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D'Oronzo S, Cives M, Lauricella E, Stucci S, Centonza A, Gentile M, Ostuni C, Porta C. Assessment of bone turnover markers and DXA parameters to predict bone metastasis progression during zoledronate treatment: a single-center experience. Clin Exp Med 2024; 24:7. [PMID: 38240866 PMCID: PMC10798926 DOI: 10.1007/s10238-023-01280-1] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 11/18/2023] [Indexed: 01/22/2024]
Abstract
Bone metastases (BM) are a serious cancer complication, potentially causing substantial morbidity. Among the clinical issues related to BM, there is the lack of specific tools for early diagnosis and prognosis. We explored whether combining bone turnover markers (BTM) with dual-energy X-ray absorptiometry (DXA) assessment could identify early BM progression and risk of skeletal-related events (SREs) during zoledronate treatment. Before the initiation of zoledronate (T0) and after six months of treatment (T1), serum levels of five BTM were measured, and patients (N = 47) underwent DXA evaluation. Standard radiological imaging was performed to assess bone tumor response to medical anti-cancer treatment. High tumor burden in bone correlated with higher serum CTX (p = 0.007) and NTX (p = 0.005) at baseline. Low concentrations of OPG at T0 predicted BM progression with a sensitivity and specificity of 63% and 77%, respectively, when a cutoff of 5.2 pmol/l was used; such a predictive meaning was stronger in patients with lytic BM (sensitivity: 88%, specificity: 80%; p = 0.0006). As for the risk of SREs, we observed an association between low baseline OC (p = 0.04) and OPG (p = 0.08) and the onset of any-time SREs, whereas an increase in OPG over time was associated with reduced risk of on-study events (p = 0.03). Moreover, a statistically significant correlation emerged between low baseline lumbar T-score and femur BMD and on-study SREs (p < 0.001 in both instances). These findings suggest that addition of DXA to BTM dosage could help stratifying the risk of SREs at the time of BM diagnosis but does not enhance our capability of detecting bone progression, during zoledronate treatment.
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Affiliation(s)
- Stella D'Oronzo
- Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, Italy.
- Division of Medical Oncology, A.O.U. Consorziale Policlinico Di Bari, Bari, Italy.
| | - Mauro Cives
- Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, Italy
- Division of Medical Oncology, A.O.U. Consorziale Policlinico Di Bari, Bari, Italy
| | - Eleonora Lauricella
- Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Stefania Stucci
- Division of Medical Oncology, A.O.U. Consorziale Policlinico Di Bari, Bari, Italy
| | - Antonella Centonza
- Unit of Oncology, Fondazione IRCCS "Casa Sollievo Della Sofferenza", San Giovanni Rotondo, Italy
| | - Marica Gentile
- Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Carmela Ostuni
- Oncology Unit of National Institute of Gastroenterology - IRCCS "Saverio de Bellis", Research Hospital Castellana Grotte, Bari, Italy
| | - Camillo Porta
- Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, Italy
- Division of Medical Oncology, A.O.U. Consorziale Policlinico Di Bari, Bari, Italy
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Del Re M, Crucitta S, Omarini C, Bargagna I, Mongillo M, Palleschi M, Stucci S, Meattini I, D'Onofrio R, Lorenzini G, Biondani P, De Giorgi U, Porta C, Livi L, Natalizio S, Fontana A, Giontella E, Angelini L, Fogli S, Danesi R. Concomitant administration of proton pump inhibitors does not significantly affect clinical outcomes in metastatic breast cancer patients treated with ribociclib. Breast 2022; 66:157-161. [PMID: 36283134 PMCID: PMC9593796 DOI: 10.1016/j.breast.2022.10.005] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/20/2022] [Accepted: 10/12/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Gastric pH changes by proton-pump-inhibitors (PPIs) were found to affect progression-free survival (PFS) in metastatic breast cancer (mBC) patients treated with palbociclib. The current study was aimed at investigating whether the same effect could occur in patients treated with ribociclib. PATIENTS AND METHODS Patients with hormone-positive/HER-2-negative mBC candidates for first-line treatment with ribociclib were enrolled in this retrospective-cohort study. Patients were classified as "no concomitant PPIs" or "concomitant PPIs"; PPI administration covered the entire or not less than 2/3 of treatment with ribociclib. All clinical interventions were made according to clinical practice. RESULTS A total of 128 patients were consecutively enrolled in the study; 78 belonged to the "no concomitant PPIs" group and 50 to the "concomitant PPIs" group. One hundred and six patients were endocrine-sensitive and received ribociclib and letrozole, while 22 were endocrine-resistant and were treated with ribociclib and fulvestrant. The most prescribed PPI was lansoprazole. According to PFS, patients taking PPIs had a PFS almost superimposable to those assuming ribociclib and endocrine therapy alone (35.3 vs. 49.2 months, p = 0.594). No difference in PFS was observed in estrogen-sensitive or estrogen-resistant mBC in the presence or absence of concomitant PPI treatment (p = 0.852). No correlation with adverse events was found including grade>2 hematological toxicities. CONCLUSIONS The present study supports the hypothesis that the concomitant use of PPIs does not compromise the efficacy of ribociclib in a real-life setting.
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Affiliation(s)
- Marzia Del Re
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Stefania Crucitta
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | | | - Irene Bargagna
- Unit of Medical Oncology, Department of Translational Research and New Technologies in Medicine, University of Pisa, Italy
| | - Marta Mongillo
- Section of Oncology, Department of Medicine, University of Verona and University and Hospital Trust of Verona, Italy
| | - Michela Palleschi
- Unit of Medical Oncology, IRCCS-Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’, Meldola, Italy
| | - Stefania Stucci
- Division of Oncology, Department of Biomedical Sciences and Human Oncology, University of Bari, Italy
| | - Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences ‘M. Serio’, University of Florence, Italy,Radiation Oncology Unit e Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | | | - Giulia Lorenzini
- Unit of Medical Oncology, Department of Translational Research and New Technologies in Medicine, University of Pisa, Italy
| | - Pamela Biondani
- Section of Oncology, Department of Medicine, University of Verona and University and Hospital Trust of Verona, Italy
| | - Ugo De Giorgi
- Unit of Medical Oncology, IRCCS-Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’, Meldola, Italy
| | - Camillo Porta
- Division of Oncology, Department of Biomedical Sciences and Human Oncology, University of Bari, Italy
| | - Lorenzo Livi
- Department of Experimental and Clinical Biomedical Sciences ‘M. Serio’, University of Florence, Italy,Radiation Oncology Unit e Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | | | - Andrea Fontana
- Unit of Medical Oncology, Department of Translational Research and New Technologies in Medicine, University of Pisa, Italy
| | - Elena Giontella
- Section of Oncology, Department of Medicine, University of Verona and University and Hospital Trust of Verona, Italy
| | - Lucia Angelini
- Department of Experimental and Clinical Biomedical Sciences ‘M. Serio’, University of Florence, Italy,Radiation Oncology Unit e Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Stefano Fogli
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, Italy,Corresponding author. Department of Clinical and Experimental Medicine, Via Roma, 55, 56126, Pisa, Italy.
| | - Romano Danesi
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, Italy
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D'Oronzo S, Salonne F, Scardino N, Stucci S, Paparella G, Taurisano P, Abbatantuono C, De Caro MF, Porta C. Psychosocial impact of COVID-19 pandemic on cancer patients with bone metastases (PsyCO-B): a multicentre prospective observational study. Bone Rep 2022. [PMCID: PMC9212925 DOI: 10.1016/j.bonr.2022.101371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Stucci S, Palmirotta R, Passarelli A, Silvestris E, Argentiero A, Lanotte L, Acquafredda S, Todisco A, Silvestris F. Immune-related adverse events during anticancer immunotherapy: Pathogenesis and management. Oncol Lett 2017; 14:5671-5680. [PMID: 29113194 PMCID: PMC5661371 DOI: 10.3892/ol.2017.6919] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [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: 03/24/2017] [Accepted: 07/27/2017] [Indexed: 12/20/2022] Open
Abstract
Immunotherapy is one of the most recent systemic treatments to emerge for use in oncology, and is based on the blocking of inhibitory immune checkpoints to potentiate the immune response to cancer. The anti-cytotoxic T lymphocyte-associated antigen-4 antibody ipilimumab and anti-programmed cell death protein 1 antibodies, including nivolumab and pembrolizumab, are currently available and widely used, and other immune-inhibiting antibodies are now under intensive investigation. These antibodies have shown efficacy in a growing number of tumor types, following initial observations of their notable effects in melanoma treatment. Despite the efficacy of these antibodies, their novel mechanisms of action are also associated with a new class of side effects called immune-related adverse events (IRAEs). These side effects do not share a common pathophysiology with other anticancer treatments and, therefore, they often require specific therapies. When detected early and correctly treated, IRAEs are reversible; however, they can become severe and life-threatening if underestimated or inappropriately treated. This review aims to revisit the pathogenesis of IRAEs, with attention to gastrointestinal manifestations, since these are common and potentially dangerous complications of immunotherapy and represent a major cause of treatment discontinuation. Recommendations and guidelines for the management of IRAEs are also presented, in order to provide a clear and applicable algorithm for use by clinicians.
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Affiliation(s)
- Stefania Stucci
- Department of Internal Medicine and Clinical Oncology, University of Bari Aldo Moro, I-70124 Bari, Italy
| | - Raffaele Palmirotta
- Department of Internal Medicine and Clinical Oncology, University of Bari Aldo Moro, I-70124 Bari, Italy
| | - Anna Passarelli
- Department of Internal Medicine and Clinical Oncology, University of Bari Aldo Moro, I-70124 Bari, Italy
| | - Erica Silvestris
- Department of Internal Medicine and Clinical Oncology, University of Bari Aldo Moro, I-70124 Bari, Italy
| | - Antonella Argentiero
- Department of Internal Medicine and Clinical Oncology, University of Bari Aldo Moro, I-70124 Bari, Italy
| | - Laura Lanotte
- Department of Internal Medicine and Clinical Oncology, University of Bari Aldo Moro, I-70124 Bari, Italy
| | - Silvana Acquafredda
- Department of Internal Medicine and Clinical Oncology, University of Bari Aldo Moro, I-70124 Bari, Italy
| | - Annalisa Todisco
- Department of Internal Medicine and Clinical Oncology, University of Bari Aldo Moro, I-70124 Bari, Italy
| | - Franco Silvestris
- Department of Internal Medicine and Clinical Oncology, University of Bari Aldo Moro, I-70124 Bari, Italy
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Nacchiero E, Stucci S, Annoscia P, Vestita M, Elia R, Marannino PC. A large metastatic intramammary lesion of an occult melanoma. Ann Ital Chir 2017; 88:553-556. [PMID: 28944768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Malignant melanomas presenting with unknown primaries are uncommon. In the majority of cases metastases of occult melanoma were detected in skin or in lymph nodes. Melanoma can rarely occur as a primary or metastatic intramammary tumor. CASE REPORT We report the case of a 58-year-old Caucasian woman who came to our department with a voluminous mass in her right breast. Histopathological examination found metastasis of epithelioid melanoma with unknown primary lesion. Our patient underwent a radical enlarged mastectomy, but due to the extension a radical removal was not possible. DISCUSSION In 2.2% of cases, melanoma may present with a metastasis without an identifiable primary lesion; this case should be considered a stage IV melanoma (Tx; N1; M1) due to the extension of the lesion and the infiltration of adjacent structures. CONCLUSIONS In literature, the presence of a breast metastasis of melanoma with unknown primary origin was reported just in one case. The execution of histopathological analysis is mandatory for a correct differential diagnosis with primary carcinoma of the breast. Palliative metastasectomy should be discussed with multidisciplinary melanoma board. KEY WORDS Breast metastases, Metastatic melanoma, Unknown primary site.
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Orgiano L, Bruder F, Madeddu C, Marconcini R, Gambale E, Galizia E, Stucci S, Spagnolo F, Di Guardo L, Loi C, Dessi A, Massa E, Massa D, Astara G, Del Vecchio M, Silvestris F, De Tursi M, Falcone A, Queirolo P, Scartozzi M. 409P CARAMEL study: ClinicAl prognostic biomarkers for Ipilimumab-Related outcome in metastatic MELanoma patients. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw589.006] [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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7
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Orgiano L, Bruder F, Madeddu C, Marconcini R, Gambale E, Galizia E, Stucci S, Spagnolo F, Di Guardo L, Loi C, Dessi A, Massa E, Massa D, Astara G, Del Vecchio M, Silvestris F, De Tursi M, Falcone A, Queirolo P, Scartozzi M. 409P CARAMEL study: ClinicAl prognostic biomarkers for Ipilimumab-Related outcome in metastatic MELanoma patients. Ann Oncol 2016. [DOI: 10.1016/s0923-7534(21)00567-6] [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: 11/17/2022] Open
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Tucci M, Stucci S, Passarelli A, D'Oronzo S, Silvestris F. Everolimus restrains the IL-17A-dependent osteoclast-like transdifferentiation of dendritic cells in multiple myeloma. Exp Hematol 2016; 47:48-53. [PMID: 27765615 DOI: 10.1016/j.exphem.2016.10.004] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 08/31/2016] [Accepted: 10/06/2016] [Indexed: 10/20/2022]
Abstract
Interleukin-17A (IL-17A) promotes the osteoclast (OC)-like differentiation of dendritic cells (DCs) in multiple myeloma (MM) and contributes to the pathogenesis of myeloma bone disease (MBD). In our study, everolimus (EVR) abrogated the in vitro OC-like activity of DCs from 12 MM patients significantly. Exploring the EVR effects, we found that the inhibition of the osteoerosive activity of OC-DCs was mostly due to the blockade of signals driven by the IL-17A receptor toward the CCAAT/enhancer-binding protein beta/musculoaponeurotic fibrosarcoma oncogene homolog B axis Therefore, MM patients with MBD would probably benefit from mammalian target of rapamycin inhibition.
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Affiliation(s)
- Marco Tucci
- Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Italy.
| | - Stefania Stucci
- Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Italy
| | - Anna Passarelli
- Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Italy
| | - Stella D'Oronzo
- Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Italy
| | - Franco Silvestris
- Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Italy
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9
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Orgiano L, Bruder F, Madeddu C, Marconcini R, Gambale E, Galizia E, Stucci S, Spagnolo F, Di Guardo L, Loi C, Pani F, Massa D, Massa E, Astara G, Del Vecchio M, Silvestris F, de tursi M, Falcone A, Queirolo P, Scartozzi M. CARAMEL study: Clinical prognostic biomarkers for ipilimumab-related outcome in metastatic melanoma patients. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw379.23] [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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10
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ORGIANO L, Bruder F, Madeddu C, Marconcini R, Gambale E, Galizia E, Stucci S, Spagnolo F, Di Guardo L, Loi C, Pani F, Massa D, Massa E, Astara G, Del Vecchio M, Silvestris F, De Tursi M, Falcone A, Queirolo P, Scartozzi M. CARAMEL study: ClinicAl prognostic biomarkers for Ipilimumab-Related outcome in metastatic MELanoma patients. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw341.02] [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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Orgiano L, Bruder F, Madeddu C, Marconcini R, Gambale E, Galizia E, Stucci S, Spagnolo F, Di Guardo L, Carla L, Pani F, Massa D, Massa E, Astara G, Del Vecchio M, Silvestris F, Natoli C, Falcone A, Queirolo P, Scartozzi M. CARAMEL study: Clinical prognostic biomarkers for ipilimumab-related outcome in metastatic melanoma patients. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e21009] [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)
- Laura Orgiano
- AOU Cagliari, Department of Medical Oncology, Monserrato, Italy
| | - Francesca Bruder
- Businco Hospital, Department of Medical Oncology, Cagliari, Italy
| | - Clelia Madeddu
- AOU Cagliari, Department of Medical Oncology, Cagliari, Italy
| | | | | | - Eva Galizia
- Oncologia Medica, Ospedale Profili, Fabriano, Italy
| | | | | | | | - Loi Carla
- AOU Cagliari, Department of Medical Oncology, Monserrato, Italy
| | - Fabiana Pani
- Endocrinology and Diabetes Unit, Department of Medical SciencesUniversity of Cagliari, Cagliari, Italy
| | - Daniela Massa
- Businco Hospital, Department of Medical Oncology, Cagliari, Italy
| | - Elena Massa
- Department of Medical Oncology, Cagliari, Italy
| | - Giorgio Astara
- AOU Cagliari, Department of Medical Oncology, Cagliari, Italy
| | | | | | - Clara Natoli
- Department of Experimental and Clinical Sciences, University, Chieti, Italy
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Tucci M, Stucci S, Felici C, Cafforio P, Resta L, Rossi R, Silvestris F. Cilengitide restrains the osteoclast-like bone resorbing activity of myeloma plasma cells. Br J Haematol 2016; 173:59-69. [DOI: 10.1111/bjh.13922] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Accepted: 11/18/2015] [Indexed: 12/13/2022]
Affiliation(s)
- Marco Tucci
- Department of Biomedical Sciences and Human Oncology; University of Bari ‘Aldo Moro’; Bari Italy
| | - Stefania Stucci
- Department of Biomedical Sciences and Human Oncology; University of Bari ‘Aldo Moro’; Bari Italy
| | - Claudia Felici
- Department of Biomedical Sciences and Human Oncology; University of Bari ‘Aldo Moro’; Bari Italy
| | - Paola Cafforio
- Department of Biomedical Sciences and Human Oncology; University of Bari ‘Aldo Moro’; Bari Italy
| | - Leonardo Resta
- Department of Emergency and Organ Transplantation; University of Bari ‘Aldo Moro’; Bari Italy
| | - Roberta Rossi
- Department of Emergency and Organ Transplantation; University of Bari ‘Aldo Moro’; Bari Italy
| | - Franco Silvestris
- Department of Biomedical Sciences and Human Oncology; University of Bari ‘Aldo Moro’; Bari Italy
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Cives M, Rizzo F, Simone V, Bisceglia F, Stucci S, Seeber A, Spizzo G, Montrone T, Resta L, Silvestris F. Reviewing the Osteotropism in Neuroendocrine Tumors: The Role of Epithelial-Mesenchymal Transition. Neuroendocrinology 2016; 103:321-34. [PMID: 26227818 DOI: 10.1159/000438902] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Accepted: 07/15/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Neuroendocrine tumors (NETs) metastasize to the bone. However, the incidence, clinical features, management and pathogenesis of bone involvement in NET patients have been poorly investigated. METHODS We reviewed all published reports of histologically confirmed bone metastatic NETs and explored clinical, radiological, prognostic and therapeutic characteristics in a population of 152 patients. We then evaluated immunohistochemical expression of a panel of eight epithelial-mesenchymal transition (EMT)-related factors including SNAIL, TGF-β1, CTGF, IL-11, PTHrP, EpCAM, CXCR4 and RANK in an independent cohort of 44 archival primary NETs. Biomarker expression was correlated with clinicopathological variables, including skeletal involvement, and tested for survival prediction. RESULTS We found that 55% of NET patients with bone metastases were male, with a median age of 55 years at diagnosis. Metastases were restricted to the skeleton in 34% of the NET population, and axial and osteoblastic lesions were prevalent. NETs differently expressed proteins involved in EMT activation. High CXCR4 (p < 0.0001) and low TGF-β1 levels (p = 0.0015) were significantly associated with increased risk of skeletal metastases, suggesting that EMT is implicated in NET osteotropism. By applying an algorithm measuring distinct immunohistochemical predictors of osteotropism on primary tumors, we were able to identify NET patients with bone metastases with a sensitivity and specificity of 91 and 100%, respectively (p < 0.0001). Patients whose primary tumors expressed CTGF (p = 0.0007) as well as the truncated form of EpCAM (p = 0.06) showed shorter survival. CONCLUSION Although underestimated, bone metastases are a prominent feature of NETs, and the tumor expression of EMT markers at diagnosis may predict concurrent or subsequent skeleton colonization.
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Affiliation(s)
- Mauro Cives
- Department of Biomedical Sciences and Clinical Oncology, University of Bari, Bari, Italy
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Stucci S, Tucci M, Passarelli A, Mannavola F, Felici C, Giudice G, Silvestris F. Circulating dendritic cell levels identify high-risk stage II-III melanoma patients: a potential role as additional prognostic marker. Lab Invest 2015. [PMCID: PMC4315279 DOI: 10.1186/1479-5876-13-s1-p14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Abstract
The crosstalk of melanoma cells with components of the microenvironment promotes malignant cell proliferation and spread to distant tissues. Although the major pathogenetic events have already been elucidated, the mechanisms that drive the metastatic behavior of tumor cells are still undefined. MicroRNAs (miRNAs) are small non-coding RNAs that control post-transcriptional gene expression through interconnected kinases upstream of functional genes involved in tumor progression. Here, we review the biological relevance of melanoma-related miRNAs and focus on their potential role in propagating signals that may cause tumor microenvironment rearrangements, as well as disablement of the immune system and melanoma cell proliferation.
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Affiliation(s)
- Francesco Mannavola
- a DIMO, Department of Internal Medicine and Clinical Oncology , University of Bari 'Aldo Moro' , Bari , Italy
| | - Marco Tucci
- a DIMO, Department of Internal Medicine and Clinical Oncology , University of Bari 'Aldo Moro' , Bari , Italy
| | - Claudia Felici
- a DIMO, Department of Internal Medicine and Clinical Oncology , University of Bari 'Aldo Moro' , Bari , Italy
| | - Stefania Stucci
- a DIMO, Department of Internal Medicine and Clinical Oncology , University of Bari 'Aldo Moro' , Bari , Italy
| | - Franco Silvestris
- a DIMO, Department of Internal Medicine and Clinical Oncology , University of Bari 'Aldo Moro' , Bari , Italy
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D'Oronzo S, Stucci S, Tucci M, Silvestris F. Cancer treatment-induced bone loss (CTIBL): pathogenesis and clinical implications. Cancer Treat Rev 2015; 41:798-808. [PMID: 26410578 DOI: 10.1016/j.ctrv.2015.09.003] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [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: 06/11/2015] [Revised: 09/07/2015] [Accepted: 09/09/2015] [Indexed: 12/20/2022]
Abstract
Osteopenia and osteoporosis are often long-term complications of anti-neoplastic treatments, defined as "cancer treatment-induced bone loss" (CTIBL). This pathological condition in oncologic patients results in a higher fracture risk than in the general population, and so has a significant negative impact on their quality of life. Hormone treatment is the main actor in this scenario, but not the only one. In fact, chemotherapies, radiotherapy and tyrosine kinase inhibitors may contribute to deregulate bone remodeling via different mechanisms. Thus, the identification of cancer patients at risk for CTIBL is essential for early diagnosis and appropriate intervention, that includes both lifestyle modifications and pharmacological approaches to prevent bone metabolism failure during anti-tumor treatments.
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Affiliation(s)
- S D'Oronzo
- University of Bari "Aldo Moro", Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine and Clinical Oncology, Piazza Giulio Cesare, 11, 70124 Bari, Italy.
| | - S Stucci
- University of Bari "Aldo Moro", Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine and Clinical Oncology, Piazza Giulio Cesare, 11, 70124 Bari, Italy.
| | - M Tucci
- University of Bari "Aldo Moro", Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine and Clinical Oncology, Piazza Giulio Cesare, 11, 70124 Bari, Italy.
| | - F Silvestris
- University of Bari "Aldo Moro", Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine and Clinical Oncology, Piazza Giulio Cesare, 11, 70124 Bari, Italy.
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Stucci S, Tucci M, Ascierto PA, Passarelli A, Mariaelena C, Madonna G, Ester S, Grimaldi AM, Silvestris F. Dendritic cell-derived exosomes (Dex) are potential biomarkers of response to Ipilimumab in metastatic melanoma. J Transl Med 2015. [PMCID: PMC4315280 DOI: 10.1186/1479-5876-13-s1-p15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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18
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Affiliation(s)
- Marco Tucci
- Department of Biomedical Sciences and Clinical Oncology, University of Bari 'Aldo Moro', 11-70124 Bari, Italy.
| | - Stefania Stucci
- Department of Biomedical Sciences and Clinical Oncology, University of Bari 'Aldo Moro', 11-70124 Bari, Italy
| | - Franco Silvestris
- Department of Biomedical Sciences and Clinical Oncology, University of Bari 'Aldo Moro', 11-70124 Bari, Italy
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Tucci M, Stucci S, Savonarola A, Resta L, Cives M, Rossi R, Silvestris F. An imbalance between Beclin-1 and p62 expression promotes the proliferation of myeloma cells through autophagy regulation. Exp Hematol 2014; 42:897-908.e1. [DOI: 10.1016/j.exphem.2014.06.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 05/02/2014] [Accepted: 06/13/2014] [Indexed: 12/19/2022]
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Tucci M, Stucci S, Passarelli A, Giudice G, Dammacco F, Silvestris F. The immune escape in melanoma: role of the impaired dendritic cell function. Expert Rev Clin Immunol 2014; 10:1395-404. [DOI: 10.1586/1744666x.2014.955851] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Tucci M, Stucci S, Vallarelli S, Gesualdo L, Brunetti O, Dei Tos AP, Silvestris F. Paraneoplastic focal segmental glomerulosclerosis in sarcomatoid renal cell cancer. J Clin Oncol 2014; 33:e66-70. [PMID: 24663052 DOI: 10.1200/jco.2013.50.0413] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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
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22
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Cafforio P, Savonarola A, Stucci S, De Matteo M, Tucci M, Brunetti AE, Vecchio VM, Silvestris F. PTHrP produced by myeloma plasma cells regulates their survival and pro-osteoclast activity for bone disease progression. J Bone Miner Res 2014; 29:55-66. [PMID: 23787729 DOI: 10.1002/jbmr.2022] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 05/31/2013] [Accepted: 06/10/2013] [Indexed: 11/07/2022]
Abstract
To promote their survival and progression in the skeleton, osteotropic malignancies of breast, lung, and prostate produce parathyroid hormone-related protein (PTHrP), which induces hypercalcemia. PTHrP serum elevations have also been described in multiple myeloma (MM), although their role is not well defined. When we investigated MM cells from patients and cell lines, we found that PTHrP and its receptor (PTH-R1) are highly expressed, and that PTHrP is secreted both as a full-length molecule and as small subunits. Among these subunits, the mid-region, including the nuclear localization sequence (NLS), exerted a proliferative effect because it was accumulated in nuclei of MM cells surviving in starvation conditions. This was confirmed by increased transcription of several genes enrolled in proliferation and apoptosis control. PTHrP was also found to stimulate PTH-R1 in MM cells. PTH-R1's selective activation by the full-length PTHrP molecule or the NH2 -terminal fragment resulted in a significant increase of intracellular Ca(2+) influx, cyclic adenosine monophosphate (cAMP) content, and expression of receptor activator of NF-κB ligand (RANKL) and monocyte chemoattractant protein-1 (MCP-1). Our data definitely clarify the role of PTHrP in MM. The PTHrP peptide is functionally secreted by malignant plasma cells and contributes to MM tumor biology and progression, both by intracrine maintenance of cell proliferation in stress conditions and by autocrine or paracrine stimulation of PTH-R1, which in turn reinforces the production of osteoclastogenic factors. © 2014 American Society for Bone and Mineral Research.
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Affiliation(s)
- Paola Cafforio
- Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine and Oncology, University of Bari "Aldo Moro,", Bari, Italy
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Tucci M, Stucci S, Savonarola A, Ciavarella S, Cafforio P, Dammacco F, Silvestris F. Immature dendritic cells in multiple myeloma are prone to osteoclast-like differentiation through interleukin-17A stimulation. Br J Haematol 2013; 161:821-31. [PMID: 23594390 DOI: 10.1111/bjh.12333] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 02/26/2013] [Indexed: 12/27/2022]
Abstract
Interleukin 17A (IL17A), a cytokine involved in allergy, inflammation and osteoclastogenesis, was investigated in multiple myeloma (MM) to assess its role in the osteoclast (OC)-like activity of marrow immature dendritic cells (iDCs). Comparing nine MM patients with control subjects affected by monoclonal gammopathy of undetermined significance, we found high IL17A expression in the marrow plasma of MM patients in parallel with its deposits within the stromal matrix. Increased expression of the IL17A receptor (IL17RA) was also found in primary myeloma iDCs, which underwent OC-like transdifferentiation after IL17A stimulation. To assess the role of IL17A, we measured the activity of the IL17/IL17RA pathway in IL17A-transdifferentiated iDCs and the expression of functional OC genes by Western blotting and real-time polymerase chain reaction. These cells showed increased RNA transcription of genes enrolled in the maturation of OCs, while NFATC1 and FOS were induced by IL17A, independently of NFKB1 phosphorylation. Moreover, the concurrent phosphorylation of the Lip isoform of CEBPB and the down-regulation of MAFB supported the activation of IL17RA pathway in OC-like transdifferentiated iDCs that was apparently unrelated to TNFRSF11A signalling. These data emphasize the involvement of iDCs in MM hyperactive osteoclastogenesis and suggest that their bone resorption activity is also regulated, at least in vitro, by IL17RA.
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Affiliation(s)
- Marco Tucci
- Department of Biomedical Science and Clinical Oncology, University of Bari Aldo Moro, Piazza Giulio Cesare, Bari, Italy.
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Tucci M, Stucci S, Strippoli S, Dammacco F, Silvestris F. Dendritic cells and malignant plasma cells: an alliance in multiple myeloma tumor progression? Oncologist 2011; 16:1040-8. [PMID: 21659611 DOI: 10.1634/theoncologist.2010-0327] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The crosstalk of myeloma cells with accessory cells drives the expansion of malignant plasma cell clones and the hyperactivation of osteoclastogenesis that occurs in multiple myeloma (MM). These reciprocal interactions promote defective dendritic cell (DC) function in terms of antigen processing, clearance of tumor cells, and efficacy of the immune response. Thus, myeloma cells exert immune suppression that explains, at least in part, the failure of therapeutic approaches, including DC vaccination. Impairment of DCs depends on high bone marrow levels of cytokines and adhesion molecules that affect both maturation and expression of costimulatory molecules by DCs. Moreover, DCs share with osteoclasts (OCs) a common ontogenetic derivation from the monocyte lineage, and thus may undergo OC-like transdifferentiation both in vitro and in vivo. Immature DCs (iDCs) induce clonogenic growth of malignant plasma cells while displaying OC-like features, including the ability to resorb bone tissue once cultured with myeloma cells. This OC-like transdifferentiation of iDCs is dependent on the activation of both the receptor activator of nuclear factor κB (RANK)-RANK ligand (RANK-L) and CD47-thrombospondin (TSP)-I axes, although interleukin 17-producing T helper-17 clones within the bone microenvironment may also take part in this function. Therefore, iDCs allied with malignant plasma cells contribute to MM osteoclastogenesis, although other molecules released by tumor cells may independently contribute to the bone-resorbing machinery.
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Affiliation(s)
- Marco Tucci
- IMO, Department of Internal Medicine and Clinical Oncology, University of Bari, Aldo Moro, Italy.
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Strippoli S, Stucci S, Dammacco F, Silvestris F. [Novel markers in osteo-oncology: the tartrate resistant acid phosphatase in myeloma bone disease]. Recenti Prog Med 2011; 102:88-95. [PMID: 21513124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
In tumors characterized by a high osteotropism, such as multiple myeloma, the measurement of bone metabolism markers is helpful in monitoring both severity and prognosis of the skeletal disease. Here, we review the pathophysiology of these markers including tartrate resistant acid phosphatase (TRAcP), which appears highly specific and closely related to the extent of myeloma bone lesions.
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