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Ardavanis-Loukeris G, Kokkali S, Perdikari K, Karatrasoglou E, Talagani S, Tzovaras A, Ardavanis A. A Real-world Study of Everolimus Plus Aromatase Inhibitor in Hormone Receptor-positive, HER2-negative Advanced Breast Cancer. Anticancer Res 2024; 44:1559-1565. [PMID: 38537957 DOI: 10.21873/anticanres.16953] [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: 12/26/2023] [Revised: 01/22/2024] [Accepted: 02/25/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND/AIM Everolimus in combination with exemestane was shown to offer benefit versus exemestane monotherapy in hormone receptor (HR)-positive, HER2-negative advanced breast cancer patients who progressed after aromatase inhibitor (AI) therapy. PATIENTS AND METHODS The medical records of metastatic breast cancer patients, treated with everolimus, were retrospectively reviewed to generate real life safety and efficacy data. RESULTS Sixty-eight percent of the patients had received chemotherapy (for early or metastatic disease) and 26% had received chemotherapy for metastatic disease. Among the 25 included patients, the most common adverse events were fatigue, neutropenia, epistaxis, stomatitis, and pneumonitis. Toxicity led to treatment discontinuation in 3 patients (12%). The median progression-free survival (PFS) was 7 months (95%CI=3.5-10.5). With a median follow-up of 73.3 months, the median overall survival was not reached. Twenty-five percent of the patients had received prior therapy with CDK4/6 inhibitors. Median PFS was significantly shorter in this subgroup (p=0.025). There was also a trend towards a longer PFS in patients with grade 3 breast cancer (p=0.085) and in patients receiving everolimus as first-line treatment (p=0.081). Some long responses were noted, with four patients exhibiting a PFS >5 years. CONCLUSION These real-life data show that everolimus in combination with AI in patients with HER2-negative, HR-positive advanced breast cancer is an effective treatment with an acceptable toxicity profile.
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Affiliation(s)
| | - Stefania Kokkali
- 1 Medical Oncology Clinic, Saint-Savvas Anticancer Hospital, Athens, Greece;
- Oncology Unit, 2 Department of Medicine, National and Kapodistrian University of Athens, Medical School, Hippocratio General Hospital of Athens, Athens, Greece
| | | | | | - Sofia Talagani
- 1 Medical Oncology Clinic, Saint-Savvas Anticancer Hospital, Athens, Greece
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2
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Zylis D, Kokkali S, Sofopoulos M, Zografaki E, Vourlakou C, Skafida E. Metastatic Granular Cell Tumor: A Rare Entity. Int J Surg Pathol 2024:10668969241229347. [PMID: 38321950 DOI: 10.1177/10668969241229347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Granular cell tumor, which is thought to recapitulate a Schwann cell phenotype, is a very rare neoplasm that belongs to soft tissue tumors. It can be classified as benign, atypical or malignant, based on specific histological criteria, with the majority of cases exhibiting an indolent behavior. Its biology and clinical course are poorly understood and its optimal management is yet to be defined, given the rarity of cases. Here we describe an atypical granular cell tumor in the upper middle back skin that evolved after a thirty-year indolent period. Despite complete surgical removal, the patient experienced a recurrence, both local and in the lungs, following an aggressive clinical course. Data on management of metastatic disease are extremely scarce, comprised exclusively of case reports. Therefore, we administered to the patient systemic therapy according to soft tissue sarcoma guidelines, which led to disease progression, with fatal outcome. In conclusion, recurrent and/or metastatic granular cell tumor is a rare disease that can be life-threatening, for which response to different therapies is unknown. The biologic behavior of atypical and malignant granular cell tumor is quite different from its benign counterpart, evoking soft tissue sarcomas, and its diagnosis should alert clinicians. The role of adjuvant chemotherapy and radiation therapy in this setting should be explored, to limit disease recurrence.
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Affiliation(s)
- Dimosthenis Zylis
- First Medical Oncology Clinic, Saint-Savvas Cancer Hospital, Athens, Greece
| | - Stefania Kokkali
- First Medical Oncology Clinic, Saint-Savvas Cancer Hospital, Athens, Greece
- Oncology Unit, 2nd Department of Medicine, National and Kapodistrian University of Athens, Medical School, Hippocratio General Hospital of Athens, Athens, Greece
| | | | - Eirini Zografaki
- Department of Plastic Surgery, Saint-Savvas Cancer Hospital, Athens, Greece
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3
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Kokkali S, Georgaki E, Mandrakis G, Valverde C, Theocharis S. Genomic Profiling and Clinical Outcomes of Targeted Therapies in Adult Patients with Soft Tissue Sarcomas. Cells 2023; 12:2632. [PMID: 37998367 PMCID: PMC10670373 DOI: 10.3390/cells12222632] [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: 10/01/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 11/25/2023] Open
Abstract
Genomic profiling has improved our understanding of the pathogenesis of different cancers and led to the development of several targeted therapies, especially in epithelial tumors. In this review, we focus on the clinical utility of next-generation sequencing (NGS) to inform therapeutics in soft tissue sarcoma (STS). The role of NGS is still controversial in patients with sarcoma, given the low mutational burden and the lack of recurrent targetable alterations in most of the sarcoma histotypes. The clinical impact of genomic profiling in STS has not been investigated prospectively. A limited number of retrospective, mainly single-institution, studies have addressed this issue using various NGS technologies and platforms and a variety of criteria to define a genomic alteration as actionable. Despite the detailed reports on the different gene mutations, fusions, or amplifications that were detected, data on the use and efficacy of targeted treatment are very scarce at present. With the exception of gastrointestinal stromal tumors (GISTs), these targeted therapies are administered either through off-label prescription of an approved drug or enrollment in a matched clinical trial. Based mainly on anecdotal reports, the outcome of targeted therapies in the different STS histotypes is discussed. Prospective studies are warranted to assess whether genomic profiling improves the management of STS patients.
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Affiliation(s)
- Stefania Kokkali
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 11527 Athens, Greece;
- Oncology Unit, 2nd Department of Medicine, Medical School, Hippocratio General Hospital of Athens, National and Kapodistrian University of Athens, V. Sofias 114, 11527 Athens, Greece;
| | - Eleni Georgaki
- Oncology Unit, 2nd Department of Medicine, Medical School, Hippocratio General Hospital of Athens, National and Kapodistrian University of Athens, V. Sofias 114, 11527 Athens, Greece;
| | - Georgios Mandrakis
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 11527 Athens, Greece;
| | - Claudia Valverde
- Medical Oncology Department, Vall d’Hebron University Hospital, Pg. Vall d’Hebron 119-12, 08035 Barcelona, Spain;
| | - Stamatios Theocharis
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 11527 Athens, Greece;
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Stergioula A, Kokkali S, Pantelis E. Multimodality treatment of primary cardiac angiosarcoma: A systematic literature review. Cancer Treat Rev 2023; 120:102617. [PMID: 37603906 DOI: 10.1016/j.ctrv.2023.102617] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/08/2023] [Accepted: 08/15/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Primary cardiac angiosarcoma (PCA) is the most prevalent histological type of cardiac sarcoma but its rarity poses a challenge for standardizing treatment protocols. Moreover, published studies are limited by small patient numbers and lack of randomization, making it challenging to establish evidence-based treatment strategies. This systematic review aims to consolidate the heterogeneous published data and identify factors related to the treatment outcome of PCA patients. METHODS The PubMed and Scopus bibliographic databases were systematically searched for original articles reporting clinical, treatment and outcome data for PCA patients. Kaplan-Meier analysis was used to calculate the time to progression and survival. The Log-Rank test was used to compare progression-free and overall survival data. The Cox proportional hazards regression model was used for univariate and multivariate analysis of survival data. RESULTS A total of 127 studies containing data for 162 patients were analyzed. The median age of the patient cohort was 45 years, with males being 1.5 times more frequently affected than females. Tumors were primarily located on the right side of the heart, with a median size of 6 cm. Median progression-free and overall survival of 5 months and 12 months, respectively, were calculated. Age, sex, and resection margins did not have a significant impact on PCA survival, as determined by both univariate and multivariate analyses. The presence of metastases at diagnosis was associated with lower overall survival in univariate analysis, although this effect was not significant in multivariate analysis. Multimodality treatment that incorporated surgery and adjuvant chemo-radiotherapy was associated with a statistically significant survival benefit. Median overall survival increased from 6 months with surgery alone to 13 months and 27 months with adjuvant chemotherapy and chemo-radiotherapy, respectively. CONCLUSION Multimodality treatment including surgery and chemo-radiotherapy was found to offer the greatest survival benefit for PCA patients.
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Affiliation(s)
- Anastasia Stergioula
- Radiotherapy Department, Iatropolis Clinic, Athens, Greece; Center of Radiotherapy, IASO General Hospital, Athens, Greece.
| | - Stefania Kokkali
- Oncology Unit, Department of Internal Medicine, Hippocratio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Evaggelos Pantelis
- Radiotherapy Department, Iatropolis Clinic, Athens, Greece; Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Psilopatis I, Vrettou K, Kokkali S, Theocharis S. The Role of MicroRNAs in Uterine Leiomyosarcoma Diagnosis and Treatment. Cancers (Basel) 2023; 15:cancers15092420. [PMID: 37173887 PMCID: PMC10177388 DOI: 10.3390/cancers15092420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/19/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023] Open
Abstract
Uterine sarcomas are rare gynecological tumors arising from the myometrium or the connective tissue of the endometrium with a relatively poor prognosis. MicroRNAs (miRNAs) represent small, single-stranded, non-coding RNA molecules that can function as oncogenes or tumor suppressors under certain conditions. The current review aims at studying the role of miRNAs in uterine sarcoma diagnosis and treatment. In order to identify relevant studies, a literature review was conducted using the MEDLINE and LIVIVO databases. The search terms "microRNA" and "uterine sarcoma" were employed, and we were able to identify 24 studies published between 2008 and 2022. The current manuscript represents the first comprehensive review of the literature focusing on the particular role of miRNAs as biomarkers for uterine sarcomas. miRNAs were found to exhibit differential expression in uterine sarcoma cell lines and interact with certain genes correlating with tumorigenesis and cancer progression, whereas selected miRNA isoforms seem to be either over- or under-expressed in uterine sarcoma samples compared to normal uteri or benign tumors. Furthermore, miRNA levels correlate with various clinical prognostic parameters in uterine sarcoma patients, whereas each uterine sarcoma subtype is characterized by a unique miRNA profile. In summary, miRNAs seemingly represent novel trustworthy biomarkers for the diagnosis and treatment of uterine sarcoma.
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Affiliation(s)
- Iason Psilopatis
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, Bld 10, Goudi, 11527 Athens, Greece
- Department of Gynecology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Kleio Vrettou
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, Bld 10, Goudi, 11527 Athens, Greece
| | - Stefania Kokkali
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, Bld 10, Goudi, 11527 Athens, Greece
- Oncology Unit, 2nd Department of Medicine, National and Kapodistrian University of Athens, Medical School, Hippocratio General Hospital of Athens, V. Sofias 114, 11527 Athens, Greece
| | - Stamatios Theocharis
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, Bld 10, Goudi, 11527 Athens, Greece
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Kokkali S, Kyriazoglou A, Mangou E, Economopoulou P, Panousieris M, Psyrri A, Ardavanis A, Vassos N, Boukovinas I. Real-World Data on Cabozantinib in Advanced Osteosarcoma and Ewing Sarcoma Patients: A Study from the Hellenic Group of Sarcoma and Rare Cancers. J Clin Med 2023; 12:jcm12031119. [PMID: 36769769 PMCID: PMC9918141 DOI: 10.3390/jcm12031119] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/04/2023] [Accepted: 01/18/2023] [Indexed: 02/05/2023] Open
Abstract
Advanced osteosarcomas (OSs) and Ewing sarcomas (ESs) tend to have poor prognosis with limited therapeutic options beyond first-line therapy. Aberrant angiogenesis and MET signaling play an important role in preclinical models. The anti-angiogenic drug cabozantinib was tested in a phase 2 trial of advanced OS and ES and was associated with clinical benefits. We retrospectively analyzed the off-label use of cabozantinib in adult patients with advanced OS and ES/primitive neuroectodermal tumors (PNETs) in three centers of the Hellenic Group of Sarcoma and Rare Cancers (HGSRC). Between April 2019 and January 2022, 16 patients started taking 60 mg of cabozantinib for advanced bone sarcoma or PNET. Median age at cabozantinib initiation was 31 years (17-83). All patients had received peri-operative chemotherapy for primary sarcoma and between 0 and 4 lines of treatment (median; 2.5) for advanced disease. The most common adverse effects included fatigue, anorexia, hypertransaminasemia, weight loss, and diarrhea. One toxic death was noted (cerebral hemorrhage). Dose reduction to 40 mg was required in 31.3% of the patients. No objective response was noted, and 9/16 patients exhibited stable disease outcomes. Progression-free survival varied from 1 to 8 (median; 5) months. Our study demonstrates that cabozantinib has antitumor activity in this population. In the real-life setting, we observed similar adverse events as in the CABONE study and in other neoplasms.
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Affiliation(s)
- Stefania Kokkali
- Department of Medical Oncology, Saint-Savvas Anticancer Hospital, 11522 Athens, Greece
- Medical Oncology Unit, Department of Internal Medicine, Hippocratio General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Correspondence: ; Tel.: +30-2132089511
| | - Anastasios Kyriazoglou
- Medical Oncology Unit, Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Elpida Mangou
- Department of Medical Oncology, Saint-Savvas Anticancer Hospital, 11522 Athens, Greece
| | - Panagiota Economopoulou
- Medical Oncology Unit, Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Michail Panousieris
- Department of Medical Oncology, Saint-Savvas Anticancer Hospital, 11522 Athens, Greece
| | - Amanda Psyrri
- Medical Oncology Unit, Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Alexandros Ardavanis
- Department of Medical Oncology, Saint-Savvas Anticancer Hospital, 11522 Athens, Greece
| | - Nikolaos Vassos
- Medical Faculty Mannheim, University Medical Center Mannheim, University of Heidelberg, 68167 Mannheim, Germany
| | - Ioannis Boukovinas
- Department of Medical Oncology, Bioclinic Hospital, 54622 Thessaloniki, Greece
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Masaoutis C, Palamaris K, Kokkali S, Levidou G, Theocharis S. Unraveling the Immune Microenvironment of Thymic Epithelial Tumors: Implications for Autoimmunity and Treatment. Int J Mol Sci 2022; 23:ijms23147864. [PMID: 35887212 PMCID: PMC9323059 DOI: 10.3390/ijms23147864] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 07/14/2022] [Indexed: 11/16/2022] Open
Abstract
Thymic Epithelial Tumors (TETs) represent a rare tumor family, originating from the epithelial component of the thymus gland. Clinicopathologically, they are segregated into six major subtypes, associated with distinct histological features and clinical outcomes. Their emergence and evolution are accompanied by the generation of a complex tumor microenvironment (TME), dominated by phenotypically and functionally divergent immune cellular subsets, in different maturation states and in analogies that vary significantly among different subtypes. These heterogenous leukocyte populations exert either immune-permissive and tumor-suppressive functions or vice versa, and the dynamic equilibrium established among them either dictates the tumor immune milieu towards an immune-tolerance state or enables the development of a productive spontaneous tumoricidal response. The immunologically “hot” microenvironment, defining a significant proportion of TETs, makes them a promising candidate for the implementation of immune checkpoint inhibitors (ICIs). A number of phase I and II clinical trials have already demonstrated significant, type-specific clinical efficacy of PD-L1 inhibitors, even though substantial limitations in their utilization derive from their immune-mediated adverse effects. Moreover, the completed clinical studies involved relatively restricted patient samples and an expansion in the enrolled cohorts is required, so that more trustworthy conclusions regarding the benefit from ICIs in TETs can be extracted.
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Affiliation(s)
- Christos Masaoutis
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, 75, M. Asias Str., Bld 10, Goudi, GR11527 Athens, Greece; (C.M.); (K.P.); (G.L.)
| | - Kostas Palamaris
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, 75, M. Asias Str., Bld 10, Goudi, GR11527 Athens, Greece; (C.M.); (K.P.); (G.L.)
| | - Stefania Kokkali
- Oncology Unit, 2nd Department of Medicine, Medical School, National and Kapodistrian University of Athens, Hippocratio General Hospital of Athens, 114, V. Sofias Str., GR11527 Athens, Greece;
| | - Georgia Levidou
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, 75, M. Asias Str., Bld 10, Goudi, GR11527 Athens, Greece; (C.M.); (K.P.); (G.L.)
- Second Department of Pathology, Paracelsus Medical University, 90419 Nurenberg, Germany
| | - Stamatios Theocharis
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, 75, M. Asias Str., Bld 10, Goudi, GR11527 Athens, Greece; (C.M.); (K.P.); (G.L.)
- Correspondence:
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Hadjimichael AC, Pergaris A, Kaspiris A, Foukas AF, Kokkali S, Tsourouflis G, Theocharis S. The EPH/Ephrin System in Bone and Soft Tissue Sarcomas' Pathogenesis and Therapy: New Advancements and a Literature Review. Int J Mol Sci 2022; 23:ijms23095171. [PMID: 35563562 PMCID: PMC9100911 DOI: 10.3390/ijms23095171] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/02/2022] [Accepted: 05/04/2022] [Indexed: 12/04/2022] Open
Abstract
Musculoskeletal sarcomas represent rare heterogenous malignancies of mesenchymal origin that can be divided in two distinct subtypes, bone and soft tissue sarcomas. Current treatment options combine the surgical excision of local tumors and multidrug chemotherapy to prevent metastatic widespread disease. Due to the grim prognosis that usually accompanies such tumors, researchers have attempted to shed light on the molecular pathways implicated in their pathogenesis in order to develop novel, innovative, personalized therapeutic strategies. Erythropoietin-producing human hepatocellular receptors (EPHs) are tyrosine-kinase transmembrane receptors that, along with their ligands, ephrins, participate in both tumor-suppressive or tumor-promoting signaling pathways in bone and soft tissue sarcomas. The EPH/ephrin axis orchestrates cancerous processes such as cell–cell and cell–substrate adhesion and enhances the remodeling of the intracellular cytoskeleton to stimulate the motility and invasiveness of sarcoma cells. The purpose of our study was to review published PubMed literature to extract results from in vitro, in vivo and clinical trials indicative of the role of EPH/ephrin signaling in bone and soft tissue sarcomas. Based on these reports, significant interactions between the EPH/ephrin signaling pathway and a plethora of normal and abnormal cascades contribute to molecular mechanisms enhancing malignancy during sarcoma progression. In addition, EPHs and ephrins are prospective candidates for diagnostic, monitoring and therapeutic purposes in the clinical setting against bone and soft tissue sarcomas.
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Affiliation(s)
- Argyris C. Hadjimichael
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 11527 Athens, Greece; (A.C.H.); (A.P.); (S.K.); (G.T.)
- Department of Orthopaedics, St Mary’s Hospital, Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, UK
| | - Alexandros Pergaris
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 11527 Athens, Greece; (A.C.H.); (A.P.); (S.K.); (G.T.)
| | - Angelos Kaspiris
- Laboratory of Molecular Pharmacology, Department of Pharmacy, School of Health Sciences, University of Patras, 26504 Patras, Greece;
| | - Athanasios F. Foukas
- Third Department of Orthopaedic Surgery, “KAT” General Hospital of Athens, Nikis 2, 14561 Kifissia, Greece;
| | - Stefania Kokkali
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 11527 Athens, Greece; (A.C.H.); (A.P.); (S.K.); (G.T.)
| | - Gerasimos Tsourouflis
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 11527 Athens, Greece; (A.C.H.); (A.P.); (S.K.); (G.T.)
| | - Stamatios Theocharis
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 11527 Athens, Greece; (A.C.H.); (A.P.); (S.K.); (G.T.)
- Correspondence:
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Kokkali S, Boukovinas I, Samantas E, Papakotoulas P, Athanasiadis I, Andreadis C, Makrantonakis P, Samelis G, Timotheadou E, Vassilopoulos G, Papadimitriou C, Tzanninis D, Ardavanis A, Kotsantis I, Karvounis-Marolachakis K, Theodoropoulou T, Psyrri A. A Multicenter, Prospective, Observational Study to Assess the Clinical Activity and Impact on Symptom Burden and Patients' Quality of Life in Patients with Advanced Soft Tissue Sarcomas Treated with Trabectedin in a Real-World Setting in Greece. Cancers (Basel) 2022; 14:1879. [PMID: 35454787 PMCID: PMC9031293 DOI: 10.3390/cancers14081879] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/28/2022] [Accepted: 04/04/2022] [Indexed: 11/16/2022] Open
Abstract
This non-interventional, multicenter, prospective study aimed to evaluate the real-world activity of trabectedin, and its impact on symptom burden and quality of life in patients with advanced soft tissue sarcoma (aSTS) treated in routine clinical settings in Greece. Patients with histologically confirmed aSTS newly initiated on trabectedin were enrolled. The primary endpoint was progression-free survival (PFS) rate at 6 months. Secondary endpoints included PFS rate at 3 months, median PFS, objective response rate (ORR), disease control rate (DCR), overall survival (OS), and an assessment of the impact of treatment on health-related quality of life (HRQoL), cancer-related symptom burden and symptom interference with function, as well as all-cause treatment discontinuation rate. A total of 64 eligible patients from 13 Greek centers were evaluated. Patients received a median of three trabectedin cycles per patient (interquartile range [IQR]: 2.0-6.0). Median PFS was 6.6 months with 67.9% and 51.2% of patients free from progression at 3 and 6 months, respectively. ORR was 7.8% and DCR 21.9%. Median OS was 13.1 months. No significant changes from enrolment were noted in HRQoL scores. In total, 30 patients (46.9%) had at least one trabectedin-related adverse drug reaction (ADR) and 9 (14.1%) at least one serious ADR. The treatment discontinuation rate due to toxicity was 9.4%. These results suggest that trabectedin is an active treatment with clinically meaningful benefits in patients with aSTS with no new safety signals.
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Affiliation(s)
- Stefania Kokkali
- First Department of Medical Oncology, Agios Savvas Athens General Hospital, 11522 Athens, Greece;
| | - Ioannis Boukovinas
- Medical Oncology, Bioclinic of Thessaloniki, 54622 Thessaloniki, Greece;
| | - Epaminondas Samantas
- Third Oncology Clinic, Agioi Anargiroi Athens General Hospital, 14564 Athens, Greece;
| | - Pavlos Papakotoulas
- First Chemotherapeutic Oncology Department, Theagenion Anti-Cancer Hospital of Thessaloniki, 54639 Thessaloniki, Greece;
| | - Ilias Athanasiadis
- Oncology Department, Hygeia Athens Private Hospital, 15123 Maroussi, Greece;
| | - Charalampos Andreadis
- Third Department of Clinical Oncology and Chemotherapy, Theagenion Anti-Cancer Hospital of Thessaloniki, 54639 Thessaloniki, Greece;
| | - Parisis Makrantonakis
- Second Department of Clinical Oncology and Chemotherapy, Theagenion Anti-Cancer Hospital of Thessaloniki, 54639 Thessaloniki, Greece;
| | - Georgios Samelis
- Oncology Department, Hippocration General Hospital of Athens, 11527 Athens, Greece;
| | - Eleni Timotheadou
- Department of Medical Oncology, Papageorgiou Hospital, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 54629 Thessaloniki, Greece;
| | | | - Christos Papadimitriou
- Oncology Unit, Aretaieion University Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece;
| | | | - Alexandros Ardavanis
- First Department of Medical Oncology, Agios Savvas Athens General Hospital, 11522 Athens, Greece;
| | - Ioannis Kotsantis
- Division Medical Oncology, Attikon University General Hospital of Athens, 12462 Haidari, Greece; (I.K.); (A.P.)
| | | | | | - Amanda Psyrri
- Division Medical Oncology, Attikon University General Hospital of Athens, 12462 Haidari, Greece; (I.K.); (A.P.)
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Kokkali S, Moreno JD, Klijanienko J, Theocharis S. Clinical and Molecular Insights of Radiation-Induced Breast Sarcomas: Is There Hope on the Horizon for Effective Treatment of This Aggressive Disease? Int J Mol Sci 2022; 23:ijms23084125. [PMID: 35456944 PMCID: PMC9029574 DOI: 10.3390/ijms23084125] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/31/2022] [Accepted: 04/01/2022] [Indexed: 11/16/2022] Open
Abstract
Radiation-induced breast sarcomas (RIBS) are rare entities representing <1% of all primary breast malignancies, limiting most reports to small retrospective case series. They constitute a heterogeneous group of neoplasms, with high-grade angiosarcoma being the most common subtype. Other sarcoma histotypes, such as undifferentiated pleomorphic sarcoma and leiomyosarcoma, can also be identified. Radiation-induced breast angiosarcoma (RIBA) has an incidence of approximately 0.1% after breast-conserving therapy and arises mainly from the dermis of the irradiated breast. MYC gene amplification is highly indicative of secondary breast angiosarcomas. Their clinical presentation often mimics benign port-radiation lesions, leading to a delay in diagnosis and a lost window of opportunity for cure. Surgery with negative margins is the mainstay of treatment of localized RIBS. In the case of angiosarcoma, technical difficulties, including multifocality, infiltrative margins, and difficulty in assessing tumor margins, render surgical treatment quite challenging. A limited number of studies showed that adjuvant radiation therapy reduces local recurrences; therefore, it is proposed by many groups for large, high-grade tumors. Chemotherapy has been evaluated retrospectively in a small subset of patients, with some evidence supporting its use in angiosarcoma patients. Approximately half of patients with RIBA will show local recurrence. In the advanced setting, different therapeutic options are discussed in the review, including chemotherapy, antiangiogenic therapy, and immunotherapy, whereas the need for further research on molecular therapeutic targets is pointed out.
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Affiliation(s)
- Stefania Kokkali
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 11527 Athens, Greece;
- Oncology Unit, 2nd Department of Medicine, Medical School, National and Kapodistrian University of Athens, Hippocratio General Hospital of Athens, V. Sofias 114, 11527 Athens, Greece
- Correspondence: ; Tel.: +30-6932326547
| | - Jose Duran Moreno
- Hellenic Group of Sarcoma and Rare Cancers, G. Theologou 5, 11471 Athens, Greece;
| | - Jerzy Klijanienko
- Department of Pathology, Institut Curie, 26 Rue d’Ulm, CEDEX 05, 75248 Paris, France;
| | - Stamatios Theocharis
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 11527 Athens, Greece;
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Kokkali S, Saloustros E, Stefanou D, Makrantonakis P, Kentepozidis N, Boukovinas I, Xenidis N, Katsaounis P, Ardavanis A, Ziras N, Christopoulou A, Rigas G, Kalbakis K, Vardakis N, Emmanouilides C, Athanasiadis I, Anagnostopoulos A, Hatzidaki D, Prinarakis E, Simopoulou F, Kotsakis A, Georgoulias V. Front-Line Bevacizumab plus Chemotherapy with or without Maintenance Therapy for Metastatic Breast Cancer: An Observational Study by the Hellenic Oncology Research Group. Curr Oncol 2022; 29:1237-1251. [PMID: 35200604 PMCID: PMC8871254 DOI: 10.3390/curroncol29020105] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 11/16/2022] Open
Abstract
Front-line bevacizumab (BEV) in combination with taxanes offers benefit in progression-free survival (PFS) in metastatic breast cancer (mBC). The medical records of mBC patients, treated with front-line BEV-based chemotherapy, were retrospectively reviewed in order to generate real life safety and efficacy data. Patients with human epidermal growth factor receptor 2 (HER2)-negative mBC treated with front-line BEV in combination with chemotherapy were eligible. Maintenance therapy with BEV and/or hormonal agents was at the physicians’ discretion. Among the 387 included patients, the most common adverse events were anemia (61.9%, mainly grade 1), grade 3/4 neutropenia (16.5%), grade 1/2 fatigue (22.3%), and grade 1/2 neuropathy (19.6%). Dose reductions were required in 164 cycles (7.1%) and toxicity led to treatment discontinuation in 21 patients (5.4%). The median PFS and the median overall survival (OS) were 13.3 (95% CI: 11.7–14.8) and 32.3 months (95% CI: 27.7–36.9), respectively. Maintenance therapy, with hormonal agents (ET) and/or BEV, was associated with longer OS versus no maintenance therapy (47.2 versus 23.6 months; p < 0.001) in patients with hormone receptor (HR)-positive disease and BEV maintenance offered longer OS versus no maintenance in patients with HR-negative disease (52.8 versus 23.3; p = 0.023). These real-life data show that front-line BEV-based chemotherapy in HER2-negative mBC patients is an effective treatment with an acceptable toxicity profile. The potential benefit of maintenance treatment, especially ET, is important and warrants further research.
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Affiliation(s)
- Stefania Kokkali
- 1st Department of Medical Oncology, Saint Savas Anticancer Hospital, 11522 Athens, Greece; (S.K.); (D.S.); (A.A.)
| | | | - Dimitra Stefanou
- 1st Department of Medical Oncology, Saint Savas Anticancer Hospital, 11522 Athens, Greece; (S.K.); (D.S.); (A.A.)
| | - Paris Makrantonakis
- 2nd Department of Medical Oncology, Theageneio Anticancer Hospital, 54639 Thessaloniki, Greece;
| | - Nikolaos Kentepozidis
- Department of Medical Oncology, 251 Airforce General Hospital, 11525 Athens, Greece;
| | | | - Nikolaos Xenidis
- Department of Medical Oncology, University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece;
| | - Panagiotis Katsaounis
- 1st Department of Medical Oncology, Metropolitan General Hospital, 11522 Athens, Greece;
| | - Alexandros Ardavanis
- 1st Department of Medical Oncology, Saint Savas Anticancer Hospital, 11522 Athens, Greece; (S.K.); (D.S.); (A.A.)
| | - Nikolaos Ziras
- 2nd Department of Medical Oncology, Metaxas’ Anticancer Hospital, 18537 Piraeus, Greece;
| | | | - George Rigas
- Medical Oncology Unit, General Hospital of Volos, 38222 Volos, Greece;
| | - Kostas Kalbakis
- Department of Medical Oncology, University Hospital of Heraklion, 71500 Crete, Greece; (K.K.); (N.V.)
| | - Nikolaos Vardakis
- Department of Medical Oncology, University Hospital of Heraklion, 71500 Crete, Greece; (K.K.); (N.V.)
| | | | - Ilias Athanasiadis
- 2nd Department of Medical Oncology, MITERA Hospital, 11522 Athens, Greece;
| | | | - Dora Hatzidaki
- Department of Medical Oncology, Hellenic Oncology Research Group, 11471 Athens, Greece; (D.H.); (E.P.)
| | - Efthimios Prinarakis
- Department of Medical Oncology, Hellenic Oncology Research Group, 11471 Athens, Greece; (D.H.); (E.P.)
| | - Foteini Simopoulou
- Department of Radiation Oncology, Iaso Thessaly Hospital, 41005 Larissa, Greece;
| | - Athanasios Kotsakis
- Department of Oncology, University Hospital of Larissa, 41221 Larissa, Greece;
- Correspondence: (A.K.); (V.G.); Tel./Fax: +30-2413502009 (A.K.); +30-2106448450 (V.G.)
| | - Vassilis Georgoulias
- Department of Medical Oncology, Hellenic Oncology Research Group, 11471 Athens, Greece; (D.H.); (E.P.)
- Correspondence: (A.K.); (V.G.); Tel./Fax: +30-2413502009 (A.K.); +30-2106448450 (V.G.)
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12
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Georgantzoglou N, Kokkali S, Tsourouflis G, Theocharis S. Tumor Microenvironment in Adrenocortical Carcinoma: Barrier to Immunotherapy Success? Cancers (Basel) 2021; 13:1798. [PMID: 33918733 PMCID: PMC8069982 DOI: 10.3390/cancers13081798] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/26/2021] [Accepted: 04/06/2021] [Indexed: 12/13/2022] Open
Abstract
Adrenocortical carcinoma is a rare malignancy with aggressive behavior, with up to 40% of patients presenting with metastases at the time of diagnosis. Both conventional chemotherapeutic regimens and novel immunotherapeutic agents, many of which are currently being tested in ongoing clinical trials, have yielded modest results so far, bringing the need for a deeper understanding of adrenal cancer behavior to the forefront. In the recent years, the tumor microenvironment has emerged as a major determinant of cancer response to immunotherapy and an increasing number of studies on other solid tumors have focused on manipulating the microenvironment in the favor of the host and discovering new potential target molecules. In the present review we aim to explore the characteristics of adrenocortical cancer's microenvironment, highlighting the mechanisms of immune evasion responsible for the modest immunotherapeutic results, and identify novel potential strategies.
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Affiliation(s)
- Natalia Georgantzoglou
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (N.G.); (S.K.)
| | - Stefania Kokkali
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (N.G.); (S.K.)
- First Medical Oncology Clinic, Saint-Savvas Anti Cancer Hospital, 115 27 Athens, Greece
| | - Gerasimos Tsourouflis
- Second Department of Propedeutic Surgery, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece;
| | - Stamatios Theocharis
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (N.G.); (S.K.)
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13
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Kokkali S, Stravodimou A, Duran-Moreno J, Koufopoulos N, Voutsadakis IA, Digklia A. Chemotherapy and targeted treatments of breast sarcoma by histologic subtype. Expert Rev Anticancer Ther 2021; 21:591-604. [PMID: 33554686 DOI: 10.1080/14737140.2021.1880327] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Breast sarcomas (BS) are uncommon and often present both diagnostic and therapeutic challenges. Historically, radical surgery has been the mainstay of treatment for localized breast sarcomas. On the other hand, in advanced disease, since they are a heterogeneous group of neoplasms consisting of several different subtypes including angiosarcoma, phyllodes tumor, and pleomorphic undifferentiated sarcoma, there is a lack of proven specific therapy. As a result, their treatment is based on the soft tissue sarcoma (STS) paradigm, whereas histotype-tailored approaches apply to specific subtypes like dermatofibrosarcoma protuberans. To date, advanced stages constitute an incurable form of disease and chemotherapy remains the cornerstone of treatment with the aim of palliation of symptoms and increase in survival.Areas covered: In this manuscript, we review the clinicopathologic characteristics of the most common subtypes of BS, as well as the current treatment landscape of BS, with a particular focus on opportunities and challenges provided by new targeted molecules and immunotherapy.Expert opinion: The treatment approach of advanced BS is based on the pathologic subtype. A true breakthrough has still to be obtained, as the development of new agents in BS suffers from the same weaknesses as in other STS.
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Affiliation(s)
- Stefania Kokkali
- First Medical Oncology Clinic, Saint-Savvas Anticancer Hospital, Athens, Greece
| | - Athina Stravodimou
- Department of Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jose Duran-Moreno
- Fourth Department of Internal Medicine, Hematology Oncology Unit, Attikon University General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nektarios Koufopoulos
- Second Pathology Department, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Ioannis A Voutsadakis
- Algoma District Cancer Program, Sault Area Hospital, Sault Ste. Marie, ON, Canada.,Division of Clinical Sciences, Northern Ontario School of Medicine, Sudbury, ON, Canada
| | - Antonia Digklia
- Department of Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Abstract
INTRODUCTION Uveal melanoma (UM) is the most common intraocular cancer and represents a discrete subtype of melanoma. Metastatic disease, which occurs in half of patients, has a dismal prognosis. Immunotherapy with immune checkpoint inhibitors has produced promising results in cutaneous melanoma but has failed to show analogous efficacy in metastatic UM. This is attributable to UM's distinct genetics and its complex interaction with the immune system. Hence, more efficacious immunotherapeutic approaches are under investigation. AREAS COVERED We discuss those novel immunotherapeutic strategies in clinical and preclinical studies for advanced disease and which are thought to overcome the hurdles set by UM in terms of immune recognition. We also highlight the need to determine predictive markers in relation to these strategies to improve clinical outcomes. We used a simple narrative analysis to summarize the data. The search methodology is located in the Introduction. EXPERT OPINION Novel immunotherapeutic strategies focus on transforming immune excluded tumor microenvironment in metastatic UM to T cell inflamed. Preliminary results of approaches such as vaccines, adoptive cell transfer and other novel molecules are encouraging. Factors such as HLA compatibility and expression level of targeted antigens should be considered to optimize personalized management.
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Affiliation(s)
- Christos Masaoutis
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Stefania Kokkali
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,First Medical Oncology Clinic, Saint-Savvas Anticancer Hospital, Athens, Greece
| | - Stamatios Theocharis
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Kokkali S, Ternant D, Kemmel V, Levêque D, Wendling F, Barthelemy P, Kurtz JE. Intravenous and subcutaneous administration of trastuzumab in a patient on peritoneal dialysis. Br J Clin Pharmacol 2021; 87:3372-3374. [PMID: 33464605 DOI: 10.1111/bcp.14731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 11/30/2020] [Accepted: 12/22/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Stefania Kokkali
- Department of Medical Oncology, Strasbourg University Hospital, Strasbourg, France.,First Medical Oncology Department, Saint-Savvas Anticancer Hospital, Athens, Greece
| | - David Ternant
- Department of Medical Pharmacology, CHRU de Tours, Tours University Hospital, Tours, France
| | - Véronique Kemmel
- Biochemistry and Molecular Biology Department, Strasbourg University Hospital, Strasbourg, France
| | - Dominique Levêque
- Pharmacy Department, Strasbourg University Hospital, Strasbourg, France
| | - Fréderique Wendling
- Department of Medical Oncology, Strasbourg University Hospital, Strasbourg, France
| | - Philippe Barthelemy
- Department of Medical Oncology, Strasbourg University Hospital, Strasbourg, France
| | - Jean-Emmanuel Kurtz
- Department of Medical Oncology, Strasbourg University Hospital, Strasbourg, France
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16
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Theocharis S, Tasoulas J, Masaoutis C, Kokkali S, Klijanienko J. Salivary gland cancer in the era of immunotherapy: can we exploit tumor microenvironment? Expert Opin Ther Targets 2020; 24:1047-1059. [PMID: 32744127 DOI: 10.1080/14728222.2020.1804863] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 02/08/2023]
Abstract
INTRODUCTION Salivary gland cancers (SGCs) consist of a rare family of neoplasms with varying histology and biological behavior. Therapeutic regimens have been relatively unchanged for decades. The recent successes of immunotherapy have raised hopes for the development of more effective strategies in SGC, thus emphasizing the role of tumor microenvironment (TME) in the design for more effective therapies. AREAS COVERED This review presents an overview of the current knowledge on the pathobiology of SGC TME and discusses the potential of immunotherapeutic targeting. EXPERT OPINION Most data on the role of TME in SGC carcinogenesis are derived from preclinical studies. Signaling cascades of immunotherapeutic interest, PD-1/PD-L1 and PD-1/PD-L2, are active in many SGCs and might be associated with biological behavior and prognosis. Immunotherapeutic attempts are very limited, but recent findings in other tumors on the role of exosomes and PD-L2 signaling suggest that TME of SGCs warrants further research, emphasizing larger cohorts, histology-based stratification, and standardized evaluation of immunomodulatory molecules, to explore the potential of targeting tumor stroma and its signaling cascades. Furthermore, combination of immunotherapies or immunotherapies with the antineoplastic agents targeting AR, HER2, and tyrosine kinases, recently introduced in SGC treatment, constitutes a promising approach for the future.
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Affiliation(s)
- Stamatios Theocharis
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens , Athens, Greece.,Department of Pathology, Institut Curie , Paris, France
| | - Jason Tasoulas
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens , Athens, Greece
| | - Christos Masaoutis
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens , Athens, Greece
| | - Stefania Kokkali
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens , Athens, Greece.,First Medical Oncology Clinic, Saint-Savvas Anticancer Hospital , Athens, Greece
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Kokkali S, Oddou I, Gantzer J, Fitsiori A. Human herpesvirus 6 encephalitis in a patient treated with everolimus for renal cell carcinoma. J Oncol Pharm Pract 2020; 26:2052-2057. [PMID: 32299316 DOI: 10.1177/1078155220918022] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Everolimus is a mammalian target of rapamycin inhibitor and is approved as second-line treatment or beyond for renal cell carcinoma. We report a case of a 75-year-old male treated with everolimus for metastatic renal cell carcinoma, after sunitinib treatment, who was diagnosed with human herpesvirus 6 encephalitis. CASE REPORT After 39 months of everolimus, 10 mg per day, our patient was admitted with fever, consciousness disorders and a partial epileptic crisis. Laboratory tests revealed lymphopenia (170 lymphocytes/mm3), and polymerase chain reaction in cerebrospinal fluid was positive for human herpesvirus 6. Brain magnetic resonance imaging study demonstrated hippocampal abnormality and a pontine lesion. MANAGEMENT AND OUTCOME The patient stopped everolimus treatment indefinitely. He received ganciclovir initially intravenously, with a rapid clinical improvement, as well as polyvalent immunoglobulins were given to correct hypogammaglobulinemia. Two months later, antiviral therapy was switched to oral ganciclovir, which was never stopped. A new lumbar puncture was performed one month after the initiation of antiviral treatment, which did not reveal human herpesvirus 6 DNA anymore. DISCUSSION Human herpesvirus 6 encephalitis is more common in hematopoietic stem cell transplant recipients and HIV patients. This is the first case probably associated to everolimus treatment. In contrast to most patients diagnosed with this infection, who either die or develop neurologic sequelae, our patient almost fully recovered two months later.
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Affiliation(s)
- Stefania Kokkali
- Agios Savvas General Cancer and Oncology, Hospital of Athens, Athens, Greece
| | - Isabelle Oddou
- University Hospitals Strasbourg, Strasbourg, Alsace, France
| | | | - Aikaterini Fitsiori
- Service Neuroradiologie Diagnostique et Interventionnelle, Hopitaux Universitaires de Geneve, Geneve, Switzerland
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18
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Duran-Moreno J, Kokkali S, Ramfidis V, Salomidou M, Digklia A, Koumarianou A, Tomos P, Koufopoulos N, Vamvakaris I, Psychogiou E, Syrigos K. Primary Sarcoma of the Lung - Prognostic Value of Clinicopathological Characteristics of 26 Cases. Anticancer Res 2020; 40:1697-1703. [PMID: 32132077 DOI: 10.21873/anticanres.14122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 02/11/2020] [Accepted: 02/13/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Primary sarcomas of the lung (PSL) represent a rare, largely unknown entity. We herein present a retrospective study of 26 patients diagnosed with PSL. PATIENTS AND METHODS For a period of 10 years, the records of patients from 5 centers were gathered and analyzed. RESULTS Median age at diagnosis was 61.96 years (range=31-75 years). Eight patients (33.33%) had mediastinal node invasion (MNI). From 17 patients (70.83%) with localized disease, 11 patients (64.70%) underwent surgery. Recurrence rate was 72.72%. Median disease-free interval was 15 months. The median overall survival (OS) of patients with metastatic disease was 4 months and 10 months for the whole population. Only surgery had an impact on survival. CONCLUSION Prognosis of PSL is somber. The high proportion of patients with MNI at diagnosis may serve as an indication for surgical evaluation of mediastinum and raises the question whether patients with locoregional PSL should be treated with a more aggressive approach.
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Affiliation(s)
- Jose Duran-Moreno
- Fourth Department of Internal Medicine - Hematology Oncology Unit, Attikon University General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Stefania Kokkali
- 1st Medical Oncology Clinic, Saint-Savvas Anticancer Hospital, Athens, Greece
| | - Vasileios Ramfidis
- 3rd Department of Internal Medicine, National and Kapodistrian University of Athens, Sotiria General Hospital, Athens, Greece
| | - Maria Salomidou
- Pneumology Department, Saint-Savvas Anticancer Hospital, Athens, Greece
| | - Antonia Digklia
- Department of Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Anna Koumarianou
- Fourth Department of Internal Medicine - Hematology Oncology Unit, Attikon University General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Periklis Tomos
- Department of Thoracic surgery, Attikon University General Hospital, Athens, Greece
| | - Nektarios Koufopoulos
- 2nd Pathology Department, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Ioannis Vamvakaris
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Psychogiou
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Syrigos
- 3rd Department of Internal Medicine, National and Kapodistrian University of Athens, Sotiria General Hospital, Athens, Greece
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Koufopoulos N, Nasi D, Goudeli C, Antoniadou F, Kokkali S, Pigadioti E, Provatas I, Maggo E, Ardavanis A, Terzakis E, Arkoumani E, J Agnantis N, Apostolikas N, Khaldi L. Primary squamous cell carcinoma of the ovary. Review of the literature. J BUON 2019; 24:1776-1784. [PMID: 31786837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE Primary squamous cell carcinoma (SCC) of the ovary is rare. Most cases arise from a cystic teratoma or less frequently from Brenner tumor or endometriosis. We reviewed 36 cases of primary ovarian SCC reported in the literature including a case diagnosed and treated in our institution. METHODS Data was collected by using the key-words "primary squamous cell carcinoma" and "ovary" on Google Scholar and PubMed in April 2018. All reviewed cases were analyzed according to diagnosis, surgical approach, adjuvant therapy and outcome. RESULTS To date 23 articles presenting 36 cases of primary ovarian SCC are reported. Nine patients had stage I, 8 stage II, 11 stage III and 5 stage IV disease, whereas 3 patients had in situ carcinoma. All patients underwent surgery (mainly hysterectomy with bilateral salpingo-oophorectomy). Adjuvant therapy was reported in 24 patients, 15 of which received chemotherapy, 6 radiotherapy and 3 a combination of both. Chemotherapy regimens were similar to the ones used in ovarian carcinoma (more often platinum plus paclitaxel). Follow-up period was in general short and survival varied between 9 days and 14 years, depending on the stage at diagnosis. CONCLUSIONS Primary ovarian SCC is a rare entity with poor prognosis, compared to serous carcinoma. Treatment is usually extrapolated from classical ovarian carcinoma algorithms, including surgical management combined with adjuvant chemotherapy with or without radiotherapy. Further investigations are needed to define optimal treatment, such as chemotherapy regimens and the role of radiotherapy and lymph node dissection.
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Affiliation(s)
- Nektarios Koufopoulos
- Department of Pathology, Anticancer Oncologic Hospital "Saint Savvas", Athens, Greece
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Koufopoulos N, Antoniadou F, Kokkali S, Pigadioti E, Khaldi L. Invasive Lobular Carcinoma with Extracellular Mucin Production: Description of a Case and Review of the Literature. Cureus 2019; 11:e5550. [PMID: 31695973 PMCID: PMC6820319 DOI: 10.7759/cureus.5550] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Invasive lobular carcinoma of the breast is the second most common subtype of breast carcinoma. It accounts for 5-15% of the breast carcinoma cases reported. It shows a different metastatic pattern compared to invasive carcinoma of no special type. There are several variants of this cancer including the classic, solid, signet ring cell, tubulolobular, alveolar, trabecular, pleomorphic, and mixed subtypes each one with a distinctive morphology. Invasive lobular carcinoma has been associated with intracellular mucin production, in the form of intracytoplasmic lumina and signet ring cells whereas extracellular mucin production has been related to carcinomas of ductal origin. A new variant that displays extracellular mucin production was described recently. Only nineteen cases of this rare entity have been reported to date. In this manuscript, we report an additional case of invasive lobular carcinoma with extracellular mucin production, describing its clinico-pathological characteristics, and review the literature on the same.
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Affiliation(s)
| | | | | | | | - Lubna Khaldi
- Pathology, Saint Savvas Cancer Hospital, Athens, GRC
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21
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Abstract
Matrix-producing carcinoma (MPC) is a rare subtype of metaplastic breast carcinoma (MBC) that was first described in 1989 by Wargotz and Norris. It accounts for less than 1% of breast carcinomas and has distinctive clinical, morphological, and immunohistochemical features. Histologically it consists of invasive carcinoma of no special type with transition to cartilaginous or osseous matrix without a spindle cell component. Data on this entity are limited with the literature consisting mostly of case reports and a small number of case series. We report a case of matrix-producing breast carcinoma, with excellent clinical outcome. We also discuss the histogenesis, imaging, histological, and immunohistochemical characteristics, treatment, and focus on the differential diagnosis of this rare tumor.
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Kokkali S, Ntokou A, Drizou M, Perdikari K, Makaronis P, Katsarou E, Koufopoulos N, Tzovaras A, Ardavanis A. Nivolumab in patients with rare head and neck carcinomas: A single center's experience. Oral Oncol 2019; 101:104359. [PMID: 31300270 DOI: 10.1016/j.oraloncology.2019.07.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 07/02/2019] [Accepted: 07/04/2019] [Indexed: 12/19/2022]
Abstract
Immunotherapy (IO) with anti-PD1 inhibitors is available for the treatment of recurrent/metastatic squamous cell carcinomas of the head and neck (SCCHD) since 2016. Both nivolumab and pembrolizumab were tested in phase 3 randomized trials in adults progressing on or after platinum-based therapy and were found to confer an overall survival benefit compared to investigator's choice. However, very limited data exist concerning IO use in rare subtypes of head and neck carcinoma, like salivary gland carcinoma. We retrospectively collected clinical data of all patients diagnosed with rare subtypes of head and neck carcinoma, who were treated with immune checkpoint inhibitors in our department during the last 5 years. We analyzed safety and efficacy of these therapies. We identified six patients who received nivolumab for recurrent or metastatic head and neck carcinomas, between 31 and 57 years old. All patients had received at least one line of platinum-chemotherapy, as well as radiation therapy. Treatment was administered every 2 weeks, at a dose of 3 mg per kilogram of body weight. Number of nivolumab cycles varied between 2 and 18. Progression-free survival varied from 1 to 12 months and overall survival from 4 to 24 months. Tolerance was very good, except for one case of diabetes and hypothyroidism requiring medication. There is currently insufficient evidence regarding the optimal treatment of the rare non-squamous cell carcinoma of the head and neck. Our case series supports a role for immunotherapy in these patients. However, larger collaborative studies are needed to evaluate this treatment.
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Affiliation(s)
- Stefania Kokkali
- First Medical Oncology Department, Saint-Savvas Anticancer Hospital, L.Alexandras 171, 11521 Athens, Greece.
| | - Anna Ntokou
- First Medical Oncology Department, Saint-Savvas Anticancer Hospital, L.Alexandras 171, 11521 Athens, Greece
| | - Maria Drizou
- First Medical Oncology Department, Saint-Savvas Anticancer Hospital, L.Alexandras 171, 11521 Athens, Greece
| | - Konstantina Perdikari
- First Medical Oncology Department, Saint-Savvas Anticancer Hospital, L.Alexandras 171, 11521 Athens, Greece
| | - Panagiotis Makaronis
- First Medical Oncology Department, Saint-Savvas Anticancer Hospital, L.Alexandras 171, 11521 Athens, Greece
| | - Elena Katsarou
- First Medical Oncology Department, Saint-Savvas Anticancer Hospital, L.Alexandras 171, 11521 Athens, Greece
| | - Nektarios Koufopoulos
- Pathology Department, Saint-Savvas Anticancer Hospital, L.Alexandras 171, 11521 Athens, Greece
| | - Alexandros Tzovaras
- First Medical Oncology Department, Saint-Savvas Anticancer Hospital, L.Alexandras 171, 11521 Athens, Greece
| | - Alexandros Ardavanis
- First Medical Oncology Department, Saint-Savvas Anticancer Hospital, L.Alexandras 171, 11521 Athens, Greece
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Koufopoulos N, Kokkali S, Manatakis D, Balalis D, Nasi D, Ardavanis A, Korkolis D, Khaldi L. Primary peripheral neuroectodermal tumor (PNET) of the adrenal gland: a rare entity. J BUON 2019; 24:770-778. [PMID: 31128035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE Ewing Sarcoma/Primitive Neuroectodermal Tumor (ES/PNET) is a malignant small round cell tumor belonging to the Ewing Sarcoma Family of Tumors. It occurs more commonly in children and young adults. Its localization in the adrenal gland is extremely rare. We reviewed 35 cases of ES/PNET of the adrenal gland reported in the literature and presented our case. METHODS Data were collected by searching for ES/PNET and adrenal gland key words on Google Scholar and PubMed in March 2018, including a case diagnosed in our department. We analyzed all reviewed cases for diagnosis, surgical and systemic therapy and outcome. RESULTS To date 24 articles presenting cases of ES/PNET of the adrenal gland are reported in the literature. We included in our review 35 cases previously described and one new case. Histologically all cases consisted of sheets of small round cells. Immunohistochemistry was also performed in all cases. Most cases stained positive for CD99 and negative for lymphocytic markers. Markers of epithelial differentiation displayed variable results. In all cases tested, characteristic translocations were displayed supporting the diagnosis. All patients but four were treated surgically and the majority received adjuvant therapy. Only very few cases received neoadjuvant chemotherapy. CONCLUSIONS Primary ES/PNET of the adrenal gland is a rare tumor, showing specific morphological, immunohistochemical and cytogenetic characteristics. Treatment consists of surgery, chemotherapy and radiotherapy. Further investigations paired with long term follow-up are necessary to define prognosis for this rare entity.
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MESH Headings
- 12E7 Antigen/genetics
- Adolescent
- Adrenal Gland Neoplasms/epidemiology
- Adrenal Gland Neoplasms/genetics
- Adrenal Gland Neoplasms/pathology
- Adrenal Gland Neoplasms/therapy
- Adrenal Glands/pathology
- Adult
- Child
- Child, Preschool
- Female
- Gene Expression Regulation, Neoplastic/genetics
- Humans
- Male
- Middle Aged
- Neuroectodermal Tumors, Primitive, Peripheral/epidemiology
- Neuroectodermal Tumors, Primitive, Peripheral/genetics
- Neuroectodermal Tumors, Primitive, Peripheral/pathology
- Neuroectodermal Tumors, Primitive, Peripheral/therapy
- Prognosis
- Sarcoma, Ewing/epidemiology
- Sarcoma, Ewing/genetics
- Sarcoma, Ewing/pathology
- Sarcoma, Ewing/therapy
- Young Adult
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Abstract
Ovarian metastasis is common with secondary tumors representing up to 15% of ovarian neoplasms. The malignancies most commonly involving the ovaries are carcinomas of the stomach, colon, breast, endocervix, endometrium, and lymphoma. Secondary ovarian involvement by kidney carcinoma occurs very rarely and is usually associated with widespread dissemination. We conducted a review of kidney carcinoma with ovarian metastasis in the literature using the keywords clear cell renal cell carcinoma, papillary renal cell carcinoma, chromophobe renal cell carcinoma collecting duct carcinoma, and ovarian metastasis on Google Scholar and PubMed indices in April 2018, including a case diagnosed in our department. To date, 30 articles presenting 41 cases of kidney carcinoma with ovarian metastasis are reported in the literature. All reviewed cases were analyzed for diagnosis, surgical and systemic therapy, and outcome. Diagnosis may sometimes be challenging, requiring appropriate immunohistochemical markers in difficult cases. A combination of surgery and adjuvant therapy offers significant benefit in disease control or palliation of symptoms. Due to inconsistency in the reported data, further studies are needed to make safe conclusions regarding survival.
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Affiliation(s)
| | - Despoina Nasi
- Department of Oncology, "Saint Savvas" Cancer Hospital, Athens, GRC
| | | | - Stefania Kokkali
- Department of Oncology, "Saint Savvas" Cancer Hospital, Athens, GRC
| | - Stamatios Theocharis
- Department of Pathology, National and Kapodistrian University of Athens, Athens, GRC
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Kokkali S, Drizou M, Tripodaki E, Stefanou D, Magou E, Zylis D, Kapiris M, Nasi D, Georganta C, Ardavanis A. Updated results of biweekly gemcitabine/nab-paclitaxel as first-line treatment for advanced pancreatic cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy151.141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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26
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Kokkali S, Tripodaki ES, Drizou M, Stefanou D, Magou E, Zylis D, Kapiris M, Nasi D, Georganta C, Ardavanis A. Biweekly Gemcitabine/Nab-Paclitaxel as First-line Treatment for Advanced Pancreatic Cancer. In Vivo 2018; 32:653-657. [PMID: 29695574 PMCID: PMC6000799 DOI: 10.21873/invivo.11289] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 02/13/2018] [Accepted: 02/20/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND/AIM During recent years, a survival advantage was reported for first-line treatment of advanced pancreatic cancer with two new regimens, FOLFIRINOX and gemcitabine/nab-paclitaxel, over gemcitabine monotherapy. Gemcitabine/nab-paclitaxel administration on days 1, 8 and 15 of a 4-week cycle is associated with some practical disadvantages. We adopted a biweekly regimen with the same dose density. PATIENTS AND METHODS Patients with Eastern Cooperative Oncology Group performance status 0-2 diagnosed with advanced histologically or cytologically confirmed pancreatic cancer and no prior treatment were included in the study. Study combination included 1.5 g/m2 gemcitabine and 175 mg/m2 nab-paclitaxel given every 2 weeks. Survival analysis was performed using the Kaplan-Meier method. RESULTS Forty-six patients were treated with this regimen. Adverse events were similar to those of the original regimen. Median progression-free and overall survival were 5 and 10 months, respectively. CONCLUSION Biweekly gemcitabine/nab-paclitaxel seems to have a similar safety and efficacy profile as the original regimen.
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Affiliation(s)
- Stefania Kokkali
- First Medical Oncology Clinic, Saint Savvas Anticancer Hospital, Athens, Greece
| | | | - Maria Drizou
- First Medical Oncology Clinic, Saint Savvas Anticancer Hospital, Athens, Greece
| | - Dimitra Stefanou
- First Medical Oncology Clinic, Saint Savvas Anticancer Hospital, Athens, Greece
| | - Elpida Magou
- First Medical Oncology Clinic, Saint Savvas Anticancer Hospital, Athens, Greece
| | - Dimosthenis Zylis
- First Medical Oncology Clinic, Saint Savvas Anticancer Hospital, Athens, Greece
| | - Matthaios Kapiris
- First Medical Oncology Clinic, Saint Savvas Anticancer Hospital, Athens, Greece
| | - Despoina Nasi
- First Medical Oncology Clinic, Saint Savvas Anticancer Hospital, Athens, Greece
| | - Chara Georganta
- First Medical Oncology Clinic, Saint Savvas Anticancer Hospital, Athens, Greece
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27
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Abstract
INTRODUCTION The therapeutic armamentarium for advanced soft tissue sarcoma (STS) has increased over the last few years. Doxorubicin monotherapy or in combination is now the established first line treatment. Beyond first line treatment, no standard therapy has been established. Novel drugs have reached the late-clinical stage development demonstrating to be effective in controlled studies. While these novel treatments can be beneficial to a subset of patients, even producing long lasting remissions, a significant fraction of the STS population derives limited benefit. This is due to the fact that STS is a very heterogeneous disease with different histopathologic features, biological characteristics and clinical behaviour. Areas covered: The primary aim of this review is to summarize data from recent phase III clinical trials in unselected STS population, and to discuss their impact on the current clinical practice. Phase I-II trials of special interest are discussed as well. Expert commentary: Although our efforts in this research task are ongoing, the integration of biological therapies, the anti-angiogenesis targeted treatments as well as immunotherapy that may further improve the long term control of advanced STS are of special clinical interest. Clinical management of advanced STS should be tailored to each patient in order to optimize therapy.
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Affiliation(s)
- E Skafida
- a Department of Internal Medicine, Oncology Unit , University Hospital of Athens , Athens , Greece
| | - S Kokkali
- b Department of Internal Medicine, Oncology Unit , University Hospital of Athens, 'Agios Sabbas' , Athens , Greece
| | - M Nikolaou
- c Department of Internal Medicine, Oncology Unit , University Hospital of Athens, 'Hippokration' , Athens , Greece
| | - A Digklia
- d Department of Oncology , CHUV , Lausanne , Switzerland
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28
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Kokkali S, Hristova D, Kirsten H, Ahnert P, Hunzelmann N, Vaith P, Melchers I. PTPN22 R620W may affect age at onset and survival of SSC patients. Ann Rheum Dis 2011. [DOI: 10.1136/ard.2010.149104.11] [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: 11/04/2022]
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Stergiopoulos C, Kountouras J, Kapetanakis N, Katsinelos P, Kokkali S, Tsapournas G, Zavos C, Zaramboukas T. Distant cutaneous metastasis preceding the diagnosis of ductal cholangiocarcinoma. J Eur Acad Dermatol Venereol 2008; 23:242-3. [PMID: 18554225 DOI: 10.1111/j.1468-3083.2008.02845.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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