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Johansson H, Guerrieri-Gonzaga A, Gandini S, Bertelsen BE, Macis D, Serrano D, Mellgren G, Lazzeroni M, Thomas PS, Crew KD, Kumar NB, Briata IM, Galimberti V, Viale G, Vornik LA, Aristarco V, Buttiron Webber T, Spinaci S, Brown PH, Heckman-Stoddard BM, Szabo E, Bonanni B, DeCensi A. Alternative dosing regimen of exemestane in a randomized presurgical trial: the role of obesity in biomarker modulation. NPJ Breast Cancer 2024; 10:7. [PMID: 38238336 PMCID: PMC10796398 DOI: 10.1038/s41523-024-00616-8] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 01/04/2024] [Indexed: 01/22/2024] Open
Abstract
In a 3-arm presurgical trial, four-six weeks exemestane 25 mg three times/week (TIW) was non-inferior to 25 mg/day (QD) in suppressing circulating estradiol in postmenopausal women with ER-positive breast cancer. Since obesity may decrease exemestane efficacy, we analyzed changes in sex steroids, adipokines, Ki-67, and drug levels in relation to obesity. Postmenopausal women with early-stage ER-positive breast cancer were randomized to either exemestane 25 mg QD (n = 57), 25 mg TIW (n = 57), or 25 mg/week (QW, n = 62) for 4-6 weeks before breast surgery. Serum and tissue pre- and post-treatment biomarkers were stratified by body mass index (BMI)< or ≥30 kg/m2. Post-treatment median exemestane and 17-OH exemestane levels were 5-6 times higher in the QD arm compared to the TIW arm. For obese women, TIW maintained comparable reductions to QD in systemic estradiol levels, although the reduction in estrone was less with the TIW regimen. There was less suppression of SHBG with the TIW versus the QD dose schedule in obese women which should result in less systemic bioavailable estrogens. Metabolically, the effect of the TIW regimen was similar to the QD regimen for obese women in terms of leptin suppression and increase in the adiponectin-leptin ratio. Reduction in tissue Ki-67 was less for obese women on the TIW regimen than QD, although changes were similar for non-obese women. Our findings suggest that TIW exemestane should be explored further for primary cancer prevention in both normal weight and obese cohorts.
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Affiliation(s)
| | | | - Sara Gandini
- IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Bjørn-Erik Bertelsen
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Debora Macis
- IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Gunnar Mellgren
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | | | | | - Nagi B Kumar
- Moffitt Cancer Center, University of South Florida, Tampa, FL, USA
| | | | | | | | - Lana A Vornik
- University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | | | | | | | - Powel H Brown
- University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | | | - Eva Szabo
- Division of Cancer Prevention, NCI Bethesda, MD, USA
| | | | - Andrea DeCensi
- E.O. Galliera Hospital, Genoa, Italy
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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Macis D, Briata IM, D’Ecclesiis O, Johansson H, Aristarco V, Buttiron Webber T, Oppezzi M, Gandini S, Bonanni B, DeCensi A. Inflammatory and Metabolic Biomarker Assessment in a Randomized Presurgical Trial of Curcumin and Anthocyanin Supplements in Patients with Colorectal Adenomas. Nutrients 2023; 15:3894. [PMID: 37764678 PMCID: PMC10537228 DOI: 10.3390/nu15183894] [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: 08/17/2023] [Revised: 09/01/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
Colorectal cancer prevention is crucial for public health, given its high mortality rates, particularly in young adults. The early detection and treatment of precancerous lesions is key to preventing carcinogenesis progression. Natural compounds like curcumin and anthocyanins show promise in impeding adenomatous polyp progression in preclinical models. We conducted a randomized, double-blind, placebo-controlled, phase II presurgical trial in 35 patients with adenomatous polyps to explore the biological effects of curcumin and anthocyanins on circulating biomarkers of inflammation and metabolism. No significant difference in biomarker changes by treatment arm was observed. However, the network analysis before treatment revealed inverse correlations between adiponectin and BMI and glycemia, as well as direct links between inflammatory biomarkers and leptin and BMI. In addition, a considerable inverse relationship between adiponectin and grade of dysplasia was detected after treatment (corr = -0.45). Finally, a significant increase in IL-6 at the end of treatment in subjects with high-grade dysplasia was also observed (p = 0.02). The combined treatment of anthocyanins and curcumin did not result in the direct modulation of circulating biomarkers of inflammation and metabolism, but revealed a complex modulation of inflammatory and metabolic biomarkers of colon carcinogenesis.
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Affiliation(s)
- Debora Macis
- Division of Cancer Prevention and Genetics, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (D.M.); (H.J.); (V.A.); (B.B.)
| | - Irene Maria Briata
- Division of Medical Oncology, E.O. Galliera Hospital, 16128 Genoa, Italy; (I.M.B.); (T.B.W.)
| | - Oriana D’Ecclesiis
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, 20139 Milan, Italy; (O.D.); (S.G.)
| | - Harriet Johansson
- Division of Cancer Prevention and Genetics, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (D.M.); (H.J.); (V.A.); (B.B.)
| | - Valentina Aristarco
- Division of Cancer Prevention and Genetics, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (D.M.); (H.J.); (V.A.); (B.B.)
| | - Tania Buttiron Webber
- Division of Medical Oncology, E.O. Galliera Hospital, 16128 Genoa, Italy; (I.M.B.); (T.B.W.)
| | - Massimo Oppezzi
- Division of Gastroenterology, E.O. Galliera Hospital, 16128 Genoa, Italy;
| | - Sara Gandini
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, 20139 Milan, Italy; (O.D.); (S.G.)
| | - Bernardo Bonanni
- Division of Cancer Prevention and Genetics, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (D.M.); (H.J.); (V.A.); (B.B.)
| | - Andrea DeCensi
- Division of Medical Oncology, E.O. Galliera Hospital, 16128 Genoa, Italy; (I.M.B.); (T.B.W.)
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Lazzeroni M, Puntoni M, Guerrieri-Gonzaga A, Serrano D, Boni L, Buttiron Webber T, Fava M, Briata IM, Giordano L, Digennaro M, Cortesi L, Falcini F, Serra P, Avino F, Millo F, Cagossi K, Gallerani E, De Simone A, Cariello A, Aprile G, Renne M, Bonanni B, DeCensi A. Randomized Placebo Controlled Trial of Low-Dose Tamoxifen to Prevent Recurrence in Breast Noninvasive Neoplasia: A 10-Year Follow-Up of TAM-01 Study. J Clin Oncol 2023:JCO2202900. [PMID: 36917758 DOI: 10.1200/jco.22.02900] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
Abstract
PURPOSE Five-year data of the phase III trial TAM-01 showed that low-dose tamoxifen at 5 mg once daily administered for 3 years in women with intraepithelial neoplasia (IEN) reduced by 52% the recurrence of invasive breast cancer or ductal carcinoma in situ (DCIS), without additional adverse events over placebo. Here, we present the 10-year results. METHODS We randomly assigned 500 women with breast IEN (atypical ductal hyperplasia, lobular carcinoma in situ [LCIS], or hormone-sensitive or unknown DCIS) to low-dose tamoxifen or placebo after surgery with or without irradiation. The primary end point was the incidence of invasive breast cancer or DCIS. RESULTS The TAM-01 population included 500 women (20% atypical ductal hyperplasia, 11% LCIS, and 69% DCIS). The mean (±SD) age at the start of treatment was 54 ± 9 years, and 58% of participants were postmenopausal. After a median follow-up of 9.7 years (IQR, 8.3-10.9 years), 66 breast cancers (15 in situ; 51 invasive) were diagnosed: 25 in the tamoxifen group and 41 in the placebo group (annual rate per 1,000 person-years, 11.3 with tamoxifen v 19.5 with placebo; hazard ratio [HR], 0.58; 95% CI, 0.35 to 0.95; log-rank P = .03). Most recurrences were invasive (77%) and ipsilateral (59%). Regarding contralateral breast cancer incidence, there were six events in the tamoxifen arm and 16 in the placebo arm (HR, 0.36; 95% CI, 0.14 to 0.92; P = .025). The number needed to be treated to prevent one case of breast event with tamoxifen therapy was 22 in 5 years and 14 in 10 years. The benefit was seen across all patient subgroups. There was a significant 50% reduction of recurrence with tamoxifen in the DCIS cohort, which represents 70% of the overall population (HR, 0.50; 95% CI, 0.28 to 0.91; P = .02). No between-group difference in the incidence of serious adverse events was reported during the prolonged follow-up period. CONCLUSION Tamoxifen 5 mg once daily for 3 years significantly prevents recurrence from noninvasive breast cancer after 7 years from treatment cessation without long-term adverse events.
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Affiliation(s)
| | - Matteo Puntoni
- Clinical and Epidemiological Research Unit, University Hospital of Parma, Parma, Italy
| | | | | | - Luca Boni
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | | | | | - Livia Giordano
- Azienda Ospedaliera-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | | | - Laura Cortesi
- Azienda Ospedaliera-Universitaria Policlinico di Modena, Modena, Italy
| | - Fabio Falcini
- Dipartimento Onco-ematologico AUSL-Romagna, Ravenna, Italy.,IRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori"-IRST S.r.l., Meldola, (FC), Italy
| | - Patrizia Serra
- IRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori"-IRST S.r.l., Meldola, (FC), Italy
| | - Franca Avino
- Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy
| | - Francesco Millo
- Ospedali Riuniti ASL AL-Ospedale SS. Antonio e Margherita, Tortona (AL), Italy
| | | | | | | | | | - Giuseppe Aprile
- Dipartimento di Oncologia, Ospedale San Bortolo, Azienda ULSS 8 Berica, Vicenza, Italy
| | - Maria Renne
- Azienda Ospedaliera Mater Domini, Catanzaro, Italy
| | | | - Andrea DeCensi
- IEO-European Institute of Oncology IRCCS, Milan, Italy.,Ente Ospedaliero Ospedali Galliera, Genoa, Italy.,Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
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Buttiron Webber T, Briata IM, DeCensi A, Cevasco I, Paleari L. Taste and Smell Disorders in Cancer Treatment: Results from an Integrative Rapid Systematic Review. Int J Mol Sci 2023; 24:ijms24032538. [PMID: 36768861 PMCID: PMC9916934 DOI: 10.3390/ijms24032538] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 01/31/2023] Open
Abstract
Taste and smell disorders (TSDs) are common side effects in patients undergoing cancer treatments. Knowing which treatments specifically cause them is crucial to improve patients' quality of life. This review looked at the oncological treatments that cause taste and smell alterations and their time of onset. We performed an integrative rapid review. The PubMed, PROSPERO, and Web of Science databases were searched in November 2022. The article screening and study selection were conducted independently by two reviewers. Data were analyzed narratively. Fourteen studies met the inclusion criteria and were included. A high heterogeneity was detected. Taste disorders ranged between 17 and 86%, while dysosmia ranged between 8 and 45%. Docetaxel, paclitaxel, nab-paclitaxel, capecitabine, cyclophosphamide, epirubicin, anthracyclines, and oral 5-FU analogues were found to be the drugs most frequently associated with TSDs. This review identifies the cancer treatments that mainly lead to taste and smell changes and provides evidence for wider studies, including those focusing on prevention. Further studies are warranted to make conclusive indication possible.
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Affiliation(s)
| | - Irene Maria Briata
- Division of Medical Oncology, E.O. Galliera Hospital, 16128 Genoa, Italy
| | - Andrea DeCensi
- Division of Medical Oncology, E.O. Galliera Hospital, 16128 Genoa, Italy
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London E1 4NS, UK
| | - Isabella Cevasco
- Department of Health Professions, E.O. Galliera Hospital, 16128 Genoa, Italy
| | - Laura Paleari
- Research, Innovation and HTA Unit, (A.Li.Sa.) Liguria Health Authority, 16121 Genoa, Italy
- Correspondence: ; Tel.: +39-010-5484-243
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Provinciali N, Greppi M, Pesce S, Rutigliani M, Briata IM, Buttiron Webber T, Fava M, DeCensi A, Marcenaro E. Case report: Variable response to immunotherapy in ovarian cancer: Our experience within the current state of the art. Front Immunol 2022; 13:1094017. [PMID: 36601114 PMCID: PMC9806340 DOI: 10.3389/fimmu.2022.1094017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
Despite recent advances in ovarian cancer (OC) treatment, including the introduction of bevacizumab and PARP-inhibitors, OC remains a lethal disease. Other therapeutic options are being explored, such as immunotherapy (IT), which has been proved effective in many solid tumors. Findings about tumor-infiltrating cytotoxic and regulatory T cells, together with the expression of PD-1 on immune cells and of PD-L1 on tumor cells, gave the rationale for an attempt to the use of IT also in OC. We treated two patients with avelumab, an anti-PD-L1 monoclonal antibody, after the first line of chemotherapy: Patient A underwent 19 cycles of maintenance therapy with avelumab with a disease-free interval of 12 months, whereas patient B showed a slight progression of disease after only eight cycles. A higher PD-L1 expression in tumor cells of patient A was detected. She also underwent a genomic assessment that described the presence of a high Tumor Mutational Burden (TMB) and a status of Loss of Heterozygosity (LoH). This different response to the same treatment puts in evidence that some genomic and immune features might be investigated.
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Affiliation(s)
- Nicoletta Provinciali
- Division of Medical Oncology, Ente Ospedaliero (E.O.), Ospedali Galliera, Genoa, Italy
| | - Marco Greppi
- Dipartimento di Medicina Sperimentale (DIMES), Università degli Studi di Genova, Genova, Italy
| | - Silvia Pesce
- Dipartimento di Medicina Sperimentale (DIMES), Università degli Studi di Genova, Genova, Italy,*Correspondence: Emanuela Marcenaro, ; Silvia Pesce,
| | | | - Irene Maria Briata
- Division of Medical Oncology, Ente Ospedaliero (E.O.), Ospedali Galliera, Genoa, Italy
| | - Tania Buttiron Webber
- Division of Medical Oncology, Ente Ospedaliero (E.O.), Ospedali Galliera, Genoa, Italy
| | - Marianna Fava
- Division of Medical Oncology, Ente Ospedaliero (E.O.), Ospedali Galliera, Genoa, Italy
| | - Andrea DeCensi
- Division of Medical Oncology, Ente Ospedaliero (E.O.), Ospedali Galliera, Genoa, Italy,Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Emanuela Marcenaro
- Dipartimento di Medicina Sperimentale (DIMES), Università degli Studi di Genova, Genova, Italy,IRCCS Ospedale Policlinico San Martino, Genova, Italy,*Correspondence: Emanuela Marcenaro, ; Silvia Pesce,
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6
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Danielis M, Regano D, Castaldo A, Mongardi M, Buttiron Webber T. What are the nursing competencies related to antimicrobial stewardship and how they have been assessed? Results from an integrative rapid review. Antimicrob Resist Infect Control 2022; 11:153. [PMID: 36474301 PMCID: PMC9727984 DOI: 10.1186/s13756-022-01189-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 11/27/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Antimicrobial resistance issues, and the consequent demand for antimicrobial stewardship (AMS) programs, need to be investigated urgently and clearly. Considering the large amount of time nurses spend at patients' bedside, the aim of the present study was to examine recent literature on nursing competency in AMS. METHODS Drawing from Tricco and colleagues' seven-stage process, a rapid review was performed. MEDLINE, CINAHL and EMBASE databased were searched from December 1st, 2019 until December 31st, 2021. Article screening and study selection were conducted independently by three reviewers. Data were analyzed narratively and categorized adopting an inductive thematic coding. RESULTS Sixteen studies met the inclusion criteria and were included. Publications were mainly authored in USA (n = 4), Australia and New Zealand (n = 4) and Asia (n = 4), followed by Europe (n = 2) and Africa (n = 2). Ten studies were quantitative in design, followed by qualitative (n = 4) and mixed-methods studies (n = 2). Nursing competency in AMS seems to be influenced by a two-dimensional model: on the one hand, internal factors which consisted in knowledge, attitudes and practices and, on the other hand, external aspects which are at environmental level in terms of structures and processes. CONCLUSION This study provided a map of dimensions for researchers and practitioners to consider when planning clinical governance, educational activities, and research programs. Significant opportunities exist for nurses to contribute to practice, education, research, and policy efforts aimed at reducing antimicrobial resistance.
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Affiliation(s)
- Matteo Danielis
- ANIPIO, Società Scientifica Nazionale degli Infermieri Specialisti del Rischio Infettivo - National Association of Nurses for the Prevention of Hospital Infections, Bologna, Italy ,grid.5390.f0000 0001 2113 062XSchool of Nursing, Department of Medical Sciences, University of Udine, Viale Ungheria 20, 33100 Udine, Italy
| | - Domenico Regano
- ANIPIO, Società Scientifica Nazionale degli Infermieri Specialisti del Rischio Infettivo - National Association of Nurses for the Prevention of Hospital Infections, Bologna, Italy ,grid.6292.f0000 0004 1757 1758IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Anna Castaldo
- ANIPIO, Società Scientifica Nazionale degli Infermieri Specialisti del Rischio Infettivo - National Association of Nurses for the Prevention of Hospital Infections, Bologna, Italy ,IRCCS Fondazione Don Gnocchi, Via Capecelatro, 66, 20148 Milano, Italy
| | - Maria Mongardi
- ANIPIO, Società Scientifica Nazionale degli Infermieri Specialisti del Rischio Infettivo - National Association of Nurses for the Prevention of Hospital Infections, Bologna, Italy ,grid.5611.30000 0004 1763 1124Infectious Diseases Division, Diagnostics and Public Health Department, University of Verona, P. le L.A. Scuro 10, 37134 Verona, Italy
| | - Tania Buttiron Webber
- ANIPIO, Società Scientifica Nazionale degli Infermieri Specialisti del Rischio Infettivo - National Association of Nurses for the Prevention of Hospital Infections, Bologna, Italy ,grid.450697.90000 0004 1757 8650Medical Oncology, Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy
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7
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Buttiron Webber T, Giuliano S, Patrone C, Briata IM, Franconeri M, Marceca F, Magnani M, Paciolla F, Provinciali N, Defferrari C, Clavarezza M, D’Amico M, Gozza A, Boitano M, Alessio-Mazzola M, Cevasco I, DeCensi A. Home Se-Cure: A Home Care Service for Cancer Patients during the COVID-19 Pandemic. Int J Environ Res Public Health 2021; 18:ijerph182010913. [PMID: 34682650 PMCID: PMC8535406 DOI: 10.3390/ijerph182010913] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/11/2021] [Accepted: 10/13/2021] [Indexed: 12/15/2022]
Abstract
Cancer patients are exposed to a greater risk of COVID-19 infection, resulting in treatment delays and unnecessary hospitalizations. International authorities have suggested reducing visits to hospitals and guarantee continuity of care. We developed a home care project called Home Se-Cure (HSC) to guarantee the continuity of oral, intramuscular, and subcutaneous cancer therapy during COVID-19. The Home Se-Cure project included cancer patients living near Galliera Hospital. Patients received home visits by registered nurses (RNs), whoperformed blood tests and delivered cancer therapies. Patients were instructed to take drugs after blood test results and therapy confirmation by oncologists. Sixty-six patients decided to participate and 38 declined the service. A customer satisfaction questionnaire was administered to a subgroup of patients participating in the project. The most prevalent disease in the HSC group was prostate cancer. The mean age of the patients in HSC was 78.4 years and 68.9 in the decliner group. The majority of the HSC participants appreciated the project because they could stay at home (71%) and reduce the risk of COVID-19 contagion (67.7%). Compared to decliners, the time the study group saved was 2033 hours. HSC guaranteed the continuity of care during the COVID-19 pandemic by reducing the number of patients in the hospital and avoiding crowds in the waiting room.
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Affiliation(s)
- Tania Buttiron Webber
- Medical Oncology, Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy; (T.B.W.); (S.G.); (I.M.B.); (M.F.); (F.M.); (M.M.); (F.P.); (N.P.); (C.D.); (M.C.); (M.D.); (A.G.); (M.B.)
| | - Silvia Giuliano
- Medical Oncology, Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy; (T.B.W.); (S.G.); (I.M.B.); (M.F.); (F.M.); (M.M.); (F.P.); (N.P.); (C.D.); (M.C.); (M.D.); (A.G.); (M.B.)
| | - Carlotta Patrone
- Office Innovation, Development and Lean Application, Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy;
| | - Irene Maria Briata
- Medical Oncology, Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy; (T.B.W.); (S.G.); (I.M.B.); (M.F.); (F.M.); (M.M.); (F.P.); (N.P.); (C.D.); (M.C.); (M.D.); (A.G.); (M.B.)
| | - Maria Franconeri
- Medical Oncology, Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy; (T.B.W.); (S.G.); (I.M.B.); (M.F.); (F.M.); (M.M.); (F.P.); (N.P.); (C.D.); (M.C.); (M.D.); (A.G.); (M.B.)
| | - Francesca Marceca
- Medical Oncology, Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy; (T.B.W.); (S.G.); (I.M.B.); (M.F.); (F.M.); (M.M.); (F.P.); (N.P.); (C.D.); (M.C.); (M.D.); (A.G.); (M.B.)
| | - Monica Magnani
- Medical Oncology, Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy; (T.B.W.); (S.G.); (I.M.B.); (M.F.); (F.M.); (M.M.); (F.P.); (N.P.); (C.D.); (M.C.); (M.D.); (A.G.); (M.B.)
| | - Fortuna Paciolla
- Medical Oncology, Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy; (T.B.W.); (S.G.); (I.M.B.); (M.F.); (F.M.); (M.M.); (F.P.); (N.P.); (C.D.); (M.C.); (M.D.); (A.G.); (M.B.)
| | - Nicoletta Provinciali
- Medical Oncology, Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy; (T.B.W.); (S.G.); (I.M.B.); (M.F.); (F.M.); (M.M.); (F.P.); (N.P.); (C.D.); (M.C.); (M.D.); (A.G.); (M.B.)
| | - Carlotta Defferrari
- Medical Oncology, Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy; (T.B.W.); (S.G.); (I.M.B.); (M.F.); (F.M.); (M.M.); (F.P.); (N.P.); (C.D.); (M.C.); (M.D.); (A.G.); (M.B.)
| | - Matteo Clavarezza
- Medical Oncology, Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy; (T.B.W.); (S.G.); (I.M.B.); (M.F.); (F.M.); (M.M.); (F.P.); (N.P.); (C.D.); (M.C.); (M.D.); (A.G.); (M.B.)
| | - Mauro D’Amico
- Medical Oncology, Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy; (T.B.W.); (S.G.); (I.M.B.); (M.F.); (F.M.); (M.M.); (F.P.); (N.P.); (C.D.); (M.C.); (M.D.); (A.G.); (M.B.)
| | - Alberto Gozza
- Medical Oncology, Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy; (T.B.W.); (S.G.); (I.M.B.); (M.F.); (F.M.); (M.M.); (F.P.); (N.P.); (C.D.); (M.C.); (M.D.); (A.G.); (M.B.)
| | - Monica Boitano
- Medical Oncology, Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy; (T.B.W.); (S.G.); (I.M.B.); (M.F.); (F.M.); (M.M.); (F.P.); (N.P.); (C.D.); (M.C.); (M.D.); (A.G.); (M.B.)
| | - Mattia Alessio-Mazzola
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Viale Benedetto XV, 6, 16132 Genoa, Italy;
| | - Isabella Cevasco
- Healthcare Professions Structure, Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy;
| | - Andrea DeCensi
- Medical Oncology, Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy; (T.B.W.); (S.G.); (I.M.B.); (M.F.); (F.M.); (M.M.); (F.P.); (N.P.); (C.D.); (M.C.); (M.D.); (A.G.); (M.B.)
- European Institute of Oncology (IEO), IRCCS, 20141 Milan, Italy
- Correspondence: ; Tel.: +39-01-0563-4535
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8
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Buttiron Webber T, Marra D, Puntoni M, Giuliano S, Briata IM, Cevasco I, Clavarezza M, D'Amico M, Defferrari C, Gozza A, Provinciali N, Lazzeroni M, Bonanni B, DeCensi A. Patient- versus physician-reported outcomes in a low-dose tamoxifen trial in noninvasive breast cancer. Breast J 2021; 27:817-823. [PMID: 34626060 DOI: 10.1111/tbj.14296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 09/28/2021] [Accepted: 09/28/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND We recently conducted a de-escalation trial of low-dose tamoxifen 5 mg/day ("babytam", BT) or placebo given for 3 years in 500 women with noninvasive breast cancer. Women on babytam had a 52% reduction of recurrence (invasive breast cancer or DCIS) after 5 years. Since menopausal symptoms are major reasons for treatment withdrawal during tamoxifen preventive therapy, we compared and analyzed the patient-reported outcomes (PROs) with the physician-reported adverse events and studied their association with recurrence. METHODS Menopausal symptoms recorded by physicians using the Common Terminology Criteria (CTCAEs) were compared with a patient self-reported validated questionnaire reviewed by a research nurse at baseline and every 6 months up to 36 months. Hot flashes (HF), the main outcome measure, were detected through a self-report 7-day diary for frequency and intensity. Treatment adherence and efficacy were assessed by the Kaplan-Meier curves and the Cox model. RESULTS The number of HF events at 12, 24, and 36 months for PROs versus CTCAEs was 246 versus 12, 238 versus 8, and 210 versus 4, respectively. The majority of events were grade 1. There was no difference in PROs between babytam and placebo except for HF daily frequency, which increased by 1.5 events (95% CI, 1.1-1.8) on placebo to 2.1 on babytam (95% CI, 1.7-2.5, p = 0.05). The presence of HF at baseline was a favorable prognostic factor for recurrence and a predictive factor for response to babytam. Adherence was similar between babytam and placebo. CONCLUSIONS The use of PROs is effective for identifying frequent mild grade menopausal symptoms which are underestimated by physicians but important prognostic and predictive factors. Research nurse can use these results as a tool to reassure patients about symptoms, improve adherence to treatment, and limit dropouts.
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Affiliation(s)
| | | | - Matteo Puntoni
- Clinical & Epidemiological Research Unit, University Hospital of Parma, Parma, Italy
| | - Silvia Giuliano
- Division of Medical Oncology, E.O. Ospedali Galliera, Genoa, Italy
| | | | - Isabella Cevasco
- Division of Medical Oncology, E.O. Ospedali Galliera, Genoa, Italy
| | | | - Mauro D'Amico
- Division of Medical Oncology, E.O. Ospedali Galliera, Genoa, Italy
| | | | - Alberto Gozza
- Division of Medical Oncology, E.O. Ospedali Galliera, Genoa, Italy
| | | | | | | | - Andrea DeCensi
- Division of Medical Oncology, E.O. Ospedali Galliera, Genoa, Italy.,Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
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Congiu M, Buttiron Webber T. Educating the cancer patient about the immunotherapy toxicity: a descriptive observational study. Prof Inferm 2021; 74:262. [PMID: 35363972 DOI: 10.7429/pi.2021.744262b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Immunotherapy can cause immune-related adverse events. Recognizing and communicating these symptoms is important for the patient to allow nurses to manage them promptly, avoiding complications or interruptions in therapy. AIM We conducted an observational study with the objective of creating a readable tool to be shared with patients to provide information on immune-related adverse events and provide clinical guidance to prevent and manage symptoms. Secondary objective was to determine the acceptability of the tool through a questionnaire developed ad hoc. METHODS For each patient, data were collected such as: sex, age, educational qualification, marital status, area of residence, diagnosis, comorbidities, therapy, performance status. The information tool and a questionnaire were administered with the aim of evaluating its acceptability and feasibility. RESULTS 35 patients were enrolled (mean age 65 years, standard deviation 10.7). The drugs used are: Pembrolizumab, Nivolumab, Atezolizumab, Durvalumab. A preliminary analysis of the data revealed a poor knowledge of immune-related adverse events (skin rash, thyroid disorders, pneumonia, gastrointestinal disorders, fatigue). All patients find the educational tool useful and easy to understand for recognizing and managing symptoms of therapy. The format of the tool was also appreciated. CONCLUSIONS Patient education is of fundamental importance to ensure early identification of immune-related adverse events, to avoid severe grades of toxicity and therapy interruptions, also causing a poor patient quality of life. NURSING IMPLICATIONS The nurse has a fundamental role in educating the patient about possible immune related adverse events and training courses are also needed in collaboration with oncologists.
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Buttiron Webber T, Provinciali N, Briata IM, Boitano M, Defferrari C, Magnani M, Paciolla F, Mercenaro E, Cevasco I, Gandini S, DeCensi A. Predictors of poor seroconversion and adverse events to SARS-CoV-2 mRNA BNT162b2 vaccine in cancer patients on active treatment. Role of the Research Nurse. Prof Inferm 2021; 74:261. [PMID: 35363969 DOI: 10.7429/pi.2021.744261a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Vaccines have shown 95% protection from COVID-19 disease in healthy populations. Initial findings in cancer patients suggest a lower seroconversion and greater toxicity possibly related to myelo-immunosuppressive therapies. AIM We conducted a prospective study to assess factors predicting poor seroconversion and adverse events following immunization (AEFI) to the BNT162b2 vaccine in cancer patients on active treatment. METHODS Blood samples were collected by the research nurse at first dose (visit 1), second dose (visit 2), after 42 days (visit 3) and after 6 months (visit 4). At visit 1, 3 and 4 participants received: Hospital Anxiety and Depression Scale (HADS) and Distress Thermometer. Patients who ended treatment >6 months on active surveillance served as controls. RESULTS Between March and July 2021, 320 subjects were recruited and 291 were assessable. The lack of seroconversion at 21 days from the second dose was 1.6% (95% CI, 0.4-8.7) on active surveillance, 13.9% (8.2-21.6) on chemotherapy, 11.4% (5.1-21.3) on hormone therapy, 21.7% (7.5-43.7) on targeted therapy and 4.8% (0.12-23.8) on immunotherapy. Compared to controls, the risk of no IgG response was greater for chemotherapy (P=0.033), targeted therapy (0.005) and hormonotherapy (P=0.051). Lymphocyte count less than 1x109/L, older age and advanced stage also significantly predicted poor seroconversion. Overall, 43 patients (14.8%) complained of AEFI, mostly of mild grade. Risk of AEFI was greater in females (P=0.001) and younger patients (P=0.009). CONCLUSIONS A third booster dose and long-term serological testing is required in subjects who have not responded to the vaccine. NURSING IMPLICATIONS nurses must take responsibility for promoting and protecting the health of cancer patients.
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Affiliation(s)
- Tania Buttiron Webber
- E.O. Ospedali Galliera, Genoa, Italy, 16128. Correspondence to: Tania Buttiron Webber,
| | | | | | | | | | | | | | | | | | - Sara Gandini
- European Institute of Oncology IRCCS, Milan, Italy, 20141
| | - Andrea DeCensi
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
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Dondi C, Buttiron Webber T. Nurses' attitutudes about the ESAS scale in oncology: cross sectional observational study. Prof Inferm 2021; 74:265. [PMID: 35363977 DOI: 10.7429/pi.2021.744265a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND The evaluation of signs and symptoms in cancer patients has to be realized by validated screening tools, such as the ESAS scale that is considerend by scientistists an appropriate instrument. AIM I conducted an observational study. The primary objective of my study was to describe the nurses' attitude towards the ESAS questionnaire. The secondary objective was to assess the level of agreement between the compilation of the ESAS by the nurse and by the patient. METHODS I prepared a questionaire with eleven items for the nurses in order to understand their attitude forward the ESAS scale. Secondly, I administered the ESAS scale to the cancer patients and the nurses also completed the scale; they answered using their knowledges about the patients. RESULTS 12 nurses took part to my project. For each question at least one nurse answered "completely in agreement" and no one answered "disagreement" or "completely disagreement". Furthermore, a significant difference between the answers gave by the nurses and the answers gave by the patients is present for 5 symptoms of the ESAS scale: pain, tiredness, drowsiness, nausea, shortness of breath. For the other symptoms (depression, anxiety, appetite and wellbeing) I didn't find significant differences. CONCLUSIONS The evaluation of signs and symptoms in cancer patients is an activity of primary importance as it is able to significatly improve the quality of life and the therapeutic results. NURSING IMPLICATIONS nurses must take responsibility in order to promote and protect the health of cancer patients.
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Affiliation(s)
- Caterina Dondi
- Undergraduate nursing student, Department of Health Sciences, University of Genoa, Italy Correspondence:
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12
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DeCensi A, Johansson H, Helland T, Puntoni M, Macis D, Aristarco V, Caviglia S, Webber TB, Briata IM, D'Amico M, Serrano D, Guerrieri-Gonzaga A, Bifulco E, Hustad S, Søiland H, Boni L, Bonanni B, Mellgren G. Association of CYP2D6 genotype and tamoxifen metabolites with breast cancer recurrence in a low-dose trial. NPJ Breast Cancer 2021; 7:34. [PMID: 33767162 PMCID: PMC7994552 DOI: 10.1038/s41523-021-00236-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 09/15/2020] [Accepted: 02/16/2021] [Indexed: 12/30/2022] Open
Abstract
Low-dose tamoxifen halves recurrence in non-invasive breast cancer without significant adverse events. Some adjuvant trials with tamoxifen 20 mg/day had shown an association between low endoxifen levels (9–16 nM) and recurrence, but no association with CYP2D6 was shown in the NSABP P1 and P2 prevention trials. We studied the association of CYP2D6 genotype and tamoxifen metabolites with tumor biomarkers and recurrence in a randomized phase III trial of low-dose tamoxifen. Median (IQR) endoxifen levels at year 1 were 8.4 (5.3–11.4) in patients who recurred vs 7.5 (5.1–10.2) in those who did not recur (p = 0.60). Tamoxifen and metabolites significantly decreased C-reactive protein (CRP, p < 0.05), and a CRP increase after 3 years was associated with higher risk of recurrence (HR = 4.37, 95% CI, 1.14–16.73, P = 0.03). In conclusion, endoxifen is below 9 nM in most subjects treated with 5 mg/day despite strong efficacy and there is no association with recurrence, suggesting that the reason for tamoxifen failure is not poor drug metabolism. Trial registration: ClinicalTrials.gov, Identifier: NCT01357772.
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Affiliation(s)
- Andrea DeCensi
- Division of Medical Oncology, E.O. Galliera Hospital, Genoa, Italy.
| | - Harriet Johansson
- Division of Cancer Prevention and Genetics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Thomas Helland
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Matteo Puntoni
- Clinical Trial Unit, Office of the Scientific Director, E.O. Galliera Hospital, Genoa, Italy
| | - Debora Macis
- Division of Cancer Prevention and Genetics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Valentina Aristarco
- Division of Cancer Prevention and Genetics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Silvia Caviglia
- Division of Medical Oncology, E.O. Galliera Hospital, Genoa, Italy
| | | | | | - Mauro D'Amico
- Division of Medical Oncology, E.O. Galliera Hospital, Genoa, Italy
| | - Davide Serrano
- Division of Cancer Prevention and Genetics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Aliana Guerrieri-Gonzaga
- Division of Cancer Prevention and Genetics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Ersilia Bifulco
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Steinar Hustad
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Håvard Søiland
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Breast and Endocrine Surgery, Stavanger University Hospital, Stavanger, Norway
| | - Luca Boni
- IRCCS San Martino Hospital, Genoa, Italy
| | - Bernardo Bonanni
- Division of Cancer Prevention and Genetics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Gunnar Mellgren
- Department of Clinical Science, University of Bergen, Bergen, Norway
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13
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DeCensi A, Puntoni M, Johansson H, Guerrieri-Gonzaga A, Caviglia S, Avino F, Cortesi L, Ponti A, Pacquola MG, Falcini F, Gulisano M, Digennaro M, Cariello A, Cagossi K, Pinotti G, Lazzeroni M, Serrano D, Briata IM, Buttiron Webber T, Boni L, Bonanni B. Effect Modifiers of Low-Dose Tamoxifen in a Randomized Trial in Breast Noninvasive Disease. Clin Cancer Res 2021; 27:3576-3583. [PMID: 33608319 DOI: 10.1158/1078-0432.ccr-20-4213] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/21/2020] [Accepted: 02/17/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE Low-dose tamoxifen halved recurrence after surgery in a phase III trial in breast noninvasive disease without increasing adverse events. We explored the effect of low-dose tamoxifen in clinically relevant subgroups, including menopausal status, estradiol levels, smoking, body mass index, and proliferation of baseline lesion. PATIENTS AND METHODS Incidence of invasive breast cancer or ductal carcinoma in situ was the primary endpoint. HRs and interaction terms were estimated using Cox models. RESULTS A favorable HR and 95% confidence interval (CI) could be demonstrated for postmenopausal status (HR = 0.30; 95% CI, 0.11-0.82 vs. HR = 0.73; 95% CI, 0.30-1.76 in premenopausal women; P interaction = 0.13), women with estradiol less than 15.8 pg/mL, presence of menopausal symptoms at baseline, and never smoking (P interaction = 0.07), although the interaction P value was >0.05 for all characteristics. Efficacy was similar in all body mass index categories. Tumors with Ki-67 above the median level of 10% had a greater benefit (HR = 0.27; 95% CI, 0.09-0.81) than those with Ki-67 ≤10% (HR = 1.58; 95% CI, 0.45-5.60; P interaction = 0.04). CONCLUSIONS The efficacy of low-dose tamoxifen seems to be greater in postmenopausal women and in women with lower estradiol levels. Benefits appear to be larger also in women with menopausal symptoms, never smokers, and tumors with Ki-67 >10%. Our results by menopausal status provide important insight into low-dose tamoxifen personalized treatment, although caution is necessary given their exploratory nature. Observation of an improved response in tumors with Ki-67 >10% is consistent but the use of the marker in this setting is investigational.See related commentary by Fabian, p. 3510.
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Affiliation(s)
- Andrea DeCensi
- E.O. Ospedali Galliera, Genoa, Italy. .,Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
| | | | | | | | | | - Franca Avino
- Istituto Nazionale Tumori "Fondazione Pascale," Naples, Italy
| | - Laura Cortesi
- A. O. Universitaria Policlinico di Modena, Modena, Italy
| | - Antonio Ponti
- CPO Piemonte, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | | | - Fabio Falcini
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.), Meldola, Italy
| | | | | | | | | | | | | | | | | | | | - Luca Boni
- IRCCS Ospedale San Martino, Genova, Italy
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Lazzeroni M, Puntoni M, Provinciali N, Webber TB, Briata IM, D'Amico M, Giuliano S, Siri G, Cagnacci S, DeCensi A. Estimating the magnitude of clinical benefit of systemic therapy in patients with DCIS or pre-invasive disease of the breast. Breast 2020; 48 Suppl 1:S39-S43. [PMID: 31839158 DOI: 10.1016/s0960-9776(19)31121-x] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
The challenge of effective management of ductal carcinoma in situ (DCIS) and other pre-malignant disorders of the breast is to select patients who will not progress to invasive carcinoma from those at the highest risk who require radiotherapy and/or endocrine therapy to minimize the risk of a subsequent invasive recurrence. Although IBIS-II and NSABP-B35 DCIS phase III trials proved that tamoxifen 20 mg/day and anastrozole reduce the risk of ipsilateral and contralateral events, the toxicities of both drugs have hampered the drug uptake by high-risk women. We recently reported results of a 3-year placebo-controlled trial of low-dose (5 mg/d) tamoxifen in 500 women with intraepithelial neoplasia (70% DCIS). At a median follow-up of 5 years, women randomly assigned to low-dose tamoxifen had half the number of subsequent diagnoses of DCIS or invasive cancer compared with those randomly assigned to placebo but no increase in thromboembolic events or endometrial cancers. The 5-year number needed to treat was 22 (95% CI, 20-27). Our attention is now focused on prognostic and predictive markers to identify patients who can derive the greatest benefits from low dose tamoxifen, such as for instance the expression of 23 genes involved in cell cycle progression (CCP). In conclusion, we endorse an active treatment of DCIS as the standard of care.
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Affiliation(s)
- Matteo Lazzeroni
- Division of Cancer Prevention and Genetics, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Matteo Puntoni
- Clinical Trial Office, E.O. Ospedali Galliera, Genoa, Italy
| | | | | | | | - Mauro D'Amico
- Division of Medical Oncology, E.O. Ospedali Galliera, Genoa, Italy
| | - Silvia Giuliano
- Division of Medical Oncology, E.O. Ospedali Galliera, Genoa, Italy
| | - Giacomo Siri
- Clinical Trial Office, E.O. Ospedali Galliera, Genoa, Italy
| | - Sara Cagnacci
- Division of Cancer Prevention and Genetics, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Andrea DeCensi
- Division of Medical Oncology, E.O. Ospedali Galliera, Genoa, Italy; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom.
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De Censi A, Johansson HA, Helland T, Puntoni M, Buttiron Webber T, Macis D, Aristarco V, Briata IM, Serrano D, D'Amico M, Bifulco E, Hustad S, Søiland H, Bonanni B, Mellgren G. Relationship between CYP2D6 genotype, tamoxifen metabolites, and adverse events, tumor biomarkers and breast cancer recurrence in a low-dose phase III trial in noninvasive disease. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.1553] [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
1553 Background: Low dose tamoxifen (T, 5 mg/d) given for 3 years halved recurrence in 500 women with non-invasive disease (DeCensi et al. JCO 2019). Retrospective studies with 20 mg/d have shown an association between low levels of endoxifen (9-16 nM) or Z-4OHtam (3.26 nM) and recurrence, but recent prospective studies have not confirmed these findings. We measured CYP2D6 genotype and 8 metabolite levels to determine their associations with adverse events, tumor biomarkers (IGF-I, SHBG, C-reactive protein, CRP) and breast cancer recurrence. Methods: CYP2D6 genotyping was performed in the T arm (n = 183) as previously described (Johansson H et al. BCRT 2016). T and metabolites were measured at 1 (n = 169) and 3 y (n = 152) as previously described (Helland T et al. BCR 2017). We tested linear relationships between metabolite levels and biomarkers, adjusting for age, BMI, treatment compliance and baseline biomarker levels. Cumulative incidence of recurrence according to endoxifen levels was calculated by the Cox model. Results: Endoxifen concentrations were associated to CYP2D6 metabolizer status (p < 0.001). Median (IQR) endoxifen levels were 8.4 (5.2-11.3) and 8.8 (5.8-11.5) at 1 and 3 y, with only 42% and 47% of subjects reaching 9 nM. Median endoxifen levels were related to pill count (5.5, 7.1 and 9.0 nM/L for medication possession rate < 83.3%, 83.4-99.9%, 100%, respectively). There was no difference in metabolite levels and menopausal symptoms. There was an inverse relationship between endoxifen and endometrial thickness at 3 y (p = 0.04), and between endoxifen or tamoxifen levels and IGF-I levels at 3 y (p = 0.001). T levels were positively associated with SHBG levels in postmenopausal women (p-interaction = 0.04). Endoxifen, T and 4OHtam decreased CRP, with a greater effect in premenopausal women (p-interaction = 0.02). An increase in CRP after 3 years was associated with a HR of 4.37 (95% CI, 1.14-16.73, P = 0.03) of recurrence compared to women with no increase of CRP. Median (IQR) endoxifen levels at year 1 were 8.4 (5.3-11.4) in patients who recurred vs 7.5 (5.1-10.2) in those who did not recur (p = 0.6), although this comparison was underpowered. Conclusions: T levels themselves may contribute to clinical activity by decreasing IGF-I and increasing SHBG. Elevated CRP is a predictive factor for recurrence which is down-regulated by T and metabolites. Endoxifen is below 9 nM in the majority of subjects treated with 5 mg/day, although this threshold was obtained in studies up to 20 years. Clinical trial information: NCT01357772.
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Affiliation(s)
- Andrea De Censi
- Division of Medical Oncology, E.O. Galliera Hospital, Genoa, Italy
| | | | | | - Matteo Puntoni
- Clinical Trial Unit, Office of the Scientific Director, E.O. Galliera Hospital, Genoa, Italy
| | | | | | | | | | | | | | | | | | | | - Bernardo Bonanni
- Division of Cancer Prevention & Genetics, IEO, European Institute of Oncology IRCCS, Milan, Italy
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Johansson H, Puntoni M, Macis D, Aristarco V, Guerrieri-Gonzaga A, Serrano D, Caviglia S, Cortesi L, Taverniti C, Ponti A, Pacquola MG, Gulisano M, Falcini F, Digennaro M, Carriello A, Cagossi K, Pinotti G, Webber TB, Lazzeroni M, Bonanni B, Boni L, DeCensi A. Abstract PD3-08: Effects of low dose tamoxifen on circulating risk biomarkers in a phase III trial in breast pre-invasive disease. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-pd3-08] [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: 11/16/2022]
Abstract
Abstract
Background: We recently showed that low dose (5mg/d) tamoxifen (babytam) for 3 years can halve the incidence of new breast neoplastic events in hormone sensitive or unknown breast pre-invasive neoplasia after surgery with limited toxicity (DeCensi et al JCO 2019; 37:1629-37). Here we report the results of circulating surrogate endpoint biomarkers of breast cancer risk with special attention to the risk of ovarian stimulation observed with the full dose in premenopausal women. Methods: Five hundred women 75 years old or younger were randomized to babytam or placebo (PLA). A subgroup of 406 women consented for collection of morning fasting serum at baseline (0), 1 (1Y) and 3 years (3Y) of treatment. There was a loss of about 25% of blood sampling at 3Y. Serum IGF-I, IGFBP-3, SHBG and C-reactive Protein (CRP) were performed on all available samples. Estradiol and testosterone were determined in a subsample (n=285) to determine the extent of ovarian stimulation by babytam in premenopausal women. We used Mann-Whitney test for univariate comparisons and linear regression modeling for multivariate analyses setting changes from baseline (1Y or 3Y minus baseline values) as dependent variable and treatment arm, age, BMI and baseline biomarkers values as explanatory factors. We tested treatment*menopausal status as interaction term. COX P-H model was used to calculate hazard ratio for CRP increase. Results: At baseline, all biomarkers were evenly balanced between arms (data not shown). IGF-I decreased significantly on babytam as compared to PLA. The difference of the changes between arms was -20 ng/mL after 1Y (p<0.001) and -23 after 3Y (p<0.001). A treatment by menopausal status interaction was observed after 1Y (p=0.017) and 3Y (p=0.058), with a steeper decrease in postmenopausal (-25, p<0.001 both after 1Y and 3Y) as compared to premenopausal women (-15, p=0.007 after 1Y and -17, p=0.009 after 3Y). IGFBP-3 increased significantly on babytam, without effect modification by menopausal status. The difference between arms was +0.26 ug/mL after 1Y (p=0.006) and +0.19 after 3Y (p=0.024). SHBG increased markedly on babytam, irrespective of menopausal status. The difference between arms from 0 to 1Y and 3Y was 24 nMol/L (p<0.001). CRP levels followed a trend towards a decrease with babytam (-0.172 mg/dL, p=0.057 after 1Y and -0.091, p=0.108 after 3Y), without effect modification by menopausal status. There was no significant increase in serum estradiol after 1Y with babytam overall (+12 pg/mL, p=0.106), but a trend to an interaction with menopausal status (p=0.079): +17 (p=0.361) in premenopausal women versus +3 (p=0.284) in postmenopausal women. Similarly, there was no overall effect of babytam on testosterone after 1Y (-0.008 ng/mL, p=0.518), but a significant effect modification by menopausal status (p=0.001), showing an increase of +0.056 (p=0.006) in premenopausal women, and a decrease of -0.045 (p=0.006) in postmenopausal women. Irrespective of treatment, the increase in CRP at 3Y was significantly higher in women who experienced recurrence compared to women who did not (Mann-Whitney p=0.009). An increase in CRP was associated with a HR of 2.9 (95% CI, 1.0-8.3, p=0.05) as compared to women with a decreased or stable CRP levels. Conclusions: Babytam for 3 years exhibits a favorable effect on sex hormones and IGFs with only a slight increase of estradiol in premenopausal women which is far below that observed with 20 mg and is well compensated by a significant increase in SHBG. These findings further support the use of babytam as an effective and safe treatment for high risk individuals. ClinicalTrials.gov Identifier: NCT01357772. Supported by the Italian Ministry of Health (RFPS-2006-339898), the Italian Association for Cancer Research (IG 2008 Grant No 5611) and the Italian League against Cancer (LILT 7-08).
Citation Format: Harriet Johansson, Matteo Puntoni, Debora Macis, Valentina Aristarco, Aliana Guerrieri-Gonzaga, Davide Serrano, Silvia Caviglia, Laura Cortesi, Cristiana Taverniti, Antonio Ponti, Maria Grazia Pacquola, Marcella Gulisano, Fabio Falcini, Maria Digennaro, Anna Carriello, Katia Cagossi, Graziella Pinotti, Tania Buttiron Webber, Matteo Lazzeroni, Bernardo Bonanni, Luca Boni, Andrea DeCensi. Effects of low dose tamoxifen on circulating risk biomarkers in a phase III trial in breast pre-invasive disease [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr PD3-08.
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Affiliation(s)
| | | | | | | | | | | | | | - Laura Cortesi
- 3Azienda Ospedaliera-Universitaria Policlinico di Modena, Modena, Italy
| | - Cristiana Taverniti
- 4Azienda Ospedaliera-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Antonio Ponti
- 4Azienda Ospedaliera-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | | | | | - Fabio Falcini
- 7Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori IRCCS, Meldola, Italy
| | | | - Anna Carriello
- 9Azienda Unità Sanitaria Locale della Romagna, Ravenna, Italy
| | | | | | | | | | | | - Luca Boni
- 12Azienda Ospedaliera-Universitaria Careggi, Florence, Italy
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De Censi A, Puntoni M, Guerrieri-Gonzaga A, Caviglia S, Avino F, Cortesi L, Ponti A, Paquola MG, Falcini F, Gulisano M, Digennaro M, Cariello A, Cagossi K, Johansson HA, Pinotti G, Lazzeroni M, Buttiron Webber T, Corradengo D, Boni L, Bonanni B. Effect modifiers in a randomized phase III trial of low-dose tamoxifen in breast preinvasive disease. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.1500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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
1500 Background: Low-dose tamoxifen (babytam) at 5 mg/day for 3 years decreases local or contralateral recurrence by 52% in women with hormone sensitive breast pre-invasive neoplasia after surgery (DeCensi et al JCO 2019). Here we report the results of exploratory analyses to assess whether the benefit of babytam varies among subgroups of patients defined by individual characteristics. Methods: Post-hoc subgroup analyses were performed according to a mixed approach based on the test for interaction and biological plausibility. Incidence of invasive breast cancer or DCIS was the primary endpoint. HRs were estimated using Cox proportional-hazards modeling. Results: Age at menopause, smoking status and Ki-67 exhibited a significant interaction with treatment. Specifically, the effect of babytam was greater in women aged > 50y (n = 293, HR = 0.27, 95%CI: 0.10-0.73) than in women aged ≤50y (n = 207, HR = 0.86, 0.35-2.07), p-interaction = .09. Never smokers (n = 307) had a greater benefit than former (n = 68) or current smokers (n = 97): HR = 0.28, 0.11-0.70 vs HR = 0.57, 0.09-3.45 vs HR = 1.51, 0.41-5.64, respectively (p = .05). Tumors with Ki-67 above the median level of 10% (n = 133) had a greater effect (HR = 0.27, 0.09-0.81) than Ki-67 ≤10% (n = 145, HR = 1.58, 0.45-5.60, p = .04). Weaker statistical interactions (p > .1) were also found for waist circumference and hot flashes (HF) at baseline. Women with waist circumference ≥89 cm (metabolic syndrome, n = 208) had a greater effect (HR = 0.22, 0.07-0.78) than women < 89 cm (n = 228, HR = 0.61, 0.25-1.46). Compared with placebo and no HF, babytam effect was stronger in women with HF (HR = 0.13, 0.02-0.96) than in women on babytam and no HF (HR = 0.50, 0.24-1.03) or placebo and HF (HR = 0.72, 0.31-1.69, log-rank p-trend = .004). Additional subgroups according to obesity, family history of breast or ovarian cancer, alcohol use, extent of surgery, radiotherapy for DCIS, ER and HER2 expression, positive margins and treatment compliance showed no significant heterogeneity of treatment. Conclusions: Exploratory analyses showed a trend to a higher effect of babytam in women aged 50 or older, never smokers, women with hot flashes or abdominal obesity and tumors with Ki-67 above 10%. Our results provide insight into the efficacy of babytam towards a personalized preventive approach. Clinical trial information: NCT01357772.
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Affiliation(s)
- Andrea De Censi
- Division of Medical Oncology, E.O. Galliera Hospital, Genoa, Italy
| | - Matteo Puntoni
- Clinical Trial Unit, Office of the Scientific Director, E.O. Galliera Hospital, Genoa, Italy
| | | | - Silvia Caviglia
- Division of Medical Oncology, E.O. Galliera Hospital, Genoa, Italy
| | | | | | | | | | | | | | - Maria Digennaro
- Irccs Istituto Oncologico "Giovanni Paolo II" Bari, Bari, Italy
| | | | - Katia Cagossi
- Division of Medical Oncology, Ramazzini Hospital, Carpi, Italy
| | | | | | - Matteo Lazzeroni
- Division of Cancer Prevention and Genetics, European Institute of Oncology, Milan, Italy
| | | | | | - Luca Boni
- Clinical Trial Coordinating Center, AOU Careggi, Florence, Italy
| | - Bernardo Bonanni
- Division of Cancer Prevention & Genetics, IEO, European Institute of Oncology IRCCS, Milan, Italy
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DeCensi A, Puntoni M, Guerrieri-Gonzaga A, Caviglia S, Avino F, Cortesi L, Taverniti C, Pacquola MG, Falcini F, Gulisano M, Digennaro M, Cariello A, Cagossi K, Pinotti G, Lazzeroni M, Serrano D, Branchi D, Campora S, Petrera M, Buttiron Webber T, Boni L, Bonanni B. Randomized Placebo Controlled Trial of Low-Dose Tamoxifen to Prevent Local and Contralateral Recurrence in Breast Intraepithelial Neoplasia. J Clin Oncol 2019; 37:1629-1637. [PMID: 30973790 PMCID: PMC6601429 DOI: 10.1200/jco.18.01779] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [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: 01/01/2023] Open
Abstract
PURPOSE Tamoxifen administered for 5 years at 20 mg/d is effective in breast cancer treatment and prevention, but toxicity has limited its broad use. Biomarker trials showed that 5 mg/d is not inferior to 20 mg/d in decreasing breast cancer proliferation. We hypothesized that a lower dose given for a shorter period could be as effective in preventing recurrence from breast intraepithelial neoplasia but have a lower toxicity than the standard dose. PATIENTS AND METHODS We conducted a multicenter randomized trial of tamoxifen, 5 mg/d or placebo administered for 3 years after surgery in women with hormone-sensitive or unknown breast intraepithelial neoplasia, including atypical ductal hyperplasia and lobular or ductal carcinoma in situ. The primary end point was the incidence of invasive breast cancer or ductal carcinoma in situ. RESULTS Five hundred women 75 years of age or younger were included. After a median follow-up of 5.1 years (interquartile range, 3.9-6.3 years), there were 14 neoplastic events with tamoxifen and 28 with placebo (11.6 v 23.9 per 1,000 person-years; hazard ratio, 0.48; 95% CI, 0.26 to 0.92; P = .02), which resulted in a 5-year number needed to treat of 22 (95% CI, 20 to 27). Tamoxifen decreased contralateral breast events by 75% (three v 12 events; hazard ratio, 0.25; 95% CI, 0.07 to 0.88; P = .02). Patient-reported outcomes were not different between arms except for a slight increase in frequency of daily hot flashes with tamoxifen (P = .02). There were 12 serious adverse events with tamoxifen and 16 with placebo, including one deep vein thrombosis and one stage I endometrial cancer with tamoxifen and one pulmonary embolism with placebo. CONCLUSION Tamoxifen at 5 mg/d for 3 years can halve the recurrence of breast intraepithelial neoplasia with a limited toxicity, which provides a new treatment option in these disorders.
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Affiliation(s)
- Andrea DeCensi
- 1 Ente Ospedaliero Ospedali Galliera, Genoa, Italy.,2 Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | | | | | - Franca Avino
- 4 Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy
| | - Laura Cortesi
- 5 Azienda Ospedaliera-Universitaria Policlinico di Modena, Modena, Italy
| | - Cristiana Taverniti
- 6 Azienda Ospedaliera-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | | | - Fabio Falcini
- 8 Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori IRCCS, Meldola, Italy
| | | | | | - Anna Cariello
- 11 Azienda Unità Sanitaria Locale della Romagna, Ravenna, Italy
| | | | | | | | | | | | - Sara Campora
- 1 Ente Ospedaliero Ospedali Galliera, Genoa, Italy
| | | | | | - Luca Boni
- 14 Azienda Ospedaliera-Universitaria Careggi, Florence, Italy
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