1
|
Pasello G, Lorenzi M, Scattolin D, Del Conte A, Cecere F, Pavan A, Macerelli M, Polo V, Pilotto S, Santarpia M, Cumerlato E, Da Ros V, Targato G, Bortolami A, Bonanno L, Ferro A, Dal Maso A, Frega S, Guarneri V. Osimertinib in Patients With Treatment-Naive EGFR-Mutant Non-small Cell Lung Cancer: Overall Survival, Post-progression Management and Budget Impact Analysis in Real-World. Oncologist 2024:oyae043. [PMID: 38520745 DOI: 10.1093/oncolo/oyae043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/05/2024] [Indexed: 03/25/2024] Open
Abstract
INTRODUCTION The observational multicenter prospective FLOWER study (NCT04965701) confirmed effectiveness and safety of osimertinib in the real-world (RW) management of untreated EGFR-mutant advanced non-small cell lung cancer (aNSCLC) patients. METHODS Herein, we report updated survival data, post-progression management, cost/effectiveness and budget impact (BI) of osimertinib compared with a RW population receiving gefitinib or erlotinib. RESULTS Overall, 189 Caucasian patients receiving first-line osimertinib were included. After a follow-up of 20.7 months, 74(39.2%) patients discontinued osimertinib, median time-to-treatment discontinuation (mTTD) was 27.9 months, overall survival 36.8 months. At progression, tissue biopsy was performed in 29 (56.9%), liquid biopsy in 15 (29.4%) and both in 7 (13.7%) cases. The most frequent resistant mechanism was MET amplification (N = 14, 29.8%). At data cutoff, 13 (6.9%) patients were continuing osimertinib beyond progression; 52 (67.5%) received second-line treatment; no further treatments were administered in 25 (32.5%) cases. Thirty-three (63.4%) patients received chemotherapy, 12(23.1%) TKIs combination. Cost-effectiveness analysis showed a total cost per patient based on RW mTTD of 98,957.34€, 21,726.28€ and 19,637.83€ for osimertinib, erlotinib and gefitinib, respectively. The incremental cost-effectiveness ratio (ICER)/month for osimertinib was 359,806.0€/life-year-gained (LYG) and 197,789.77€/LYG compared to erlotinib and gefitinib. For osimertinib, the BI-gap between RW-TTD and theoretical-TTD was 16,501.0€ per patient. CONCLUSIONS This updated analysis confirms the effectiveness of osimertinib in RW. Although the ICER of osimertinib seems not cost-effective, additional costs for the management of disease progression to old generation TKIs were not considered in this study. The BI-gap suggests RW mTTD as a more reliable measure for expense estimation.
Collapse
Affiliation(s)
- Giulia Pasello
- Department of Surgery, Oncology, and Gastroenterology, University of Padova, Padova, Italy
- Division of Medical Oncology 2, Veneto Institute of Oncology - IRCCS, Padova, Italy
| | - Martina Lorenzi
- Department of Surgery, Oncology, and Gastroenterology, University of Padova, Padova, Italy
| | - Daniela Scattolin
- Department of Surgery, Oncology, and Gastroenterology, University of Padova, Padova, Italy
- Division of Medical Oncology 2, Veneto Institute of Oncology - IRCCS, Padova, Italy
| | - Alessandro Del Conte
- Medical Oncology and Immunorelated Tumors, National Cancer Institute Centro di Riferimento Oncologico (CRO) - IRCCS, Aviano (PN), Italy
| | - Fabiana Cecere
- Oncology 1, Regina Elena National Cancer Institute - IRCCS, Roma, Italy
| | - Alberto Pavan
- Medical Oncology Department, Azienda Unità Locale Socio Sanitaria (AULSS 3) Serenissima, Mestre-Venezia, Italy
| | - Marianna Macerelli
- Department of Oncology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Valentina Polo
- Oncology Unit, AULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy
| | - Sara Pilotto
- Section of Innovation Biomedicine - Oncology Area, Department of Engineering for Innovation Medicine (DIMI), University of Verona and University and Hospital Trust (AOUI) of Verona, Verone, Italy
| | | | - Enrico Cumerlato
- Medical Oncology, AULSS 6 Euganea, South Padua Hospital, Monselice (PD), Italy
| | - Valentina Da Ros
- Medical Oncology and Immunorelated Tumors, National Cancer Institute Centro di Riferimento Oncologico (CRO) - IRCCS, Aviano (PN), Italy
| | - Giada Targato
- Department of Oncology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Alberto Bortolami
- Veneto Oncology Network, Istituto Oncologico Veneto, I.R.C.C.S., Padua, Italy
| | - Laura Bonanno
- Division of Medical Oncology 2, Veneto Institute of Oncology - IRCCS, Padova, Italy
| | - Alessandra Ferro
- Division of Medical Oncology 2, Veneto Institute of Oncology - IRCCS, Padova, Italy
| | - Alessandro Dal Maso
- Division of Medical Oncology 2, Veneto Institute of Oncology - IRCCS, Padova, Italy
| | - Stefano Frega
- Division of Medical Oncology 2, Veneto Institute of Oncology - IRCCS, Padova, Italy
| | - Valentina Guarneri
- Department of Surgery, Oncology, and Gastroenterology, University of Padova, Padova, Italy
- Division of Medical Oncology 2, Veneto Institute of Oncology - IRCCS, Padova, Italy
| |
Collapse
|
2
|
Lorenzi M, Resi MV, Bonanno L, Frega S, Dal Maso A, Ferro A, Guarneri V, Pasello G. Tissue and circulating biomarkers of benefit to immunotherapy in extensive-stage small cell lung cancer patients. Front Immunol 2024; 15:1308109. [PMID: 38348046 PMCID: PMC10859471 DOI: 10.3389/fimmu.2024.1308109] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/12/2024] [Indexed: 02/15/2024] Open
Abstract
Extensive stage-Small-Cell Lung Cancer (ES-SCLC) is an aggressive cancer with dismal prognosis. The addition of immune-checkpoint inhibitors (ICIs) to platinum-based chemotherapy have been consistently demonstrated to improve outcomes and survival, becoming the new standard in first - line treatment of ES-SCLC patients. However, despite positive results reported in the pivotal trials, longer benefit appears evident only for a selected group of patients. Several predictive biomarkers have been studied so far but the prospective identification of patients more likely to experience better outcome seems to be challenging in SCLC. Indeed, classical immune predictive biomarkers as PD-L1 and tumor mutational burden (TMB) seem not to correlate with outcomes. Recently, a new molecular classification of SCLC based on differential expression of genes associated with specific clinical behaviors and therapeutic vulnerability have been presented suggesting a new field to be investigated. Despite the achievements, these studies focused mainly on inter-tumoral heterogeneity, limiting the exploration of intra-tumoral heterogeneity and cell to cell interactions. New analysis methods are ongoing in order to explore subtypes plasticity. Analysis on single biopsies cannot catch the whole genomic profile and dynamic change of disease over time and during treatment. Moreover, the availability of tissue for translational research is limited due to the low proportion of patients undergoing surgery. In this context, liquid biopsy is a promising tool to detect reliable predictive biomarkers. Here, we reviewed the current available data on predictive role of tissue and liquid biomarkers in ES-SCLC patients receiving ICIs. We assessed latest results in terms of predictive and prognostic value of gene expression profiling in SCLC. Finally, we explored the role of liquid biopsy as a tool to monitor SCLC patients over time.
Collapse
Affiliation(s)
- Martina Lorenzi
- Department of Medical Oncology, Santa Chiara Hospital, Trento, Italy
| | - Maria Vittoria Resi
- Division of Medical Oncology 2, Veneto Institute of Oncology - IRCCS, Padova, Italy
- Department of Surgery, Oncology, and Gastroenterology, University of Padova, Padova, Italy
| | - Laura Bonanno
- Division of Medical Oncology 2, Veneto Institute of Oncology - IRCCS, Padova, Italy
| | - Stefano Frega
- Division of Medical Oncology 2, Veneto Institute of Oncology - IRCCS, Padova, Italy
| | - Alessandro Dal Maso
- Division of Medical Oncology 2, Veneto Institute of Oncology - IRCCS, Padova, Italy
| | - Alessandra Ferro
- Division of Medical Oncology 2, Veneto Institute of Oncology - IRCCS, Padova, Italy
| | - Valentina Guarneri
- Division of Medical Oncology 2, Veneto Institute of Oncology - IRCCS, Padova, Italy
- Department of Surgery, Oncology, and Gastroenterology, University of Padova, Padova, Italy
| | - Giulia Pasello
- Division of Medical Oncology 2, Veneto Institute of Oncology - IRCCS, Padova, Italy
- Department of Surgery, Oncology, and Gastroenterology, University of Padova, Padova, Italy
| |
Collapse
|
3
|
Bonanno L, Calvetti L, Dal Maso A, Pavan A, Bao LC, De Nuzzo M, Frega S, Sartori G, Ferro A, Pasello G, Morandi P, Aprile G, Guarneri V. Real-world impact of the introduction of chemo-immunotherapy in extended small cell lung cancer: a multicentric analysis. Front Immunol 2024; 15:1353889. [PMID: 38322260 PMCID: PMC10845350 DOI: 10.3389/fimmu.2024.1353889] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 01/09/2024] [Indexed: 02/08/2024] Open
Abstract
Background Recent clinical trials demonstrated longer survival in extended small cell lung cancer (SCLC) patients treated with immunotherapy in addition to chemotherapy. However, the magnitude of benefit is modest and the impact in real-world setting has to be fully established. Methods We collected clinical data and radiological imaging of patients affected by extended or relapsing SCLC and consecutively treated according to clinical practice between 2016 and 2023. As primary end-point, we compared pre-defined outcome indicators before and after the introduction of chemo-immunotherapy (May 2020): 6-month and 12-month progression free survival (PFS) rate, 12-month and 18-month overall survival (OS). Among those who were treated after May 2020, patients who did not receive immunotherapy according to treating physician's choice were included in the analysis to minimize clinical selection bias. Results The analysis included 214 patients: 132 (61.7%) were treated in an Academic cancer center and 82 (38.3%) in two community hospitals; 104 were treated before May 2020. Median PFS of the overall study population was 4.8 months (95% confidence interval [95% CI]: 4.4-5.4), median OS was 7.1 months (95% CI: 6.3-7.7). Estimated PFS and OS were significantly longer in patients treated after May 2020 with hazard ratio (HR) for PFS and OS of 0.61 (95% CI: 0.46-0.81, p < 0.001) and 0.70 (95% CI: 0.52-0.93, p = 0.015), respectively. 6-month PFS rate increased from 27% to 40% (p = 0.04) while 12-months PFS raised from 1% to 11% (p = 0.003). 12-month and 18-month OS rate increased from 15% to 28% (p = 0.03) and from 2.1% to 12% (p = 0.009), respectively. After May 2020 the median number of hospitalization days per patient decreased significantly and the incidence of severe AEs was similar. Among patients treated with chemo-immunotherapy, the onset of immune-related AEs was associated with improved PFS and OS (HR 0.55, 95% CI: 0.35-0.89, p = 0.012 and HR 0.47, 95%CI 0.28-0.77, p = 0.002, respectively). Conclusions The real-world analysis shows a meaningful improvement of outcome indicators after the introduction of chemo-immunotherapy, with reduction of the duration of hospitalization, thus supporting the use of chemo-immunotherapy and the need for further biomarker research.
Collapse
Affiliation(s)
- Laura Bonanno
- Medical Oncology 2, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
| | - Lorenzo Calvetti
- Department of Oncology, Azienda ULSS 8 Berica, San Bortolo General Hospital, Vicenza, Italy
| | | | - Alberto Pavan
- Medical Oncology Department, Azienda ULSS 3 Serenissima, Dell’Angelo General Hospital, Mestre and SS Giovanni e Paolo General Hospital, Venezia, Italy
| | - Loc Carlo Bao
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Mattia De Nuzzo
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Stefano Frega
- Medical Oncology 2, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
| | - Giulia Sartori
- Department of Oncology, Azienda ULSS 8 Berica, San Bortolo General Hospital, Vicenza, Italy
| | - Alessandra Ferro
- Medical Oncology 2, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
| | - Giulia Pasello
- Medical Oncology 2, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Paolo Morandi
- Medical Oncology Department, Azienda ULSS 3 Serenissima, Dell’Angelo General Hospital, Mestre and SS Giovanni e Paolo General Hospital, Venezia, Italy
| | - Giuseppe Aprile
- Department of Oncology, Azienda ULSS 8 Berica, San Bortolo General Hospital, Vicenza, Italy
| | - Valentina Guarneri
- Medical Oncology 2, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| |
Collapse
|
4
|
Bonanno L, Lorenzi M, Massa D, De Nuzzo M, Angerilli V, Zingone F, Barberio B, Russi A, Girardi F, Ferro A, Dal Maso A, Frega S, Pasello G, Dei Tos AP, Coppola M, Fassan M, Savarino EV, Guarneri V. Immune-Related Diarrhea and Colitis in Non-small Cell Lung Cancers: Impact of Multidisciplinary Management in a Real-World Setting. Oncologist 2024; 29:e118-e130. [PMID: 37603442 PMCID: PMC10769780 DOI: 10.1093/oncolo/oyad238] [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: 04/05/2023] [Accepted: 07/13/2023] [Indexed: 08/23/2023] Open
Abstract
INTRODUCTION Immune-related adverse events (irAEs) constitute a challenge in the clinical management of solid tumors. This study aims to collect real-world data on the occurrence of immune-mediated diarrhea and colitis (IMDC) in advanced non-small cell lung cancer (aNSCLC) treated with immune checkpoint inhibitors (ICIs) and to assess the clinical impact of a multidisciplinary approach (MDA) on IMDC management. METHODS We retrospectively collected data on patients with aNSCLC consecutively treated with ICIs, either as single agent or in combination with chemotherapy, between September 2013 and July 2022. Among patients developing IMDC, we conducted blinded revision of colonic biopsies and evaluated the clinical impact of the introduction of MDA through predefined indicators. RESULTS Among the 607 patients included, 84 (13.8%) experienced IMDC. Pathological review highlighted a high prevalence of microscopic colitis (28%), with a collagenous pattern linked to longer symptoms duration (P = .01). IMDC occurred more frequently in females (P = .05) and PD-L1 expressors (P = .014) and was correlated with longer progression-free survival (17.0 vs 5.8, P < .001) and overall survival (28.3 vs 9.5, P < .001). The introduction of MDA was associated with increased employment of diagnostical tools such as fecal calprotectin test (P < .001), colonoscopy (P < .001), and gastroenterological evaluation (P = .017) and a significant decrease in both grade 3 conversion rate (P = .046) and recurrence after rechallenge (P = .016). Hospitalization rate dropped from 17.2% to 3.8% (P: ns). CONCLUSION These findings highlight the clinical relevance of IMDC and support the incorporation of a MDA to optimize the clinical management of this irAE to improve patient care. Prospective validation has been planned.
Collapse
Affiliation(s)
- Laura Bonanno
- Oncology 2, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | - Martina Lorenzi
- Oncology 2, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Davide Massa
- Oncology 2, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Mattia De Nuzzo
- Oncology 2, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Valentina Angerilli
- Department of Medicine (DIMED), Surgical Pathology Unit, University of Padova, Padova, Italy
| | - Fabiana Zingone
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
- Gastroenterology Unit, Azienda Ospedale Università of Padua, Padova, Italy
| | - Brigida Barberio
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
- Gastroenterology Unit, Azienda Ospedale Università of Padua, Padova, Italy
| | - Alberto Russi
- Pharmacy Unit, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | - Fabio Girardi
- Oncology 2, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | | | | | - Stefano Frega
- Oncology 2, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | - Giulia Pasello
- Oncology 2, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Angelo Paolo Dei Tos
- Department of Medicine (DIMED), Surgical Pathology Unit, University of Padova, Padova, Italy
| | - Marina Coppola
- Pharmacy Unit, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | - Matteo Fassan
- Department of Medicine (DIMED), Surgical Pathology Unit, University of Padova, Padova, Italy
- Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | - Edoardo Vincenzo Savarino
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
- Gastroenterology Unit, Azienda Ospedale Università of Padua, Padova, Italy
| | - Valentina Guarneri
- Oncology 2, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| |
Collapse
|
5
|
Pasello G, Lorenzi M, Crivellaro G, Capelletto E, Butticè S, Perrone F, Tiseo M, Scotti V, Polo V, Favaretto A, Montrone M, Berardi R, Zustovich F, Toschi L, Bearz A, Milella M, Frega S, Bonanno L, Guarneri V. 21P Bevacizumab plus atezolizumab and chemotherapy in NSCLC harbouring EGFR mutation previously treated with EGFR tyrosine kinase inhibitor: The BACH-NET study. J Thorac Oncol 2023. [DOI: 10.1016/s1556-0864(23)00275-7] [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: 04/03/2023]
|
6
|
Pasello G, Lorenzi M, Tosi A, Roma A, Pavan A, Scapinello A, Lonardi S, Ferro A, Maso AD, Frega S, Bonanno L, Del Bianco P, Guarneri V, Rosato A. 164P Immune cells distribution and spatial relationship within microenvironment as predictive biomarkers of benefit in extended stage small cell lung cancer patients receiving atezolizumab plus carboplatin and etoposide as first-line treatment. J Thorac Oncol 2023. [DOI: 10.1016/s1556-0864(23)00418-5] [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: 04/04/2023]
|
7
|
Canova S, Ceresoli G, Grosso F, Zucali P, Gelsomino F, Pasello G, Mencoboni M, Rulli E, Galli F, De Simone I, Carlucci L, De Angelis A, Belletti M, Bonomi M, D’Aveni A, Perrino M, Bono F, Cortinovis D, Canova S, Colonese F, Abbate M, Sala L, Sala E, Perez Gila M, Bono F, Pagni F, Ceresoli G, D’Aveni A, Bonomi M, Grosso F, De Angelis A, Ugo F, Belletti M, Zucali P, Perrino M, De Vincenzo F, Santoro A, Gelsomino F, Ardizzoni A, Pasello G, Frega S, Mencoboni M, Carlucci L, De Simone I, D’Incalci M, Galli F, Poli D, Rulli E, Torri V. Final results of DIADEM, a phase II study to investigate the efficacy and safety of durvalumab in advanced pretreated malignant pleural mesothelioma. ESMO Open 2022; 7:100644. [PMID: 36463732 PMCID: PMC9808442 DOI: 10.1016/j.esmoop.2022.100644] [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: 04/27/2022] [Revised: 09/15/2022] [Accepted: 10/26/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Malignant pleural mesothelioma (MPM) is a cancer with a high mortality rate and few therapeutic options. After platinum-pemetrexed combination, no further promising drug seems to be effective. Immune checkpoint inhibitors may have some activity in pretreated patients and no data are available in this population about durvalumab. MATERIALS AND METHODS DIADEM was a multicenter, open-label, single-arm, phase II trial aimed at evaluating the efficacy and safety of durvalumab. Patients with locally advanced/metastatic MPM who progressed after platinum-pemetrexed chemotherapy were enrolled to receive durvalumab (1500 mg, intravenously Q4W) for 12 months or until evidence of disease progression or unacceptable toxicity. The primary endpoint was the proportion of patients alive and free from progression at 16 weeks (PFS16wks) calculated from treatment initiation. Secondary endpoints were progression-free survival, overall survival, overall response rate, and safety. RESULTS Sixty-nine patients with a median age of 69 years (range 44-82 years) were enrolled; 62 patients (89.9%) had epithelioid histotype. As first-line treatment, all patients received platinum derivatives-pemetrexed combination (60.9% with carboplatin and 39.1% with cisplatin). As of March 2021, the median follow-up was 9.2 months (interquartile range 5.2-11.1 months). Six patients (8.7%) completed the 12-month treatment; 60 patients discontinued, of whom 42 for progressive disease, and 4 died. Seventeen patients (28.3%; 95% confidence interval 17.5% to 41.4%) were alive or free from progression at 16 weeks. Eleven patients (18.6%) had a grade 3 or 4 treatment-related adverse event (AE), and one (1.4%) had a grade ≥3 immune-related, treatment-related AE. There was one drug-related death. CONCLUSION Durvalumab alone in pretreated non-selected MPM did not reach a meaningful clinical activity, showing any new major safety issue signals.
Collapse
Affiliation(s)
- S. Canova
- ASST H S Gerardo, SC Medical Oncology, Monza
| | - G.L. Ceresoli
- Humanitas Gavazzeni, Bergamo,Department of Oncology, Saronno Hospital, ASST Valle Olona, Saronno (VA)
| | - F. Grosso
- Mesothelioma Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria
| | - P.A. Zucali
- Department of Oncology, IRCCS Humanitas Research Hospital, Rozzano,Department of Biomedical Sciences, Humanitas University, Rozzano
| | - F. Gelsomino
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna
| | - G. Pasello
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova,Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova
| | | | - E. Rulli
- Methodology for Clinical Research Laboratory, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan
| | - F. Galli
- Methodology for Clinical Research Laboratory, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan
| | - I. De Simone
- Methodology for Clinical Research Laboratory, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan
| | - L. Carlucci
- Methodology for Clinical Research Laboratory, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan
| | - A. De Angelis
- Mesothelioma Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria
| | - M. Belletti
- Mesothelioma Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria
| | - M. Bonomi
- Humanitas Gavazzeni, Bergamo,Department of Oncology, ASST Cremona, Cremona, Italy
| | - A. D’Aveni
- Humanitas Gavazzeni, Bergamo,Department of Oncology, Saronno Hospital, ASST Valle Olona, Saronno (VA)
| | - M. Perrino
- Department of Oncology, IRCCS Humanitas Research Hospital, Rozzano
| | - F. Bono
- ASST H S Gerardo, SC Medical Oncology, Monza
| | - D.L. Cortinovis
- ASST H S Gerardo, SC Medical Oncology, Monza,Correspondence to: Dr Diego Luigi Cortinovis, ASST-Monza San Gerardo Hospital, SC Medical Oncology, Monza, Via Pergolesi 33 20900 Monza, Italy. Tel: +39-0392339575; Fax: +39-0392332284
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Ferro A, Girardi F, Pretelli G, Mulargiu C, Resi M, Benetti B, Marinato G, Lorenzi M, Dal Maso A, Frega S, Pasello G, Guarneri V, Bonanno L. 1584P Immune-related adverse events (irAEs) in advanced non-small cell lung cancer (aNSCLC) in a real-world analysis: A risk prediction nomogram. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1677] [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] Open
|
9
|
Lorenzi M, Scattolin D, Del Conte A, Sangiorgi S, Polo V, Pavan A, Pilotto S, Santarpia M, Da Ros V, Maso AD, Ferro A, Frega S, Bortolami A, Bonanno L, Indraccolo S, Guarneri V, Pasello G. EP08.02-104 Osimertinib in Untreated EGFR-Mutant Non-small Cell Lung Cancers: Overall Survival and Budget Impact Analysis in Real-World. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.787] [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: 11/25/2022]
|
10
|
Pasello G, Lorenzi M, Pretelli G, Comacchio GM, Pezzuto F, Schiavon M, Buja A, Frega S, Bonanno L, Guarneri V, Calabrese F, Rea F. Diagnostic-Therapeutic Pathway and Outcomes of Early Stage NSCLC: a Focus on EGFR Testing in the Real-World. Front Oncol 2022; 12:909064. [PMID: 35847912 PMCID: PMC9278847 DOI: 10.3389/fonc.2022.909064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/31/2022] [Indexed: 11/30/2022] Open
Abstract
Background Osimertinib is considered the standard-of-care for previously-untreated EGFR mutant advanced non-small cell lung cancer (NSCLC). Oncogene driver screening in early NSCLC is not standard practice. A real-world study has been designed in order to investigate the optimal testing frequency and timing for EGFR mutations in early NSCLC in clinical practice. Patients and Methods The present observational, retrospective study evaluated the real-world diagnostic-therapeutic pathway and clinical outcomes of 225 patients with stage I-III NSCLC, with particular reference to the EGFR-mutant subgroup. Results Prior to surgery, 101 patients had undergone a diagnostic biopsy; EGFR mutational analysis was available in 56 (55%) patients and 12 patients (21%) had a cancer harboring an EGFR mutation. Among surgical specimens, reflex EGFR test was performed in 181 (80%) of 225 and 35 cases (19%) were EGFR mutant. The majority of patients had not received adjuvant chemotherapy (N=174, 77%) or adjuvant radiotherapy (N=201, 89%). Of 49 (22%) patients experiencing disease relapse, 26 (53%) received first-line systemic treatment. All EGFR-mutant relapsed patients (N=6, 12.2%) received an EGFR-TKI. Median overall survival (OS) and relapse-free survival for the entire population were not reached. Multivariate analysis for OS confirmed a significant correlation with age, female gender, EGFR status, necrosis score, perineural invasion, and relapsed disease. EGFR test costs represented 1.6-2.4% of the total costs of management per patient (€34,340). Conclusions Our results suggest that the frequency of EGFR mutations in early stage (I-III) NSCLC is similar to that of advanced stages. Reflex EGFR testing in all early-stage NSCLC at diagnosis or after surgery appears to be a valid tool to give patients the chance to benefit from targeted adjuvant treatment.
Collapse
Affiliation(s)
- Giulia Pasello
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
- Division of Medical Oncology 2, Veneto Institute of Oncology IOV – Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padua, Italy
- *Correspondence: Giulia Pasello,
| | - Martina Lorenzi
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
- Division of Medical Oncology 2, Veneto Institute of Oncology IOV – Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padua, Italy
| | - Giulia Pretelli
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
- Division of Medical Oncology 2, Veneto Institute of Oncology IOV – Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padua, Italy
| | - Giovanni Maria Comacchio
- Thoracic Surgery Unit, Department of Cardio-Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Federica Pezzuto
- Pathology Unit, Department of Cardio-Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Marco Schiavon
- Thoracic Surgery Unit, Department of Cardio-Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Alessandra Buja
- Department of Cardiologic, Vascular, and Thoracic Sciences and Public Health, University of Padua, Padua, Italy
| | - Stefano Frega
- Division of Medical Oncology 2, Veneto Institute of Oncology IOV – Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padua, Italy
| | - Laura Bonanno
- Division of Medical Oncology 2, Veneto Institute of Oncology IOV – Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padua, Italy
| | - Valentina Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
- Division of Medical Oncology 2, Veneto Institute of Oncology IOV – Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padua, Italy
| | - Fiorella Calabrese
- Pathology Unit, Department of Cardio-Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Federico Rea
- Thoracic Surgery Unit, Department of Cardio-Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| |
Collapse
|
11
|
Pasello G, Ferro A, Scagliori E, Gennaro G, Costa M, Sepulcri M, Schiavon M, Bonanno L, Frega S, Caumo F, Calabrese F, Rea F, Guarneri V. Exploratory radiomic analysis of stage III non-small cell lung cancer CT images: Correlation with clinical-pathological characteristics. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e20574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e20574 Background: Recent evidences have suggested potential applications of radiomics in early diagnosis, prognostic stratification and treatment outcome prediction of Non-Small Cell Lung Cancer (NSCLC) patients. The purpose of this study is to evaluate the ability of radiomic analysis to discriminate between different clinical-pathological conditions in patients with stage III NSCLC. Methods: Baseline CT studies from 59 patients with stage III NSCLC referred to our Institution from 2010 and 2020 were retrospectively reviewed, and the segmentation of the main lung lesion and the extraction of 517 radiomic features performed using a commercial software. The number of features was reduced to 46 by means of principal component analysis applied using the R package “RadAR” (Radiomics Analysis with R). The Kruskal-Wallis test was applied to all the radiomic features in order to evaluate which of them can discriminate between 7 clinical dichotomous characteristics: tumor stage, type, presence of mutation, treatment response, relapse free survival (RFS), smoking habit, patient outcome. P < 0.05 means that there is a statistically significant difference between the two subgroups. Results: The median age at diagnosis was 69 years (range 43-83). Most patients were males (40/59 = 67.8%) and heavy smokers (36/59 = 61.0%). Adenocarcinoma was the most common histology (41/59 = 70.7%), while cases were almost equally splitted between stage IIIA (45.8%) and stage IIIB or IIIC (54.2%). Most selected radiomic features (29/46 = 63.0%) showed a statistically significant difference between patients with and without mutations. Ten (10/46 = 21.7%) radiomic features were associated with patient sex. Seven features (7/45 = 15.2%) were “sensitive” to the tumor clinical stage (stage IIIA vs. stage IIIB+IIIC), 4 (4/46 = 8.7%) to the histological type, and 2 (2/46 = 4.3%) to the patient outcome. None of the selected radiomic features was able to discriminate between responder and non-responder patients, current/previous smokers and never smokers, and patients with RFS lower than 12 months versus RFS equal or higher than 12 months. Conclusions: This preliminary analysis showed that radiomics has the potential of identifying mathematical features associated with clinical and histopathological characteristics in stage III NSCLC patients, which might feed multiparametric predictive models. Larger datasets and further analysis are necessary in order to confirm initial results.
Collapse
Affiliation(s)
- Giulia Pasello
- Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
| | - Alessandra Ferro
- Medical Oncology 2 Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Elena Scagliori
- Oncologic Radiology Unit, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Gisella Gennaro
- Breast Radiology Unit, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | | | - Matteo Sepulcri
- Radiation Oncology Unit, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Marco Schiavon
- Thoracic Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Laura Bonanno
- Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - Stefano Frega
- Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - Francesca Caumo
- Oncologic Radiology Unit, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Fiorella Calabrese
- Department of CardioThoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Federico Rea
- Thoracic Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Valentina Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padova, and Oncology 2, Veneto Insittute of Oncology IOV-IRCCS, Padua, Italy
| |
Collapse
|
12
|
Pretelli G, Pavan A, Dal Maso A, Resi M, Mulargiu C, Ferro A, Benetti B, Lorenzi M, Marinato G, Frega S, Pasello G, Conte P, Guarneri V, Bonanno L. 63P Immune-related adverse events (irAEs) in advanced non-small cell lung cancer (aNSCLC) patients (pts): Neutrophil to lymphocyte ratio (NLR) and the risk for toxicity recurrence. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.02.072] [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: 11/01/2022] Open
|
13
|
Cantini L, Mentrasti G, Lo Russo G, Signorelli D, Pasello G, Rijavec E, Russano M, Antonuzzo L, Rocco D, Giusti R, Adamo V, Genova C, Tuzi A, Morabito A, Gori S, La Verde N, Chiari R, Cortellini A, Cognigni V, Pecci F, Indini A, De Toma A, Zattarin E, Oresti S, Pizzutilo E, Frega S, Erbetta E, Galletti A, Citarella F, Fancelli S, Caliman E, Della Gravara L, Malapelle U, Filetti M, Piras M, Toscano G, Zullo L, De Tursi M, Di Marino P, D’Emilio V, Cona M, Guida A, Caglio A, Salerno F, Spinelli G, Bennati C, Morgillo F, Russo A, Dellepiane C, Vallini I, Sforza V, Inno A, Rastelli F, Tassi V, Nicolardi L, Pensieri M, Emili R, Roca E, Migliore A, Galassi T, Rocchi M, Berardi R. Erratum to ‘Evaluation of COVID-19 impact on DELAYing diagnostic-therapeutic pathways of lung cancer patients in Italy (COVID-DELAY study): fewer cases and higher stages from a real-world scenario’. ESMO Open 2022; 7:100471. [PMID: 35378403 PMCID: PMC8973259 DOI: 10.1016/j.esmoop.2022.100471] [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: 11/03/2022] Open
|
14
|
Pretelli G, Pavan A, Dal Maso A, Resi M, Mulargiu C, Ferro A, Benetti B, Lorenzi M, Marinato G, Frega S, Pasello G, Conte P, Guarneri V, Bonanno L. 40P Immune-related adverse events (irAEs) in advanced non-small cell lung cancer (aNSCLC) patients (pts): A real-world analysis. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.02.049] [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: 11/01/2022] Open
|
15
|
Ferro A, Sepulcri M, Schiavon M, Scagliori E, Gennaro G, Costa M, Bonanno L, Frega S, Dal Maso A, Calabrese F, Rea F, Caumo F, Guarneri V, Pasello G. 119P Evolution of the management of stage III non-small cell lung cancer (NSCLC): A single-center real-world scenario over 10 years. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.02.146] [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: 12/01/2022] Open
|
16
|
Lorenzi M, Ferro A, Cecere F, Scattolin D, Del Conte A, Follador A, Pilotto S, Polo V, Santarpia M, Chiari R, Pavan A, Dal Maso A, Da Ros V, Targato G, Vari S, Indraccolo S, Calabrese F, Frega S, Bonanno L, Conte PF, Guarneri V, Pasello G. First-Line Osimertinib in Patients with EGFR-Mutant Advanced Non-Small Cell Lung Cancer: Outcome and Safety in the Real World: FLOWER Study. Oncologist 2022; 27:87-e115. [PMID: 35641222 PMCID: PMC9714585 DOI: 10.1002/onco.13951] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 06/24/2021] [Accepted: 08/17/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Osimertinib became the standard treatment for patients with untreated EGFR-mutant advanced non-small cell lung cancer (aNSCLC) following results reported in the phase III randomized FLAURA trial. Because of strict exclusion criteria, patient populations included in pivotal trials are only partially representative of real-world patients. METHODS We designed an observational, prospective, multicenter study enrolling patients with EGFR-mutant aNSCLC receiving first-line osimertinib to evaluate effectiveness, safety, and progression patterns in the real-world. RESULTS At data cutoff, 126 White patients from nine oncology centers were included. At diagnosis, 16 patients (12.7%) had a performance status (PS) ≥2 and 38 (30.2%) had brain metastases. Overall response rate (ORR) was 73%, disease control rate (DCR) 96.0%. After a median follow-up of 12.3 months, median time to treatment discontinuation (mTTD) was 25.3 months, median progression-free-survival (mPFS) was 18.9 months and median overall survival (mOS) was not reached (NR). One hundred and ten patients (87%) experienced adverse events (AEs), 42 (33%) of grade 3-4, with venous thromboembolism (VTE) as the most common (n = 10, 7.9%). No difference in rates of VTE was reported according to age, PS, comorbidity, and tumor load. We observed longer mTTD in patients without symptoms (NR vs. 18.8 months) and with fewer than three metastatic sites at diagnosis (NR vs. 21.4 months). Patients without brain metastases experienced longer mPFS (NR vs. 13.3 months). No difference in survival outcome was observed according to age, comorbidity, and type of EGFR mutation. Isolated progression and progression in fewer than three sites were associated with longer time to treatment discontinuation (TTD). CONCLUSION Osimertinib confirmed effectiveness and safety in the real world, although thromboembolism was more frequent than previously reported.
Collapse
Affiliation(s)
- Martina Lorenzi
- Department of Surgery, Oncology, and Gastroenterology, University of
Padova, Padova, Italy
- Division of Medical Oncology 2, Veneto Institute of Oncology -
IRCCS, Padova, Italy
| | - Alessandra Ferro
- Department of Surgery, Oncology, and Gastroenterology, University of
Padova, Padova, Italy
- Division of Medical Oncology 2, Veneto Institute of Oncology -
IRCCS, Padova, Italy
| | - Fabiana Cecere
- Oncology 1, Regina Elena National Cancer Institute – IRCCS,
Padova, Italy
| | - Daniela Scattolin
- Department of Surgery, Oncology, and Gastroenterology, University of
Padova, Padova, Italy
| | - Alessandro Del Conte
- Medical Oncology and Immunorelated Tumors, National Cancer Institute Centro di
Riferimento Oncologico (CRO) – IRCCS, Aviano (PN),
Italy
| | - Alessandro Follador
- Department of Medical Oncology, Azienda Sanitaria Universitaria Integrata of
Udine, Santa Maria della Misericordia Hospital,
Udine, Italy
| | - Sara Pilotto
- Oncology Department, Azienda Ospedaliera Universitaria Integrata di
Verona, Verona, Italy
| | - Valentina Polo
- Oncology Unit, Azienda Unità Locale Socio Sanitaria (AULSS 2) Marca Trevigiana,
Ca’ Foncello Hospital, Treviso, Italy
| | - Mariacarmela Santarpia
- Medical Oncology, Azienda Ospedaliera Policlinico Universitario “G.
Martino,”Messina, Italy
| | - Rita Chiari
- Medical Oncology, AULSS 6 Euganea, South Padua Hospital,
Monselice (PD), Italy
| | - Alberto Pavan
- Medical Oncology, AULSS 6 Euganea, South Padua Hospital,
Monselice (PD), Italy
| | - Alessandro Dal Maso
- Department of Surgery, Oncology, and Gastroenterology, University of
Padova, Padova, Italy
- Division of Medical Oncology 2, Veneto Institute of Oncology -
IRCCS, Padova, Italy
| | - Valentina Da Ros
- Medical Oncology and Immunorelated Tumors, National Cancer Institute Centro di
Riferimento Oncologico (CRO) – IRCCS, Aviano (PN),
Italy
| | - Giada Targato
- Department of Medical Oncology, Azienda Sanitaria Universitaria Integrata of
Udine, Santa Maria della Misericordia Hospital,
Udine, Italy
| | - Sabrina Vari
- Oncology 1, Regina Elena National Cancer Institute - IRCCS,
Rome, Italy
| | - Stefano Indraccolo
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology IOV –
IRCCS, Padua, Italy
| | - Fiorella Calabrese
- Cardiovascular Pathology Unit, Department of Cardio-Thoracic and Vascular
Sciences, University of Padova, Padova, Italy
| | - Stefano Frega
- Division of Medical Oncology 2, Veneto Institute of Oncology -
IRCCS, Padova, Italy
| | - Laura Bonanno
- Division of Medical Oncology 2, Veneto Institute of Oncology -
IRCCS, Padova, Italy
| | - Pier Franco Conte
- Department of Surgery, Oncology, and Gastroenterology, University of
Padova, Padova, Italy
- Division of Medical Oncology 2, Veneto Institute of Oncology -
IRCCS, Padova, Italy
| | - Valentina Guarneri
- Department of Surgery, Oncology, and Gastroenterology, University of
Padova, Padova, Italy
- Division of Medical Oncology 2, Veneto Institute of Oncology -
IRCCS, Padova, Italy
| | - Giulia Pasello
- Department of Surgery, Oncology, and Gastroenterology, University of
Padova, Padova, Italy
- Division of Medical Oncology 2, Veneto Institute of Oncology -
IRCCS, Padova, Italy
| |
Collapse
|
17
|
Cantini L, Mentrasti G, Russo GL, Signorelli D, Pasello G, Rijavec E, Russano M, Antonuzzo L, Rocco D, Giusti R, Adamo V, Genova C, Tuzi A, Morabito A, Gori S, Verde NL, Chiari R, Cortellini A, Cognigni V, Pecci F, Indini A, De Toma A, Zattarin E, Oresti S, Pizzutilo EG, Frega S, Erbetta E, Galletti A, Citarella F, Fancelli S, Caliman E, Della Gravara L, Malapelle U, Filetti M, Piras M, Toscano G, Zullo L, De Tursi M, Di Marino P, D'Emilio V, Cona MS, Guida A, Caglio A, Salerno F, Spinelli G, Bennati C, Morgillo F, Russo A, Dellepiane C, Vallini I, Sforza V, Inno A, Rastelli F, Tassi V, Nicolardi L, Pensieri V, Emili R, Roca E, Migliore A, Galassi T, Rocchi MLB, Berardi R. Evaluation of COVID-19 impact on DELAYing diagnostic-therapeutic pathways of lung cancer patients in Italy (COVID-DELAY study): fewer cases and higher stages from a real-world scenario. ESMO Open 2022; 7:100406. [PMID: 35219245 PMCID: PMC8810307 DOI: 10.1016/j.esmoop.2022.100406] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [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: 09/20/2021] [Revised: 01/19/2022] [Accepted: 01/23/2022] [Indexed: 12/18/2022] Open
Abstract
Introduction COVID-19 has disrupted the global health care system since March 2020. Lung cancer (LC) patients (pts) represent a vulnerable population highly affected by the pandemic. This multicenter Italian study aimed to evaluate whether the COVID-19 outbreak had an impact on access to cancer diagnosis and treatment of LC pts compared with pre-pandemic time. Methods Consecutive newly diagnosed LC pts referred to 25 Italian Oncology Departments between March and December 2020 were included. Access rate and temporal intervals between date of symptoms onset and diagnostic and therapeutic services were compared with the same period in 2019. Differences between the 2 years were analyzed using the chi-square test for categorical variables and the Mann–Whitney U test for continuous variables. Results A slight reduction (−6.9%) in newly diagnosed LC cases was observed in 2020 compared with 2019 (1523 versus 1637, P = 0.09). Newly diagnosed LC pts in 2020 were more likely to be diagnosed with stage IV disease (P < 0.01) and to be current smokers (someone who has smoked more than 100 cigarettes, including hand-rolled cigarettes, cigars, cigarillos, in their lifetime and has smoked in the last 28 days) (P < 0.01). The drop in terms of new diagnoses was greater in the lockdown period (percentage drop −12% versus −3.2%) compared with the other months included. More LC pts were referred to a low/medium volume hospital in 2020 compared with 2019 (P = 0.01). No differences emerged in terms of interval between symptoms onset and radiological diagnosis (P = 0.94), symptoms onset and cytohistological diagnosis (P = 0.92), symptoms onset and treatment start (P = 0.40), and treatment start and first radiological revaluation (P = 0.36). Conclusions Our study pointed out a reduction of new diagnoses with a shift towards higher stage at diagnosis for LC pts in 2020. Despite this, the measures adopted by Italian Oncology Departments ensured the maintenance of the diagnostic-therapeutic pathways of LC pts. The COVID-19 outbreak had an impact on access to lung cancer (LC) diagnosis and treatment. A slight reduction (−6.9%) in newly diagnosed LC cases was observed in 2020 compared with 2019. Newly diagnosed LC pts in 2020 were more likely to be diagnosed with stage IV disease. The Italian Oncology Departments ensured the maintenance of the diagnostic-therapeutic pathways of LC pts. A reverse migration from high-volume to low-volume cancer centers was noted during the pandemic.
Collapse
Affiliation(s)
- L Cantini
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, Ancona, Italy. https://twitter.com/LucaCantiniMD
| | - G Mentrasti
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, Ancona, Italy
| | - G L Russo
- Oncologia Medica 1, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - D Signorelli
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - G Pasello
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy; Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - E Rijavec
- Medical Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M Russano
- Department of Medical Oncology, Campus Bio-Medico University, Rome, Italy
| | - L Antonuzzo
- Medical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - D Rocco
- Department of Pulmonology and Oncology, AORN dei Colli Monaldi, Naples, Italy
| | - R Giusti
- UOC Oncologia Medica, Azienda Ospedaliero Universitaria Sant'Andrea, Università La Sapienza, Rome, Italy
| | - V Adamo
- Oncologia Medica, A.O.Papardo & Università di Messina, Messina, Italy
| | - C Genova
- UOC Clinica di Oncologia Medica, IRCCS Ospedale San Martino, Department of Internal Medicine and Medical Specialties (DIMI), Università degli Studi di Genova, Genoa, Italy
| | - A Tuzi
- Oncologia Medica, ASST Sette Laghi, Varese, Italy
| | - A Morabito
- Thoracic Medical Oncology, Istituto Nazionale Tumori "Fondazione G Pascale", IRCCS, Naples, Italy
| | - S Gori
- UOC Oncologia Medica, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Verona, Italy
| | - N La Verde
- Department of Oncology, Ospedale Luigi Sacco, ASST Fatebenefratelli Sacco, Milan, Italy
| | - R Chiari
- Medical Oncology, Ospedali Riuniti Padova Sud, Monselice, Italy
| | - A Cortellini
- Medical Oncology, St Salvatore Hospital, L'Aquila, Italy
| | - V Cognigni
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, Ancona, Italy
| | - F Pecci
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, Ancona, Italy
| | - A Indini
- Medical Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A De Toma
- Oncologia Medica 1, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - E Zattarin
- Oncologia Medica 1, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - S Oresti
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy; Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
| | - E G Pizzutilo
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy; Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
| | - S Frega
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - E Erbetta
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - A Galletti
- Department of Medical Oncology, Campus Bio-Medico University, Rome, Italy
| | - F Citarella
- Department of Medical Oncology, Campus Bio-Medico University, Rome, Italy
| | - S Fancelli
- Medical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - E Caliman
- Medical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - L Della Gravara
- Dipartment of Experimental Medicine, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - U Malapelle
- Department of Public Health, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - M Filetti
- UOC Oncologia Medica, Azienda Ospedaliero Universitaria Sant'Andrea, Università La Sapienza, Rome, Italy
| | - M Piras
- UOC Oncologia Medica, Azienda Ospedaliero Universitaria Sant'Andrea, Università La Sapienza, Rome, Italy
| | - G Toscano
- Oncologia Medica, A.O.Papardo, Messina, Italy
| | - L Zullo
- UOC Oncologia Medica 2, IRCCS Ospedale San Martino, Genoa, Italy
| | - M De Tursi
- Department of Innovative Technologies in Medicine & Dentistry, Università G. D'Annunzio, Chieti-Pescara, Chieti, Italy
| | - P Di Marino
- Department of Innovative Technologies in Medicine & Dentistry, Università G. D'Annunzio, Chieti-Pescara, Chieti, Italy
| | - V D'Emilio
- UOC Pneumologia, Ospedale Mazzoni, Ascoli Piceno, Italy
| | - M S Cona
- Department of Oncology, Ospedale Luigi Sacco, ASST Fatebenefratelli Sacco, Milan, Italy
| | - A Guida
- Oncologia Medica e Traslazionale, AO Santa Maria, Terni, Italy
| | - A Caglio
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, Turin, Italy
| | - F Salerno
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, Turin, Italy
| | - G Spinelli
- UOC Territorial Oncology, University "Sapienza", AUSL Latina, Cds Aprilia, Aprilia, Italy
| | - C Bennati
- Department of Onco-Hematology, AUSL della Romagna, Ravenna, Italy
| | - F Morgillo
- UOC Oncologia ed Ematologia, Department of Precision Medicine, Università degli studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - A Russo
- Oncologia Medica, A.O.Papardo, Messina, Italy
| | - C Dellepiane
- UOC Oncologia Medica 2, IRCCS Ospedale San Martino, Genoa, Italy
| | - I Vallini
- Oncologia Medica, ASST Sette Laghi, Varese, Italy
| | - V Sforza
- Thoracic Medical Oncology, Istituto Nazionale Tumori "Fondazione G Pascale", IRCCS, Naples, Italy
| | - A Inno
- UOC Oncologia Medica, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Verona, Italy
| | - F Rastelli
- UOC Oncologia, Ospedale Mazzoni, Ascoli Piceno, Italy
| | - V Tassi
- Chirurgia Toracica, AO Santa Maria, Terni, Italy
| | - L Nicolardi
- Medical Oncology, Ospedali Riuniti Padova Sud, Monselice, Italy
| | - V Pensieri
- Medical Oncology, St Salvatore Hospital, L'Aquila, Italy
| | - R Emili
- Operative Oncology Unit, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - E Roca
- Thoracic Oncology - Lung Unit, Pederzoli Hospital, Peschiera Del Garda, Italy
| | - A Migliore
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, Ancona, Italy
| | - T Galassi
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, Ancona, Italy
| | - M L Bruno Rocchi
- Biomolecular Sciences Department, University of Urbino, Urbino, Italy
| | - R Berardi
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, Ancona, Italy.
| |
Collapse
|
18
|
Pinto C, Zucali PA, Pagano M, Grosso F, Pasello G, Garassino MC, Tiseo M, Soto Parra H, Grossi F, Cappuzzo F, de Marinis F, Pedrazzoli P, Bonomi M, Gianoncelli L, Perrino M, Santoro A, Zanelli F, Bonelli C, Maconi A, Frega S, Gervasi E, Boni L, Ceresoli GL. Gemcitabine with or without ramucirumab as second-line treatment for malignant pleural mesothelioma (RAMES): a randomised, double-blind, placebo-controlled, phase 2 trial. Lancet Oncol 2021; 22:1438-1447. [PMID: 34499874 DOI: 10.1016/s1470-2045(21)00404-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/05/2021] [Accepted: 07/06/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND There is a preclinical rationale for inhibiting angiogenesis in mesothelioma. We aimed to assess the efficacy and safety of the anti-VEGFR-2 antibody ramucirumab combined with gemcitabine in patients with pretreated malignant pleural mesothelioma. METHODS RAMES was a multicentre, randomised, double-blind, placebo-controlled, phase 2 trial done at 26 hospitals in Italy. Eligible patients were aged 18 years or older, had Eastern Cooperative Oncology Group performance status 0-2, and histologically proven malignant pleural mesothelioma progressing during or after first-line treatment with pemetrexed plus platinum. Patients were randomly assigned (1:1) to receive intravenous gemcitabine 1000 mg/m2 on days 1 and 8 every 3 weeks plus either intravenous placebo (gemcitabine plus placebo group) or ramucirumab 10 mg/kg (gemcitabine plus ramucirumab group) on day 1 every 3 weeks, until tumour progression or unacceptable toxicity. Central randomisation was done according to a minimisation algorithm method, associated with a random element using the following stratification factors: ECOG performance status, age, histology, and first-line time-to-progression. The primary endpoint was overall survival, measured from the date of randomisation to the date of death from any cause. Efficacy analyses were assessed in all patients who had been correctly randomised and received their allocated treatment, and safety analyses were assessed in all patients who received at least one dose of their assigned treatment. This trial is registered with ClinicalTrials.gov, NCT03560973, and with EudraCT, 2016-001132-36. FINDINGS Between Dec 22, 2016, and July 30, 2018, of 165 patients enrolled 161 were correctly assigned and received either gemcitabine plus placebo (n=81) or gemcitabine plus ramucirumab (n=80). At database lock (March 8, 2020), with a median follow-up of 21·9 months (IQR 17·7-28·5), overall survival was longer in the ramucirumab group (HR 0·71, 70% CI 0·59-0·85; p=0·028). Median overall survival was 13·8 months (70% CI 12·7-14·4) in the gemcitabine plus ramucirumab group and 7·5 months (6·9-8·9) in the gemcitabine plus placebo group. Grade 3-4 treatment-related adverse events were reported in 35 (44%) of 80 patients in the gemcitabine plus ramucirumab group and 24 (30%) of 81 in the gemcitabine plus placebo group. The most common treatment-related grade 3-4 adverse events were neutropenia (16 [20%] for gemcitabine plus ramucirumab vs ten [12%] for gemcitabine plus placebo) and hypertension (five [6%] vs none). Treatment-related serious adverse events were reported in five (6%) in the gemcitabine plus ramucirumab group and in four (5%) patients in the gemcitabine plus placebo group; the most common was thromboembolism (three [4%] for gemcitabine plus ramucirumab vs two [2%] for gemcitabine plus placebo). There were no treatment-related deaths. INTERPRETATION Ramucirumab plus gemcitabine significantly improved overall survival after first-line standard chemotherapy, with a favourable safety profile. This combination could be a new option in this setting. FUNDING Eli Lilly Italy. TRANSLATION For the Italian translation of the abstract see Supplementary Materials section.
Collapse
Affiliation(s)
- Carmine Pinto
- Medical Oncology Unit, Clinical Cancer Centre, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Paolo Andrea Zucali
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; Department of Oncology, IRCCS Humanitas Research Hospital, Milan, Italy.
| | - Maria Pagano
- Medical Oncology Unit, Clinical Cancer Centre, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Federica Grosso
- Mesothelioma Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Infrastruttura Ricerca Formazione e Innovazione, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Giulia Pasello
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy; Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Marina Chiara Garassino
- Thoracic Oncology Unit, Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marcello Tiseo
- Department of Medicine and Surgery, University of Parma, Parma, Italy; Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Hector Soto Parra
- Medical Oncology Unit, AOU Policlinico Vittorio Emanuele, Catania, Italy
| | - Francesco Grossi
- Medical Oncology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore, Milan, Italy; Medical Oncology Unit, University of Insubria, Varese, Italy
| | - Federico Cappuzzo
- Medical Oncology Unit, IRCCS Istituto Nazionale Tumori Regina Elena, Rome, Italy
| | - Filippo de Marinis
- Thoracic Oncology Division, Istituto Europeo di Oncologia IRCCS, Milan, Italy
| | - Paolo Pedrazzoli
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy
| | - Maria Bonomi
- Department of Oncology, Cliniche Humanitas Gavazzeni, Bergamo, Italy; Department of Oncology, ASST Cremona, Cremona, Italy
| | - Letizia Gianoncelli
- Department of Oncology, Cliniche Humanitas Gavazzeni, Bergamo, Italy; Department of Oncology, Ospedale San Paolo, Milan, Italy
| | - Matteo Perrino
- Department of Oncology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Armando Santoro
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; Department of Oncology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Francesca Zanelli
- Medical Oncology Unit, Clinical Cancer Centre, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Candida Bonelli
- Medical Oncology Unit, Clinical Cancer Centre, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Antonio Maconi
- Infrastruttura Ricerca Formazione e Innovazione, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Stefano Frega
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Erika Gervasi
- Medical Oncology Unit, Clinical Cancer Centre, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Luca Boni
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | |
Collapse
|
19
|
Pasello G, Menis J, Pilotto S, Frega S, Belluomini L, Pezzuto F, Caliò A, Sepulcri M, Cernusco NLV, Schiavon M, Infante MV, Damin M, Micheletto C, Del Bianco P, Giovannetti R, Bonanno L, Fantoni U, Guarneri V, Calabrese F, Rea F, Milella M, Conte P. How the COVID-19 Pandemic Impacted on Integrated Care Pathways for Lung Cancer: The Parallel Experience of a COVID-Spared and a COVID-Dedicated Center. Front Oncol 2021; 11:669786. [PMID: 34262861 PMCID: PMC8273534 DOI: 10.3389/fonc.2021.669786] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 06/07/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction The COVID-19 pandemic has proved to be a historic challenge for healthcare systems, particularly with regard to cancer patients. So far, very limited data have been presented on the impact on integrated care pathways (ICPs). Methods We reviewed the ICPs of lung cancer patients who accessed the Veneto Institute of Oncology (IOV)/University Hospital of Padua (Center 1) and the University Hospital of Verona (Center 2) before and after the COVID-19 pandemic, through sixteen indicators chosen by the members of a multidisciplinary team (MDT). Results Two window periods (March and April 2019 and 2020) were chosen for comparison. Endoscopic diagnostic procedures and major resections for early stage NSCLC patients increased at Center 1, where a priority pathway with dedicated personnel was established for cancer patients. A slight decrease was observed at Center 2 which became part of the COVID unit. Personnel shortage and different processing methods of tumor samples determined a slightly longer time for diagnostic pathway completion at both Centers. Personnel protection strategies led to a MDT reshape on a web basis and to a significant selection of cases to be discussed in both Centers. The optimization of patient access to healthcare units reduced first outpatient oncological visits, patient enrollment in clinical trials, and end-of-life cancer systemic treatments; finally, a higher proportion of hypofractionation was delivered as a radiotherapy approach for early stage and locally advanced NSCLC. Conclusions Based on the experience of the two Centers, we identified the key steps in ICP that were impacted by the COVID-19 pandemic so as to proactively put in place a robust service provision of thoracic oncology.
Collapse
Affiliation(s)
- Giulia Pasello
- Medical Oncology Department, Istituto Oncologico Veneto IRCCS, Padova, Italy.,Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Jessica Menis
- Medical Oncology Department, Istituto Oncologico Veneto IRCCS, Padova, Italy.,Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Sara Pilotto
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Stefano Frega
- Medical Oncology Department, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Lorenzo Belluomini
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Federica Pezzuto
- University of Padova, Medical School, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova, Italy
| | - Anna Caliò
- Department of Diagnostics and Public Health, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Matteo Sepulcri
- Radiation Oncology Department, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Nunzia Luna Valentina Cernusco
- Radiation Oncology Department, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Marco Schiavon
- University of Padova, Medical School, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova, Italy
| | - Maurizio Valentino Infante
- Cardiovascular and Thoracic Department, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Marco Damin
- University of Padova, Medical School, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova, Italy
| | - Claudio Micheletto
- Cardiovascular and Thoracic Department, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Paola Del Bianco
- Medical Oncology Department, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Riccardo Giovannetti
- Cardiovascular and Thoracic Department, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - Laura Bonanno
- Medical Oncology Department, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Umberto Fantoni
- University of Padova, Medical School, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova, Italy
| | - Valentina Guarneri
- Medical Oncology Department, Istituto Oncologico Veneto IRCCS, Padova, Italy.,Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Fiorella Calabrese
- University of Padova, Medical School, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova, Italy
| | - Federico Rea
- University of Padova, Medical School, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova, Italy
| | - Michele Milella
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - PierFranco Conte
- Medical Oncology Department, Istituto Oncologico Veneto IRCCS, Padova, Italy.,Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| |
Collapse
|
20
|
Dal Maso A, Lorenzi M, Ferro A, Pilotto S, Cecere F, Follador A, Polo V, Del Conte A, Sartori G, Giavarra M, Scattolin D, Indraccolo S, Frega S, De Maglio G, Menis J, Bonanno L, Calabrese F, Guarneri V, Conte P, Pasello G. Real-world data on treatment outcomes in EGFR-mutant non-small-cell lung cancer patients receiving osimertinib in second or further lines. Future Oncol 2021; 17:2513-2527. [PMID: 33988036 DOI: 10.2217/fon-2021-0356] [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: 01/10/2023] Open
Abstract
Aims: This study describes real-world outcomes of pretreated EGFR T790M-positive (T790M+) advanced non-small-cell lung cancer patients progressing after first- or second-generation tyrosine kinase inhibitors and receiving osimertinib, compared with T790M-negative (T790M-) patients. We have also described progression patterns and treatment sequences. Patients & methods: This is a retrospective multicenter Italian observational study including consecutive Caucasian patients referred between 2014 and 2018. Results: 167 patients were included. Median progression-free survival was 9.8 months (95% CI: 8.3-13.3) for T790M+ and 6.0 months (95% CI: 4.9-7.2) for T790M- patients, respectively. Median overall survival was 20.7 months (95% CI: 18.9-28.4) for T790M+ and 10.6 months (95% CI: 8.6-23.6) for T790M- patients, respectively. The T790M mutation correlated with absence of new sites of disease. After progression, most T790M+ patients continued osimertinib, whereas most T790M- patients received a different treatment line. Conclusion: Better outcomes were shown in patients receiving osimertinib. A more limited progression pattern for T790M+ was suggested.
Collapse
Affiliation(s)
- Alessandro Dal Maso
- Oncology 2, Istituto Oncologico Veneto IOV - IRCCS, Padova, 35128, Italy.,Department of Surgery, Oncology & Gastroenterology, University of Padova, Padova, 35128, Italy
| | - Martina Lorenzi
- Oncology 2, Istituto Oncologico Veneto IOV - IRCCS, Padova, 35128, Italy.,Department of Surgery, Oncology & Gastroenterology, University of Padova, Padova, 35128, Italy
| | - Alessandra Ferro
- Oncology 2, Istituto Oncologico Veneto IOV - IRCCS, Padova, 35128, Italy.,Department of Surgery, Oncology & Gastroenterology, University of Padova, Padova, 35128, Italy
| | - Sara Pilotto
- Medical Oncology, University of Verona, AOUI Verona, Verona, 37126, Italy
| | - Fabiana Cecere
- Oncology 1, Regina Elena National Cancer Institute IRCCS Rome, Rome, 00144, Italy
| | - Alessandro Follador
- Department of Oncology, Azienda Sanitaria Universitaria Friuli Centrale, Udine Hospital, Udine, 33100, Italy
| | - Valentina Polo
- Oncology Unit, AULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, 31100, Italy
| | - Alessandro Del Conte
- Medical Oncology & Immunorelated Tumors, Centro di Riferimento Oncologico (CRO) - IRCCS, Aviano (PN), 33081, Italy
| | - Giulia Sartori
- Medical Oncology, University of Verona, AOUI Verona, Verona, 37126, Italy
| | - Marco Giavarra
- Department of Oncology, Azienda Sanitaria Universitaria Friuli Centrale, Udine Hospital, Udine, 33100, Italy
| | - Daniela Scattolin
- Department of Surgery, Oncology & Gastroenterology, University of Padova, Padova, 35128, Italy
| | - Stefano Indraccolo
- Department of Surgery, Oncology & Gastroenterology, University of Padova, Padova, 35128, Italy.,Immunology & Molecular Oncology Unit, Istituto Oncologico Veneto IOV - IRCCS, Padova, 35128, Italy
| | - Stefano Frega
- Oncology 2, Istituto Oncologico Veneto IOV - IRCCS, Padova, 35128, Italy
| | - Giovanna De Maglio
- Department of Pathology, Azienda Sanitaria Universitaria Friuli Centrale, Udine Hospital, Udine, 33100, Italy
| | - Jessica Menis
- Oncology 2, Istituto Oncologico Veneto IOV - IRCCS, Padova, 35128, Italy.,Department of Surgery, Oncology & Gastroenterology, University of Padova, Padova, 35128, Italy
| | - Laura Bonanno
- Oncology 2, Istituto Oncologico Veneto IOV - IRCCS, Padova, 35128, Italy
| | - Fiorella Calabrese
- Pathology Unit, Department of Cardio-Thoracic & Vascular Sciences, University of Padova, Padova, 35128, Italy
| | - Valentina Guarneri
- Oncology 2, Istituto Oncologico Veneto IOV - IRCCS, Padova, 35128, Italy.,Department of Surgery, Oncology & Gastroenterology, University of Padova, Padova, 35128, Italy
| | - PierFranco Conte
- Oncology 2, Istituto Oncologico Veneto IOV - IRCCS, Padova, 35128, Italy.,Department of Surgery, Oncology & Gastroenterology, University of Padova, Padova, 35128, Italy
| | - Giulia Pasello
- Oncology 2, Istituto Oncologico Veneto IOV - IRCCS, Padova, 35128, Italy.,Department of Surgery, Oncology & Gastroenterology, University of Padova, Padova, 35128, Italy
| |
Collapse
|
21
|
Lorenzi M, Dal Maso A, Ferro A, Polo V, Scattolin D, Macerelli M, Follador A, Targato G, Indraccolo S, Frega S, Menis J, Bonanno L, Guarneri V, Conte P, Pasello G. 149P First-line (1L) osimertinib in EGFR mutant (mut) advanced non-small cell lung cancer (aNSCLC) patients (pts): Progression (PD) pattern and safety in the real-world (RW). J Thorac Oncol 2021. [DOI: 10.1016/s1556-0864(21)01991-2] [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: 11/26/2022]
|
22
|
Pavan A, Bragadin AB, Calvetti L, Ferro A, Zulato E, Attili I, Nardo G, Dal Maso A, Frega S, Menin AG, Fassan M, Calabrese F, Pasello G, Guarneri V, Aprile G, Conte P, Rosell R, Indraccolo S, Bonanno L. Role of next generation sequencing-based liquid biopsy in advanced non-small cell lung cancer patients treated with immune checkpoint inhibitors: impact of STK11, KRAS and TP53 mutations and co-mutations on outcome. Transl Lung Cancer Res 2021; 10:202-220. [PMID: 33569305 PMCID: PMC7867770 DOI: 10.21037/tlcr-20-674] [Citation(s) in RCA: 14] [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] [Indexed: 01/07/2023]
Abstract
BACKGROUND Characterization of tumor-related genetic alterations is promising for the screening of new predictive markers in non-small cell lung cancer (NSCLC). Aim of the study was to evaluate prognostic and predictive role of most frequent tumor-associated genetic alterations detected in plasma before starting immune checkpoint inhibitors (ICIs). METHODS Between January 2017 and October 2019, advanced NSCLC patients were prospectively screened with plasma next-generation sequencing (NGS) while included in two trials: VISION (NCT02864992), using Guardant360® test, and MAGIC (Monitoring Advanced NSCLC through plasma Genotyping during Immunotherapy: Clinical feasibility and application), using Myriapod NGS-IL 56G Assay. A control group of patients not receiving ICIs was analyzed. RESULTS A total of 103 patients receiving ICIs were analyzed: median overall survival (OS) was 20.8 (95% CI: 16.7-24.9) months and median immune-related progression free disease (irPFS) 4.2 (95% CI: 2.3-6.1) months. TP53 mutations in plasma negatively affected OS both in patients treated with ICIs and in control group (P=0.001 and P=0.009), indicating a prognostic role. STK11 mutated patients (n=9) showed a trend for worse OS only if treated with ICIs. The presence of KRAS/STK11 co-mutation and KRAS/STK11/TP53 co-mutation affected OS only in patients treated with ICIs (HR =10.936, 95% CI: 2.337-51.164, P=0.002; HR =17.609, 95% CI: 3.777-82.089, P<0.001, respectively), indicating a predictive role. CONCLUSIONS Plasma genotyping demonstrated prognostic value of TP53 mutations and predictive value of KRAS/STK11 and KRAS/STK11/TP53 co-mutations.
Collapse
Affiliation(s)
- Alberto Pavan
- Medical Oncology 2, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
| | - Andrea Boscolo Bragadin
- Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, Padova, Italy
| | - Lorenzo Calvetti
- Department of Oncology, San Bortolo General Hospital, ULSS8 Berica - East District, Vicenza, Italy
| | - Alessandra Ferro
- Medical Oncology 2, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy;,Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, Padova, Italy
| | - Elisabetta Zulato
- Immunology and Molecular Oncology Unit, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
| | - Ilaria Attili
- Medical Oncology 2, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy;,Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, Padova, Italy
| | - Giorgia Nardo
- Immunology and Molecular Oncology Unit, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
| | - Alessandro Dal Maso
- Medical Oncology 2, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy;,Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, Padova, Italy
| | - Stefano Frega
- Medical Oncology 2, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
| | - Andrea Giovanni Menin
- Department of Pathology, San Bortolo General Hospital, ULSS8 Berica - East District, Vicenza, Italy
| | - Matteo Fassan
- Department of Medicine, Surgical Pathology and Cytopathology Unit, Università degli Studi di Padova, Padova, Italy
| | - Fiorella Calabrese
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Università degli Studi di Padova, Padova, Italy
| | - Giulia Pasello
- Medical Oncology 2, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
| | - Valentina Guarneri
- Medical Oncology 2, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy;,Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, Padova, Italy
| | - Giuseppe Aprile
- Department of Oncology, San Bortolo General Hospital, ULSS8 Berica - East District, Vicenza, Italy
| | - PierFranco Conte
- Medical Oncology 2, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy;,Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, Padova, Italy
| | - Rafael Rosell
- Cancer Biology and Precision Medicine Program, Catalan Institute of Oncology, Germans Trias I Pujol Health Sciences Institute and Hospital Badalona, Barcelona, Spain
| | - Stefano Indraccolo
- Immunology and Molecular Oncology Unit, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
| | - Laura Bonanno
- Medical Oncology 2, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
| |
Collapse
|
23
|
Bonanno L, Pavan A, Ferro A, Calvetti L, Frega S, Pasello G, Aprile G, Guarneri V, Conte P. Clinical Impact of Plasma and Tissue Next-Generation Sequencing in Advanced Non-Small Cell Lung Cancer: A Real-World Experience. Oncologist 2020; 25:e1996-e2005. [PMID: 32557976 PMCID: PMC8108051 DOI: 10.1634/theoncologist.2020-0148] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 02/24/2020] [Accepted: 05/13/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Targeted agents have improved the outcome of a subset of non-small cell lung cancer (NSCLC). Molecular profiling by next-generation sequencing (NGS) allows screening for multiple genetic alterations both in tissue and in plasma, but limited data are available concerning its feasibility and impact in real-world clinical practice. METHODS Patients with advanced NSCLC consecutively referring to our Institution for potential eligibility to VISION trial (NCT02864992) were prospectively enrolled. They were already screened with standard method, and EGFR/ALK/ROS-1 positive cases were excluded. NGS was performed in plasma and tissue using the Guardant360 test covering 73 genes and the Oncomine Focus Assay covering 59 genes, respectively. RESULTS The study included 235 patients. NGS was performed in plasma in 209 (88.9%) cases; 78 of these (37.3%) were evaluated also in tissue; tissue only was analyzed in 26 cases (11.1%). Half of the tissue samples were deemed not evaluable. Druggable alterations were detected in 13 (25%) out of 52 evaluable samples and 31 of 209 (14.8%) of plasma samples. Improved outcome was observed for patients with druggable alterations if treated with matched targeted agents: they had a longer median overall survival (not reached) compared with the ones who did not start any targeted therapy (9.1 months; 95% confidence interval, 4.6-13.6; p = .046). The results of NGS testing potentially also affected the outcome of patients treated with immunotherapy. CONCLUSION Systematic real-life NGS testing showed the limit of tissue analysis in NSCLC and highlighted the potentiality of genetic characterization in plasma in increasing the number of patients who may benefit from NGS screening, both influencing the clinical decision-making process and affecting treatment outcome. IMPLICATIONS FOR PRACTICE Genetic characterization of cancer has become more important with time, having had positive implications for treatment specificity and efficacy. Such analyses changed the natural history of advanced non-small cell lung cancer (aNSCLC) with the introduction of drugs targeted to specific gene alterations (e.g., EGFR mutations, ALK and ROS-1 rearrangements). In the field of cancer molecular characterization, the applicability of the analysis of a wide panel of genes using a high-throughput sequencing approach, such as next-generation sequencing (NGS), is still a matter of research. This study used NGS in a real-world setting to systematically and prospectively profile patients with aNSCLC. The aim was to evaluate its feasibility and reliability, as well as consequent access to targeted agents and impact on clinical outcome whenever a druggable alteration was detected either in tumor tissue samples or through liquid biopsy.
Collapse
Affiliation(s)
- Laura Bonanno
- Medical Oncology 2, Istituto Oncologico Veneto (IOV)–Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS)PadovaItaly
| | - Alberto Pavan
- Medical Oncology 2, Istituto Oncologico Veneto (IOV)–Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS)PadovaItaly
| | - Alessandra Ferro
- Medical Oncology 2, Istituto Oncologico Veneto (IOV)–Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS)PadovaItaly
- Department of Surgery, Oncology, and Gastroenterology, University of PadovaPadovaItaly
| | - Lorenzo Calvetti
- Department of Oncology, San Bortolo General HospitalUnità Locale Socio Sanitaria (ULSS) 8 Berica—East DistrictVicenzaItaly
| | - Stefano Frega
- Medical Oncology 2, Istituto Oncologico Veneto (IOV)–Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS)PadovaItaly
| | - Giulia Pasello
- Medical Oncology 2, Istituto Oncologico Veneto (IOV)–Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS)PadovaItaly
| | - Giuseppe Aprile
- Department of Oncology, San Bortolo General HospitalUnità Locale Socio Sanitaria (ULSS) 8 Berica—East DistrictVicenzaItaly
| | - Valentina Guarneri
- Medical Oncology 2, Istituto Oncologico Veneto (IOV)–Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS)PadovaItaly
- Department of Surgery, Oncology, and Gastroenterology, University of PadovaPadovaItaly
| | - PierFranco Conte
- Medical Oncology 2, Istituto Oncologico Veneto (IOV)–Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS)PadovaItaly
- Department of Surgery, Oncology, and Gastroenterology, University of PadovaPadovaItaly
| | | |
Collapse
|
24
|
Boscolo A, Fortarezza F, Lunardi F, Comacchio G, Urso L, Frega S, Menis J, Bonanno L, Guarneri V, Rea F, Conte P, Calabrese F, Pasello G. Combined Immunoscore for Prognostic Stratification of Early Stage Non-Small-Cell Lung Cancer. Front Oncol 2020; 10:564915. [PMID: 33072595 PMCID: PMC7544833 DOI: 10.3389/fonc.2020.564915] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 08/27/2020] [Indexed: 11/13/2022] Open
Abstract
Background To date, no combined immunoscore has been evaluated for prognostic stratification of early stage non-small-cell lung cancer (NSCLC). The main goal of this study was to investigate the prognostic impact of programmed death ligand 1 (PD-L1) expression and different immune cell components (CD4+, CD8+ T-lymphocytes, and CD68+ macrophages) in early stage NSCLC patients, distinguishing peritumoral (PT) and intratumoral (IT) localizations. The secondary aim was to identify a combined immunoscore to optimize the prognostic stratification of NSCLC patients. Methods This retrospective study included surgical specimens from consecutive chemo-naive stage II-III radically resected NSCLC patients. Immunohistochemistry was carried out to evaluate PD-L1 expression and to quantify IT and PT CD4+, CD8+ T-lymphocytes, and CD68+ macrophages. The impact of a single marker and of a combination of multiple markers on overall survival (OS) was investigated. Results Seventy-nine patients were included in the study. PD-L1 expression was associated with worse prognosis (3 years OS: 58% in high- compared with 67% in low-expressing tumors), even though without statistical significance. When integrating PT CD8+, CD4+, and CD68 into a combined PT immunoscore, a significant prognostic stratification of patients was obtained and confirmed at multivariate analysis (3 years OS: 86% in patients with low PT immunoscore vs. 59% in patients with high PT immunoscore, p = 0.018). The integration of derived neutrophil/lymphocyte ratio (dNLR) with combined PT immunoscore improved prognostic stratification, with longer OS in patients with low PT immunoscore and low dNLR (p = 0.002). Conclusion The combined PT immunoscore (CD8+, CD4+, and CD68) integrated with dNLR may be a promising marker for the development of an integrated Tumor, Node, Metastasis (TNM) immunoscore.
Collapse
Affiliation(s)
- Alice Boscolo
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Francesco Fortarezza
- Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Francesca Lunardi
- Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Giovanni Comacchio
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Loredana Urso
- Oncology Unit 2, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Stefano Frega
- Oncology Unit 2, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Jessica Menis
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.,Oncology Unit 2, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Laura Bonanno
- Oncology Unit 2, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Valentina Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.,Oncology Unit 2, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Federico Rea
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - PierFranco Conte
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.,Oncology Unit 2, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Fiorella Calabrese
- Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Giulia Pasello
- Oncology Unit 2, Istituto Oncologico Veneto IRCCS, Padua, Italy
| |
Collapse
|
25
|
Maso AD, Ferro A, Lorenzi M, Polo V, Scattolin D, Del Conte A, Scoccia E, Frega S, Bonanno L, Indraccolo S, Calabrese F, Guarneri V, Conte P, Pasello G. 1398P Real-life progression (PD) pattern of EGFR mutant advanced non-small cell lung cancer (aNSCLC) patients (pts) receiving systemic therapy after first- or second-generation tyrosine kinase inhibitor (1-2 gen TKI). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1712] [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: 11/29/2022] Open
|
26
|
Pavan A, Zulato E, Calvetti L, Ferro A, Nardo G, Boscolo A, Attili I, Frega S, Dal Maso A, Pasello G, Guarneri V, Aprile G, Conte PF, Indraccolo S, Bonanno L. Plasma next-generation sequencing (NGS) in advanced non-small cell lung cancer (aNSCLC) patients (pts) treated with immune checkpoint inhibitors (ICIs): Impact of STK11 and TP53 mutations on outcome. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.3046] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3046 Background: ICIs revolutionized aNSCLC treatment. The next challenge lays on the search for predictive markers. Detection of multiple tumor-related genetic alterations through NGS in cell free DNA is a promising tool, provided the limited availability of tumor tissue in most cases. Methods: Between January 2017 and October 2019, aNSCLC pts consecutively referring to our Institution were prospectively screened with plasma NGS while included in two clinical trials: VISION (NCT02864992) and MAGIC trial, an observational study. In VISION trial NGS was performed in plasma (Guardant360 test) and tissue (Oncomine Focus Assay). In MAGIC Myriapod NGS-IL 56G Assay was used. Aim of the study was to evaluate the impact of STK11, KRAS and TP53 mutations (muts) on outcome of ICI-treated pts, with overall survival (OS) as primary endpoint. A control group of pts not receiving ICIs was also analyzed. Results: A total of 235 NSCLC pts were enrolled and received ICIs. 93 pts were analyzed in plasma at the time of beginning ICIs: median OS was 18.9 m (95% CI: 13.7-24.1) and median immune-related progression free disease (irPFS) 3.8 m (95% CI: 2.5-5.1). 49 (52.7%), 22 (23.7%) and 8 (8.6%) pts carried TP53, KRAS and STK11 pathogenic alterations, respectively. STK11 mutated pts showed a trend for worse OS compared with wildtype counterpart (14.9 m, 95% CI: 6.5-23.3, versus 20.3, 95% CI: 13.4-27.2, p = 0.192) KRAS muts had no impact on outcome. Pts with TP53 or STK11/KRAS co-mut (n = 3) had worse OS (12.3 m, 95% CI: 9.2-15.4; HR = 3, 95% CI: 1.6-5.8, p = 0.001 and 5.9 m, 95% CI: 1.4-7.6; HR = 2.9, 95% CI: 1.4-6.3, p = 0.007) and worse irPFS (2.8 m, 95% CI: 1.7-3.9, HR = 1.8 95% CI: 1.1-3.1, p = 0.03 and 1.2 m, 95% CI: 0.9-1.5, HR = 2.2 95% CI: 1.2-4.1, p = 0.01). Number of muts negatively impacts pts’ OS (HR = 1.2, 95% CI: 1.1-1.3, p = 0.02) and was higher among TP53 mutated pts (p < 0.001, Mann-Whitney test). In multivariate analysis, TP53 and STK11/KRAS retained significance. A control group of pts not receiving ICIs was analyzed (n = 101): median OS was 16.8 m (95% CI: 13-20.6). Nor STK11 (n = 10), nor STK11/KRAS (n = 6) had impact on OS (HR = 1.8, 95% CI: 0.7-4.7, p = 0.267 and 1.4, 95% CI: 0.7-3.0, p = 0.293) while the presence of TP53 muts (n = 41) was associated with shorter OS (11.4 m, 95% CI: 7.3-15.5; HR = 2.2, 95% CI: 1.2-4.2, p = 0.009). Conclusions: NGS performed in plasma might be used to detect predictive markers. TP53 muts in plasma at baseline had prognostic value, while STK11/KRAS muts were associated with worse outcome to ICIs.
Collapse
Affiliation(s)
- Alberto Pavan
- Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - Elisabetta Zulato
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Lorenzo Calvetti
- Department of Oncology, San Bortolo General Hospital, ULSS8 Berica - East District, Vicenza, Italy, Vicenza, Italy
| | - Alessandra Ferro
- Department of Surgery, Oncology and Gastroenterology, University of Padua and Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Giorgia Nardo
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Alice Boscolo
- Department of Surgery, Oncology and Gastroenterology, University of Padua and Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Ilaria Attili
- Department of Surgery, Oncology and Gastroenterology, University of Padua and Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Stefano Frega
- Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - Alessandro Dal Maso
- Department of Surgery, Oncology and Gastroenterology, University of Padua and Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Giulia Pasello
- Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - Valentina Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padua and Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Giuseppe Aprile
- Department of Oncology, San Bortolo General Hospital, ULSS8 Berica-East District, Vicenza, Italy
| | - Pier Franco Conte
- Department of Surgery, Oncology and Gastroenterology, University of Padova and Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Stefano Indraccolo
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Laura Bonanno
- Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| |
Collapse
|
27
|
Frega S, Ferro A, Bonanno L, Guarneri V, Conte P, Pasello G. Lung Cancer (LC) in HIV Positive Patients: Pathogenic Features and Implications for Treatment. Int J Mol Sci 2020; 21:E1601. [PMID: 32111093 PMCID: PMC7084664 DOI: 10.3390/ijms21051601] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 02/12/2020] [Accepted: 02/21/2020] [Indexed: 12/23/2022] Open
Abstract
: The human immunodeficiency virus (HIV) infection continues to be a social and public health problem. Thanks to more and more effective antiretroviral therapy (ART), nowadays HIV-positive patients live longer, thus increasing their probability to acquire other diseases, malignancies primarily. Senescence along with immune-system impairment, HIV-related habits and other oncogenic virus co-infections increase the cancer risk of people living with HIV (PLWH); in the next future non-AIDS-defining cancers will prevail, lung cancer (LC) in particular. Tumor in PLWH might own peculiar predictive and/or prognostic features, and antineoplastic agents' activity might be subverted by drug-drug interactions (DDIs) due to concurrent ART. Moreover, PLWH immune properties and comorbidities might influence both the response and tolerability of oncologic treatments. The therapeutic algorithm of LC, rapidly and continuously changed in the last years, should be fitted in the context of a special patient population like PLWH. This is quite challenging, also because HIV-positive patients have been often excluded from participation to clinical trials, so that levels of evidence about systemic treatments are lower than evidence in HIV-uninfected individuals. With this review, we depicted the epidemiology, pathogenesis, clinical-pathological characteristics and implications for LC care in PLWH, offering a valid focus about this topic to clinicians.
Collapse
Affiliation(s)
- Stefano Frega
- Medical Oncology 2, Istituto Oncologico Veneto IOV- IRCCS, 35, 128 Padova, Italy; (S.F.); (A.F.); (L.B.); (V.G.); (P.C.)
| | - Alessandra Ferro
- Medical Oncology 2, Istituto Oncologico Veneto IOV- IRCCS, 35, 128 Padova, Italy; (S.F.); (A.F.); (L.B.); (V.G.); (P.C.)
- Department of Surgery, Oncology and Gastroenterology, University of Padova, 35, 128 Padova, Italy
| | - Laura Bonanno
- Medical Oncology 2, Istituto Oncologico Veneto IOV- IRCCS, 35, 128 Padova, Italy; (S.F.); (A.F.); (L.B.); (V.G.); (P.C.)
| | - Valentina Guarneri
- Medical Oncology 2, Istituto Oncologico Veneto IOV- IRCCS, 35, 128 Padova, Italy; (S.F.); (A.F.); (L.B.); (V.G.); (P.C.)
- Department of Surgery, Oncology and Gastroenterology, University of Padova, 35, 128 Padova, Italy
| | - PierFranco Conte
- Medical Oncology 2, Istituto Oncologico Veneto IOV- IRCCS, 35, 128 Padova, Italy; (S.F.); (A.F.); (L.B.); (V.G.); (P.C.)
- Department of Surgery, Oncology and Gastroenterology, University of Padova, 35, 128 Padova, Italy
| | - Giulia Pasello
- Medical Oncology 2, Istituto Oncologico Veneto IOV- IRCCS, 35, 128 Padova, Italy; (S.F.); (A.F.); (L.B.); (V.G.); (P.C.)
| |
Collapse
|
28
|
Boldrin E, Nardo G, Zulato E, Bonanno L, Polo V, Frega S, Pavan A, Indraccolo S, Saggioro D. Detection of Loss of Heterozygosity in cfDNA of Advanced EGFR- or KRAS-Mutated Non-Small-Cell Lung Cancer Patients. Int J Mol Sci 2019; 21:ijms21010066. [PMID: 31861832 PMCID: PMC6981934 DOI: 10.3390/ijms21010066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/11/2019] [Accepted: 12/16/2019] [Indexed: 11/16/2022] Open
Abstract
Liquid biopsy is currently approved for management of epidermal growth factor receptor (EGFR)-mutated non-small-cell lung cancer (NSCLC) patients. However, one unanswered question is whether the rate of cell-free DNA (cfDNA)-negative samples is due to technical limitations rather than to tumor genetic characteristics. Using four microsatellite markers that map specific chromosomal loci often lost in lung cancer, we conducted a pilot study to investigate whether other alterations, such as loss of heterozygosity (LOH), could be detected in EGFR-negative cfDNA. We analyzed EGFR-mutated NSCLC patients (n = 24) who were positive or negative for EGFR mutations in cfDNA and compared the results with a second cohort of 24 patients bearing KRAS-mutated cancer, which served as a representative control population not exposed to targeted therapy. The results showed that in EGFR-negative post-tyrosine-kinase-inhibitor (TKI) cfDNAs, LOH frequency was significantly higher than in both pre- and post-TKI EGFR-positive cfDNAs. By contrast, no association between KRAS status in cfDNA and number of LOH events was found. In conclusion, our study indicates the feasibility of detecting LOH events in cfDNA from advanced NSCLC and suggests LOH analysis as a new candidate molecular assay to integrate mutation-specific assays.
Collapse
Affiliation(s)
- Elisa Boldrin
- Immunology and Molecular Oncology Unit, Istituto Oncologico Veneto IOV-IRCCS, Via Gattamelata 64, 35128 Padova, Italy; (E.B.); (G.N.); (E.Z.); (D.S.)
| | - Giorgia Nardo
- Immunology and Molecular Oncology Unit, Istituto Oncologico Veneto IOV-IRCCS, Via Gattamelata 64, 35128 Padova, Italy; (E.B.); (G.N.); (E.Z.); (D.S.)
| | - Elisabetta Zulato
- Immunology and Molecular Oncology Unit, Istituto Oncologico Veneto IOV-IRCCS, Via Gattamelata 64, 35128 Padova, Italy; (E.B.); (G.N.); (E.Z.); (D.S.)
| | - Laura Bonanno
- Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Via Gattamelata 64, 35128 Padova, Italy; (L.B.); (S.F.); (A.P.)
| | | | - Stefano Frega
- Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Via Gattamelata 64, 35128 Padova, Italy; (L.B.); (S.F.); (A.P.)
| | - Alberto Pavan
- Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Via Gattamelata 64, 35128 Padova, Italy; (L.B.); (S.F.); (A.P.)
| | - Stefano Indraccolo
- Immunology and Molecular Oncology Unit, Istituto Oncologico Veneto IOV-IRCCS, Via Gattamelata 64, 35128 Padova, Italy; (E.B.); (G.N.); (E.Z.); (D.S.)
- Correspondence:
| | - Daniela Saggioro
- Immunology and Molecular Oncology Unit, Istituto Oncologico Veneto IOV-IRCCS, Via Gattamelata 64, 35128 Padova, Italy; (E.B.); (G.N.); (E.Z.); (D.S.)
| |
Collapse
|
29
|
Bonanno L, Pavan A, Ferro A, Calvetti L, Frega S, Pasello G, Aprile G, Guarneri V, Conte P. Clinical impact of plasma next-generation sequencing (NGS) in advanced non-small cell lung cancer (aNSCLC). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz257.009] [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
|
30
|
Pasello G, Boscolo A, Fortarezza F, Lunardi F, Urso L, Frega S, Comacchio G, Bonanno L, Guarneri V, Rea F, Calabrese F, Conte P. Combined immunoscore for prognostic stratification of early stage NSCLC patients. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz258.013] [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
|
31
|
Pasello G, Urso L, Boscolo A, Pezzuto F, Silic-Benussi M, Vuljian S, Frega S, Bonanno L, Schiavon M, Rea F, Ciminale V, Conte P, Calabrese F. Immune microenvironment modulation by p14/ARF in malignant pleural mesothelioma. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz266.009] [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
|
32
|
Dal Maso A, Lorenzi M, Roca E, Pilotto S, Macerelli M, Polo V, Cecere FL, Del Conte A, Nardo G, Buoro V, Scattolin D, Monteverdi S, Urso L, Zulato E, Frega S, Bonanno L, Indraccolo S, Calabrese F, Conte P, Pasello G. Clinical Features and Progression Pattern of Acquired T790M-positive Compared With T790M-negative EGFR Mutant Non-small-cell Lung Cancer: Catching Tumor and Clinical Heterogeneity Over Time Through Liquid Biopsy. Clin Lung Cancer 2019; 21:1-14.e3. [PMID: 31601525 DOI: 10.1016/j.cllc.2019.07.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 05/02/2019] [Revised: 06/18/2019] [Accepted: 07/26/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND Clinical-pathologic predictors of acquired T790M epidermal growth factor receptor (EGFR) mutation in Caucasian patients with non-small-cell lung cancer (NSCLC) progressing after first-/second-generation tyrosine kinase inhibitors (TKIs) is an open field for research. Similarly, the best time point for T790M detection by liquid or tissue biopsy after disease progression is currently matter of debate. PATIENTS AND METHODS This is an observational study at 7 Italian centers enrolling patients with EGFR-mutant NSCLC progressing after first-/second-generation EGFR TKIs, between 2014 and 2018, aiming at comparing baseline clinical-pathologic features and progression patterns in acquired T790M-positive compared with T790M-negative cases. RESULTS A total of 235 patients received first-line treatment with gefitinib (N = 126; 53%), erlotinib (N = 51; 22%), or afatinib (N = 58; 25%). In 120 (51%) cases, T790M was detected in liquid biopsy, tissue biopsy, or both. Age younger than 65 years (P = .037), the presence of common mutations (P = .004), and better response to first-line TKI (P = .023) were correlated with T790M positivity. T790M detection was associated with higher number of new progressing sites (P = .04), liver progression (P = .002), and a lower frequency of lung metastases (P = .027). When serial liquid biopsies were performed (N = 15), an oligoprogressive disease was correlated with a negative test outcome, whereas systemic progression was observed at the time of T790M positivity. CONCLUSION This study on a Caucasian population showed that age, type of EGFR mutation at diagnosis, response to first-line treatment, and peculiar progression pattern are associated with T790M status. Serial liquid biopsy might be useful for treatment selection, especially when tissue rebiopsy is not feasible.
Collapse
Affiliation(s)
- Alessandro Dal Maso
- Department of Oncology 2, Istituto Oncologico Veneto - IRCCS, Padova, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Martina Lorenzi
- Department of Oncology 2, Istituto Oncologico Veneto - IRCCS, Padova, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Elisa Roca
- Department of Medical Oncology, ASST - Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Sara Pilotto
- Department of Medical Oncology, University of Verona, AOUI Verona, Verona, Italy
| | - Marianna Macerelli
- Department of Medical Oncology - ASUIUD Santa Maria della Misericordia, Udine, Italy
| | - Valentina Polo
- Oncology Unit, AULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy
| | - Fabiana Letizia Cecere
- Department of Oncology 1, Regina Elena National Cancer Institute IRCCS Rome, Rome, Italy
| | - Alessandro Del Conte
- Department of Medical Oncology and Immunorelated Tumors, Centro di Riferimento Oncologico (CRO) - IRCCS, Aviano (PN), Italy
| | - Giorgia Nardo
- Immunology and Molecular Oncology Unit, Istituto Oncologico Veneto - IRCCS, Padova, Italy
| | - Vanessa Buoro
- Department of Medical Oncology - ASUIUD Santa Maria della Misericordia, Udine, Italy
| | - Daniela Scattolin
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Sara Monteverdi
- Department of Medical Oncology, University of Verona, AOUI Verona, Verona, Italy
| | - Loredana Urso
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Elisabetta Zulato
- Immunology and Molecular Oncology Unit, Istituto Oncologico Veneto - IRCCS, Padova, Italy
| | - Stefano Frega
- Department of Oncology 2, Istituto Oncologico Veneto - IRCCS, Padova, Italy
| | - Laura Bonanno
- Department of Oncology 2, Istituto Oncologico Veneto - IRCCS, Padova, Italy
| | - Stefano Indraccolo
- Immunology and Molecular Oncology Unit, Istituto Oncologico Veneto - IRCCS, Padova, Italy
| | - Fiorella Calabrese
- Pathology Unit, Department of Cardio-Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - PierFranco Conte
- Department of Oncology 2, Istituto Oncologico Veneto - IRCCS, Padova, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Giulia Pasello
- Department of Oncology 2, Istituto Oncologico Veneto - IRCCS, Padova, Italy.
| |
Collapse
|
33
|
Pasello G, Dal Maso A, Lorenzi M, Roca E, Pilotto S, Macerelli M, Polo V, Del Conte A, Nardo G, Buoro V, Scattolin D, Monteverdi S, Urso L, Zulato E, Frega S, Bonanno L, Indraccolo S, Calabrese F, Conte P. Clinical features and progression pattern of T790M+ compared with T790M-EGFR mutant NSCLC. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e20612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e20612 Background: Acquired T790M EGFR mutation (mut) is not predictable by any clinical-pathological feature. The best time point for T790M mut detection by liquid or tissue biopsy is currently undefined. Methods: This is an observational study at 6 Italian Centers enrolling EGFR mutant NSCLC patients (pts) progressing after first/second generation EGFR TKI, between 2014 and 2018. The primary endpoint of the study was to compare clinical features in acquired T790M+ compared with T790M- cases. The secondary endpoint was to assess different progression (PD) patterns between the two groups. We also explored the PD pattern at the time of cfDNA negativity and subsequent positivity, in a subgroup of pts receiving serial liquid biopsies. Statistical analysis was performed by the Chi-square test to correlate clinical features with T790M status, and by the Kaplan-Meier estimator to evaluate median progression free (mPFS) and overall survival (mOS). Multiple logistic regression and log-rank tests were applied. Results: 219 pts were included. Median follow-up since diagnosis was 25 months. First line treatment was gefitinib (N = 119, 54%), erlotinib (N = 48, 22%) or afatinib (N = 52, 24%). In 108 (49%) cases a T790M acquired mut was detected in liquid (70), tissue (31) biopsy or both (7). Age younger than 65 years ( p= 0.05) and presence of sensitizing exon 19 deletion ( p= 0.04) were correlated with T790M mut; this association was confirmed at multivariate analysis ( p= 0.010 and p= 0.006, respectively). At the time of PD, new PD sites ( p= 0.005) and liver PD ( p< 0.001) were more commonly observed in T790M+ group; at multivariate analysis statistical significance was confirmed ( p= 0.01 and p= 0.008, respectively). Longer mOS was observed in T790M+ cases at univariate (53 versus 22 months, p < 0.0001) and multivariate analysis. In 13 pts undergoing serial liquid biopsies, an oligoprogressive disease was correlated with a negative test outcome, while PS/symptoms worsening, higher number of new lesions and PD sites were observed at the time of T790M positivity, although without statistical significance. Conclusions: This is the first caucasian series showing different clinical features and progression patterns of T790M+ versus T790M- EGFR mutant NSCLC.
Collapse
Affiliation(s)
| | | | | | - Elisa Roca
- Oncology Department, Spedali Civili Hospital, Brescia, Italy
| | - Sara Pilotto
- University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | | | | | - Giorgia Nardo
- Immunology and Molecular Oncology Unit, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Vanessa Buoro
- Department of Medicine (DAME) - University of Udine, Udine, Italy, Udine, Italy
| | | | | | - Loredana Urso
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Elisabetta Zulato
- Immunology and Molecular Oncology Unit, Istituto Oncologico Veneto IOV IRCCS, Padua, Italy
| | - Stefano Frega
- Medical Oncology 2, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | | | - Stefano Indraccolo
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Fiorella Calabrese
- Department of CardioThoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Pierfranco Conte
- University of Padova and Istituto Oncologico Veneto, Padova, Italy
| |
Collapse
|
34
|
Frega S, Dal Maso A, Ferro A, Bonanno L, Conte P, Pasello G. Heterogeneous tumor features and treatment outcome between males and females with lung cancer (LC): Do gender and sex matter? Crit Rev Oncol Hematol 2019; 138:87-103. [PMID: 31092389 DOI: 10.1016/j.critrevonc.2019.03.012] [Citation(s) in RCA: 10] [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: 10/15/2018] [Revised: 03/14/2019] [Accepted: 03/20/2019] [Indexed: 12/24/2022] Open
Abstract
Lung cancer (LC) is the leading cause of cancer-related death worldwide, despite a decreasing incidence rate in recent years, especially in men. Most risk factors for LC could be linked to an individual's reproductive system and secondary sex characteristics ('sex-related') and/or to some physical, behavioral and personality traits ('gender-related') peculiar to males rather than females or vice versa. An imbalance of these etiologic factors could explain why some LC features may differ between sexes. For this review, an extended literature data collection was performed, using keywords to identify 'sex/gender' and 'LC'. Differences between genders in LC epidemiology, pathological and molecular characteristics, loco-regional and/or systemic treatments outcome and prognosis were systematically analyzed. The possible predictive role of physio-pathological factors in males and females paves the way for a personalized therapeutic approach, emphasizing the need to include gender as a stratification factor in future clinical trials design.
Collapse
Affiliation(s)
- Stefano Frega
- Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy
| | - Alessandro Dal Maso
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Italy; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy
| | - Alessandra Ferro
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Italy; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy
| | - Laura Bonanno
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Italy
| | - PierFranco Conte
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Italy; Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy
| | - Giulia Pasello
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Italy.
| |
Collapse
|
35
|
Pasello G, Vicario G, Zustovich F, Oniga F, Gori S, Rosetti F, Bonetti A, Favaretto A, Toso S, Redelotti R, Santo A, Bernardi D, Giovanis P, Oliani C, Calvetti L, Gatti C, Palazzolo G, Baretta Z, Bortolami A, Bonanno L, Basso M, Menis J, Corte DD, Frega S, Guarneri V, Conte P. From Diagnostic-Therapeutic Pathways to Real-World Data: A Multicenter Prospective Study on Upfront Treatment for EGFR-Positive Non-Small Cell Lung Cancer (MOST Study). Oncologist 2019; 24:e318-e326. [PMID: 30846513 DOI: 10.1634/theoncologist.2018-0712] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 01/25/2019] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Gefitinib, erlotinib, and afatinib represent the approved first-line options for epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancer (NSCLC). Because pivotal trials frequently lack external validity, real-world data may help to depict the diagnostic-therapeutic pathway and treatment outcome in clinical practice. METHODS MOST is a multicenter observational study promoted by the Veneto Oncology Network, aiming at monitoring the diagnostic-therapeutic pathway of patients with nonsquamous EGFR-mutant NSCLC. We reported treatment outcome in terms of median time to treatment failure (mTTF) and assessed the impact of each agent on the expense of the regional health system, comparing it with a prediction based on the pivotal trials. RESULTS An EGFR mutation test was performed in 447 enrolled patients, of whom 124 had EGFR mutation and who received gefitinib (n = 69, 55%), erlotinib (n = 33, 27%), or afatinib (n = 22, 18%) as first-line treatment. Because erlotinib was administered within a clinical trial to 15 patients, final analysis was limited to 109 patients. mTTF was 15.3 months, regardless of the type of tyrosine kinase inhibitor (TKI) used. In the MOST study, the budget impact analysis showed a total expense of €3,238,602.17, whereas the cost estimation according to median progression-free survival from pivotal phase III trials was €1,813,557.88. CONCLUSION Good regional adherence and compliance to the diagnostic-therapeutic pathway defined for patients with nonsquamous NSCLC was shown. mTTF did not significantly differ among the three targeted TKIs. Our budget impact analysis suggests the potential application of real-world data in the process of drug price negotiation. IMPLICATIONS FOR PRACTICE The MOST study is a real-world data collection reporting a multicenter adherence and compliance to diagnostic-therapeutic pathways defined for patients with epidermal growth factor receptor-mutant non-small cell lung cancer. This represents an essential element of evidence-based medicine, providing information on patients and situations that may be challenging to assess using only data from randomized controlled trials, e.g., turn-around time of diagnostic tests, treatment compliance and persistence, guideline adherence, challenging-to-treat populations, drug safety, comparative effectiveness, and cost effectiveness. This study may be of interest to various stakeholders (patients, clinicians, and payers), providing a meaningful picture of the value of a given therapy in routine clinical practice.
Collapse
Affiliation(s)
- Giulia Pasello
- Medical Oncology 2, Istituto Oncologico Veneto (IOV) Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padova, Italy
| | - Giovanni Vicario
- Medical Oncology, Azienda Unità Locale Socio Sanitaria (AULSS) 2 Marca Trevigiana, San Giacomo Hospital, Castelfranco Veneto, Italy
| | - Fable Zustovich
- Clinical Oncology Department, AULSS 1 Dolomiti, San Martino Hospital, Belluno, Italy
| | - Francesco Oniga
- Medical Oncology, AULSS 3 Serenissima, Angelo Hospital, Venezia-Mestre, Italy
| | - Stefania Gori
- Medical Oncology, Sacro Cuore-Don Calabria Hospital, Cancer Care Center, Negrar, Italy
| | - Francesco Rosetti
- Oncology and Oncological Hematology, AULSS 3 Serenissima, Mirano-Dolo Hospital, Venezia, Italy
| | - Andrea Bonetti
- Department of Oncology, AULSS 9 Scaligera, Mater Salutis Hospital, Legnago, Italy
| | - Adolfo Favaretto
- Department of Medical Oncology, AULSS 2 Marca Trevigiana, Ca'Foncello Hospital, Treviso, Italy
| | - Silvia Toso
- Medical Oncology, AULSS 5 Polesana, Adria Hospital, Adria, Italy
| | - Roberta Redelotti
- Medical Oncology, AULSS 6 Euganea, South Padova Hospital, Padova, Italy
| | - Antonio Santo
- Medical Oncology, University of Verona, Azienda Ospedaliera Universitaria Integra (AOUI) Verona, Verona, Italy
| | - Daniele Bernardi
- Medical Oncology, AULSS 4, San Donà Hospital, San Donà di Piave, Italy
| | - Petros Giovanis
- Medical Oncology, AULSS 1 Dolomiti, Santa Maria del Prato Hospital, Feltre, Italy
| | - Cristina Oliani
- Oncology Unit, AULSS 8, Montecchio Maggiore Hospital, Monteccio Maggiore, Italy
| | - Lorenzo Calvetti
- Department of Oncology, San Bortolo General Hospital, AULSS 8 Berica, Vicenza, Italy
| | - Carlo Gatti
- Medical Oncology, AULSS 3 Serenissima, Chioggia Hospital, Chioggia, Italy
| | - Giovanni Palazzolo
- Medical Oncology, AULSS 6 Euganea, Cittadella Camposampiero Hospital, Camposampiero, Italy
| | - Zora Baretta
- Oncology Unit, AULSS 8, Montecchio Maggiore Hospital, Monteccio Maggiore, Italy
| | - Alberto Bortolami
- Medical Oncology 2, Istituto Oncologico Veneto (IOV) Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padova, Italy
| | - Laura Bonanno
- Medical Oncology 2, Istituto Oncologico Veneto (IOV) Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padova, Italy
| | - Marco Basso
- Medical Oncology, Azienda Unità Locale Socio Sanitaria (AULSS) 2 Marca Trevigiana, San Giacomo Hospital, Castelfranco Veneto, Italy
| | - Jessica Menis
- Medical Oncology 2, Istituto Oncologico Veneto (IOV) Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padova, Italy
- Oncological, Surgical, and Gastroenterological Sciences Department, University of Padova, Padova, Italy
| | - Donatella Da Corte
- Clinical Oncology Department, AULSS 1 Dolomiti, San Martino Hospital, Belluno, Italy
| | - Stefano Frega
- Medical Oncology 2, Istituto Oncologico Veneto (IOV) Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padova, Italy
| | - Valentina Guarneri
- Medical Oncology 2, Istituto Oncologico Veneto (IOV) Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padova, Italy
- Oncological, Surgical, and Gastroenterological Sciences Department, University of Padova, Padova, Italy
| | - PierFranco Conte
- Medical Oncology 2, Istituto Oncologico Veneto (IOV) Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padova, Italy
- Oncological, Surgical, and Gastroenterological Sciences Department, University of Padova, Padova, Italy
| |
Collapse
|
36
|
Bonanno L, Zulato E, Attili I, Pavan A, Del Bianco P, Nardo G, Verza M, Pasqualini L, Pasello G, Zago G, Frega S, Fassan M, Calabrese F, Amadori A, Guarneri V, Conte P, Indraccolo S. Liquid biopsy as tool to monitor and predict clinical benefit from chemotherapy (CT) and immunotherapy (IT) in advanced non-small cell lung cancer (aNSCLC): A prospective study. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy303] [Citation(s) in RCA: 5] [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] [Indexed: 11/14/2022] Open
|
37
|
Frega S, Bonanno L, Guarneri V, Conte P, Pasello G. Therapeutic perspectives for brain metastases in non-oncogene addicted non-small cell lung cancer (NSCLC): Towards a less dismal future? Crit Rev Oncol Hematol 2018; 128:19-29. [DOI: 10.1016/j.critrevonc.2018.05.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 05/14/2018] [Indexed: 12/16/2022] Open
|
38
|
Bonanno L, Zulato E, Nardo G, Del Bianco P, Attili I, Pavan A, Verza M, Pasqualini L, Alberti G, Pasello G, Zago G, Frega S, Fassan M, Rugge M, De Salvo GL, Calabrese F, Conte PF, Indraccolo S. Monitoring advanced non-small cell lung cancer (NSCLC) through plasma genotyping during systemic treatment: KRAS-mutated (m) cohort results. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e24074] [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)
| | - Elisabetta Zulato
- Immunology and Molecular Oncology Unit, Istituto Oncologico Veneto IOV IRCCS, Padua, Italy
| | - Giorgia Nardo
- Immunology and Molecular Oncology Unit, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Paola Del Bianco
- Clinical Trials and Biostatistics Unit, Istituto Oncologico Veneto IOV IRCCS, Padua, Italy
| | - Ilaria Attili
- Medical Oncology 2, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | - Alberto Pavan
- Medical Oncology 2, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | - Martina Verza
- Immunology and Molecular Oncology Unit, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | - Lorenza Pasqualini
- Immunology and Molecular Oncology Unit, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | - Giulia Alberti
- Medical Oncology 2, Istituto Oncologico Veneto (IRCCS), Padua, IT
| | - Giulia Pasello
- Medical Oncology 2, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | - Giulia Zago
- Medical Oncology 2, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | - Stefano Frega
- Medical Oncology 2, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | - Matteo Fassan
- Department of Medicine (DIMED), Pathology Unit, University of Padua, Padova, Italy, Padova, Italy
| | - Massimo Rugge
- Department of Medicine, Pathology and Cytopathology Unit, University of Padova, Padova, Italy
| | - Gian Luca De Salvo
- Clinical Trials and Biostatistics Unit, Veneto Institute of Oncology-IRCCS, Padua, Italy
| | - Fiorella Calabrese
- Department of CardioThoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Pier Franco Conte
- University of Padova and Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Stefano Indraccolo
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| |
Collapse
|
39
|
Frega S, Lorenzi M, Fassan M, Indraccolo S, Calabrese F, Favaretto A, Bonanno L, Polo V, Zago G, Lunardi F, Attili I, Pavan A, Rugge M, Guarneri V, Conte P, Pasello G. Clinical features and treatment outcome of non-small cell lung cancer (NSCLC) patients with uncommon or complex epidermal growth factor receptor (EGFR) mutations. Oncotarget 2018; 8:32626-32638. [PMID: 28427238 PMCID: PMC5464815 DOI: 10.18632/oncotarget.15945] [Citation(s) in RCA: 13] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 02/22/2017] [Indexed: 01/03/2023] Open
Abstract
Introduction Tyrosine-kinase inhibitors (TKIs) represent the best treatment for advanced non-small cell lung cancer (NSCLC) with common exon 19 deletion or exon 21 epidermal growth factor receptor mutation (EGFRm). This is an observational study investigating epidemiology, clinical features and treatment outcome of NSCLC cases harbouring rare/complex EGFRm. Results Among 764 non-squamous NSCLC cases with known EGFRm status, 26(3.4%) harboured rare/complex EGFRm. Patients receiving first-line TKIs (N = 17) achieved median Progression Free Survival (PFS) and Overall Survival (OS) of 53 (IC 95%, 2–105) and 84 (CI 95%, 27–141) weeks respectively, without significant covariate impact. Response Rate and Disease Control Rate (DCR) were 47% and 65%, respectively. Uncommon exon 19 mutations achieved longer OS and PFS and higher DCR compared with exon 18 and 20 mutations. No additional gene mutation was discovered by MassARRAY analysis. TKIs were globally well tolerated. Materials and methods A retrospective review of advanced non-squamous NSCLC harbouring rare/complex EGFRm referred to our Center between 2010 and 2015 was performed. Additional molecular pathways disregulation was explored in selected cases, through MassARRAY analysis. Conclusions Peculiar clinical features and lower TKIs sensitivity of uncommon/complex compared with common EGFRm were shown. Exon 19 EGFRm achieved the best TKIs treatment outcome, while the optimal treatment of exon 18 and 20 mutations should be further clarified.
Collapse
Affiliation(s)
- Stefano Frega
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy.,Medical Oncology 2, Istituto Oncologico Veneto, IRCCS, Padova, Italy
| | - Martina Lorenzi
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy
| | - Matteo Fassan
- Department of Medicine, Surgical Pathology Unit, University of Padova, Padova, Italy
| | - Stefano Indraccolo
- Immunology and Molecular Oncology Unit, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Fiorella Calabrese
- Department of Cardio-Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | | | - Laura Bonanno
- Medical Oncology 2, Istituto Oncologico Veneto, IRCCS, Padova, Italy
| | - Valentina Polo
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy.,Medical Oncology 2, Istituto Oncologico Veneto, IRCCS, Padova, Italy
| | - Giulia Zago
- Medical Oncology 2, Istituto Oncologico Veneto, IRCCS, Padova, Italy
| | - Francesca Lunardi
- Department of Cardio-Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Ilaria Attili
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy.,Medical Oncology 2, Istituto Oncologico Veneto, IRCCS, Padova, Italy
| | - Alberto Pavan
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy.,Medical Oncology 2, Istituto Oncologico Veneto, IRCCS, Padova, Italy
| | - Massimo Rugge
- Department of Medicine, Surgical Pathology Unit, University of Padova, Padova, Italy
| | - Valentina Guarneri
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy.,Medical Oncology 2, Istituto Oncologico Veneto, IRCCS, Padova, Italy
| | - PierFranco Conte
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy.,Medical Oncology 2, Istituto Oncologico Veneto, IRCCS, Padova, Italy
| | - Giulia Pasello
- Medical Oncology 2, Istituto Oncologico Veneto, IRCCS, Padova, Italy
| |
Collapse
|
40
|
Polo V, Pasello G, Frega S, Favaretto A, Koussis H, Conte P, Bonanno L. Squamous cell carcinomas of the lung and of the head and neck: new insights on molecular characterization. Oncotarget 2018; 7:25050-63. [PMID: 26933818 PMCID: PMC5041888 DOI: 10.18632/oncotarget.7732] [Citation(s) in RCA: 5] [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] [Received: 10/08/2015] [Accepted: 01/29/2016] [Indexed: 12/14/2022] Open
Abstract
Squamous cell carcinomas of the lung and of the head and neck district share strong association with smoking habits and are characterized by smoke-related genetic alterations. Driver mutations have been identified in small percentage of lung squamous cell carcinoma. In parallel, squamous head and neck tumors are classified according to the HPV positivity, thus identifying two different clinical and molecular subgroups of disease.This review depicts different molecular portraits and potential clinical application in the field of targeted therapy, immunotherapy and chemotherapy personalization.
Collapse
Affiliation(s)
- Valentina Polo
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy.,Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, Padova, Italy
| | - Giulia Pasello
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Stefano Frega
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Adolfo Favaretto
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | | | - Pierfranco Conte
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy.,Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, Padova, Italy
| | - Laura Bonanno
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| |
Collapse
|
41
|
Bonanno L, Attili I, Zulato E, Nardo G, Verza M, Pavan A, Del Bianco P, Pasello G, Zago G, Polo V, Frega S, Milite N, Carlucci M, Calabrese F, De Salvo G, Conte P, Indraccolo S. P3.02-006 Monitoring Genetic Alterations in Plasma during Anti-Cancer Treatment in Advanced NSCLC (MAGIC1-Validation Cohort: Preliminary Results). J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1535] [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: 10/18/2022]
|
42
|
Pasello G, Vicario G, Gori S, Zustovich F, Bonetti A, Rosetti F, Favaretto A, Oniga F, Bria E, Toso S, Boccalon M, Oliani C, Palazzolo G, Frega S, Basso M, Pertile P, Bortolami A, Verrienti R, Scanni R, Conte P. Compliance to diagnostic and therapeutic pathways and innovative drug recommendations in advanced non-small cell lung cancer: preliminary results from the MOST study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx426.008] [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
|
43
|
Di Liso E, Pavan A, Schiavon M, Gregori D, Comacchio G, Attili I, Mantiero M, Pasello G, Zago G, Polo V, Frega S, Milite N, Rea F, Conte P, Bonanno L. Surgery in multimodal management in non-metastatic small cell lung cancer: a retrospective monocentric series. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx426.022] [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
|
44
|
Frega S, Macerelli M, Del Conte A, Bonanno L, Bartoletti M, Polo V, Zago G, Follador A, Attili I, Pavan A, Urso L, Basso S, Fasola G, Conte P, Pasello G. Clinical features of never smoker patients with lung squamous cell carcinoma: a retrospective multicenter study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx426.017] [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
|
45
|
Zago G, Lunardi F, Calabrese F, Vuljan S, Urso L, Frega S, Pavan A, Polo V, Bonanno L, Attili I, Rea F, Conte P, Pasello G. Malignant pleural mesothelioma immune microenvironment and checkpoint expression before and after systemic cytotoxic treatment. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx389.004] [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
|
46
|
Frega S, Macerelli M, Del Conte A, Bonanno L, Bartoletti M, Polo V, Zago G, Follador A, Attili I, Pavan A, Urso L, Basso S, Fasola G, Conte P, Pasello G. Clinical features of never smoker patients with lung squamous cell carcinoma: A retrospective multicenter study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx380.074] [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
|
47
|
Attili I, Frega S, Pavan A, Pasello G, Polo V, Zago G, Rea F, Calabrese F, Conte P, Bonanno L. Thymoma and thymic carcinoma: A real-life retrospective analysis. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx093.006] [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: 11/14/2022] Open
|
48
|
Frega S, Conte P, Fassan M, Polo V, Pasello G. A Triple Rare E709K and L833V/H835L EGFR Mutation Responsive to an Irreversible Pan-HER Inhibitor: A Case Report of Lung Adenocarcinoma Treated with Afatinib. J Thorac Oncol 2016; 11:e63-e64. [DOI: 10.1016/j.jtho.2016.01.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 01/28/2016] [Accepted: 01/30/2016] [Indexed: 11/30/2022]
|
49
|
Polo V, Zago G, Frega S, Canova F, Bonanno L, Favaretto A, Bonaldi L, Bertorelle R, Conte P, Pasello G. Non-Small Cell Lung Cancer in a Very Young Woman: A Case Report and Critical Review of the Literature. Am J Case Rep 2015; 16:782-9. [PMID: 26525068 PMCID: PMC4642365 DOI: 10.12659/ajcr.894426] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Lung cancer in young patients is quite uncommon; clinical presentation and outcome in this population compared to the older group are not yet well defined and data about this setting are mostly single-institutional retrospective analyses. CASE REPORT We report here a case of a very young woman with diagnosis of early-stage lung adenocarcinoma harboring EML4-ALK rearrangement; she underwent radical surgery and adjuvant chemotherapy according to the pathologic stage. Potential risk factors for lung cancer in our patient are discussed and clinico-pathologic features and outcomes of lung cancer in the young population compared to the elderly are reviewed through discussing studies with sample sizes larger than 100 patients. CONCLUSIONS A wide clinical overview should be performed when lung cancer is diagnosed in a young patient. Large-population studies are required to define the molecular signature and clinical behavior of lung cancer in young patients.
Collapse
Affiliation(s)
- Valentina Polo
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Giulia Zago
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Stefano Frega
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Fabio Canova
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Laura Bonanno
- Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Adolfo Favaretto
- Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Laura Bonaldi
- Immunology and Molecular Oncology Unit, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Roberta Bertorelle
- Immunology and Molecular Oncology Unit, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - PierFranco Conte
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Giulia Pasello
- Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| |
Collapse
|
50
|
Camera F, Giaz A, Pellegri L, Riboldi S, Blasi N, Boiano C, Bracco A, Brambilla S, Ceruti S, Coelli S, Crespi F, Csatlòs M, Krasznahorkay A, Gulyàs J, Lodetti S, Frega S, Miani A, Million B, Stuhl L, Wieland O. Characterization of Large Volume 3.5″ x 8″ LaBr3:Ce Detectors for the HECTOR+array. EPJ Web of Conferences 2014. [DOI: 10.1051/epjconf/20146611008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|