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Martini G, Ciardiello D, Famiglietti V, Rossini D, Antoniotti C, Troiani T, Napolitano S, Esposito L, Latiano TP, Maiello E, Del Re M, Lonardi S, Aprile G, Santini D, Masi G, Avallone A, Normanno N, Pietrantonio F, Pinto C, Ciardiello F, Cremolini C, Martinelli E. Cetuximab as third-line rechallenge plus either irinotecan or avelumab is an effective treatment in metastatic colorectal cancer patients with baseline plasma RAS/BRAF wild-type circulating tumor DNA: Individual patient data pooled analysis of CRICKET and CAVE trials. Cancer Med 2023; 12:9392-9400. [PMID: 36880426 PMCID: PMC10166888 DOI: 10.1002/cam4.5699] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 01/17/2023] [Accepted: 02/03/2023] [Indexed: 03/08/2023] Open
Abstract
The rechallenge strategy is based on the concept that a subset of patients with RAS wild-type (WT) metastatic colorectal cancer (mCRC) could still benefit of epidermal growth factor receptor (EGFR) inhibition, after progression to an anti-EGFR based-therapy. We performed a pooled analysis of two-phase II prospective trials to determine the role of rechallenge in third-line mCRC patients with RAS/BRAF WT baseline circulating tumor DNA (ctDNA). Individual data of 33 and 13 patients from CAVE and CRICKET trials that received as third-line therapy cetuximab rechallenge were collected. Overall survival (OS), Progression-free survival (PFS), Overall response rate (ORR), Stable disease (SD) >6 months were calculated. Adverse events were reported. For the whole 46 patient population, median PFS (mPFS) was 3.9 months (95% Confidence Interval, CI 3.0-4.9) with median OS (mOS) of 16.9 months (95% CI 11.7-22.1). For CRICKET patients, mPFS was 3.9 months (95% CI 1.7-6.2); mOS was 13.1 months (95% CI 7.3-18.9) with OS rates at 12, 18, and 24 months of 62%, 23%, and 0%, respectively. For CAVE patients, mPFS was 4.1 months (95% CI 3.0-5.2); mOS was 18.6 months (95% CI 11.7-25.4) with OS rates at 12, 18, 24 months of 61%, 52%, 21%, respectively. Skin rash was more frequently reported in CAVE trial (87.9% vs. 30.8%; p = 0.001), whereas a increased incidence of hematological toxicities was observed in CRICKET trial (53.8%% vs. 12.1%; p = 0.003). Third-line cetuximab rechallenge in combination with either irinotecan or avelumab in RAS/BRAF WT ctDNA mCRC patients represents a promising therapy.
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Affiliation(s)
- G Martini
- Medical Oncology, Department of Precision Medicine, Università degli Studi della Campania "L. Vanvitelli", Naples, Italy
| | - D Ciardiello
- Medical Oncology, Department of Precision Medicine, Università degli Studi della Campania "L. Vanvitelli", Naples, Italy.,Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - V Famiglietti
- Medical Oncology, Department of Precision Medicine, Università degli Studi della Campania "L. Vanvitelli", Naples, Italy
| | - D Rossini
- Medical Oncology, Azienda Ospedaliero-Universitaria, Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - C Antoniotti
- Medical Oncology, Azienda Ospedaliero-Universitaria, Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - T Troiani
- Medical Oncology, Department of Precision Medicine, Università degli Studi della Campania "L. Vanvitelli", Naples, Italy
| | - S Napolitano
- Medical Oncology, Department of Precision Medicine, Università degli Studi della Campania "L. Vanvitelli", Naples, Italy
| | - L Esposito
- Medical Oncology, Department of Precision Medicine, Università degli Studi della Campania "L. Vanvitelli", Naples, Italy
| | - T P Latiano
- Oncologia Medica, Ospedale Casa Sollievo della Sofferenza-IRCCS foundation, San Giovanni Rotondo, Italy
| | - E Maiello
- Oncologia Medica, Ospedale Casa Sollievo della Sofferenza-IRCCS foundation, San Giovanni Rotondo, Italy
| | - M Del Re
- Medical Oncology, Azienda Ospedaliero-Universitaria, Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - S Lonardi
- Medical Oncology, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - G Aprile
- Department of Oncology, San Bortolo General Hospital, Vicenza, Italy
| | - D Santini
- Oncologia Medica, Univeristà La Sapienza-Polo Pontino, Rome, Italy
| | - G Masi
- Medical Oncology, Azienda Ospedaliero-Universitaria, Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - A Avallone
- Oncologia Medica, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale" - IRCCS, Naples, Italy
| | - N Normanno
- Biologia Cellulare e Bioterapie, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale" - IRCCS, Naples, Italy
| | - F Pietrantonio
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - C Pinto
- Medical Oncology, Comprehensive Cancer Centre, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - F Ciardiello
- Medical Oncology, Department of Precision Medicine, Università degli Studi della Campania "L. Vanvitelli", Naples, Italy
| | - C Cremolini
- Medical Oncology, Azienda Ospedaliero-Universitaria, Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - E Martinelli
- Medical Oncology, Department of Precision Medicine, Università degli Studi della Campania "L. Vanvitelli", Naples, Italy
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Ciardiello D, Chiarazzo C, Famiglietti V, Damato A, Pinto C, Zampino MG, Castellano G, Gervaso L, Zaniboni A, Oneda E, Rapisardi S, Bordonaro R, Zichi C, De Vita F, Di Maio M, Parisi A, Giampieri R, Berardi R, Lavacchi D, Antonuzzo L, Tamburini E, Maiorano BA, Parrella P, Latiano TP, Normanno N, De Stefano A, Avallone A, Martini G, Napolitano S, Troiani T, Martinelli E, Ciardiello F, De Vita F, Maiello E. Clinical efficacy of sequential treatments in KRASG12C-mutant metastatic colorectal cancer: findings from a real-life multicenter Italian study (CRC-KR GOIM). ESMO Open 2022; 7:100567. [PMID: 35994791 PMCID: PMC9588891 DOI: 10.1016/j.esmoop.2022.100567] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/16/2022] [Accepted: 07/19/2022] [Indexed: 12/04/2022] Open
Abstract
Background The presence of KRASG12C mutation in metastatic colorectal cancer (mCRC) correlates with poor outcome. Although different selective inhibitors are under clinical development, the optimal treatment remains uncertain. Thus, we conducted a retrospective analysis in a large cohort of patients with KRASG12C mCRC treated in 12 Italian oncology units. Patients and methods Patients with unresectable mCRC harboring KRASG12C mutation receiving a first-line chemotherapy doublet or triplet between 2011 and 2021 were included in the study. Evaluation of overall response rate (ORR), progression-free survival (PFS) and overall survival (OS) analysis was carried out. Results A total of 256/6952 (3.7%) patients with mCRC displayed KRASG12C mutation; of these, 111 met the inclusion criteria. The ORR of first-line therapy was 38.7% (43/111). Median PFS (mPFS) was 9 months [95% confidence interval (CI) 7.5-10.5 months]. After progression, only 62% and 36% of the patients are fit to receive second or third lines of treatment, with limited clinical benefit. Median OS (mOS) was 21 months (95% CI 17.4-24.6 months). In patients receiving first-line triplet chemotherapy, ORR was 56.3% (9/16), mPFS was 13 months (95% CI 10.3-15.7 months) and mOS was 32 months (95% CI 7.7-56.3 months). For irinotecan-based doublets, ORR was 34.5 (10/29), mPFS was 9 months (95% CI 6.4-11.6 months) and mOS was 22 months (95% CI 16.0-28.0 months). With oxaliplatin-based doublets ORR was 36.4% (24/62), mPFS was 7 months (95% CI 4.6-9.4 months) and mOS was 18 months (95% CI, 13.6-22.4 months). Conclusion Patients with KRASG12C-mutant mCRC had a disappointing response to standard treatments. Within the limitations of a retrospective study, these results suggest that first-line chemotherapy intensification with FOLFOXIRI is a valid option in fit patients. KRASG12C mutation is rare and occurs in 3.7% of the study population. The presence of KRASG12C mutation is correlated with an aggressive disease, with reduced response to chemotherapy. Only 62% and 36% of patients with KRASG12C-mutant mCRC are fit to receive second or third lines of treatment, respectively. The use of chemotherapy triplets is associated with improved outcomes compared with chemotherapy doublets.
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Affiliation(s)
- D Ciardiello
- Oncology Unit, IRCCS Foundation Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy; Medical Oncology Unit, Department of Precision Medicine, "Luigi Vanvitelli" University of Campania, Naples, Italy
| | - C Chiarazzo
- Oncology Unit, IRCCS Foundation Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - V Famiglietti
- Medical Oncology Unit, Department of Precision Medicine, "Luigi Vanvitelli" University of Campania, Naples, Italy
| | - A Damato
- Medical Oncology Unit, Comprhensive Cancer Center, AUSL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - C Pinto
- Medical Oncology Unit, Comprhensive Cancer Center, AUSL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - M G Zampino
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - G Castellano
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - L Gervaso
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - A Zaniboni
- Medical Oncology Unit, Poliambulanza Foundation, Brescia, Italy
| | - E Oneda
- Medical Oncology Unit, Poliambulanza Foundation, Brescia, Italy
| | - S Rapisardi
- Medical Oncology Unit, ARNAS Garibaldi, Catania, Italy
| | - R Bordonaro
- Medical Oncology Unit, ARNAS Garibaldi, Catania, Italy
| | - C Zichi
- Department of Oncology, University of Turin, A.O. Ordine Mauriziano, Turin, Italy
| | - F De Vita
- Department of Oncology, University of Turin, A.O. Ordine Mauriziano, Turin, Italy
| | - M Di Maio
- Department of Oncology, University of Turin, A.O. Ordine Mauriziano, Turin, Italy
| | - A Parisi
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy; Department of Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - R Giampieri
- Department of Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - R Berardi
- Department of Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - D Lavacchi
- Clinical Oncology Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - L Antonuzzo
- Clinical Oncology Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - E Tamburini
- Oncology Department and Palliative Care, Cardinale Panico, Tricase City Hospital, Tricase, Italy
| | - B A Maiorano
- Oncology Unit, IRCCS Foundation Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy; Department of Translational Medicine and Surgery, Catholic University of the Sacred Heart, Rome, Italy
| | - P Parrella
- Oncology Laboratory, Foundation Casa Sollievo della Sofferenza IRCCS, San Giovanni Rotondo, Foggia, Italy
| | - T P Latiano
- Oncology Unit, IRCCS Foundation Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - N Normanno
- Cellular Biology and Biotherapy, Istituto Nazionale Tumori, IRCCS-Fondazione G. Pascale, Naples, Italy
| | - A De Stefano
- Experimental Clinical Abdominal Oncology Unit, Istituto Nazionale Tumori, IRCCS-Fondazione G. Pascale, Naples, Italy
| | - A Avallone
- Experimental Clinical Abdominal Oncology Unit, Istituto Nazionale Tumori, IRCCS-Fondazione G. Pascale, Naples, Italy
| | - G Martini
- Medical Oncology Unit, Department of Precision Medicine, "Luigi Vanvitelli" University of Campania, Naples, Italy
| | - S Napolitano
- Medical Oncology Unit, Department of Precision Medicine, "Luigi Vanvitelli" University of Campania, Naples, Italy
| | - T Troiani
- Medical Oncology Unit, Department of Precision Medicine, "Luigi Vanvitelli" University of Campania, Naples, Italy
| | - E Martinelli
- Medical Oncology Unit, Department of Precision Medicine, "Luigi Vanvitelli" University of Campania, Naples, Italy
| | - F Ciardiello
- Medical Oncology Unit, Department of Precision Medicine, "Luigi Vanvitelli" University of Campania, Naples, Italy.
| | - F De Vita
- Medical Oncology Unit, Department of Precision Medicine, "Luigi Vanvitelli" University of Campania, Naples, Italy
| | - E Maiello
- Oncology Unit, IRCCS Foundation Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
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Piccirillo MC, Avallone A, Carlomagno C, Maiello E, Rosati G, Alabiso O, Nasti G, De Placido S, Latiano TP, Bilancia D, Ottaiano A, De Stefano A, Romano C, Silvestro L, Nappi A, Cassata A, Giordano P, Iaffaioli RV, Normanno N, Perrone F, Daniele B. Multicenter Single-Arm, Two-Stage Phase 2 Study of Panitumumab in Patients With Cetuximab-Refractory Metastatic Colorectal Cancer: The PACER Trial. Clin Colorectal Cancer 2020; 19:270-276. [PMID: 32631788 DOI: 10.1016/j.clcc.2020.05.009] [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: 06/03/2019] [Revised: 01/23/2020] [Accepted: 05/22/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess whether panitumumab is active in patients with cetuximab-refractory metastatic colorectal cancer (mCRC). PATIENTS AND METHODS Eligible patients had pretreated RAS (renin-angiotensin system) wild-type mCRC that progressed after cetuximab treatment, after having shown either objective response or stable disease. A minimax two-stage design was applied, with progression-free rate at 2 months as the primary end point. At least 12 of 28 and 21 of 41 successes at the first and second stage, respectively, were required for a positive result. Panitumumab 6 mg/kg was provided every 2 weeks, until progression or unacceptable toxicity. RESULTS Overall, 52 patients with KRAS (Kirsten rat sarcoma viral oncogene) wild-type disease were enrolled, but 11 were found to have mutated disease after all-RAS retesting. Among 41 eligible patients, median time since diagnosis was 38 months, and 71% experienced an objective response to previous cetuximab. First stage was passed with 12 of 28 patients alive without progression at 2 months. At the second stage, 17 of 41 patients were alive without progression at 2 months. At a median follow-up of 21.8 months, 35 patients experienced disease progression, and 26 died. Median progression-free survival was 2.1 months (95% confidence interval, 1.8-3.6) and median overall survival 6.8 months (95% confidence interval, 4.6-16.6). Most of the patients experienced no adverse reactions; 25% of patients had grade 3 rash. CONCLUSION According to our study design, panitumumab was not effective in patients with cetuximab-refractory RAS wild-type mCRC.
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Affiliation(s)
- Maria Carmela Piccirillo
- Unità Sperimentazioni Cliniche, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Antonio Avallone
- Oncologia Clinica Sperimentale Addome, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Chiara Carlomagno
- Dipartimento di Medicina Clinica e Chirurgia, Università Federico II, Napoli, Italy
| | - Evaristo Maiello
- Oncologia Medica, IRCCS, Casa Sollievo Sofferenza, S. Giovanni Rotondo (FG), Italy
| | | | | | - Guglielmo Nasti
- Oncologia Clinica Sperimentale Addome, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Sabino De Placido
- Dipartimento di Medicina Clinica e Chirurgia, Università Federico II, Napoli, Italy
| | - Tizana Pia Latiano
- Oncologia Medica, IRCCS, Casa Sollievo Sofferenza, S. Giovanni Rotondo (FG), Italy
| | | | - Alessandro Ottaiano
- Oncologia Clinica Sperimentale Addome, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Alfonso De Stefano
- Oncologia Clinica Sperimentale Addome, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Carmela Romano
- Oncologia Clinica Sperimentale Addome, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Lucrezia Silvestro
- Oncologia Clinica Sperimentale Addome, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Anna Nappi
- Oncologia Clinica Sperimentale Addome, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Antonino Cassata
- Oncologia Clinica Sperimentale Addome, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | | | - Rosario Vincenzo Iaffaioli
- Oncologia Clinica Sperimentale Addome, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Nicola Normanno
- Biologia Cellulare e Bioterapie, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - Francesco Perrone
- Unità Sperimentazioni Cliniche, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
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Marmorino F, Rossini D, Lonardi S, Moretto R, Zucchelli G, Aprile G, Dell'Aquila E, Ratti M, Bergamo F, Masi G, Urbano F, Ronzoni M, Libertini M, Borelli B, Randon G, Buonadonna A, Allegrini G, Pella N, Ricci V, Boccaccino A, Latiano TP, Cordio S, Passardi A, Tamburini E, Boni L, Falcone A, Cremolini C. Impact of age and gender on the safety and efficacy of chemotherapy plus bevacizumab in metastatic colorectal cancer: a pooled analysis of TRIBE and TRIBE2 studies. Ann Oncol 2019; 30:1969-1977. [PMID: 31573612 DOI: 10.1093/annonc/mdz403] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND The phase III TRIBE and TRIBE2 studies randomized metastatic colorectal cancer patients to first-line FOLFOXIRI/bevacizumab or a doublet (FOLFIRI or FOLFOX)/bevacizumab. The studies demonstrated a significant benefit from the triplet at the price of an increased incidence of chemotherapy-related adverse events (AEs). In both trials, males and females aged between 18 and 70 years with ECOG PS ≤2 and between 71 and 75 years with ECOG PS = 0 were eligible. We investigated the effect of FOLFOXIRI/bevacizumab versus doublets/bevacizumab according to age and gender. PATIENTS AND METHODS Subgroup analyses according to age (<70 versus 70-75 years) and gender were carried out for overall response rate (ORR), progression-free survival (PFS), and AE rates. RESULTS Of 1187 patients, 1005 (85%) were aged <70 years and 182 (15%) 70-75 years; 693 (58%) were males and 494 (42%) females. There was no evidence of interaction between age or gender and the benefit provided by the intensification of the upfront chemotherapy in terms of ORR and PFS, or the increased risk of experiencing G3/4 AEs. Elderly patients and females experienced higher rates of overall G3/4 AEs (73% versus 60%, P < 0.01 and 69% versus 57%, P < 0.01, respectively). Notably, in the FOLFOXIRI/bevacizumab subgroup, G3/4 diarrhea and febrile neutropenia occurred in 27% and 16% of elderly patients, respectively, while females reported high incidences of any grade nausea (67%) and vomiting (50%). CONCLUSIONS The improvements in terms of ORR and PFS of FOLFOXIRI/bevacizumab versus doublets/bevacizumab are independent of gender and age, with a similar relative increase in AEs among elderly patients and females. Initial dose reductions and possibly primary G-CSF prophylaxis should be recommended for patients between 70 and 75 years old treated with FOLFOXIRI/bevacizumab, and a careful management of antiemetic prophylaxis should be considered among females.
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Affiliation(s)
- F Marmorino
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa
| | - D Rossini
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa
| | - S Lonardi
- Department of Clinical and Experimental Oncology, Medical Oncology Unit 1, Veneto Institute of Oncology - IRCCS, Padova
| | - R Moretto
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa
| | - G Zucchelli
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa
| | - G Aprile
- Department of Oncology, General and University Hospital, Udine; Department of Oncology, San Bortolo General Hospital, Azienda ULSS8 Berica, Vicenza
| | - E Dell'Aquila
- Department of Medical Oncology, Campus Biomedico University, Roma
| | - M Ratti
- Oncology Department, Oncology Unit, ASST of Cremona, Cremona
| | - F Bergamo
- Department of Clinical and Experimental Oncology, Medical Oncology Unit 1, Veneto Institute of Oncology - IRCCS, Padova
| | - G Masi
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa
| | - F Urbano
- Department of Radiological Science, Oncology and Pathology, Policlinico Umberto I, "Sapienza" University of Rome, Roma
| | - M Ronzoni
- Department of Oncology, Istituto Scientifico San Raffaele IRCSS, Milano
| | - M Libertini
- Medical Oncology Unit, Poliambulanza Foundation, Brescia
| | - B Borelli
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa
| | - G Randon
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - A Buonadonna
- Department of Medical Oncology, IRCCS CRO National Cancer Institute, Aviano
| | - G Allegrini
- Department of Medical Oncology, Unit of Medical Oncology, Livorno Hospital, Azienda Toscana Nord Ovest, Livorno
| | - N Pella
- Department of Oncology, General and University Hospital, Udine
| | - V Ricci
- Department of Oncology, S. Croce and Carle Teaching Hospital, Cuneo
| | - A Boccaccino
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa
| | - T P Latiano
- Oncology Unit, Foundation IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo
| | - S Cordio
- Medical Oncology Unit, ARNAS Garibaldi Catania, Catania
| | - A Passardi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola
| | - E Tamburini
- Department of Medical Oncology, Card. G. Panico Hospital of Tricase, Tricase
| | - L Boni
- Clinical Trials Coordinating Center, Toscano Cancer Institute, University Hospital Careggi, Firenze, Italy
| | - A Falcone
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa
| | - C Cremolini
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa.
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Normanno N, Esposito Abate R, Lambiase M, Forgione L, Cardone C, Iannaccone A, Sacco A, Rachiglio AM, Martinelli E, Rizzi D, Pisconti S, Biglietto M, Bordonaro R, Troiani T, Latiano TP, Giuliani F, Leo S, Rinaldi A, Maiello E, Ciardiello F. RAS testing of liquid biopsy correlates with the outcome of metastatic colorectal cancer patients treated with first-line FOLFIRI plus cetuximab in the CAPRI-GOIM trial. Ann Oncol 2019; 29:112-118. [PMID: 28950295 DOI: 10.1093/annonc/mdx417] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background Liquid biopsy is an alternative to tissue for RAS testing in metastatic colorectal carcinoma (mCRC) patients. Little information is available on the predictive role of liquid biopsy RAS testing in patients treated with first-line anti-EGFR monoclonal antibody-based therapy. Patients and methods In the CAPRI-GOIM trial, 340 KRAS exon-2 wild-type mCRC patients received first-line cetuximab plus FOLFIRI. Tumor samples were retrospectively assessed by next generation sequencing (NGS). Baseline plasma samples were analyzed for KRAS and NRAS mutations using beads, emulsion, amplification, and magnetics digital PCR (BEAMing). Discordant cases were solved by droplet digital PCR (ddPCR) or deep-sequencing. Results A subgroup of 92 patients with available both NGS data on tumor samples and baseline plasma samples were included in this study. Both NGS analysis of tumor tissue and plasma testing with BEAMing identified RAS mutations in 33/92 patients (35.9%). However, 10 cases were RAS tissue mutant and plasma wild-type, and additional 10 cases were tissue wild-type and plasma mutant, resulting in a concordance rate of 78.3%. Analysis of plasma samples with ddPCR detected RAS mutations in 2/10 tissue mutant, plasma wild-type patients. In contrast, in all tissue wild-type and plasma mutant cases, ddPCR or deep-sequencing analysis of tumor tissue confirmed the presence of RAS mutations at allelic frequencies ranging between 0.15% and 1.15%. The median progression-free survival of RAS mutant and wild-type patients according to tissue (7.9 versus 12.6 months; P = 0.004) and liquid biopsy testing (7.8 versus 13.8 moths; P < 0.001) were comparable. Similar findings were observed for the median overall survival of RAS mutant and wild-type patients based on tissue (22.1 versus 35.8 months; P = 0.016) and plasma (19.9 versus 35.8 months; P = 0.013) analysis. Conclusion This study indicates that RAS testing of liquid biopsy results in a similar outcome when compared with tissue testing in mCRC patients receiving first-line anti-EGFR monoclonal antibodies.
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Affiliation(s)
- N Normanno
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori "Fondazione Giovanni Pascale" IRCCS, Napoli, Italy
| | - R Esposito Abate
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori "Fondazione Giovanni Pascale" IRCCS, Napoli, Italy
| | - M Lambiase
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori "Fondazione Giovanni Pascale" IRCCS, Napoli, Italy
| | - L Forgione
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori "Fondazione Giovanni Pascale" IRCCS, Napoli, Italy
| | - C Cardone
- Medical Oncology, Department of Clinical and Experimental Medicine "F. Magrassi," Università della Campania "L. Vanvitelli," Napoli, Italy
| | - A Iannaccone
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori "Fondazione Giovanni Pascale" IRCCS, Napoli, Italy
| | - A Sacco
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori "Fondazione Giovanni Pascale" IRCCS, Napoli, Italy
| | - A M Rachiglio
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori "Fondazione Giovanni Pascale" IRCCS, Napoli, Italy
| | - E Martinelli
- Medical Oncology, Department of Clinical and Experimental Medicine "F. Magrassi," Università della Campania "L. Vanvitelli," Napoli, Italy
| | - D Rizzi
- Gruppo Oncologico dell'Italia Meridionale (GOIM), Bari, Italy
| | - S Pisconti
- Medical Oncology, Hospital SS. Annunziata, Taranto, Italy
| | - M Biglietto
- Medical Oncology, Hospital "A. Cardarelli," Napoli, Italy
| | - R Bordonaro
- Medical Oncology, Hospital Garibaldi-Nesima, Catania, Italy
| | - T Troiani
- Medical Oncology, Department of Clinical and Experimental Medicine "F. Magrassi," Università della Campania "L. Vanvitelli," Napoli, Italy
| | - T P Latiano
- Medical Oncology, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - F Giuliani
- Medical Oncology, National Cancer Institute Giovanni Paolo II, Bari, Italy
| | - S Leo
- Medical Oncology, Hospital Vito Fazzi, Lecce, Italy
| | - A Rinaldi
- Medical Oncology, Presidio Ospedaliero Polo Occidentale, Castellaneta, Bari, Italy
| | - E Maiello
- Medical Oncology, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - F Ciardiello
- Medical Oncology, Department of Clinical and Experimental Medicine "F. Magrassi," Università della Campania "L. Vanvitelli," Napoli, Italy
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Martinelli E, Cardone C, Troiani T, Normanno N, Pisconti S, Sforza V, Bordonaro AR, Rachiglio AM, Lambiase M, Latiano TP, Modoni G, Cordio S, Giuliani F, Biglietto M, Montesarchio V, Barone C, Tonini G, Cinieri S, Febbraro A, Rizzi D, De Vita F, Orditura M, Colucci G, Maiello E, Ciardiello F, Iaffaioli V, Nasti G, Nappi A, Botti G, Tatangelo F, Chicchinelli N, Montrone M, Sebastio A, Guarino T, Simone G, Graziano P, Chiarazzo C, Maggio G, Longhitano L, Manusia M, Cartenì G, Nappi O, Micheli P, Leo L, Rossi S, Cassano A, Tommaselli E, Giordano G, Sponziello F, Marino A, Rinaldi A, Romito S, Muda AO, Lorusso V, Leo S, Barni S, Grimaldi G, Aieta M. Clinical activity and tolerability of FOLFIRI and cetuximab in elderly patients with metastatic colorectal cancer in the CAPRI-GOIM first-line trial. ESMO Open 2017; 1:e000086. [PMID: 28848656 PMCID: PMC5548975 DOI: 10.1136/esmoopen-2016-000086] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 07/13/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND In the cetuximab after progression in KRAS wild-type colorectal cancer patients (CAPRI) trial patients with metastatic colorectal cancer (mCRC) received 5-fluorouracil, folinic acid and irinotecan (FOLFIRI) and cetuximab in first line followed by 5-Fluorouracil, folinic acid, oxaliplatin (FOLFOX) with or without cetuximab until progression. Limited data are available on the efficacy and safety of anti-epidermal growth factor receptor (anti-EGFR) agents on elderly patients with mCRC. In the current study we evaluated the efficacy and safety of FOLFIRI plus cetuximab in age-defined subgroups. METHODS A post-hoc analysis was performed in CAPRI trial patients; outcomes (progression-free survival (PFS), overall response rate (ORR), safety) were analysed by age-groups and stratified according to molecular characterisation. 3 age cut-offs were used to define the elderly population (≥65; ≥70 and ≥75 years). RESULTS 340 patients with mCRC were treated in first line with FOLFIRI plus cetuximab. Among those, 154 patients were >65 years, 86 >70 years and 35 >75 years. Next-generation sequencing (NGS) was performed in 182 patients. Among them, 87 patients were >65 years, 46 >70 and 17 >75. 104 of 182 patients were wild type (WT) for KRAS, NRAS, BRAF, PIK3CA genes. In the quadruple WT group, 51 patients were ≥65 years; 29 were ≥70; 9 were ≥75. Median PFS was similar within the age-subgroups in the intention-to-treat population, NGS cohort and quadruple WT patients, respectively. Likewise, ORR was not significantly different among age-subgroups in the 3 populations. Safety profile was acceptable and similarly reported among all age-groups, with the exception of grade ≥3 diarrhoea (55% vs 25%, p=0.04) and neutropaenia (75% vs 37%, p=0.03) in patients ≥75 years and grade ≥3 fatigue (31% vs 20%, p=0.01) in patients <75 years. CONCLUSIONS Tolerability of cetuximab plus FOLFIRI was acceptable in elderly patients. Similar ORR and PFS were observed according to age-groups. No differences in adverse events were reported among the defined subgroups with the exception of higher incidence of grade ≥3 diarrhoea and neutropaenia in patients ≥75 years and grade ≥3 fatigue in patients <75 years. TRIAL REGISTRATION NUMBER 2009-014041-81.
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Affiliation(s)
- E Martinelli
- Medical Oncology, Department of Clinical and Experimental Medicine "F. Magrassi", Universitá degli Studi della Campania "Luigi Vanvitelli" , Naples, Italy.
| | - C Cardone
- Medical Oncology, Department of Clinical and Experimental Medicine "F. Magrassi", Universitá degli Studi della Campania "Luigi Vanvitelli" , Naples, Italy
| | - T Troiani
- Medical Oncology, Department of Clinical and Experimental Medicine "F. Magrassi", Universitá degli Studi della Campania "Luigi Vanvitelli" , Naples, Italy
| | - N Normanno
- Cell Biology and Biotherapy Unit, National Cancer Institute "Fondazione Giovanni Pascale", Naples, Italy
| | - S Pisconti
- Department of Medical Oncology, Hospital SS. Annunziata, Taranto, Italy
| | - V Sforza
- Medical Oncology, Department of Clinical and Experimental Medicine "F. Magrassi", Universitá degli Studi della Campania "Luigi Vanvitelli" , Naples, Italy
| | - A R Bordonaro
- Department of Medical Oncology, Hospital Garibaldi, Nesima, Catania, Italy
| | - A M Rachiglio
- Cell Biology and Biotherapy Unit, National Cancer Institute "Fondazione Giovanni Pascale", Naples, Italy; Laboratory of Pharmacogenomics, Centro di Ricerche Oncologiche di Mercogliano (CROM)-National Cancer Institute "Fondazione Giovanni Pascale", Naples, Italy
| | - M Lambiase
- Cell Biology and Biotherapy Unit, National Cancer Institute "Fondazione Giovanni Pascale", Naples, Italy; Laboratory of Pharmacogenomics, Centro di Ricerche Oncologiche di Mercogliano (CROM)-National Cancer Institute "Fondazione Giovanni Pascale", Naples, Italy
| | - T P Latiano
- Department of Medical Oncology, Hospital Casa Sollievo della Sofferenza, San Giovanni Rotondo (Foggia), Italy
| | - G Modoni
- Department of Medical Oncology, Hospital SS. Annunziata, Taranto, Italy
| | - S Cordio
- Department of Medical Oncology, Hospital Garibaldi, Nesima, Catania, Italy
| | - F Giuliani
- Department of Medical Oncology, National Cancer Institute Giovanni Paolo II, Bari,Italy
| | - M Biglietto
- Department of Medical Oncology, Hospital "A. Cardarelli", Naples, Italy
| | - V Montesarchio
- Department of Medical Oncology, Hospital Monaldi- Azienda Ospedaliera dei Colli, Naples,Italy
| | - C Barone
- Department of Medical Oncology, University Hospital A. Gemelli ,Rome, Italy
| | - G Tonini
- Department of Medical Oncology, Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - S Cinieri
- Department of Medical Oncology, Hospital A. Perrino, Brindisi, Italy
| | - A Febbraro
- Department of Medical Oncology, Hospital Sacro Cuore di Gesù, Fatebenefratelli, Benevento, Italy
| | | | - F De Vita
- Medical Oncology, Department of Clinical and Experimental Medicine "F. Magrassi", Universitá degli Studi della Campania "Luigi Vanvitelli" , Naples, Italy
| | - M Orditura
- Medical Oncology, Department of Clinical and Experimental Medicine "F. Magrassi", Universitá degli Studi della Campania "Luigi Vanvitelli" , Naples, Italy
| | - G Colucci
- Department of Medical Oncology, National Cancer Institute Giovanni Paolo II, Bari,Italy
| | - E Maiello
- Department of Medical Oncology, Hospital Casa Sollievo della Sofferenza, San Giovanni Rotondo (Foggia), Italy
| | - F Ciardiello
- Medical Oncology, Department of Clinical and Experimental Medicine "F. Magrassi", Universitá degli Studi della Campania "Luigi Vanvitelli" , Naples, Italy
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7
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Ciardiello F, Normanno N, Martinelli E, Troiani T, Pisconti S, Cardone C, Nappi A, Bordonaro AR, Rachiglio M, Lambiase M, Latiano TP, Modoni G, Cordio S, Giuliani F, Biglietto M, Montesarchio V, Barone C, Tonini G, Cinieri S, Febbraro A, Rizzi D, De Vita F, Orditura M, Colucci G, Maiello E. Cetuximab continuation after first progression in metastatic colorectal cancer (CAPRI-GOIM): a randomized phase II trial of FOLFOX plus cetuximab versus FOLFOX. Ann Oncol 2016; 27:1055-1061. [PMID: 27002107 DOI: 10.1093/annonc/mdw136] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [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: 12/24/2015] [Accepted: 03/04/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Cetuximab plus chemotherapy is a first-line treatment option in metastatic KRAS and NRAS wild-type colorectal cancer (CRC) patients. No data are currently available on continuing anti-epidermal growth factor receptor (EGFR) therapy beyond progression. PATIENTS AND METHODS We did this open-label, 1:1 randomized phase II trial at 25 hospitals in Italy to evaluate the efficacy of cetuximab plus 5-fluorouracil, folinic acid and oxaliplatin (FOLFOX) as second-line treatment of KRAS exon 2 wild-type metastatic CRC patients treated in first line with 5-fluorouracil, folinic acid and irinotecan (FOLFIRI) plus cetuximab. Patients received FOLFOX plus cetuximab (arm A) or FOLFOX (arm B). Primary end point was progression-free survival (PFS). Tumour tissues were assessed by next-generation sequencing (NGS). This report is the final analysis. RESULTS Between 1 February 2010 and 28 September 2014, 153 patients were randomized (74 in arm A and 79 in arm B). Median PFS was 6.4 [95% confidence interval (CI) 4.7-8.0] versus 4.5 months (95% CI 3.3-5.7); [hazard ratio (HR), 0.81; 95% CI 0.58-1.12; P = 0.19], respectively. NGS was performed in 117/153 (76.5%) cases; 66/117 patients (34 in arm A and 32 in arm B) had KRAS, NRAS, BRAF and PIK3CA wild-type tumours. For these patients, PFS was longer in the FOLFOX plus cetuximab arm [median 6.9 (95% CI 5.5-8.2) versus 5.3 months (95% CI 3.7-6.9); HR, 0.56 (95% CI 0.33-0.94); P = 0.025]. There was a trend in better overall survival: median 23.7 [(95% CI 19.4-28.0) versus 19.8 months (95% CI 14.9-24.7); HR, 0.57 (95% CI 0.32-1.02); P = 0.056]. CONCLUSIONS Continuing cetuximab treatment in combination with chemotherapy is of potential therapeutic efficacy in molecularly selected patients and should be validated in randomized phase III trials.
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Affiliation(s)
- F Ciardiello
- Medical Oncology, Department of Clinical and Experimental Medicine 'F. Magrassi', Second University of Naples, Naples.
| | - N Normanno
- Cell Biology and Biotherapy Unit, National Cancer Institute 'Fondazione Giovanni Pascale', Naples
| | - E Martinelli
- Medical Oncology, Department of Clinical and Experimental Medicine 'F. Magrassi', Second University of Naples, Naples
| | - T Troiani
- Medical Oncology, Department of Clinical and Experimental Medicine 'F. Magrassi', Second University of Naples, Naples
| | - S Pisconti
- Medical Oncology, Hospital SS. Annunziata, Taranto
| | - C Cardone
- Medical Oncology, Department of Clinical and Experimental Medicine 'F. Magrassi', Second University of Naples, Naples
| | - A Nappi
- Medical Oncology, Department of Clinical and Experimental Medicine 'F. Magrassi', Second University of Naples, Naples
| | - A R Bordonaro
- Medical Oncology, Hospital Garibaldi, Nesima, Catania
| | - M Rachiglio
- Cell Biology and Biotherapy Unit, National Cancer Institute 'Fondazione Giovanni Pascale', Naples; Laboratory of Pharmacogenomics, Centro di Ricerche Oncologiche di Mercogliano (CROM)-National Cancer Institute 'Fondazione Giovanni Pascale', Naples
| | - M Lambiase
- Cell Biology and Biotherapy Unit, National Cancer Institute 'Fondazione Giovanni Pascale', Naples; Laboratory of Pharmacogenomics, Centro di Ricerche Oncologiche di Mercogliano (CROM)-National Cancer Institute 'Fondazione Giovanni Pascale', Naples
| | - T P Latiano
- Medical Oncology, Hospital Casa Sollievo della Sofferenza, San Giovanni Rotondo (Foggia)
| | - G Modoni
- Medical Oncology, Hospital SS. Annunziata, Taranto
| | - S Cordio
- Medical Oncology, Hospital Garibaldi, Nesima, Catania
| | - F Giuliani
- Medical Oncology, National Cancer Institute Giovanni Paolo II, Bari
| | - M Biglietto
- Medical Oncology, Hospital 'A. Cardarelli', Naples
| | - V Montesarchio
- Medical Oncology, Hospital Monaldi- Azienda Ospedaliera dei Colli, Naples
| | - C Barone
- Medical Oncology, University Hospital A. Gemelli, Rome
| | - G Tonini
- Policlinico Universitario Campus Bio-Medico, Rome
| | - S Cinieri
- Medical Oncology, Hospital A. Perrino, Brindisi
| | - A Febbraro
- Medical Oncology, Hospital Sacro Cuore di Gesù, Fatebenefratelli, Benevento
| | - D Rizzi
- GOIM Trial Office, Bari, Italy
| | - F De Vita
- Medical Oncology, Department of Clinical and Experimental Medicine 'F. Magrassi', Second University of Naples, Naples
| | - M Orditura
- Medical Oncology, Department of Clinical and Experimental Medicine 'F. Magrassi', Second University of Naples, Naples
| | - G Colucci
- Medical Oncology, National Cancer Institute Giovanni Paolo II, Bari
| | - E Maiello
- Medical Oncology, Hospital Casa Sollievo della Sofferenza, San Giovanni Rotondo (Foggia)
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Santini D, Tampellini M, Vincenzi B, Ibrahim T, Ortega C, Virzi V, Silvestris N, Berardi R, Masini C, Calipari N, Ottaviani D, Catalano V, Badalamenti G, Giannicola R, Fabbri F, Venditti O, Fratto ME, Mazzara C, Latiano TP, Bertolini F, Petrelli F, Ottone A, Caroti C, Salvatore L, Falcone A, Giordani P, Addeo R, Aglietta M, Cascinu S, Barni S, Maiello E, Tonini G. Natural history of bone metastasis in colorectal cancer: final results of a large Italian bone metastases study. Ann Oncol 2012; 23:2072-2077. [PMID: 22219016 DOI: 10.1093/annonc/mdr572] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Data are limited regarding bone metastases from colorectal cancer (CRC). The objective of this study was to survey the natural history of bone metastasis in CRC. PATIENTS AND METHODS This retrospective, multicenter, observational study of 264 patients with CRC involving bone examined cancer treatments, bone metastases characteristics, skeletal-related event (SRE) type and frequency, zoledronic acid therapy, and disease outcomes. RESULTS Most patients with bone metastases had pathologic T3/4 disease at CRC diagnosis. The spine was the most common site involved (65%), followed by hip/pelvis (34%), long bones (26%), and other sites (17%). Median time from CRC diagnosis to bone metastases was 11.00 months; median time to first SRE thereafter was 2.00 months. Radiation and pathologic fractures affected 45% and 10% of patients, respectively; 32% of patients had no reported SREs. Patients survived for a median of 7.00 months after bone metastases diagnosis; SREs did not significantly affect survival. Subgroup analyses revealed that zoledronic acid significantly prolonged median time to first SRE (2.00 months versus 1.00 month, respectively, P=0.009) and produced a trend toward improved overall survival versus no zoledronic acid. CONCLUSION This study illustrates the burden of bone metastases from CRC and supports the use of zoledronic acid in this setting.
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Affiliation(s)
- D Santini
- Department of Medical Oncology, University Campus Bio-Medico, Rome.
| | - M Tampellini
- Department of Medical Oncology, University of Torino, San Luigi Hospital, Orbassano, Torino
| | - B Vincenzi
- Department of Medical Oncology, University Campus Bio-Medico, Rome
| | - T Ibrahim
- Osteo-oncology Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Forlì-Cesena
| | - C Ortega
- Oncological Department, Medical Oncology, Institute for Cancer Research and Treatment (IRCC), Candiolo, Torino
| | - V Virzi
- Department of Medical Oncology, University Campus Bio-Medico, Rome
| | - N Silvestris
- Medical and Experimental Oncology Unit, Oncology Institute Giovanni Paolo II, Bari
| | - R Berardi
- Department of Medical Oncology, Universita Politecnica delle Marche, Ancona
| | - C Masini
- Department of Medical Oncology, University Hospital, Modena
| | - N Calipari
- Department of Radiotherapy, Ospedali Riuniti, Reggio Calabria
| | - D Ottaviani
- Department of Medical Oncology, Presidio Sanitario Gradenigo, Turin
| | - V Catalano
- Department of Medical Oncology, A.O. Ospedali Riuniti Marche Nord, Pesaro
| | - G Badalamenti
- Department of Surgery and Oncology, Policlinico Universitario 'P. Giaccone', Palermo
| | - R Giannicola
- Department of Medical Oncology, Ospedali Riuniti, Reggio Calabria
| | - F Fabbri
- Osteo-oncology Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Forlì-Cesena
| | - O Venditti
- Department of Medical Oncology, University Campus Bio-Medico, Rome
| | - M E Fratto
- Department of Medical Oncology, University Campus Bio-Medico, Rome
| | - C Mazzara
- Department of Medical Oncology, University Campus Bio-Medico, Rome
| | - T P Latiano
- Department of Onco-Hematology, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo
| | - F Bertolini
- Department of Medical Oncology, University Hospital, Modena
| | - F Petrelli
- Department of Medical Oncology, Azienda Ospedaliera Treviglio-Caravaggio, Treviglio, Bergamo
| | - A Ottone
- Department of Medical Oncology, University of Torino, San Luigi Hospital, Orbassano, Torino
| | - C Caroti
- S.C. Medical Oncology, Galliera Hospital, Genoa
| | - L Salvatore
- Division of Medical Oncology, Department of Oncology, University Hospital S. Chiara, Pisa
| | - A Falcone
- Division of Medical Oncology, Department of Oncology, University Hospital S. Chiara, Pisa
| | - P Giordani
- Department of Medical Oncology, A.O. Ospedali Riuniti Marche Nord, Pesaro
| | - R Addeo
- Department of Medical Oncology, Ospedale San Giovanni di Dio di Frattamaggiore, Naples
| | - M Aglietta
- Oncological Department, Medical Oncology, Institute for Cancer Research and Treatment (IRCC), Candiolo, Torino; Department of Clinical Oncology, University of Torino Medical School - Institute for Cancer Research and Treatment, Candiolo, Torino, Italy
| | - S Cascinu
- Department of Medical Oncology, Universita Politecnica delle Marche, Ancona
| | - S Barni
- Department of Medical Oncology, Azienda Ospedaliera Treviglio-Caravaggio, Treviglio, Bergamo
| | - E Maiello
- Department of Onco-Hematology, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo
| | - G Tonini
- Department of Medical Oncology, University Campus Bio-Medico, Rome
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