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Gervaso L, Bottiglieri L, Meneses-Medina MI, Pellicori S, Biffi R, Fumagalli Romario U, De Pascale S, Sala I, Bagnardi V, Barberis M, Cella CA, Fazio N. Role of microsatellite instability and HER2 positivity in locally advanced esophago-gastric cancer patients treated with peri-operative chemotherapy. Clin Transl Oncol 2023; 25:3287-3295. [PMID: 37084152 DOI: 10.1007/s12094-023-03179-5] [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: 01/21/2023] [Accepted: 03/28/2023] [Indexed: 04/22/2023]
Abstract
PURPOSE Neoadjuvant chemotherapy (NAC) significantly improved the prognosis of patients with locally advanced gastric cancer (LAGC). Several biomarkers, including HER2 and MMR/MSI are crucial for treatment decisions in the advanced stage but, currently, no biomarkers can guide the choice of NAC in clinical practice. Our aim was to evaluate the role of MSI and HER2 status on clinical outcomes. METHODS We retrospectively collected LAGC patients treated with NAC and surgery +/- adjuvant chemotherapy from 2006 to 2018. HER2 and MSI were assessed on endoscopic and surgical samples. Pathologic complete response (pCR) rate, overall survival (OS), and event-free survival (EFS) were estimated and evaluated for association with downstaging and MSI. RESULTS We included 76 patients, 8% were classified as MSI-H, entirely consistent between endoscopic and surgical samples. Six percent of patients were HER2 positive on endoscopic and 4% on surgical samples. Tumor downstaging was observed in 52.5% of cases, with three pCR (5.1%), none in MSI-H cancers. According to MSI status, event-free survival (EFS) and overall survival (OS) were higher for MSI-H patients to MSS [EFS not reached vs 30.0 months, p = 0.08; OS not reached vs 39.6 months, p = 0.10]. CONCLUSION Our work confirms the positive prognostic effect of MSI-H in the curative setting of LAGC, not correlated with pathologic tumor downstaging. Prospective ad-hoc trial and tumor molecular profiling are eagerly needed.
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Affiliation(s)
- Lorenzo Gervaso
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, IEO IRCCS, Via Ripamonti 435, Milan, Italy.
- Molecular Medicine Department, University of Pavia, Pavia, Italy.
| | - Luca Bottiglieri
- Division of Pathology, European Institute of Oncology IRCCS, Milan, Italy
| | - Monica Isabel Meneses-Medina
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, IEO IRCCS, Via Ripamonti 435, Milan, Italy
- Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Stefania Pellicori
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, IEO IRCCS, Via Ripamonti 435, Milan, Italy
| | - Roberto Biffi
- Division of Digestive Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Stefano De Pascale
- Division of Digestive Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Isabella Sala
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Massimo Barberis
- Pathology Unit, European Institute of Oncology IRCCS, Milan, Italy
| | - Chiara Alessandra Cella
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, IEO IRCCS, Via Ripamonti 435, Milan, Italy
| | - Nicola Fazio
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, IEO IRCCS, Via Ripamonti 435, Milan, Italy.
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2
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Poma S, Bonomo MC, Gazzaniga G, Pizzulli M, De Silvestri A, Baldi C, Broglia F, Ciceri M, Fuardo M, Morgante F, Pellicori S, Roldi EM, Delmonte MP, Mojoli F, Locatelli A. Complications of unintentional dural puncture during labour epidural analgesia: a 10-year retrospective observational study. J Anesth Analg Crit Care 2023; 3:42. [PMID: 37880725 PMCID: PMC10601237 DOI: 10.1186/s44158-023-00127-1] [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] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/14/2023] [Indexed: 10/27/2023]
Abstract
INTRODUCTION Unintentional dural puncture (UDP) occurs in 0.5-1.5% of labour epidural analgesia cases. To date, little is known about evidence of UDP-related complications. This work aimed to assess the incidence of intrapartum and postpartum complications in parturients who experienced UDP. METHODS This is a 10-year retrospective observational study on parturients admitted to our centre who presented UDP. Data collection gathered UDP-related complications during labour and postpartum. All women who displayed UDP received medical therapy and bed rest. An epidural blood patch (EBP) was not used in this population. Once asymptomatic, patients were discharged from the hospital. RESULTS Out of 7718 neuraxial analgesia cases, 97 cases of UDP occurred (1.25%). During labour, complications appeared in a small percentage of analgesia procedures performed, including total spinal anaesthesia (1.0%), extended motor block (3%), hypotension (4.1%), abnormal foetal heart rate (2%), inadequate analgesia (14.4%), and general anaesthesia following neuraxial anaesthesia failure (33.3% of emergency caesarean sections). During the postpartum period, 53.6% of parturients exhibited a postdural puncture headache, 13.4% showed neurological symptoms, and 14.4% required neurological consultation and neuroimaging. No patient developed subdural hematoma or cerebral venous sinus thrombosis; one woman presented posterior reversible encephalopathy syndrome associated with eclampsia. Overall, 82.5% of women experienced an extension of hospital stay. CONCLUSION Major complications occurred in a small percentage of patients during labour. However, since they represent high-risk maternal and neonatal health events, a dedicated anaesthesiologist and a trained obstetric team are essential. No major neurological complications were registered postpartum, and EBP was not performed. Nevertheless, all patients with UDP were carefully monitored and treated until complete recovery before discharge, leading to an extension of their hospitalization.
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Affiliation(s)
- S Poma
- Anaesthesia and Postoperative Intensive Care, Department of Anaesthesia and Intensive Care 3, I.R.C.C.S. Policlinic San Matteo Hospital Foundation, Pavia, 27100, Italy.
| | - M C Bonomo
- Department of Anaesthesia and Intensive Care, ASST Bergamo EST, Seriate Hospital, Seriate, Italy
| | - G Gazzaniga
- Department of Anaesthesia and Intensive Care 1, I.R.C.C.S. Policlinic San Matteo Hospital Foundation, Pavia, Italy
| | - M Pizzulli
- Anaesthesia and Postoperative Intensive Care, Department of Anaesthesia and Intensive Care 3, I.R.C.C.S. Policlinic San Matteo Hospital Foundation, Pavia, 27100, Italy
| | - A De Silvestri
- Clinical Epidemiology and Biostatistics, Scientific Direction, I.R.C.C.S. Policlinic San Matteo Hospital Foundation, Pavia, Italy
| | - C Baldi
- Anaesthesia and Postoperative Intensive Care, Department of Anaesthesia and Intensive Care 3, I.R.C.C.S. Policlinic San Matteo Hospital Foundation, Pavia, 27100, Italy
| | - F Broglia
- Anaesthesia and Postoperative Intensive Care, Department of Anaesthesia and Intensive Care 3, I.R.C.C.S. Policlinic San Matteo Hospital Foundation, Pavia, 27100, Italy
| | - M Ciceri
- Anaesthesia and Postoperative Intensive Care, Department of Anaesthesia and Intensive Care 3, I.R.C.C.S. Policlinic San Matteo Hospital Foundation, Pavia, 27100, Italy
| | - M Fuardo
- Anaesthesia and Postoperative Intensive Care, Department of Anaesthesia and Intensive Care 3, I.R.C.C.S. Policlinic San Matteo Hospital Foundation, Pavia, 27100, Italy
| | - F Morgante
- Anaesthesia and Postoperative Intensive Care, Department of Anaesthesia and Intensive Care 3, I.R.C.C.S. Policlinic San Matteo Hospital Foundation, Pavia, 27100, Italy
| | - S Pellicori
- Anaesthesia and Postoperative Intensive Care, Department of Anaesthesia and Intensive Care 3, I.R.C.C.S. Policlinic San Matteo Hospital Foundation, Pavia, 27100, Italy
| | - E M Roldi
- Anaesthesia and Postoperative Intensive Care, Department of Anaesthesia and Intensive Care 3, I.R.C.C.S. Policlinic San Matteo Hospital Foundation, Pavia, 27100, Italy
| | - M P Delmonte
- Anaesthesia and Postoperative Intensive Care, Department of Anaesthesia and Intensive Care 3, I.R.C.C.S. Policlinic San Matteo Hospital Foundation, Pavia, 27100, Italy
| | - F Mojoli
- Department of Anaesthesia and Intensive Care 1, I.R.C.C.S. Policlinic San Matteo Hospital Foundation, Pavia, Italy
| | - A Locatelli
- Anaesthesia and Postoperative Intensive Care, Department of Anaesthesia and Intensive Care 3, I.R.C.C.S. Policlinic San Matteo Hospital Foundation, Pavia, 27100, Italy
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Cella CA, Knoedler M, Hall M, Arcopinto M, Bagnardi V, Gervaso L, Pellicori S, Spada F, Zampino MG, Ravenda PS, Frassoni S, Passaro A, Milano M, Laffi A, Fazio N, Lordick F. Validation of the ONKOTEV Risk Prediction Model for Venous Thromboembolism in Outpatients With Cancer. JAMA Netw Open 2023; 6:e230010. [PMID: 36795409 PMCID: PMC9936336 DOI: 10.1001/jamanetworkopen.2023.0010] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
IMPORTANCE The assessment of the risk of venous thromboembolism (VTE) among outpatients with cancer represents an unsolved topic. Current international guidelines recommend primary prophylaxis for patients at intermediate to high risk of VTE, indicated by a Khorana score of 2 or more. A previous prospective study developed the ONKOTEV score, a 4-variable risk assessment model (RAM) consisting of a Khorana score of more than 2, metastatic disease, vascular or lymphatic compression, and previous VTE event. OBJECTIVE To validate the ONKOTEV score as a novel RAM to assess the risk of VTE among outpatients with cancer. DESIGN, SETTING, AND PARTICIPANTS ONKOTEV-2 is a noninterventional prognostic study conducted in 3 European centers located in Italy, Germany, and the United Kingdom among a prospective cohort of 425 ambulatory patients with a histologically confirmed diagnosis of a solid tumor who were receiving active treatments. The total study duration was 52 months, with an accrual period of 28 months (from May 1, 2015, to September 30, 2017) and an overall follow up-period of 24 months (data were censored September 30, 2019). Statistical analysis was performed in October 2019. EXPOSURES The ONKOTEV score was calculated for each patient at baseline by collecting clinical, laboratory, and imaging data from tests performed for routine practice. Each patient was then observed to detect any thromboembolic event throughout the study period. MAIN OUTCOMES AND MEASURES The primary outcome of the study was the incidence of VTE, including deep vein thrombosis and pulmonary embolism. RESULTS A total of 425 patients (242 women [56.9%]; median age, 61 years [range, 20-92 years]) were included in the validation cohort of the study. The cumulative incidences for the risk of developing VTE at 6 months were 2.6% (95% CI, 0.7%-6.9%), 9.1% (95% CI, 5.8%-13.2%), 32.3% (95% CI, 21.0%-44.1%), and 19.3% (95% CI, 2.5%-48.0%), respectively, among 425 patients with an ONKOTEV score of 0, 1, 2, and greater than 2 (P < .001). The time-dependent area under the curve at 3, 6, and 12 months was 70.1% (95% CI, 62.1%-78.7%), 72.9% (95% CI, 65.6%-79.1%), and 72.2% (95% CI, 65.2%-77.3%), respectively. CONCLUSIONS AND RELEVANCE This study suggests that, because the ONKOTEV score has been validated in this independent study population as a novel predictive RAM for cancer-associated thrombosis, it can be adopted into practice and into clinical interventional trials as a decision-making tool for primary prophylaxis.
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Affiliation(s)
- Chiara A Cella
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, IRCCS, Milan, Italy
| | - Maren Knoedler
- University Cancer Center Leipzig, University Hospital Leipzig, Leipzig, Germany
| | - Marcia Hall
- Department of Medical Oncology, Mount Vernon Center for Cancer Treatment, Mount Vernon Hospital, Northwood, United Kingdom
| | - Michele Arcopinto
- Department of Translational Medical Sciences, "Federico II" University Hospital and School of Medicine, Naples, Italy
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Lorenzo Gervaso
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, IRCCS, Milan, Italy
- Molecular Medicine Department, University of Pavia, Pavia, Italy
| | | | - Francesca Spada
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, IRCCS, Milan, Italy
| | - Maria G Zampino
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, IRCCS, Milan, Italy
| | - Paola S Ravenda
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, IRCCS, Milan, Italy
| | - Samuele Frassoni
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Antonio Passaro
- Division of Thoracic Oncology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Monica Milano
- Division of Medical Senology, European Institute of Oncology IRCCS, Milan, Italy
| | - Alice Laffi
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Nicola Fazio
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, IRCCS, Milan, Italy
| | - Florian Lordick
- University Cancer Center Leipzig, University Hospital Leipzig, Leipzig, Germany
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Laffi A, Gervaso L, D’Ecclesiis O, Gandini S, Riva A, Passerini R, Spada F, Pellicori S, Rubino M, Cella CA, Ravenda PS, Zampino MG, Fazio N. Observational Study on Antibody Response to COVID-19 Vaccines in PAtients with Gastro-Entero-PanCreatic Cancers and NeuroendocrIne NeoplAsms on Systemic TreatmEnts (VACCINATE). Biomedicines 2023; 11:biomedicines11020336. [PMID: 36830873 PMCID: PMC9953014 DOI: 10.3390/biomedicines11020336] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 01/26/2023] Open
Abstract
The coronavirus disease-19 (COVID-19) pandemic dramatically impacted oncological patients' care. Since the introduction of vaccines and the demonstration of their benefit on frail patients, COVID-19 vaccinations were indicated to also be beneficial to oncological population. However, data about the impact of anticancer-treatments and the timing between vaccinations and systemic therapy delivery were not available. We aimed to evaluate potential factors influencing the outcome of the COVID-19 vaccination in cancer patients. We prospectively collected data of patients undergoing the COVID-19 vaccination with gastro-entero-pancreatic and neuroendocrine neoplasms, treated at our institute, between 03/2021 and 12/2021. We enrolled 46 patients, 63.1% males; at the time of data collection, 86.9% had received two-doses of Pfizer-BioNTech and the rest had received the Moderna vaccine. All patients obtained a subsequent immune-response. Chemotherapy seems to determinate a significantly lower antibody response after vaccination compared to the other anti-cancer agents (p = 0.004). No significant effect on immune-response was reported for both vaccinations performed ≤7 vs. >7 days from the last systemic treatment (p = 0.77) and lymphocytes count (p = 0.11). The findings suggest that the optimal timing for COVID-19 vaccination and lymphocytes count are not the issue, but rather that the quality of the subset of lymphocytes before the vaccination determine the efficacy level of immune-response in this population.
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Affiliation(s)
- Alice Laffi
- Division of Gastrointestinal and Neuroendocrine Tumors, European Institute of Oncology (IEO), IRCCS, Via Ripamonti 435, 20141 Milan, Italy
- Correspondence: (A.L.); (L.G.)
| | - Lorenzo Gervaso
- Division of Gastrointestinal and Neuroendocrine Tumors, European Institute of Oncology (IEO), IRCCS, Via Ripamonti 435, 20141 Milan, Italy
- Correspondence: (A.L.); (L.G.)
| | - Oriana D’Ecclesiis
- Department of Experimental Oncology, European Institute of Oncology (IEO), IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Sara Gandini
- Department of Experimental Oncology, European Institute of Oncology (IEO), IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Agostino Riva
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, 20157 Milan, Italy
| | - Rita Passerini
- Division of Laboratory Medicine, European Institute of Oncology (IEO), IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Francesca Spada
- Division of Gastrointestinal and Neuroendocrine Tumors, European Institute of Oncology (IEO), IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Stefania Pellicori
- Oncologic Department, ASST Lodi Hospital, Piazza Ospitale 10, 26900 Lodi, Italy
| | - Manila Rubino
- Division of Gastrointestinal and Neuroendocrine Tumors, European Institute of Oncology (IEO), IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Chiara Alessandra Cella
- Division of Gastrointestinal and Neuroendocrine Tumors, European Institute of Oncology (IEO), IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Paola Simona Ravenda
- Division of Gastrointestinal and Neuroendocrine Tumors, European Institute of Oncology (IEO), IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Maria Giulia Zampino
- Division of Gastrointestinal and Neuroendocrine Tumors, European Institute of Oncology (IEO), IRCCS, Via Ripamonti 435, 20141 Milan, Italy
| | - Nicola Fazio
- Division of Gastrointestinal and Neuroendocrine Tumors, European Institute of Oncology (IEO), IRCCS, Via Ripamonti 435, 20141 Milan, Italy
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Gervaso L, Laffi A, Meneses-Medina M, Cella C, Rubino M, Pellicori S, Spada F, Fazio N. PO-19: Venous and arterial thromboembolism in pancreatic neuroendocrine neoplasms. Thromb Res 2022. [DOI: 10.1016/s0049-3848(22)00207-9] [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: 11/28/2022]
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6
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Meneses-Medina MI, Gervaso L, Cella CA, Pellicori S, Gandini S, Sousa MJ, Fazio N. Chemotherapy in pancreatic ductal adenocarcinoma: when cytoreduction is the aim. A systematic review and meta-analysis. Cancer Treat Rev 2022; 104:102338. [DOI: 10.1016/j.ctrv.2022.102338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/11/2022] [Accepted: 01/12/2022] [Indexed: 12/12/2022]
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7
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Gervaso L, Pellicori S, Cella CA, Bagnardi V, Lordick F, Fazio N. Biomarker evaluation in radically resectable locally advanced gastric cancer treated with neoadjuvant chemotherapy: an evidence reappraisal. Ther Adv Med Oncol 2021; 13:17588359211029559. [PMID: 34484429 PMCID: PMC8414610 DOI: 10.1177/17588359211029559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 06/11/2021] [Indexed: 11/16/2022] Open
Abstract
Neoadjuvant chemotherapy (NAC) significantly improved the prognosis of patients
with locally advanced resectable gastric cancer but, despite important
progresses, relapse-related death remains a major challenge. Therefore, it
appears crucial to understand which patients will benefit from peri-operative
treatment. Biomarkers such as human epidermal growth factor receptor-2 (HER2),
microsatellite instability (MSI), and Epstein-Barr Virus (EBV) have been widely
studied; however, they do not yet guide the choice of perioperative treatment in
clinical practice. We performed a narrative review, including 23 studies,
addressing the value of tissue- or blood-based biomarkers in the neoadjuvant
setting. Ten studies (43.5%) were prospective, and more than half were conducted
in East-Asia. Biomarkers were evaluated only post-NAC (on surgical samples or
blood) in seven studies (30.4%), only pre-NAC (on endoscopic specimens or blood)
in 10 studies (43.5%), and both pre- and post-NAC (26.1%) in six studies. Among
the high variety of investigated biomarkers, some of these including MSI-H or
enzymatic profile (as TS, UGT1A1, MTHFR, ERCC or XRCC) showed promising results
and deserve to be assessed in methodologically sound clinical trials. The
identification of molecular biomarkers in patients treated with NAC for locally
advanced resectable gastric or EGJ cancer remains crucial.
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Affiliation(s)
- Lorenzo Gervaso
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, IEO, European Institute of Oncology IRCCS, Milan, Lombardia, Italy
| | - Stefania Pellicori
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, IEO, European Institute of Oncology IRCCS, Milan, Lombardia, Italy
| | - Chiara A Cella
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, IEO, European Institute of Oncology IRCCS, Milan, Lombardia, Italy
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milano, Lombardia Italy
| | - Florian Lordick
- Department of Oncology, Gastroenterology, Hepatology, Pulmonology, and Infectious Diseases, University Cancer Center Leipzig (UCCL), Leipzig University Medical Center, Leipzig, Germany
| | - Nicola Fazio
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, via Ripamonti 435, Milan, Lombardia 20141, Italy
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Cella C, Knoedler M, Hall M, Pellicori S, Gervaso L, Schorling R, Bagnardi V, Lordick F, Fazio N. 1670MO Validation of a new risk-assessment model for prediction of venous thromboembolism in cancer outpatients: The ONKOTEV score. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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9
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Spada F, Pellicori S, Zampino G, Funicelli L, Gervaso L, Laffi A, Rubino M, Garcia-Carbonero R, Fazio N. SARS-CoV-2-related pneumonia can be successfully managed in patients with metastatic neuroendocrine tumors: a critical point of view. Endocrine 2020; 70:6-10. [PMID: 32681385 PMCID: PMC7367165 DOI: 10.1007/s12020-020-02419-w] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/06/2020] [Indexed: 12/23/2022]
Abstract
Primary neuroendocrine tumors of the thymus are extremely rare. In patients with advanced disease, tumor growth control, and sometimes also syndrome control are the main goals of systemic therapy. Unfortunately, no standard therapies are available in clinical practice; therefore, clinical studies are strongly recommended. Axitinib (AXI) is a tyrosine kinase inhibitor, currently under investigation in an international phase II/III trial including thymic neuroendocrine tumors. Over the past 5 months, the entire world has been facing a devastating medical emergency brought about by a pandemic due to a novel coronavirus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which emerged in Wuhan, China, in late 2019. Since then, health professionals have been expending all their efforts on trying to provide the best available treatments for patients involved. Patients with cancer, especially those with thoracic involvement, are at higher risk of coronavirus disease 19 (COVID-19) and its complications because of their immunosuppressive status caused by the cancer and the anticancer therapies. As it remains unclear how to optimally manage such patients, we wished to report our experience with a patient with a metastatic neuroendocrine tumor of the thymus infected with SARS-CoV-2 in the hope that it may provide some insights and reflections on the management of cancer patients during this challenging time in our history.
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Affiliation(s)
- F Spada
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology (IEO), IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - S Pellicori
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology (IEO), IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - G Zampino
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology (IEO), IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - L Funicelli
- Division of Radiology, European Institute of Oncology (IEO), IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - L Gervaso
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology (IEO), IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - A Laffi
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology (IEO), IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - M Rubino
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology (IEO), IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - R Garcia-Carbonero
- Medical Oncology Department, Hospital Universitario Doce de Octubre, Imas12, UCM, Madrid, Spain
| | - N Fazio
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology (IEO), IRCCS, Via Ripamonti 435, 20141, Milan, Italy.
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Gervaso L, Pellicori S, Fazio N. Ivosidenib for advanced IDH1-mutant cholangiocarcinoma. Lancet Oncol 2020; 21:e370. [DOI: 10.1016/s1470-2045(20)30343-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 05/29/2020] [Accepted: 06/01/2020] [Indexed: 12/30/2022]
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Morelli C, Formica V, Pellicori S, Menghi A, Guarino MD, Perricone R, Roselli M. Chemotherapy in Patients with Hereditary Angioedema. Anticancer Res 2018; 38:6801-6807. [PMID: 30504393 DOI: 10.21873/anticanres.13052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 10/19/2018] [Accepted: 10/26/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Hereditary angioedema (HAE) is an autosomal dominant hereditary disorder characterized by episodic swelling of many body regions (especially throat and abdomen), potentially triggered by medication. No data are available for HAE in patients with cancer assigned to standard chemotherapy. The aim of our study was to identify circulating mediators potentially predictive of acute HAE attacks during chemotherapy. PATIENT AND METHODS Repeated blood testing (approximately every week) for complement system members (C3, C4, CH50, C1 inhibitor, C1-inhibitor functional C1Q), D-dimers and for routine haematochemistry were performed in a 42-year-old male affected by type 2 HAE during standard adjuvant oxaliplatin/fluorouracil-based chemotherapy administered for stage III radically resected rectal cancer. Pre-medication with 1,000 U Berinert inhibitor C1 was administered every week throughout treatment. Mann-Whitney U-test was used to determine statistical differences in measures between the first 30 days of therapy and beyond day 30 of therapy. RESULTS Pre-chemotherapy values of tested variables (day 0) were: C3: 101 mg/dl, C4: 5.71 mg/dl, CH50: 74%, C1 inhibitor: 43.4 mg/dl, C1-inhibitor functional: 18%, C1Q: 150 mg/dl, and D-dimers: 113 g/ml. A significant change in circulating values was observed for C3, D-dimers and C1-inhibitor functional. Four HAE attacks were observed, they started from the forth cycle of treatment and all were manageable. Changes in C3, D-dimers and C1-inhibitor functional preceded the attacks. CONCLUSION The stress induced by chemotherapy such a standard oxaliplatin/fluorouracil increases the risk of attacks in patients with HAE. However, circulating biomarkers such as D-dimers, C3 and C1-inhibitor functional may serve as early predictors of acute HAE crisis.
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Affiliation(s)
- Cristina Morelli
- Internal Medicine Department, Tor Vergata University Hospital, Medical Oncology Unit, Rome, Italy
| | - Vincenzo Formica
- Internal Medicine Department, Tor Vergata University Hospital, Medical Oncology Unit, Rome, Italy
| | - Stefania Pellicori
- Unit of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, Milan, Italy
| | | | - Maria Domenica Guarino
- Rheumatology, Allergology and Clinical Immunology, Department of Systems Medicinei, Tor Vergata University Hospital, Rome, Italy
| | - Roberto Perricone
- Rheumatology, Allergology and Clinical Immunology, Department of Systems Medicinei, Tor Vergata University Hospital, Rome, Italy
| | - Mario Roselli
- Internal Medicine Department, Tor Vergata University Hospital, Medical Oncology Unit, Rome, Italy
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12
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Legramante JM, Pellicori S, Magrini A, Frittelli T, Formica V, Roselli M. Cancer Patients in the Emergency Department: A "Nightmare" that Might Become a Virtuous Clinical Pathway. Anticancer Res 2018; 38:6387-6391. [PMID: 30396962 DOI: 10.21873/anticanres.12998] [Citation(s) in RCA: 12] [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: 08/29/2018] [Revised: 09/30/2018] [Accepted: 10/01/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Emergency departments (EDs) often face overcrowding issues while simultaneously confronting with the increasing clinical needs of patients, such as cancer patients, with both acute and chronic illnesses. In order to guarantee a prompt and specialized treatment of ED-attending cancer patients and reduce inappropriate inpatient admissions, a dedicated ED cancer pathway (EDCP) consisting of ED-bound Medical Oncology (MO) resident doctor and direct admission for candidate patients exclusively to the MO division was established at the Tor Vergata University Hospital in April 2015. PATIENTS AND METHODS Consecutive cancer patients attending the ED in two reference three-month periods were enrolled: pre-EDCP period, from 1st October 2014 to 31st December 2014, and post-EDCP period, from 1st October 2014 to 31st December 2015. Inpatient admission rate, mortality rate and both ED and inpatient length of stay were compared between the two analyzed periods, pre- and post-EDCP. RESULTS In the pre- and post-EDCP periods 127 and 123 cancer patients, respectively, were included. Most of the analyzed indicators were improved by EDCP implementation: Inpatient admission rate from 70% to 41% (p<0.0001), ED mortality rate from 10-4% (p=0.04), mean ED length of stay, from 58 to 42 h (p=0.03), mean inpatient length of stay, from 15.5 to 6.5 days (p<0.0001), in the pre- and post-EDCp period, respectively. CONCLUSION EDCP implementation led to a significant improvement of health care delivery to cancer patients attending the Emergency Department.
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Affiliation(s)
| | - Stefania Pellicori
- Emergency Department, Tor Vergata University Hospital, Rome, Italy.,Medical Oncology Unit, Tor Vergata University Hospital, Rome, Italy
| | - Andrea Magrini
- Medical Directorate, Tor Vergata University Hospital, Rome, Italy
| | | | - Vincenzo Formica
- Medical Oncology Unit, Tor Vergata University Hospital, Rome, Italy
| | - Mario Roselli
- Medical Oncology Unit, Tor Vergata University Hospital, Rome, Italy
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13
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Morelli C, Formica V, Pellicori S, Nardecchia A, Roselli M. Longitudinal assessment of neutrophil-to-lymphocyte ratio (NLR) from diagnosis until death reveals a biphasic trend in metastatic pancreatic adenocarcinoma patients. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy151.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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14
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Morelli C, Formica G, Pellicori S, Roselli M, Formica V. Prediction of overall survival after 3 months of treatment using the NLR-over-the-time curve in pancreatic cancer patients. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx425.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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15
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Formica V, Morelli C, Ferroni P, Nardecchia A, Tesauro M, Pellicori S, Cereda V, Russo A, Riondino S, Guadagni F, Roselli M. Neutrophil/lymphocyte ratio helps select metastatic pancreatic cancer patients benefitting from oxaliplatin. Cancer Biomark 2017; 17:335-345. [PMID: 27434293 DOI: 10.3233/cbm-160645] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND High Neutrophil/Lymphocyte ratio (NLR), as a measure of enhanced inflammatory response, has been negatively associated with prognosis in patients with localized pancreatic ductal adenocarcinoma (PDA). OBJECTIVE In the present study, we aimed at investigating the prognostic value of NLR in two homogeneous groups of chemotherapy-naïve metastatic PDA patients. Patients were treated with either gemcitabine (GEM) or gemcitabine/oxaliplatin (GEMOXA). We also assessed whether NLR could identify patients benefiting from the use of oxaliplatin. METHODS Consecutive PDA patients treated at the Medical Oncology Unit of Tor Vergata University Hospital of Rome with either GEM or GEMOXA were included (n= 103). NLR was assessed before and during chemotherapy and correlated with outcome together with common clinical and biochemical variables. RESULTS Among 17 analyzed variables NLR, Karhofsky Perfomance Status (KPS), d-dimer and erythrocyte sedimentation rate were found to be significantly associated with median Overall Survival (mOS) at the univariate analysis. Only NLR and KPS were independent prognosticator at multivariate analysis, with NLR displaying the highest statistical significance. NLR was also predictive of oxaliplatin activity, as only patients with NLR > 2.5 (cutoff determined upon ROC analysis) derived benefit from GEMOXA over GEM. CONCLUSIONS NLR is both an independent prognostic and predictive factor in metastatic PDA, since only patients with high NLR seem to benefit from the addition of oxaliplatin. NLR may help select patients for whom a particularly poor prognosis might justify more intensive, yet less tolerable, combination regimens.
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Affiliation(s)
- Vincenzo Formica
- Department of Systems Medicine, Medical Oncology, Tor Vergata Clinical Center, Tor Vergata University of Rome, Rome, Italy
| | - Cristina Morelli
- Department of Systems Medicine, Medical Oncology, Tor Vergata Clinical Center, Tor Vergata University of Rome, Rome, Italy
| | - Patrizia Ferroni
- San Raffaele Roma Open University, Rome, Italy.,Interinstitutional Multidisciplinary Biobank (BioBIM), IRCCS San Raffaele Pisana, Rome, Italy
| | - Antonella Nardecchia
- Department of Systems Medicine, Medical Oncology, Tor Vergata Clinical Center, Tor Vergata University of Rome, Rome, Italy
| | - Manfredi Tesauro
- Department of Systems Medicine, Internal Medicine, Tor Vergata Clinical Center, Tor Vergata University of Rome, Rome, Italy
| | - Stefania Pellicori
- Department of Systems Medicine, Medical Oncology, Tor Vergata Clinical Center, Tor Vergata University of Rome, Rome, Italy
| | - Vittore Cereda
- Department of Systems Medicine, Medical Oncology, Tor Vergata Clinical Center, Tor Vergata University of Rome, Rome, Italy
| | - Antonio Russo
- Section of Medical Oncology, Department of Surgical and Oncology Sciences, University of Palermo, Italy
| | - Silvia Riondino
- Department of Systems Medicine, Medical Oncology, Tor Vergata Clinical Center, Tor Vergata University of Rome, Rome, Italy.,Interinstitutional Multidisciplinary Biobank (BioBIM), IRCCS San Raffaele Pisana, Rome, Italy
| | - Fiorella Guadagni
- San Raffaele Roma Open University, Rome, Italy.,Interinstitutional Multidisciplinary Biobank (BioBIM), IRCCS San Raffaele Pisana, Rome, Italy
| | - Mario Roselli
- Department of Systems Medicine, Medical Oncology, Tor Vergata Clinical Center, Tor Vergata University of Rome, Rome, Italy
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Abstract
Gastric cancer remains one of the most important malignancies worldwide in terms of incidence and mortality. The treatment is based on the combination of local surgery and radiation therapy as well as systemic chemotherapy and targeted molecules. Fluoropyrimidines and particularly 5-fluorouracil (FU) represent still the backbone for gastric cancer chemotherapy and new molecular versions of this molecule have been brought to clinical practice in order to improve benefits and reduce adverse effects. S-1 is an oral prodrug of 5-FU, which has demonstrated high effectiveness for gastric cancer treatment and a favorable safety profile. Currently, there are geographic differences in the treatment of gastric cancer and in the use of S-1, which is a mainstay of gastric cancer management in Eastern countries, but is not part of the standard care in the rest of the world. In this review, we gathered data from phase I, II, and III trials of S-1 in gastric cancer, in order to define its real benefit-risk ratio and assess whether geographic differences in S-1 use are justified by unchangeable factors.
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Affiliation(s)
- Eriseld Krasniqi
- Department of Systems Medicine, Medical Oncology, University of Rome 'Tor Vergata', Tor Vergata Clinical Center, Rome, Italy
| | - Stefania Pellicori
- Department of Systems Medicine, Medical Oncology, University of Rome 'Tor Vergata', Tor Vergata Clinical Center, Rome, Italy
| | - Vincenzo Formica
- Department of Systems Medicine, Medical Oncology, University of Rome 'Tor Vergata', Tor Vergata Clinical Center, Rome, Italy
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17
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Schirru M, Formica V, Massimiliani V, Pellegrino R, Lucchetti J, Antonetti F, Pellicori S, Riondino S, Roselli M. Body Mass Index (BMI) e quality of life (QoL) in cancer patients – the ‘Tor Vergata’ Observational study in oNCOlogy– TV-ONCO study. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv347.04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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18
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Morelli C, Formica V, Guarino M, Cereda V, Krasniqui E, Martano L, Menghi A, Morelli A, Pellicori S, Perricone R, Roselli M. Chemotherapy delivery in patients with hereditary angioedema. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv340.35] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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19
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Formica V, Martano L, Nardecchia A, Benassi M, Del Vecchio Blanco G, Giudice E, Mannisi E, Sileri P, Franceschilli L, Rossi P, Portarena I, Pellicori S, Krasniqi E, Adamo R, Riondino S, Santoni R, Roselli M. Cisplatin plus capecitabine (CisCape) and concurrent pelvic radiotheapy for the neoadjuvant treatment of rectal cancer (RC). Ann Oncol 2015. [DOI: 10.1093/annonc/mdv340.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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20
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Formica V, Pellicori S, Arkenau HT, Morelli C, Lucchetti J, Nardecchia A, Riondino S, Ferroni P, Cereda V, Roselli M. Ideal Body Mass Index (BMI) difference between curatively resected and metastatic colorectal cancer (CRC) patients on chemotherapy. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e20675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | - Cristina Morelli
- Medical Oncology Unit, Tor Vergata University Hospital, Rome, Italy
| | | | | | - Silvia Riondino
- Medical Oncology Unit, Tor Vergata University Hospital, Rome, Italy
| | | | - Vittore Cereda
- Medical Oncology Unit, 'Tor Vergata' Clinical Center, University of Rome, Rome, Italy
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Cereda V, Formica V, Menghi A, Pellicori S, Roselli M. Kallikrein-related peptidases targeted therapies in prostate cancer: perspectives and challenges. Expert Opin Investig Drugs 2015; 24:929-47. [PMID: 25858813 DOI: 10.1517/13543784.2015.1035708] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Despite the emergence of several new effective treatments for metastatic castration-resistant prostate cancer patients, disease progression inevitably occurs, leading scientific community to carefully look for novel therapeutic targets of prostate cancer. Kallikrein (KLK)-related peptidases have been demonstrated to facilitate prostate tumorigenesis and disease progression through the development of an oncogenic microenvironment for prostate cells. AREAS COVERED This review first summarizes the large amount of preclinical data showing the involvement of KLKs in prostate cancer pathobiology. In the second part, the authors assess the current status and future directions for KLK-targeted therapy and briefly describe the advances and challenges implicated in the design of effective manufactured drugs. The authors then focus on the preclinical data and on Phase I/II studies of the most promising KLK-targeted agents in prostate cancer. The drugs discussed here are divided on the basis of their mechanism of action: KLK-engineered inhibitors; KLK-activated pro-drugs; KLK-targeted microRNAs and small interfering RNAs(-/)small hairpin RNAs; KLK vaccines and antibodies. EXPERT OPINION Targeting KLK expression and/or activity could be a promising direction in prostate cancer treatment. Future human clinical trials will help us to evaluate the real benefits, toxicities and the consequent optimal use of KLK-targeted drugs, as mono-therapy or in combination regimens.
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Affiliation(s)
- Vittore Cereda
- 1 University of Rome Tor Vergata, Tor Vergata University Clinical Center, Department of Systems Medicine, Medical Oncology , Viale Oxford 81, 00133 Rome , Italy +39 0620908190 ; +39 0620903504 ;
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Raimondi M, Landriscina M, Pellicori S, Brancaglione A, Comelli A, Sforzini I, Rizzardi R, Brancati S, Poma S. [Territorial emergency: physician or nurse?]. Minerva Anestesiol 2004; 70:405-9. [PMID: 15181423] [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]
Abstract
This study was conceived to assess a pattern of Italian prehospital critical care team, especially referring to the advanced life support (ALS) rescue team. Function and management of ALS rescue team and its relationship with other members of the emergency medical system (intra hospital physician, basic life support team, general practitioner) are analysed; stress is laidon the knowledge, the background and the complexity of the emergency procedures. The benefit of 2 major prehospital options of the ALS team, composed by 1 physician and 1 nurse staffing or by 2 trained nurse staffing, is discussed; the importance of educational programs for ambulance teams, a comparison of cost-effectiveness and the number of emergency teams availability is underlined. The authors, finally emphasize the advantages of a territorial coverage with an integrated system of ambulances staffed with specially trained rescuers or technicians, ambulances with rescuers and nurses, and ALS teams staffed with emergency physician and 1 nurse (integrated or not with ambulances with 2 trained nurses), being perfectly capable to face up any background in pre-hospital emergency medicine setting.
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Affiliation(s)
- M Raimondi
- Centrale Operativa S S U Em. 118 Pavia e Provincia, I R C C S Policlinico S Matteo, Pavia, Italy
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Cardani A, Pellicori S, Ciceri M, Di Mauro S, Roberto M, Coven G, Langer M. Caesarean section and mediastinal mass: how to approach anaesthesia? Case report. Int J Obstet Anesth 2002. [DOI: 10.1016/s0959-289x(02)80047-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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