oncologia, Università Politecnica delle Marche, Ancona, Italy; Clinica di Oncologia Medica AOU Ospedali Riuniti Ancona, Ancona, Italy; Clinica di Oncologia Medica, A. O. Ospedali Riuniti-Università
| | - Elena Maccaroni
- Scuola di Specializzazione in Oncologia Medica, Università Politecnica delle Marche, Ancona, Italy; Anatomia Patologica, A. O. Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy; A. O. Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy; Scuola di Specializzazione in Oncologia, Università Politecnica delle Marche, Ancona, Italy; Clinica di Oncologia Medica AOU Ospedali Riuniti Ancona, Ancona, Italy; Clinica di Oncologia Medica, A. O. Ospedali Riuniti-Università
| | - Riccardo Giampieri
- Scuola di Specializzazione in Oncologia Medica, Università Politecnica delle Marche, Ancona, Italy; Anatomia Patologica, A. O. Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy; A. O. Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy; Scuola di Specializzazione in Oncologia, Università Politecnica delle Marche, Ancona, Italy; Clinica di Oncologia Medica AOU Ospedali Riuniti Ancona, Ancona, Italy; Clinica di Oncologia Medica, A. O. Ospedali Riuniti-Università
| | - Maristella Bianconi
- Scuola di Specializzazione in Oncologia Medica, Università Politecnica delle Marche, Ancona, Italy; Anatomia Patologica, A. O. Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy; A. O. Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy; Scuola di Specializzazione in Oncologia, Università Politecnica delle Marche, Ancona, Italy; Clinica di Oncologia Medica AOU Ospedali Riuniti Ancona, Ancona, Italy; Clinica di Oncologia Medica, A. O. Ospedali Riuniti-Università
| | - Alessandro Bittoni
- Scuola di Specializzazione in Oncologia Medica, Università Politecnica delle Marche, Ancona, Italy; Anatomia Patologica, A. O. Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy; A. O. Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy; Scuola di Specializzazione in Oncologia, Università Politecnica delle Marche, Ancona, Italy; Clinica di Oncologia Medica AOU Ospedali Riuniti Ancona, Ancona, Italy; Clinica di Oncologia Medica, A. O. Ospedali Riuniti-Università
| | - Michela Del Prete
- Scuola di Specializzazione in Oncologia Medica, Università Politecnica delle Marche, Ancona, Italy; Anatomia Patologica, A. O. Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy; A. O. Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy; Scuola di Specializzazione in Oncologia, Università Politecnica delle Marche, Ancona, Italy; Clinica di Oncologia Medica AOU Ospedali Riuniti Ancona, Ancona, Italy; Clinica di Oncologia Medica, A. O. Ospedali Riuniti-Università
| | - Stefania Antognoli
- Scuola di Specializzazione in Oncologia Medica, Università Politecnica delle Marche, Ancona, Italy; Anatomia Patologica, A. O. Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy; A. O. Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy; Scuola di Specializzazione in Oncologia, Università Politecnica delle Marche, Ancona, Italy; Clinica di Oncologia Medica AOU Ospedali Riuniti Ancona, Ancona, Italy; Clinica di Oncologia Medica, A. O. Ospedali Riuniti-Università
| | - Mario Scartozzi
- Scuola di Specializzazione in Oncologia Medica, Università Politecnica delle Marche, Ancona, Italy; Anatomia Patologica, A. O. Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy; A. O. Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy; Scuola di Specializzazione in Oncologia, Università Politecnica delle Marche, Ancona, Italy; Clinica di Oncologia Medica AOU Ospedali Riuniti Ancona, Ancona, Italy; Clinica di Oncologia Medica, A. O. Ospedali Riuniti-Università
| | - Italo Bearzi
- Scuola di Specializzazione in Oncologia Medica, Università Politecnica delle Marche, Ancona, Italy; Anatomia Patologica, A. O. Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy; A. O. Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy; Scuola di Specializzazione in Oncologia, Università Politecnica delle Marche, Ancona, Italy; Clinica di Oncologia Medica AOU Ospedali Riuniti Ancona, Ancona, Italy; Clinica di Oncologia Medica, A. O. Ospedali Riuniti-Università
| | - Stefano Cascinu
- Scuola di Specializzazione in Oncologia Medica, Università Politecnica delle Marche, Ancona, Italy; Anatomia Patologica, A. O. Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy; A. O. Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy; Scuola di Specializzazione in Oncologia, Università Politecnica delle Marche, Ancona, Italy; Clinica di Oncologia Medica AOU Ospedali Riuniti Ancona, Ancona, Italy; Clinica di Oncologia Medica, A. O. Ospedali Riuniti-Università
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Scartozzi M, Baroni GS, Faloppi L, Paolo MDP, Pierantoni C, Candelari R, Berardi R, Antognoli S, Mincarelli C, Risaliti A, Marmorale C, Antico E, Benedetti A, Cascinu S. Trans-arterial chemo-embolization (TACE), with either lipiodol (traditional TACE) or drug-eluting microspheres (precision TACE, pTACE) in the treatment of hepatocellular carcinoma: efficacy and safety results from a large mono-institutional analysis. J Exp Clin Cancer Res 2010; 29:164. [PMID: 21159184 PMCID: PMC3014898 DOI: 10.1186/1756-9966-29-164] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Accepted: 12/15/2010] [Indexed: 12/15/2022]
Abstract
More data about TACE and pTACE seem necessary to better define the global treatment strategy for HCC. Aim of our analysis was to evaluate the role of TACE, either with lipiodol (traditional) or drug-eluting microspheres in terms of response rate (RR), time to progression (TTP), overall survival (OS) and toxicity in HCC. Patients with HCC undergoing traditional TACE or pTACE (either alone or in combination with other treatment options) were eligible One hundred and fifty patients were analyzed. In the global patient population median OS was 46 months for lipiodol TACE and 19 months for pTACE (p < 0.0001), TTP was 30 months versus 16 months for patients receiving TACE or pTACE respectively (p = 0.003). These results were confirmed also among the group of patients who received exclusive TACE or pTACE. Neither RR nor toxicity was different between TACE or pTACE. At multivariate analysis, age, the Okuda stage, type of TACE and number of TACE proved to be independent prognostic factors influencing overall survival. In our experience, lipiodol TACE showed a better OS and TTP over pTACE, without difference in toxicity profile and RR. Among the staging systems analyzed only the Okuda stage seemed able to reliably predict patients outcome.
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Affiliation(s)
- Mario Scartozzi
- Clinica di Oncologia Medica, AO Ospedali Riuniti-Università Politecnica delle Marche, via Conca, 60020, Ancona, Italy
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6
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Scartozzi M, Galizia E, Verdecchia L, Berardi R, Antognoli S, Chiorrini S, Cascinu S. Chemotherapy for advanced gastric cancer: across the years for a standard of care. Expert Opin Pharmacother 2007; 8:797-808. [PMID: 17425475 DOI: 10.1517/14656566.8.6.797] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Chemotherapy is of crucial importance in advanced gastric cancer patients, in order to obtain palliation of symptoms and improve survival. The most extensively studied drugs as single agents are 5-fluorouracil, cisplatin, doxorubicin, epirubicin, mitomycin C and etoposide. Newer chemotherapeutic agents include the taxanes (docetaxel and paclitaxel), oral fluoropyrimidines (capecitabine and S-1), oxaliplatin and irinotecan. Randomised trials comparing monotherapy with combination regimens have consistently shown increased response rates in favour of combination regimens, whereas only marginally improved survival rates were usually found. Several combination therapies have been developed and have been examined in Phase III trials. However, in most cases, they have failed to demonstrate a survival advantage over the reference arm. There is no internationally accepted standard of care, and uncertainty remains regarding the choice of the optimal chemotherapy regimen. The objective of this article is to review the present literature available on major Phase II - III clinical trials, in which patients suffering from advanced gastric cancer were treated with cytotoxic chemotherapy.
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Affiliation(s)
- Mario Scartozzi
- Università Politecnica delle Marche, Department of Clinica di Oncologia Medica, Azienda Ospedaliera Ospedali Riuniti, Ancona, Italy
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7
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Scartozzi M, Pierantoni C, Berardi R, Antognoli S, Bearzi I, Cascinu S. Epidermal growth factor receptor: a promising therapeutic target for colorectal cancer. Anal Quant Cytol Histol 2006; 28:61-8. [PMID: 16637508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
The epidermal growth factor receptor is a 170,000-kd transmembrane glycoprotein involved in signaling pathways affecting cellular growth, differentiation, and proliferation. An abnormal expression of the epidermal growth factor receptor (EGFR) has been described in many human tumors and implicated in the development and prognosis of malignancies, thus representing not only a possible prognostic marker, but primarily a rational molecular target for a new class of anticancer agents. The aim of this analysis is to review the available data about the biology of the EGFR and its use as a target for a new class of anticancer agents for colorectal cancer. Several clinical trials have been reported with the use of EGFR-targeted monoclonal antibodies and tyrosine kinase inhibitors, mainly in combination with chemotherapy for advanced colorectal cancer patients. Results available so far demonstrated a manageable and acceptable toxicity profile and a promising level of activity. Many critical issues are yet unresolved, such as the optimal chemotherapy regimen to combine with anti-EGFR treatment and the most adequate patient setting. Moreover, the biological selection of colorectal tumors more likely to benefit from this treatment approach is still to be defined.
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Affiliation(s)
- Mario Scartozzi
- Department of Clinica di Oncologia Medica, Azienda Ospedaliera Ospedali Riuniti-Università Politecnica delle Marche, Ancona and Istituto di Anatomia Patologica, Università Politecnica delle Marche, Ancona, Italy.
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Berardi R, Scartozzi M, Romagnoli E, Antognoli S, Cascinu S. Gastric cancer treatment: a systematic review. Oncol Rep 2004; 11:911-6. [PMID: 15010894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
Gastric cancer remains one of the leading causes of cancer related deaths worldwide. The overall 5-year survival rate in the United States and most of the Western World ranges from 5 to 15%. The only potentially curative treatment for localized gastric cancer is complete surgical resection. Meta-analyses of adjuvant systemic chemotherapy in gastric cancer have shown at best marginal benefits, neoadjuvant chemotherapy and chemoradiotherapy are also feasible and are the subject of several ongoing studies. In metastatic disease, chemotherapy confers benefit when compared with best supportive care alone. This review will focus on the several treatment modalities available for gastric cancer patients: surgery, adjuvant, neoadjuvant and palliative chemotherapy as well as new target agents.
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Affiliation(s)
- Rossana Berardi
- Clinica di Oncologia Medica, Università Politecnica delle Marche-Azienda Ospedaliera Umberto I, 60020 Ancona, Italy.
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Scartozzi M, Galizia E, Antognoli S, Bracci R, Grillo-Ruggieri F, Mantello G, Marmorale C, Berardi R, Cascinu S, Cellerino R. 243 Preoperative chemotherapy plus concomitant radiotherapy in rectal cancer patients (pts): updated results of a phase II study. EJC Suppl 2003. [DOI: 10.1016/s1359-6349(03)90276-x] [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: 11/16/2022] Open
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Cascinu S, Graziano F, Ferraù F, Catalano V, Massacesi C, Santini D, Silva RR, Barni S, Zaniboni A, Battelli N, Siena S, Giordani P, Mari D, Baldelli AM, Antognoli S, Maisano R, Priolo D, Pessi MA, Tonini G, Rota S, Labianca R. Raltitrexed plus oxaliplatin (TOMOX) as first-line chemotherapy for metastatic colorectal cancer. A phase II study of the Italian Group for the Study of Gastrointestinal Tract Carcinomas (GISCAD). Ann Oncol 2002; 13:716-20. [PMID: 12075739 DOI: 10.1093/annonc/mdf091] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND To evaluate the safety and efficacy of the novel raltitrexed/oxaliplatin combination (TOMOX) as first-line chemotherapy for patients with advanced colorectal cancer. MATERIALS AND METHODS Previously untreated patients with metastatic colorectal cancer received raltitrexed 3 mg/m2 plus oxaliplatin 100 mg/m2, both intravenously, on day 1 every 3 weeks. Patients were re-evaluated after every third cycle and chemotherapy was continued up to tolerance or disease progression. RESULTS Fifty-eight patients from 13 Italian Group for the Study of Gastrointestinal Tract Carcinomas (GISCAD) centers were accrued from September 1999 to November 2000. According to the intention-to-treat analysis from 58 patients, the overall response rate was 50% [95% confidence interval (CI) 38% to 62%], with three complete responses and 26 partial responses. The median overall survival (44 patients currently alive) was >9 months and the median time to disease progression was 6.5 months (range 1-15 months). The main hematological toxicity was grade III/IV neutropenia, which occurred in 17% of patients, while anemia and thrombocytopenia were uncommon. Grade III/IV non-hematological toxicities were transient transaminitis (17% of patients); asthenia (16% of patients); neurotoxicity (10% of patients) and diarrhea (7% of patients). No toxic death was observed, one patient with grade IV asthenia after the first cycle refused chemotherapy. CONCLUSIONS The results of this study suggest that the TOMOX combination is an effective and well tolerated regimen for the treatment of advanced colorectal cancer. Its ease of administration and patient tolerance warrant further investigation as an alternative to fluoropyrimidine-based regimens with repeated and prolonged fluorouracil infusions.
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Affiliation(s)
- S Cascinu
- Department of Medical Oncology, Azienda Ospedaliera di Parma, Italy.
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Massacesi C, Bascioni R, Cellerino R, Scartozzi M, Bracci R, Alessandroni P, Antognoli S, Ciavattini A, De Nictolis M, Piga A. Cisplatin, epirubicin and cyclophosphamide (PEC) in the treatment of advanced ovarian cancer. J Exp Clin Cancer Res 2000; 19:13-6. [PMID: 10840930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
We report the long-term results of a series of patients affected by advanced epithelial ovarian cancer treated with the PEC combination (cisplatin 60 mg/m2, epirubicin 60 mg/m2 and cyclophosphamide 750 mg/m2, all at day 1, every 21 days). Response was evaluated after three cycles, and treatment continued in responsive patients. A total of 80 patients with a median follow-up of 55 months were studied. Fifty-eight patients with stage III ovarian cancer and 22 patients with stage IV received PEC as primary treatment (41 patients), or for residual disease after surgery (37 patients), or for relapsed disease after primary surgery (2 patients). The overall response rate was 67.5% (20.0% complete response, 47.5% partial response), with 22.5% stable disease and 3.7% progressive disease. Median progression free survival was 13.0 months, and median survival was 25 months. Grade III-IV toxicity was moderate: leukopenia 20.0% of patients, thrombocytopenia 5.0%, anemia 16.2%. No cardiac toxicity was observed. In conclusion, the PEC combination, an anthracycline-containing platinum-based regimen, proved to be effective in advanced ovarian cancer, in terms of response rate and overall survival. The regimen was devoid of significant toxicity and in particular of cardiac toxicity.
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Affiliation(s)
- C Massacesi
- Medical Oncology, University of Ancona, Italy
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Piga A, Giordani P, Quattrone A, Giulioni M, Signoribus GD, Antognoli S, Cellerino R. A phase II study of interferon alpha and low-dose subcutaneous interleukin-2 in advanced renal cell carcinoma. Cancer Immunol Immunother 1997; 44:348-51. [PMID: 9298938 PMCID: PMC11037662 DOI: 10.1007/s002620050393] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [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] [Indexed: 02/05/2023]
Abstract
The activity of the drugs employed in the treatment of metastatic renal cell carcinoma, including biological response modifiers, is limited; one of the aims of clinical research in this area is to maintain the benefits of treatment whilst reducing its toxicity to a minimum level. We have evaluated toxicity and response of the combined administration of recombinant interferon alpha (IFN alpha) and low-dose subcutaneous (s.c.) recombinant interleukin-2 (IL-2) in patients with advanced renal cell carcinoma. A group of 20 previously untreated patients with advanced renal cell carcinoma were included in the study. Treatment consisted of 3 MU/m2 recombinant IFN alpha daily i.m. continuously, and 0.5 MU/m2 recombinant IL-2 twice a day s.c. on days 1-5 for the first week, followed by 1 MU/m2 twice a day for 5 days in the following weeks. For IL-2, a 1-week rest was allowed after 4 weeks of treatment. Response was assessed after 3 months of therapy. Three objective responses were seen, one complete and two partial. Eight patients had stable disease. The median time to progression was 6 months; the median survival for all patients was 14 months. Side-effects were low, limited to grades 1 and 2 in the majority of patients, and included fever, anemia, leukopenia, dyspnea, and abnormalities of liver and renal function tests. Any flu-like syndrome was judged moderate in most patients; however, one-third of the patients refused treatment mostly because of the flu-like syndrome. One of these was the patient experiencing a complete response, who virtually received IFN alpha alone. This regimen, similar to others employed in the treatment of advanced renal cell carcinoma, produced a 15% response rate (95% confidence interval, 0-31%) with 14 months median survival, moderate toxicity and low cost, and required no hospitalization. These data seem to indicate an effectiveness comparable to, and a toxicity lower than, that of regimens employing higher doses of IL-2.
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Affiliation(s)
- A. Piga
- Medical Oncology, University of Ancona, Ospedale Torrette, 60023 Ancona, Italy Tel. +39 71 882581; Fax +39 71 882582 e-mail , , , , IT
| | - Paolo Giordani
- Medical Oncology, University of Ancona, Ospedale Torrette, 60023 Ancona, Italy Tel. +39 71 882581; Fax +39 71 882582 e-mail , , , , IT
| | - Agata Quattrone
- Medical Oncology, University of Ancona, Ospedale Torrette, 60023 Ancona, Italy Tel. +39 71 882581; Fax +39 71 882582 e-mail , , , , IT
| | - Marco Giulioni
- Medical Oncology, University of Ancona, Ospedale Torrette, 60023 Ancona, Italy Tel. +39 71 882581; Fax +39 71 882582 e-mail , , , , IT
| | - Giorgio De Signoribus
- Medical Oncology, University of Ancona, Ospedale Torrette, 60023 Ancona, Italy Tel. +39 71 882581; Fax +39 71 882582 e-mail , , , , IT
| | - Stefania Antognoli
- Medical Oncology, University of Ancona, Ospedale Torrette, 60023 Ancona, Italy Tel. +39 71 882581; Fax +39 71 882582 e-mail , , , , IT
| | - Riccardo Cellerino
- Medical Oncology, University of Ancona, Ospedale Torrette, 60023 Ancona, Italy Tel. +39 71 882581; Fax +39 71 882582 e-mail , , , , IT
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Giorgi F, Cellerino R, Gramazio A, Tummarello D, Menichetti ET, Giordani P, Antognoli S, Carle F, Piga A. Assessing quality of life in patients with cancer: a comparison of a visual-analogue and a categorical model. Am J Clin Oncol 1996; 19:394-9. [PMID: 8677913 DOI: 10.1097/00000421-199608000-00016] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
A simple instrument for self-assessment of quality of life (QL) in patients with cancer was elaborated using a linear analogue scale (LAS). The instrument was based on five questions, exploring different functional areas; the same questions were also addressed in a parallel format, where problems were seen from an opposite point of view (positive/negative). The LAS was given to 222 patients, for a total of 372 tests collected. Internal consistency was satisfactory (Cronbach's alpha = 0.75); QL score was significantly correlated to parameters of disease. Concordance between scales, as judged by comparison of parallel formats, was statistically significant but poor. A questionnaire was then elaborated with similar items, based on a categorical scale. A direct comparison between LAS and our questionnaire was made on a group of 41 patients. Internal consistency was poor for the LAS (alpha = 0.58) and good for the questionnaire (alpha = 0.93); Spearman's rank correlation coefficients were disappointing for the LAS and good for the questionnaire; the questionnaire was judged reliable in 82.9% of cases, the LAS in 29.3% only; the questionnaire score, and not the LAS score, was significantly correlated with PS and disease status. In conclusion, many patients appeared unable to correctly interpret the visual-analogue scale; the categorical scale was more immediate and correctly understood by the large majority of patients; the correlation between score and important parameters of QL was maintained, and internal consistency was excellent, indicating a satisfactory reliability of this instrument.
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Affiliation(s)
- F Giorgi
- Department of Medical Oncology, University of Ancona, Italy
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Cascinu S, Latini L, Fedeli A, Giordani P, Antognoli S, Catalano G, Cellerino R. The clinical impact of FEM regimen (5-fluorouracil, 4-epidoxorubicin and mitomycin-C) in advanced gastric cancer patients. Anticancer Res 1995; 15:2781-3. [PMID: 8669864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The activity of FEM regimen in metastatic gastric cancer patients was assessed in seventy-seven patients receiving, as palliative treatment, 5FU 600 mg/m2 i.v. on days 1, 8, 29, 36; epiADR 70 mg/m2 i.v. on days 1, 29; MIT-C 10 mg/m2 i.v. on days 1, 29. Cycles were repeated every 58 days. One patient achieved a complete response and 12 a partial response, resulting in an overall response rate of 16% (95% CI: 8% to 24%). Median remission duration was 6 months. Median survival time for all patients was 8 months. Side-effects were mild and principally in the form of leukopenia (three episodes grade III). Our results support the recent findings about the lack of effectiveness of this regimen. Although it is a safe and well tolerable chemotherapeutic combination, FEM regimen should not be recommended as routinary treatment for gastric cancer patients who are not eligible for clinical trials.
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Affiliation(s)
- S Cascinu
- Clinica di Oncologia Medica, Università di Ancona, Italy
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Manna P, Giuseppetti GM, Latini L, Baldassarre S, Antognoli S. [A case of leiomyoma of the breast]. Radiol Med 1993; 86:155-8. [PMID: 8346349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- P Manna
- Istituto di Oncologia Clinica, Ospedale Torrette, USL 12 di Ancona
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