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Martella S, Aiello MM, Bertaglia V, Cau R, Denaro N, Cadoni A, Novello S, Scartozzi M, Novello G, Soto Parra HJ, Saba L, Solinas C, Porcu M. Malignant Pleural Mesothelioma: Staging and Radiological Response Criteria in Patients Treated with Immune Checkpoint Inhibitors. Target Oncol 2024; 19:13-28. [PMID: 38063957 DOI: 10.1007/s11523-023-01017-w] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2023] [Indexed: 02/01/2024]
Abstract
Malignant pleural mesothelioma (MPM) is a rare and challenging cancer associated with asbestos fiber exposure, which offers limited treatment options. Historically, platinum-based chemotherapy has been the primary approach, but recent developments have introduced immunotherapy as a promising alternative for the treatment of this disease. Nevertheless, the unique growth patterns and occasionally ambiguous progressive characteristics of MPM make the interpretation of radiological assessments complex. Immunotherapy further complicates matters by introducing unconventional treatment response patterns such as hyperprogression and pseudoprogression. Consequently, there is a growing imperative to integrate the standard RECIST criteria with the mesothelioma-specific mRECIST criteria (version 1.1), as outlined in iRECIST. This comprehensive review is driven by the intent to provide a valuable resource for radiologists and clinicians engaged in the diagnosis, treatment, and monitoring of MPM in the era of immunotherapy. Specifically, the current imaging methods employed for staging and follow-up will be exposed and discussed, with a focus on the technical specificities and the mRECIST 1.1 methodology. Furthermore, we will provide a discussion about major clinical trials related to the use of immunotherapy in MPM patients. Finally, the latest advancements in radiomics, the applications of artificial intelligence in MPM, and their potential impact on clinical practice for prognosis and therapy, are discussed.
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Affiliation(s)
- Serafina Martella
- Department of Medical Oncology, University Hospital Policlinico San Marco, Catania, Italy
| | - Marco Maria Aiello
- Department of Medical Oncology, University Hospital Policlinico San Marco, Catania, Italy
| | - Valentina Bertaglia
- Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Riccardo Cau
- Department of Radiology, AOU Cagliari, S.S: 554, km 4,500, CAP: 09042, Monserrato (CA), Italy
| | - Nerina Denaro
- Department of Medical Oncology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Andrea Cadoni
- Department of Medical Oncology, AOU Cagliari, Monserrato (CA), Italy
| | - Silvia Novello
- Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Mario Scartozzi
- Department of Medical Oncology, AOU Cagliari, Monserrato (CA), Italy
| | - Giuseppe Novello
- Department of Medical Oncology, University Hospital Policlinico San Marco, Catania, Italy
| | - Hector Josè Soto Parra
- Department of Medical Oncology, University Hospital Policlinico San Marco, Catania, Italy
| | - Luca Saba
- Department of Radiology, AOU Cagliari, S.S: 554, km 4,500, CAP: 09042, Monserrato (CA), Italy
| | - Cinzia Solinas
- Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Michele Porcu
- Department of Radiology, AOU Cagliari, S.S: 554, km 4,500, CAP: 09042, Monserrato (CA), Italy.
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2
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Garbo E, Del Rio B, Ferrari G, Cani M, Napoli VM, Bertaglia V, Capelletto E, Rolfo C, Novello S, Passiglia F. Exploring the Potential of Non-Coding RNAs as Liquid Biopsy Biomarkers for Lung Cancer Screening: A Literature Review. Cancers (Basel) 2023; 15:4774. [PMID: 37835468 PMCID: PMC10571819 DOI: 10.3390/cancers15194774] [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: 07/22/2023] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
Lung cancer represent the leading cause of cancer mortality, so several efforts have been focused on the development of a screening program. To address the issue of high overdiagnosis and false positive rates associated to LDCT-based screening, there is a need for new diagnostic biomarkers, with liquid biopsy ncRNAs detection emerging as a promising approach. In this scenario, this work provides an updated summary of the literature evidence about the role of non-coding RNAs in lung cancer screening. A literature search on PubMed was performed including studies which investigated liquid biopsy non-coding RNAs biomarker lung cancer patients and a control cohort. Micro RNAs were the most widely studied biomarkers in this setting but some preliminary evidence was found also for other non-coding RNAs, suggesting that a multi-biomarker based liquid biopsy approach could enhance their efficacy in the screening context. However, further studies are needed in order to optimize detection techniques as well as diagnostic accuracy before introducing novel biomarkers in the early diagnosis setting.
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Affiliation(s)
- Edoardo Garbo
- Department of Oncology, University of Turin, San Luigi Hospital, 10124 Orbassano, Italy; (E.G.); (B.D.R.); (G.F.); (M.C.); (V.M.N.); (V.B.); (E.C.); (S.N.)
| | - Benedetta Del Rio
- Department of Oncology, University of Turin, San Luigi Hospital, 10124 Orbassano, Italy; (E.G.); (B.D.R.); (G.F.); (M.C.); (V.M.N.); (V.B.); (E.C.); (S.N.)
| | - Giorgia Ferrari
- Department of Oncology, University of Turin, San Luigi Hospital, 10124 Orbassano, Italy; (E.G.); (B.D.R.); (G.F.); (M.C.); (V.M.N.); (V.B.); (E.C.); (S.N.)
| | - Massimiliano Cani
- Department of Oncology, University of Turin, San Luigi Hospital, 10124 Orbassano, Italy; (E.G.); (B.D.R.); (G.F.); (M.C.); (V.M.N.); (V.B.); (E.C.); (S.N.)
| | - Valerio Maria Napoli
- Department of Oncology, University of Turin, San Luigi Hospital, 10124 Orbassano, Italy; (E.G.); (B.D.R.); (G.F.); (M.C.); (V.M.N.); (V.B.); (E.C.); (S.N.)
| | - Valentina Bertaglia
- Department of Oncology, University of Turin, San Luigi Hospital, 10124 Orbassano, Italy; (E.G.); (B.D.R.); (G.F.); (M.C.); (V.M.N.); (V.B.); (E.C.); (S.N.)
| | - Enrica Capelletto
- Department of Oncology, University of Turin, San Luigi Hospital, 10124 Orbassano, Italy; (E.G.); (B.D.R.); (G.F.); (M.C.); (V.M.N.); (V.B.); (E.C.); (S.N.)
| | - Christian Rolfo
- Center for Thoracic Oncology, Tisch Cancer Institute, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA;
| | - Silvia Novello
- Department of Oncology, University of Turin, San Luigi Hospital, 10124 Orbassano, Italy; (E.G.); (B.D.R.); (G.F.); (M.C.); (V.M.N.); (V.B.); (E.C.); (S.N.)
| | - Francesco Passiglia
- Department of Oncology, University of Turin, San Luigi Hospital, 10124 Orbassano, Italy; (E.G.); (B.D.R.); (G.F.); (M.C.); (V.M.N.); (V.B.); (E.C.); (S.N.)
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Denaro N, Romanò R, Alfieri S, Dolci A, Licitra L, Nuzzolese I, Ghidini M, Bareggi C, Bertaglia V, Solinas C, Garrone O. The Tumor Microenvironment and the Estrogen Loop in Thyroid Cancer. Cancers (Basel) 2023; 15:cancers15092458. [PMID: 37173925 PMCID: PMC10177023 DOI: 10.3390/cancers15092458] [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: 01/31/2023] [Revised: 03/31/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023] Open
Abstract
Thyroid cancer (TC) cells employ multiple signaling pathways, such as PI3K/AKT/mTOR and RAS/Raf/MAPK, fostering cell proliferation, survival and metastasis. Through a complex interplay with immune cells, inflammatory mediators and stroma, TC cells support an immunosuppressive, inflamed, pro-carcinogenic TME. Moreover, the participation of estrogens in TC pathogenesis has previously been hypothesized, in view of the higher TC incidence observed among females. In this respect, the interactions between estrogens and the TME in TC could represent a relevant, unexplored area of research. We thereby collectively reviewed the available evidence concerning the potential carcinogenic role of estrogens in TC, specifically focusing on their crosstalk with the TME.
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Affiliation(s)
- Nerina Denaro
- Medical Oncology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Rebecca Romanò
- Head and Neck Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Salvatore Alfieri
- Head and Neck Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Alessia Dolci
- Endocrinology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Lisa Licitra
- Head and Neck Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
- Department of Hematology and Oncology, University of Milan, 20122 Milan, Italy
| | - Imperia Nuzzolese
- Head and Neck Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Michele Ghidini
- Medical Oncology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Claudia Bareggi
- Medical Oncology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Valentina Bertaglia
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, 10043 Orbassano, Italy
| | - Cinzia Solinas
- Medical Oncology, AOU Cagliari, Policlinico di Monserrato, 09042 Cagliari, Italy
| | - Ornella Garrone
- Medical Oncology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
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Solinas C, Bertaglia V, Parati M, Borgonovo K, De Silva P, Pretta A, Saba G, Migliari M, Bardanzellu F, Murgia S, D’Agata A, Cadoni A, Contu F, Cadeddu M, Sanna G, Luciani A, Novello S, Scartozzi M, Emens L, Petrelli F. P002 Adjuvant chemotherapy for resected early-stage triple negative breast cancer. Breast 2023. [DOI: 10.1016/s0960-9776(23)00121-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
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5
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Bertaglia V, Morelli AM, Solinas C, Aiello MM, Manunta S, Denaro N, Tampellini M, Scartozzi M, Novello S. Infections in lung cancer patients undergoing immunotherapy and targeted therapy: An overview on the current scenario. Crit Rev Oncol Hematol 2023; 184:103954. [PMID: 36878396 DOI: 10.1016/j.critrevonc.2023.103954] [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: 01/21/2023] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 03/08/2023] Open
Abstract
Patients with a diagnosis of lung cancer are often vulnerable to infection, and the risk is increased by tumor-associated immunosuppression and the effects of the treatments. Historically, links between the risk of infection and cytotoxic chemotherapy due to neutropenia and respiratory syndromes are well established. The advent of tyrosine kinase inhibitors (TKIs) and immune-checkpoint inhibitors (ICIs) targeting the programmed cell death-1 (PD-1)/programmed cell death- ligand 1 (PD-L1) axis and cytotoxic T-lymphocyte antigen-4 (CTLA-4) have changed the treatment paradigm for lung cancer patients. Our understanding of the risk of infections while administrating these drugs is evolving, as are the biological mechanisms that are responsible. In this overview, we focus on the risk of infection with the use of targeted therapies and ICIs, summarizing current evidence from preclinical and clinical studies and discussing their clinical implications.
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Affiliation(s)
- Valentina Bertaglia
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, 10043 Orbassano, Torino, Italy
| | - Anna Maria Morelli
- Medical Oncology, ASL TO3 Ospedale degli Infermi, 10098 Rivoli, Torino, Italy
| | - Cinzia Solinas
- Medical Oncology, AOU Cagliari, Policlinico di Monserrato, 09042 Monserrato, Cagliari, Italy.
| | - Marco Maria Aiello
- Medical Oncology, AOU Policlinico Vittorio Emanuele di Catania, 95100 Catania, Italy
| | - Silvia Manunta
- Medical Oncology, Ospedale Civile di Alghero, 07041 Alghero, Italy
| | - Nerina Denaro
- Oncology Department, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy
| | - Marco Tampellini
- Medical Oncology, ASL TO3 Ospedale degli Infermi, 10098 Rivoli, Torino, Italy
| | - Mario Scartozzi
- Medical Oncology, AOU Cagliari, Policlinico di Monserrato, 09042 Monserrato, Cagliari, Italy
| | - Silvia Novello
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, 10043 Orbassano, Torino, Italy
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6
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Petrelli F, Bertaglia V, Parati MC, Borgonovo K, De Silva P, Luciani A, Novello S, Scartozzi M, Emens LA, Solinas C. Adjuvant chemotherapy for resected triple negative breast cancer patients: A network meta-analysis. Breast 2022; 67:8-13. [PMID: 36549170 PMCID: PMC9792383 DOI: 10.1016/j.breast.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/27/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
The current standard of care for resected early-stage triple negative breast cancer (TNBC) patients who did not receive systemic preoperative therapy is adjuvant anthracycline- and taxane-based chemotherapy (CT). A network meta-analysis (NMA) of randomized controlled trials (phase III) enrolling patients with resected stage I-III TNBC comparing adjuvant regimens was performed. Overall survival (OS) and disease-free survival (DFS) data were extracted. A total of 27 phase III clinical trials were selected including 15,242 TNBC patients. This NMA showed an OS benefit from the incorporation of capecitabine into classic anthracycline/taxane-based combinations compared to anthracyclines with or without taxanes alone.
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Affiliation(s)
- Fausto Petrelli
- Oncology Unit, ASST Bergamo Ovest, Treviglio, Bergamo, Italy.
| | - Valentina Bertaglia
- Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Italy
| | | | - Karen Borgonovo
- Oncology Unit, ASST Bergamo Ovest, Treviglio, Bergamo, Italy
| | - Pushpamali De Silva
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA,Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Andrea Luciani
- Oncology Unit, ASST Bergamo Ovest, Treviglio, Bergamo, Italy
| | | | - Mario Scartozzi
- Medical Oncology, AOU Cagliari, P.O. Duilio Casula, Monserrato CA, Italy
| | - Leisha A. Emens
- Department of Medicine, University of Pittsburgh Medical Center Hillman Cancer Center, University of Pittsburgh, 5117 Centre Avenue, 1.46e, Pittsburgh, PA 15213, USA
| | - Cinzia Solinas
- Medical Oncology, AOU Cagliari, P.O. Duilio Casula, Monserrato CA, Italy
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Morelli A, Bungaro M, Capizzi I, Parlagreco E, Solitro F, Eletti L, Martinetto S, Veltri A, Tinivella M, Pedrazzoli P, Caccialanza R, Bertaglia V, Capelletto E, Reale M, Novello S, Tampellini M. 1617P Impact of nutritional counselling (NC) on CT-based body composition in patients with oncogene addicted advanced non-small cell lung cancer (aNSCLC). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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8
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Morelli A, Capizzi I, Bungaro M, Solitro F, Eletti L, Martinetto S, Veltri A, Tinivella M, Pedrazzoli P, Caccialanza R, Bertaglia V, Capelletto E, Reale M, Tampellini M, Novello S. EP10.01-015 The Role of CT-Scan as a Body Composition Tool in Oncogene-Addicted Advanced Non-Small Cell Lung Cancer (aNSCLC) Patients. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bertaglia V, Petrelli F, Porcu M, Saba L, Pearce J, Luciani A, Solinas C, Scartozzi M. Assessment of clinical studies evaluating combinations of immune checkpoint inhibitors with locoregional treatments in solid tumors. Cytokine Growth Factor Rev 2022; 67:1-10. [DOI: 10.1016/j.cytogfr.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 07/28/2022] [Accepted: 07/28/2022] [Indexed: 11/03/2022]
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Tagliamento M, Bironzo P, Curcio H, De Luca E, Pignataro D, Rapetti SG, Audisio M, Bertaglia V, Paratore C, Bungaro M, Olmetto E, Artusio E, Reale ML, Zichi C, Capelletto E, Carnio S, Buffoni L, Passiglia F, Novello S, Scagliotti GV, Di Maio M. A systematic review and meta-analysis of trials assessing PD-1/PD-L1 immune checkpoint inhibitors activity in pre-treated advanced stage malignant mesothelioma. Crit Rev Oncol Hematol 2022; 172:103639. [DOI: 10.1016/j.critrevonc.2022.103639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/08/2022] [Accepted: 02/16/2022] [Indexed: 12/29/2022] Open
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Capizzi I, Morelli A, Carnio S, Paratore C, Bungaro M, Alemanni A, Tinivella M, Tiozzo E, Pedrazzoli P, Caccialanza R, Bertaglia V, Capelletto E, Reale M, Tampellini M, Novello S. Prognostic nutritional index (pni) in oncogene addicted advanced non-small cell lung cancer (ansclc) patients (pts): an Italian experience. Clin Nutr ESPEN 2021. [DOI: 10.1016/j.clnesp.2021.09.473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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12
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Passiglia F, Bertaglia V, Reale ML, Delcuratolo MD, Tabbò F, Olmetto E, Capelletto E, Bironzo P, Novello S. Major breakthroughs in lung cancer adjuvant treatment: Looking beyond the horizon. Cancer Treat Rev 2021; 101:102308. [PMID: 34757306 DOI: 10.1016/j.ctrv.2021.102308] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 09/01/2021] [Revised: 10/11/2021] [Accepted: 10/13/2021] [Indexed: 12/15/2022]
Abstract
We are witnessing a silent revolution in the treatment of early stage non-small cell lung cancer (NSCLC), with a series of practice-changing clinical trials enriching the therapeutic perspectives of lung cancer patients with potentially curable disease. The ADAURA study marked the advent of precision medicine and biomarker testing to the early stages setting. The IMPower-010 trial interrupted the negative trend of adjuvant lung cancer immunotherapy, paving the way to the application of immune-checkpoint inhibition in the resected disease. The ITACA trial definitively established no role for tailored adjuvant chemotherapy in NSCLC, while the Lung Art data questioned the efficacy of post-operative radiotherapy for pN2 resected disease. Growing evidence is supporting MRD as effective adjuvant prognostic biomarker to stratify disease's recurrence risk after radical interventions and select best candidates to the adjuvant strategies. This work summarizes the recent major breakthroughs in lung cancer adjuvant treatment, and provides a snapshot of the current real-world scenario, discussing the upcoming challenges and opportunities featuring the clinical management of early stage NSCLC patients.
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Affiliation(s)
- Francesco Passiglia
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano (TO), Italy.
| | - Valentina Bertaglia
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Maria Lucia Reale
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano (TO), Italy.
| | | | - Fabrizio Tabbò
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Emanuela Olmetto
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Enrica Capelletto
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano (TO), Italy.
| | - Paolo Bironzo
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano (TO), Italy.
| | - Silvia Novello
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano (TO), Italy.
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Bungaro M, Bertaglia V, Audisio M, Parlagreco E, Pisano C, Cetoretta V, Persano I, Jacobs F, Baratelli C, Consito L, Reale M, Tabbò F, Bironzo P, Scagliotti G, Novello S. Performing oncological procedures during COVID-19 outbreak: a
picture from an Italian cancer center. Exploration of Targeted Anti-tumor Therapy 2021; 2:481-489. [PMID: 36045703 PMCID: PMC9400781 DOI: 10.37349/etat.2021.00058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 10/08/2021] [Indexed: 11/19/2022] Open
Abstract
Aim: Since SARS-CoV-2 infection rapidly spread around the world, Italy has quickly become one of the most affected countries. Healthcare systems introduced strict infection control measures to ensure optimal care, especially in frail groups such as cancer patients (pts). This study investigated the efficacy of SARS-CoV-2 pre-procedure screening and whether COVID-19 influenced timely diagnosis and therapy. Methods: Data of oncological procedures of pts with confirmed or suspected cancer diagnosis, treated at Oncology Department or coming from Emergency Department of San Luigi Gonzaga Hospital between June 2020 and March 2021 were retrospectively collected. A nasopharyngeal swab (NPS) was performed in outpatients 24/48 h before procedures. Inpatients were tested by NPS before and after hospitalization. Results: Two hundred and twenty-one pts were included in this analysis. Median age was 73 years, males were 58%. Eastern Cooperative Oncology Group (ECOG) Performance Status was 0 or 1 in 88% of pts. The most frequent cancer type was lung cancer (57%). Stages IV were 77%. Two hundred and forty-three scheduled procedures were performed with diagnostic (n: 142; 58%), therapeutic (n: 55; 23%), and palliative (n: 46; 19%) intent. One hundred and four and 139 procedures were performed in out- and in-pts, respectively. Of the 234 NPS performed, 10 (4%) were positive. Two pts were infected during hospitalization, 8 in community. Most of them were asymptomatic, while only 2 had mild symptoms. Eight procedures (3%) were postponed, 1 cancelled, while 2 were performed in positive pts. Median time to resolution of the infection was 17 days (11–36). Median delay in the procedures was 25 days (14–55). Five pts started systemic treatment, after a median time of 37.5 days (13–57). Conclusions: SARS-CoV-2 infection led to the postponement of a small, but not negligible percentage of oncological procedures. However, the low infection rate observed suggests that structured screening for COVID-19 is critical for the best management of scheduled procedures during pandemic.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Paolo Bironzo
- Medical Oncology, San Luigi Gonzaga University Hospital, University of Torino, Regione Gonzole 10, 10043 Orbassano, Italy
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14
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Passiglia F, Leone G, Olmetto E, Delcuratolo MD, Tabbò F, Reale ML, Bertaglia V, Consito L, Bironzo P, Capelletto E, Novello S. Immune-checkpoint inhibition in stage III unresectable NSCLC: Challenges and opportunities in the post-PACIFIC era. Lung Cancer 2021; 157:85-91. [PMID: 33994198 DOI: 10.1016/j.lungcan.2021.05.009] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/06/2021] [Accepted: 05/09/2021] [Indexed: 12/25/2022]
Abstract
The PACIFIC trial marked a new era in the treatment of stage III unresectable NSCLC, establishing durvalumab consolidation as new standard of care worldwide, with about 14 % increase of long-term survival and half of the patients alive at 4 years. A series of intensified immune-checkpoint inhibition regimens are currently under investigation in clinical trials in order to optimize the therapeutic benefit obtained in this population, while the identification of personalized approaches as well as the development of effective treatments in the post-durvalumab progression setting represent an actual and controversial topic for clinical lung cancer research. This review describes the current real-word treatment scenario for stage III unresectable NSCLC in Italy, and provides an updated overview of the upcoming therapeutic strategies under clinical investigation, discussing the most relevant challenges and opportunities featuring the post-PACIFIC era.
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Affiliation(s)
- Francesco Passiglia
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano (TO), Italy.
| | - Gianmarco Leone
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano (TO), Italy.
| | - Emanuela Olmetto
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano (TO), Italy.
| | | | - Fabrizio Tabbò
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano (TO), Italy.
| | - Maria Lucia Reale
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano (TO), Italy.
| | - Valentina Bertaglia
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano (TO), Italy.
| | - Lorena Consito
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano (TO), Italy.
| | - Paolo Bironzo
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano (TO), Italy.
| | - Enrica Capelletto
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano (TO), Italy.
| | - Silvia Novello
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano (TO), Italy.
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Pignataro D, Bertaglia V, Bironzo P, Olmetto E, Pisano C, Napoli VM, Mantovani C, Righi L, Novello S. Oligoprogressive Disease With SCLC Transformation in EGFR-Mutated NSCLC: How Biology Knowledge Can Change the Game Rules. J Thorac Oncol 2021; 15:e170-e172. [PMID: 32981608 DOI: 10.1016/j.jtho.2020.06.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 06/15/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Daniele Pignataro
- Division of Medical Oncology, Cardinal Massaia Hospital, Asti, Italy.
| | - Valentina Bertaglia
- Thoracic Oncology Unit, Department of Oncology, University of Torino, Torino, Italy
| | - Paolo Bironzo
- Thoracic Oncology Unit, Department of Oncology, University of Torino, Torino, Italy
| | - Emanuela Olmetto
- Thoracic Oncology Unit, Department of Oncology, University of Torino, Torino, Italy
| | - Chiara Pisano
- Thoracic Oncology Unit, Department of Oncology, University of Torino, Torino, Italy
| | - Valerio Maria Napoli
- Thoracic Oncology Unit, Department of Oncology, University of Torino, Torino, Italy
| | - Cristina Mantovani
- Radiotherapy Unit, Department of Oncology, Città della Salute e della Scienza, Torino, Italy
| | - Luisella Righi
- Pathology Unit, Department of Oncology, University of Torino, Torino, Italy
| | - Silvia Novello
- Thoracic Oncology Unit, Department of Oncology, University of Torino, Torino, Italy
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Passiglia F, Bironzo P, Bertaglia V, Listì A, Garbo E, Scagliotti GV. Optimizing the clinical management of EGFR-mutant advanced non-small cell lung cancer: a literature review. Transl Lung Cancer Res 2021; 11:935-949. [PMID: 35693274 PMCID: PMC9186167 DOI: 10.21037/tlcr-22-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 04/22/2022] [Indexed: 11/06/2022]
Abstract
Background and Objective Despite several steps forward in the treatment of epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancer (NSCLC), however there are still pending issues and upcoming challenges requiring adequate addressing in order to optimize the clinical management of metastatic patients harboring molecular alterations within the EGFR gene. This review aims to summarize the most recent findings regarding the diagnostic testing and therapeutic strategies of EGFR-mutant advanced NSCLC. Methods Literature search was conducted using MEDLINE/PubMed, EMBASE, Scopus and Cochrane Library databases, up to December 2021. Relevant studies in English language published between 2004 and 2021 were selected. Key Content and Findings The increased detection of uncommon EGFR mutations in the real-word practice along with the clinical development of novel selective inhibitors, highlighted the issue of an adequate selection of the best EGFR-tyrosine-kinase inhibitor (TKI) to the right patient mutation. The advent of osimertinib in first-line has dramatically changed the spectrum of molecular mechanisms underlying both innate and acquired resistance to the EGFR-TKI therapy, accelerating the clinical investigation of novel genomic-driven sequential strategies as well as upfront targeted combinations. The recent approval of potent, selective inhibitors targeting the EGFR exon-20 insertions, renewed interest toward this patients’ subset, questioning the diagnostic accuracy of old-standard genomic sequencing technologies and pushing the implementations of next-generation sequencing (NGS)-based molecular profiling in the real word practice scenario. Conclusions This review provides evidence-based answers to the aforementioned challenges aiming to optimize the clinical management of metastatic patients harboring molecular alterations within the EGFR gene.
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Leone G, Passiglia F, Bironzo P, Bertaglia V, Novello S. Is there any place for immune-checkpoint inhibitors in the treatment algorithm of fusion-driven non-small cell lung cancer?-a literature review. Transl Lung Cancer Res 2020; 9:2674-2685. [PMID: 33489826 PMCID: PMC7815346 DOI: 10.21037/tlcr-20-710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The advent of immune-checkpoint inhibitors (ICIs) targeting the programmed death-1 (PD-1)/programmed death ligand-1 (PD-L1) axis, produced a paradigm change of the treatment algorithm for metastatic, non-oncogene addicted, non-small cell lung cancer (NSCLC). However, the majority of patients with oncogene-addicted disease have been excluded from the “immunotherapy revolution”, thus the clinical efficacy of these agents in this subset of patients remains largely unknown. Although pre-clinical evidence provided a good rationale to pursue the investigation of ICI treatment in specific subgroups of oncogene-addicted NSCLC, current available evidence suggested that tumors harboring molecular alterations likely do not represent the best candidate to single agent ICI therapy. Furthermore, the prospect of further improving overall survival (OS) with the combination of tyrosine kinase inhibitors (TKIs) and ICIs led to unexpected poor results and safety issues in recent phase I trials exploring different therapeutic associations. Conversely, the combination of immunotherapy and chemotherapy is emerging as a potential effective strategy in specific subsets of NSCLC patients harboring oncogenic drivers. In this review we particularly focus on the subgroup of patients whose disease harbor oncogenic rearrangements, summarizing current evidence from preclinical and clinical studies and discussing their practical implications, in order to define the potential role of ICIs in the clinical management of fusion-driven NSCLC.
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Affiliation(s)
- Gianmarco Leone
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano, Italy
| | - Francesco Passiglia
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano, Italy
| | - Paolo Bironzo
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano, Italy
| | - Valentina Bertaglia
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano, Italy
| | - Silvia Novello
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano, Italy
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18
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Bertaglia V, Reale ML, Bironzo P, Palesandro E, Mariniello A, Leone G, Tabbò F, Bungaro M, Audisio M, Rapetti S, Di Stefano RF, Carnio S, Artusio E, Capelletto E, Sperone P, Passiglia F, Novello S. Italian survey on the clinical management of non-small cell lung cancer patients during the COVID-19 pandemic: A lesson for the second wave. Crit Rev Oncol Hematol 2020; 157:103189. [PMID: 33341505 PMCID: PMC7691849 DOI: 10.1016/j.critrevonc.2020.103189] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 11/16/2020] [Accepted: 11/23/2020] [Indexed: 01/13/2023] Open
Abstract
Survey to evaluate the clinical management of NSCLC patients during the COVID-19 pandemic. Delay of lung cancer diagnosis and a dramatic decrease of patients’ accrual within clinical trials. Major changes in the treatment management of elderly population. Major changes in the selection of second line treatments. Telemedicine as a valid support to facilitate patient-healthcare interactions.
This study investigated the clinical management of non small cell lung cancer (NSCLC) patients during the first wave of coronavirus disease 2019 (COVID-19) outbreak in Italy. A 29-questions survey was sent to 95 Italian thoracic oncologists, with 77 % of them declaring significant changes in the outpatients management and treatment. The results of this survey pointed out a significant delay of lung cancer diagnosis along with a relevant reduction of patients’ accrual within clinical trials. Telemedicine emerged as a valid support for patient-healthcare interactions. Therapeutic indications followed the guidelines for adjuvant chemotherapy and concurrent chemo-radiation. Clinical indications to first-line therapies were largely confirmed, while major changes regarded the selection of second line treatment options as well as the management of elderly population. This work may represent a valid source of information to improve the clinical management of NSCLC patients during second wave of COVID-19 pandemic.
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Affiliation(s)
- Valentina Bertaglia
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Maria Lucia Reale
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Paolo Bironzo
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Erica Palesandro
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Annapaola Mariniello
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Gianmarco Leone
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Fabrizio Tabbò
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Maristella Bungaro
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Marco Audisio
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Simonetta Rapetti
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | | | - Simona Carnio
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Elisa Artusio
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Enrica Capelletto
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Paola Sperone
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Francesco Passiglia
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano (TO), Italy.
| | - Silvia Novello
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano (TO), Italy
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Reale ML, Bironzo P, Bertaglia V, Palesandro E, Leone G, Tabbò F, Bungaro M, Audisio M, Mariniello A, Rapetti SG, Di Stefano RF, Artusio E, Capelletto E, Sperone P, Boccuzzi A, Calandri M, Perboni A, Malapelle U, Passiglia F, Novello S. SARS-CoV-2 Infection in Cancer Patients: A Picture of an Italian Onco-Covid Unit. Front Oncol 2020; 10:1722. [PMID: 32974210 PMCID: PMC7466731 DOI: 10.3389/fonc.2020.01722] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/31/2020] [Indexed: 12/15/2022] Open
Abstract
Background: The world, and Italy on the front lines, has experienced a major medical emergency due to the novel coronavirus outbreak. Cancer patients are one of the potentially most vulnerable cohorts of people, but data about their management are still few. Patients and Methods: In this monocentric retrospective study we included all SARS-CoV-2 oncological patients accepted, between March 27th and April 19th 2020, at the Onco-COVID Unit at San Luigi Gonzaga Hospital, one of the few Italian oncological-COVID wards. Data were obtained from medical records. Results: Eighteen cancer patients with COVID-19 were included. The mean (±SD) age of patients was 67 ± 14 years, 89% were men. Seven (39%) developed infection in communities and 11 (61%) during hospitalization. Lung cancer was the most frequent type of cancer (10, 56%). Seven patients (39%) were symptomatic for COVID-19 at the time of diagnosis and symptoms began 2 (±2) days before. The most common were shortness of breath and diarrhea. Fever was present in 5 patients (28%). Among the 11 asymptomatic patients, 8 (73%) became symptomatic during the hospitalization (mean time of symptoms onset 4 days ±4). Six patients (33%) were on active anti-tumor treatment: 2 (33%) received anti-tumor therapy within 2 weeks before the infection diagnosis and 2 (33%) continued oncological treatment after SARS-CoV-2 positivity. Eight (44%) patients died within a mean of 12 days (±8) from the infection diagnosis. Conclusions: Our series confirms the high mortality among cancer patients with COVID-19. The presence of asymptomatic cases evidences that typical symptoms and fever are not the only parameters to suspect the infection. The Onco-Covid unit suggests the importance of a tailored and holistic approach, even in this difficult situation.
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Affiliation(s)
- Maria Lucia Reale
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
| | - Paolo Bironzo
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
| | - Valentina Bertaglia
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
| | - Erica Palesandro
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
| | - Gianmarco Leone
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
| | - Fabrizio Tabbò
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
| | - Maristella Bungaro
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
| | - Marco Audisio
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
| | - Annapaola Mariniello
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
| | - Simonetta G Rapetti
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
| | - Rosario F Di Stefano
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
| | - Elisa Artusio
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
| | - Enrica Capelletto
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
| | - Paola Sperone
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
| | | | - Marco Calandri
- Radiology Unit, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | | | - Umberto Malapelle
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Francesco Passiglia
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
| | - Silvia Novello
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
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20
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Polverari G, Ceci F, Bertaglia V, Reale ML, Rampado O, Gallio E, Passera R, Liberini V, Scapoli P, Arena V, Racca M, Veltri A, Novello S, Deandreis D. 18F-FDG Pet Parameters and Radiomics Features Analysis in Advanced Nsclc Treated with Immunotherapy as Predictors of Therapy Response and Survival. Cancers (Basel) 2020; 12:cancers12051163. [PMID: 32380754 PMCID: PMC7281558 DOI: 10.3390/cancers12051163] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/21/2020] [Accepted: 04/30/2020] [Indexed: 01/04/2023] Open
Abstract
Objectives: (1.1) to evaluate the association between baseline 18F-FDG PET/CT semi-quantitative parameters of the primary lesion with progression free survival (PFS), overall survival (OS) and response to immunotherapy, in advanced non-small cell lung carcinoma (NSCLC) patients eligible for immunotherapy; (1.2) to evaluate the application of radiomics analysis of the primary lesion to identify features predictive of response to immunotherapy; (1.3) to evaluate if tumor burden assessed by 18F-FDG PET/CT (N and M factors) is associated with PFS and OS. Materials and Methods: we retrospectively analyzed clinical records of advanced NCSLC patients (stage IIIb/c or stage IV) candidate to immunotherapy who performed 18F-FDG PET/CT before treatment to stage the disease. Fifty-seven (57) patients were included in the analysis (F:M 17:40; median age = 69 years old). Notably, 38/57 of patients had adenocarcinoma (AC), 10/57 squamous cell carcinoma (SCC) and 9/57 were not otherwise specified (NOS). Overall, 47.4% patients were stage IVA, 42.1% IVB and 8.8% IIIB. Immunotherapy was performed as front-line therapy in 42/57 patients and as second line therapy after chemotherapy platinum-based in 15/57. The median follow up after starting immunotherapy was 10 months (range: 1.5–68.6). Therapy response was assessed by RECIST 1.1 criteria (CT evaluation every 4 cycles of therapy) in 48/57 patients or when not feasible by clinical and laboratory data (fast disease progression or worsening of patient clinical condition in nine patients). Radiomics analysis was performed by applying regions of interest (ROIs) of the primary tumor delineated manually by two operators and semi-automatically applying a threshold at 40% of SUVmax. Results: (1.1) metabolic tumor volume (MTV) (p = 0.028) and total lesion glycolysis (TLG) (p = 0.035) were significantly associated with progressive vs. non-progressive disease status. Patients with higher values of MTV and TLG had higher probability of disease progression, compared to those patients presenting with lower values. SUVmax did not show correlation with PD status, PFS and OS. MTV (p = 0.027) and TLG (p = 0.022) also resulted in being significantly different among PR, SD and PD groups, while SUVmax was confirmed to not be associated with response to therapy (p = 0.427). (1.2) We observed the association of several radiomics features with PD status. Namely, patients with high tumor volume, TLG and heterogeneity expressed by “skewness” and “kurtosis” had a higher probability of failing immunotherapy. (1.3) M status at 18F-FDG PET/CT was significantly associated with PFS (p = 0.002) and OS (p = 0.049). No significant associations were observed for N status. Conclusions: 18F-FDG PET/CT performed before the start of immunotherapy might be an important prognostic tool able to predict the disease progression and response to immunotherapy in patients with advanced NSCLC, since MTV, TLG and radiomics features (volume and heterogeneity) are associated with disease progression.
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Affiliation(s)
- Giulia Polverari
- Division of Nuclear Medicine, Department of Medical Sciences, University of Turin, AOU Città della Salute e della Scienza, 10126 Turin, Italy; (G.P.); (R.P.); (V.L.); (D.D.)
- PET/CT Center, Affidea IRMET, 10135 Turin, Italy;
| | - Francesco Ceci
- Division of Nuclear Medicine, Department of Medical Sciences, University of Turin, AOU Città della Salute e della Scienza, 10126 Turin, Italy; (G.P.); (R.P.); (V.L.); (D.D.)
- Correspondence:
| | - Valentina Bertaglia
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, 10043 Torino, Italy; (V.B.); (M.L.R.); (S.N.)
| | - Maria Lucia Reale
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, 10043 Torino, Italy; (V.B.); (M.L.R.); (S.N.)
| | - Osvaldo Rampado
- Medical Physics Unit, S.C. Fisica Sanitaria, A.O.U. Città della Salute e della Scienza, 10135 Turin, Italy; (O.R.); (E.G.)
| | - Elena Gallio
- Medical Physics Unit, S.C. Fisica Sanitaria, A.O.U. Città della Salute e della Scienza, 10135 Turin, Italy; (O.R.); (E.G.)
| | - Roberto Passera
- Division of Nuclear Medicine, Department of Medical Sciences, University of Turin, AOU Città della Salute e della Scienza, 10126 Turin, Italy; (G.P.); (R.P.); (V.L.); (D.D.)
| | - Virginia Liberini
- Division of Nuclear Medicine, Department of Medical Sciences, University of Turin, AOU Città della Salute e della Scienza, 10126 Turin, Italy; (G.P.); (R.P.); (V.L.); (D.D.)
| | - Paola Scapoli
- Nuclear Medicine, Istituto per la Ricerca e la Cura del Cancro (IRCC), 10060 Candiolo, Italy; (P.S.); (M.R.)
| | | | - Manuela Racca
- Nuclear Medicine, Istituto per la Ricerca e la Cura del Cancro (IRCC), 10060 Candiolo, Italy; (P.S.); (M.R.)
| | - Andrea Veltri
- Radiology Unit, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, 10043 Torino, Italy;
| | - Silvia Novello
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, 10043 Torino, Italy; (V.B.); (M.L.R.); (S.N.)
| | - Désirée Deandreis
- Division of Nuclear Medicine, Department of Medical Sciences, University of Turin, AOU Città della Salute e della Scienza, 10126 Turin, Italy; (G.P.); (R.P.); (V.L.); (D.D.)
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21
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Tagliamento M, Bironzo P, De Luca E, Pignataro D, Rapetti S, Audisio M, Bertaglia V, Paratore C, Bungaro M, Olmetto E, Artusio E, Reale M, Zichi C, Capelletto E, Carnio S, Buffoni L, Passiglia F, Novello S, Di Maio M. A systematic review and meta-analysis of trials assessing activity of PD-1/PD-L1 immune checkpoint inhibitors (ICIs) for pre-treated advanced malignant mesothelioma (aMM). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz449.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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22
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Pignataro D, Tagliamento M, Reale M, Tabbò F, Bungaro M, Paratore C, Cetoretta V, De Filippis M, Bertaglia V, Passiglia F, Righi L, Bironzo P, Novello S. P2.14-17 Correlation Between Clinic-Pathological Data and T790M Detection in EGFR Mutated NSCLC Patients Progressing on 1st/2nd Generation TKIs. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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23
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Mecca C, Bertaglia V, Novello S. Third line scenario in advanced non-small cell lung cancer: is the anti-angiogenetic strategy the only actor up to now? Transl Cancer Res 2019; 8:S79-S83. [PMID: 35117068 PMCID: PMC8797454 DOI: 10.21037/tcr.2018.08.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 08/14/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Caterina Mecca
- Oncology Department, San Luigi Hospital, University of Turin, Orbassano, TO, Italy
| | - Valentina Bertaglia
- Oncology Department, San Luigi Hospital, University of Turin, Orbassano, TO, Italy
| | - Silvia Novello
- Oncology Department, San Luigi Hospital, University of Turin, Orbassano, TO, Italy
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Lo Iacono M, Buttigliero C, Monica V, Bollito E, Garrou D, Cappia S, Rapa I, Vignani F, Bertaglia V, Fiori C, Papotti M, Volante M, Scagliotti GV, Porpiglia F, Tucci M. Retrospective study testing next generation sequencing of selected cancer-associated genes in resected prostate cancer. Oncotarget 2018; 7:14394-404. [PMID: 26887047 PMCID: PMC4924723 DOI: 10.18632/oncotarget.7343] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 01/25/2016] [Indexed: 12/23/2022] Open
Abstract
Purpose Prostate cancer (PCa) has a highly heterogeneous outcome. Beyond Gleason Score, Prostate Serum Antigen and tumor stage, nowadays there are no biological prognostic factors to discriminate between indolent and aggressive tumors. The most common known genomic alterations are the TMPRSS-ETS translocation and mutations in the PI3K, MAPK pathways and in p53, RB and c-MYC genes. The aim of this retrospective study was to identify by next generation sequencing the most frequent genetic variations (GVs) in localized and locally advanced PCa underwent prostatectomy and to investigate their correlation with clinical-pathological variables and disease progression. Results Identified non-synonymous GVs included TP53 p.P72R (78% of tumors), two CSFR1 SNPs, rs2066934 and rs2066933 (70%), KDR p.Q472H (67%), KIT p.M541L (28%), PIK3CA p.I391M (19%), MET p.V378I (10%) and FGFR3 p.F384L/p.F386L (8%). TP53 p.P72R, MET p.V378I and CSFR1 SNPs were significantly associated with the HI risk group, TP53 and MET variations with T≥T2c. FGFR3 p.F384L/p.F386L was correlated with T≤T2b. MET p.V378I mutation, detected in 20% of HI risk patients, was associated with early biochemical recurrence. Experimental design Nucleic acids were obtained from tissue samples of 30 high (HI) and 30 low-intermediate (LM) risk patients, according to D'Amico criteria. Genomic DNA was explored with the Ion_AmpliSeq_Cancer_Hotspot_Panel_v.2 including 50 cancer-associated genes. GVs with allelic frequency (AF) ≥10%, affecting protein function or previously associated with cancer, were correlated with clinical-pathological variables. Conclusion Our results confirm a complex mutational profile in PCa, supporting the involvement of TP53, MET, FGFR3, CSF1R GVs in tumor progression and aggressiveness.
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Affiliation(s)
- Marco Lo Iacono
- University of Turin, Department of Oncology, Orbassano, Italy
| | | | | | - Enrico Bollito
- University of Turin, Department of Oncology, Orbassano, Italy
| | - Diletta Garrou
- University of Turin, Department of Oncology, Orbassano, Italy
| | - Susanna Cappia
- University of Turin, Department of Oncology, Orbassano, Italy
| | - Ida Rapa
- University of Turin, Department of Oncology, Orbassano, Italy
| | | | | | - Cristian Fiori
- University of Turin, Department of Oncology, Orbassano, Italy
| | - Mauro Papotti
- University of Turin, Department of Oncology, Orbassano, Italy
| | - Marco Volante
- University of Turin, Department of Oncology, Orbassano, Italy
| | | | | | - Marcello Tucci
- University of Turin, Department of Oncology, Orbassano, Italy
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Bertaglia V, Vallone S, Pacchiana MV, Novello S. Advanced squamous lung cancer: therapeutic options, future directions, unmet needs and results of a monocentric survey. Lung Cancer Manag 2017; 6:93-107. [PMID: 30643575 PMCID: PMC6310352 DOI: 10.2217/lmt-2017-0011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 06/22/2017] [Accepted: 10/23/2017] [Indexed: 11/21/2022] Open
Abstract
Lung cancer is the leading cause of cancer-related deaths in worldwide, and NSCLC represents around 85% of all lung cancers. Squamous cell lung cancer (SqCLC) is the second most common subtype and it is challenging to treat. New options have been discovered but progresses are still limited for the lack of 'druggable' mutations. Specific resources for SqCLC are limited and this condition affects treatment and outcomes. This paper describes available and emerging therapeutic options and resources that may help patients to face their disease. We have also performed a monocentric survey collecting information about smoking habit and sense of guilty and analyzed the possibility for patients to find helpful sources for their disease. The results suggest that more materials focused on SqCLC are still needed.
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Affiliation(s)
- Valentina Bertaglia
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | | | | | - Silvia Novello
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
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Buttigliero C, Pisano C, Tucci M, Vignani F, Bertaglia V, Iaconis D, Guglielmini P, Numico G, Scagliotti GV, Di Maio M. Prognostic impact of pretreatment neutrophil-to-lymphocyte ratio in castration-resistant prostate cancer patients treated with first-line docetaxel. Acta Oncol 2017; 56:555-562. [PMID: 28068151 DOI: 10.1080/0284186x.2016.1260772] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The neutrophil-to-lymphocyte ratio (NLR), a measure of systemic inflammatory response, has been associated with poor outcome in several solid tumors, including prostate cancer. We retrospectively investigated the prognostic role of pretreatment NLR in metastatic castration-resistant prostate cancer (mCRPC) patients treated with first-line docetaxel. METHODS All CRPC patients treated with first-line docetaxel at two Italian institutions, with available data about baseline neutrophil and lymphocyte values, were included in this retrospective analysis. Patients were divided in two groups according to NLR ratio (low NLR: ≤3; high NLR: >3). Outcome measures were progression-free (PFS) and overall survival (OS), measured from the start of docetaxel treatment. Univariate and multivariate analysis (adjusting for baseline prostate-specific antigen, alkaline phosphatase, lactate dehydrogenase, hemoglobin, albumin, performance status, use of opioids and presence of visceral disease) were performed. RESULTS One hundred and seventy-nine patients treated between 2004 and 2016 were analyzed and 110 had information about pretreatment NLR. Forty-six patients (42%) had low NLR and 64 (58%) had high NLR. Median PFS was 8.8 months in patients with low NLR versus 7.3 months in those with high NLR [hazard ratio (HR) 1.12, 95% confidence interval (CI) 0.75-1.69, p = .58]. Median OS was 34.9 months in patients with low NLR versus 20.2 months in those with high NLR (HR 1.85, 95% CI 1.07-3.19, p = .02). At multivariate analysis, NLR confirmed an independent impact on OS (HR 3.16, 95% CI 1.50-6.65, p = .002). CONCLUSION In this retrospective series, metastatic CRPC patients who started first-line docetaxel with a low pretreatment NLR had a significantly better survival. In addition to known prognostic factors, NLR can be useful to improve prognostic evaluation of patients in this setting.
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Affiliation(s)
- Consuelo Buttigliero
- Division of Medical Oncology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
| | - Chiara Pisano
- Division of Medical Oncology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
| | - Marcello Tucci
- Division of Medical Oncology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
| | - Francesca Vignani
- Division of Medical Oncology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
| | - Valentina Bertaglia
- Division of Medical Oncology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
| | - Davide Iaconis
- Division of Medical Oncology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
| | - Pamela Guglielmini
- Oncology Unit, SS Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Gianmauro Numico
- Oncology Unit, SS Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Giorgio V. Scagliotti
- Division of Medical Oncology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
| | - Massimo Di Maio
- Division of Medical Oncology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
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Bertaglia V, Tucci M, Vignani F, Buttigliero C, Aroasio E, Berruti A, Scagliotti GV, DI Maio M. An exploratory analysis of the association between levels of hormones implied in steroid biosynthesis and activity of abiraterone in patients with metastatic castration-resistant prostate cancer. Minerva Urol Nephrol 2016; 69:349-358. [PMID: 28008755 DOI: 10.23736/s0393-2249.16.02746-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Abiraterone acetate, approved for patients with metastatic castration-resistant prostate cancer (mCRPC), blocks androgen byosinthesis. We aimed to describe changes determined by abiraterone in hormones implied in steroid biosynthesis, exploring association between hormonal levels and drug activity. METHODS Patients with mCRPC, receiving standard abiraterone + prednisone after docetaxel failure, were studied. We determined serum levels of progesterone, 17OH-progesterone, cortisol, ACTH, DHEA-sulphate, androstenedione, testosterone, sex hormone-binding globulin, aldosterone, plasma renin activity, and cholesterol, baseline and every 12 weeks. For each hormone, association with treatment activity was tested 1) comparing baseline values in responders vs. non-responders; 2) comparing progression-free survival (PFS) of patients with baseline low vs. high values; 3) comparing values after 12 weeks in responders vs. non-responders. RESULTS Forty-nine patients were analyzed; 26 patients (53.1%) experienced PSA response. Baseline values of all hormones were not statistically different between responders and non-responders. For all hormones, PFS difference of patients with low vs. high baseline values was not statistically significant. Several hormones showed significant and sustained changes vs. baseline, but all significant changes were similar between responders and non-responders. CONCLUSIONS This analysis does not suggest a significant association between baseline hormonal values, or changes induced by abiraterone, and treatment activity.
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Affiliation(s)
- Valentina Bertaglia
- Department of Medical Oncology, Azienda Ospedaliera Universitaria San Luigi Gonzaga, Orbassano, Turin, Italy
| | - Marcello Tucci
- Department of Medical Oncology, Azienda Ospedaliera Universitaria San Luigi Gonzaga, Orbassano, Turin, Italy -
| | - Francesca Vignani
- Department of Medical Oncology, Azienda Ospedaliera Universitaria San Luigi Gonzaga, Orbassano, Turin, Italy
| | - Consuelo Buttigliero
- Department of Medical Oncology, Azienda Ospedaliera Universitaria San Luigi Gonzaga, Orbassano, Turin, Italy
| | - Emiliano Aroasio
- Department of Biological and Clinical Sciences, Azienda Ospedaliera Universitaria San Luigi Gonzaga, Orbassano, Turin, Italy
| | - Alfredo Berruti
- Medical Oncology, Azienda Ospedaliera Spedali Civili di Brescia, Brescia, Italy
| | - Giorgio V Scagliotti
- Department of Medical Oncology, Azienda Ospedaliera Universitaria San Luigi Gonzaga, Orbassano, Turin, Italy
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Buttigliero C, Bertaglia V, Novello S. Anti-angiogenetic therapies for central nervous system metastases from non-small cell lung cancer. Transl Lung Cancer Res 2016; 5:610-627. [PMID: 28149756 DOI: 10.21037/tlcr.2016.09.03] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Central nervous system (CNS) metastases are common in patients with advanced non-small cell lung cancer (NSCLC), occurring in 24% to 44% of patients in the course of their disease and confer significant morbidity and mortality. Systemic therapies have been deemed ineffective in brain metastases (BM) under the hypothesis that the blood-brain barrier (BBB) limits their delivery to the brain. Angiogenesis, which is mainly mediated by vascular endothelial growth factor (VEGF) pathway, is crucial for tumor survival, growth and invasion both in primary and metastatic brain lesions. Two major categories of agents have been developed to target this pathway: antibody-based agents and VEGF receptor tyrosine kinase inhibitors (TKIs). Clinical benefits have been shown with anti-angiogenetic therapies in the treatment of metastatic NSCLC. However, patients with CNS metastases were often excluded from trials with these agents, due to concerns about a potentially greater risk of cerebral haemorrhage and thromboembolic disease. Therefore, the overall efficacy and safety of angiogenetic agents in patients with BM from NSCLC are yet to be clarified. This paper aims to review available data about the efficacy and safety of anti-angiogenetic therapies for CNS metastases in NSCLC patients.
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Affiliation(s)
- Consuelo Buttigliero
- Department of Oncology, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Valentina Bertaglia
- Department of Oncology, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Silvia Novello
- Department of Oncology, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
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Buttigliero C, Tucci M, Vignani F, Pisano C, Bertaglia V, Pignataro D, Bironzo P, Guglielmini P, Scagliotti G, Di Maio M. Prognostic impact of pre-treatment neutrophil-to-lymphocyte ratio in castration-resistant prostate cancer patients treated with first-line docetaxel. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw334.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Tucci M, Buttigliero C, Vignani F, Iaconis D, Bertaglia V, Bironzo P, Pignataro D, Scagliotti G, Di Maio M. Sequencing cabazitaxel and new generation hormonal treatments in metastatic castration resistant prostate cancer patients after first line docetaxel: a retrospective analysis. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw334.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Vignani F, Bertaglia V, Buttigliero C, Tucci M, Scagliotti GV, Di Maio M. Skeletal metastases and impact of anticancer and bone-targeted agents in patients with castration-resistant prostate cancer. Cancer Treat Rev 2016; 44:61-73. [PMID: 26907461 DOI: 10.1016/j.ctrv.2016.02.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [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: 11/17/2015] [Revised: 02/03/2016] [Accepted: 02/05/2016] [Indexed: 12/27/2022]
Abstract
Incidence of bone metastases is very high in advanced prostate cancer patients. Bone metastases likely have a significant impact on functional status and quality of life, not only related to pain, but also to the relevant risk of skeletal-related events. A better understanding of mechanisms associated with bone metastatic disease secondary to prostate cancer and more specifically to the cross-talk between tumor cells and bone microenvironment in metastatic progression represented the background for the development of new effective bone-targeted therapies. Furthermore, a better knowledge of biological mechanisms driving disease progression led to significant advances in the treatment of castration-resistant prostate cancer, with the development and approval of new effective drugs. Aim of this review is to outline the physiopathology of bone metastases in prostate cancer and summarize the main results of clinical trials conducted with different drugs to control morbidity induced by skeletal metastases and bone disease progression. For each agent, therapeutic effect on bone metastases has been measured in terms of pain control and/or incidence of skeletal-related events, usually defined as a composite endpoint, including the need for local treatment (radiation therapy or surgery), spinal cord compression, pathological bone fractures. In details, data obtained with chemotherapy (mitoxantrone, docetaxel, cabazitaxel), new generation hormonal agents (abiraterone, enzalutamide), radium-223, bone-targeted agents (zoledronic acid, denosumab) and with several experimental agents (cabozantinib, dasatinib, anti-endothelin and other agents) in patients with castration-resistant prostate cancer are reviewed.
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Affiliation(s)
- Francesca Vignani
- Division of Medical Oncology, Department of Oncology, University of Turin at San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Valentina Bertaglia
- Division of Medical Oncology, Department of Oncology, University of Turin at San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Consuelo Buttigliero
- Division of Medical Oncology, Department of Oncology, University of Turin at San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Marcello Tucci
- Division of Medical Oncology, Department of Oncology, University of Turin at San Luigi Gonzaga Hospital, Orbassano, Turin, Italy.
| | - Giorgio V Scagliotti
- Division of Medical Oncology, Department of Oncology, University of Turin at San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Massimo Di Maio
- Division of Medical Oncology, Department of Oncology, University of Turin at San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
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Tucci M, Bertaglia V, Vignani F, Buttigliero C, Berruti A, Scagliotti G, Di Maio M. Association between levels of hormones implied in steroid biosynthesis pathway and activity of abiraterone acetate (AA) in patients (pts) with metastatic castration- resistant prostate cancer (mCRPC): an exploratory analysis. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv341.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Buttigliero C, Vana F, Bertaglia V, Vignani F, Fiori C, Osella G, Porpiglia F, Tucci M, Scagliotti GV, Berruti A. The fat body mass increase after adjuvant androgen deprivation therapy is predictive of prostate cancer outcome. Endocrine 2015; 50:223-30. [PMID: 25588772 DOI: 10.1007/s12020-015-0525-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 01/06/2015] [Indexed: 01/05/2023]
Abstract
Androgen deprivation therapy (ADT) leads to important changes in body composition. No data are currently available about the relationship between these treatment-related changes and patient outcome. Using dual-energy X-ray absorptiometry, bone mineral density (BMD), fat body mass (FBM), and lean body mass (LBM) were determined at baseline, and after 1 and 2 years in 53 non-metastatic prostate cancer (PC) patients with high-risk disease treated with adjuvant ADT. Changes in these parameters were correlated with patient outcome in terms of adverse skeletal events, disease recurrence, and overall survival. ADT led to a significant decrease in BMD (p < 0.03) and LBM (p < 0.03), and an increase in FBM, (p < 0.0001). Changes in BMD failed to show any relationship with time to skeletal-related events (SRE), disease recurrence, and death. FBM increase was a significant predictor of higher risk of SRE [hazard ratio (HR) 3.024, 95 % CI 1.004-10.353, p < 0.02], higher risk of death (HR 2.373, 95 % CI 1.012-5.567, p = 0.04), and a non-significant higher risk of disease recurrence (HR 2.219, 95 % CI 0.956-5.150, p = 0.13). LBM decrease did not correlate with either time to SRE or survival, while a non-significant association with disease recurrence (HR 1.550, 95 % CI 0.670-3.605, p = 0.06) was observed. The early increase in FBM may provide predictive information of poor outcome in PC patients given ADT. These data suggest that the adoption of early preventive measures aiming to reduce fat increase can potentially reduce the morbidity and mortality risk.
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Affiliation(s)
- Consuelo Buttigliero
- Department of Oncology, Medical Oncology, University of Turin at San Luigi Hospital, Regione Gonzole 10, 10043, Orbassano, Italy,
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Buttigliero C, Tucci M, Bertaglia V, Vignani F, Bironzo P, Di Maio M, Scagliotti GV. Understanding and overcoming the mechanisms of primary and acquired resistance to abiraterone and enzalutamide in castration resistant prostate cancer. Cancer Treat Rev 2015; 41:884-92. [PMID: 26342718 DOI: 10.1016/j.ctrv.2015.08.002] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [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: 06/17/2015] [Revised: 08/16/2015] [Accepted: 08/24/2015] [Indexed: 02/08/2023]
Abstract
In recent years, in castration resistant prostate cancer (CRPC), several new drugs have been approved that prolong overall survival, including enzalutamide and abiraterone, two new-generation hormonal therapies. Despite the demonstrated benefit of these agents, not all patients with CRPC are responsive to treatment, the gain in median progression-free survival with these therapies compared to standard of care is, rather disappointingly, still less than six months and the appearance of acquired resistance is almost universal. Approximately one third of patients treated with abiraterone and 25% of those treated with enzalutamide show primary resistance to these agents. Even if the mechanisms of resistance to these agents are not fully defined, many hypotheses are emerging, including systemic and intratumoral androgen biosynthesis up-regulation, androgen receptor (AR) gene mutations and amplifications, alteration of pathways involved in cross-talk with AR signaling, glucocorticoid receptor overexpression, neuroendocrine differentiation, immune system deregulation and others. The aim of this paper is to review currently available data about mechanisms of resistance to abiraterone and enzalutamide, and to discuss how these mechanisms could be potentially overcome through novel therapeutic agents.
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Affiliation(s)
- Consuelo Buttigliero
- Department of Oncology, Medical Oncology, University of Turin at San Luigi Hospital, Orbassano, Italy.
| | - Marcello Tucci
- Department of Oncology, Medical Oncology, University of Turin at San Luigi Hospital, Orbassano, Italy
| | - Valentina Bertaglia
- Department of Oncology, Medical Oncology, University of Turin at San Luigi Hospital, Orbassano, Italy
| | - Francesca Vignani
- Department of Oncology, Medical Oncology, University of Turin at San Luigi Hospital, Orbassano, Italy
| | - Paolo Bironzo
- Department of Oncology, Medical Oncology, University of Turin at San Luigi Hospital, Orbassano, Italy
| | - Massimo Di Maio
- Department of Oncology, Medical Oncology, University of Turin at San Luigi Hospital, Orbassano, Italy
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Tucci M, Vignani F, Bertaglia V, Buttigliero C, Berruti A, Scagliotti GV, Di Maio M. Association between levels of hormones implied in steroid biosynthesis pathway and activity of abiraterone acetate (AA) in patients (pts) with metastatic castration-resistant prostate cancer (mCRPC): An exploratory analysis. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e16066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Marcello Tucci
- Department of Oncology, AOU San Luigi Gonzaga, Orbassano (TO), Italy
| | - Francesca Vignani
- Department of Oncology, AOU San Luigi Gonzaga, Orbassano (TO), Italy
| | | | | | | | - Giorgio V. Scagliotti
- Department of Oncology, University of Turin, AOU S. Luigi Gonzaga, Orbassano (TO), Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin, AOU S. Luigi Gonzaga, Orbassano (TO), Italy
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Berruti A, Amoroso V, Gallo F, Bertaglia V, Simoncini E, Pedersini R, Ferrari L, Bottini A, Bruzzi P, Sormani MP. Pathologic complete response as a potential surrogate for the clinical outcome in patients with breast cancer after neoadjuvant therapy: a meta-regression of 29 randomized prospective studies. J Clin Oncol 2014; 32:3883-91. [PMID: 25349292 DOI: 10.1200/jco.2014.55.2836] [Citation(s) in RCA: 163] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To assess the role of pathologic complete response (pCR) after neoadjuvant therapy as surrogate end point of disease-free survival (DFS) and overall survival (OS) in patients with breast cancer, we performed a trial-based meta-regression of randomized studies comparing different neoadjuvant systemic treatments. METHODS The systematic literature search included electronic databases and proceedings of oncologic meetings. Endocrine therapy trials were excluded. Treatment effects on DFS and OS were expressed as hazard ratios (HRs), and treatment effects on pCR were expressed as odds ratios (ORs). A weighted regression analysis was performed on log-transformed treatment effect estimates to test the association between treatment effects on the surrogate outcome and treatment effects on the clinical outcome. RESULTS Twenty-nine trials, 59 arms, and 30 comparisons, for a total of 14,641 patients, were included in the analysis. Using the complete set of data, the regression of either the log(HR) for DFS or the log(HR) for OS on the log(OR) for pCR demonstrated only weak associations (R(2) = 0.08; 95% CI, 0 to 0.47; and R(2) = 0.09; 95% CI, 0.01 to 0.41, respectively). Better associations were found in an exploratory analysis assessing a subset of trials comparing intensified/dose-dense chemotherapy versus standard-dose regimens (DFS: R(2) = 0.79; 95% CI, 0.26 to 0.95; P = .003; and OS: R(2) = 0.57; 95% CI, 0.19 to 0.93; P = .03). CONCLUSION This meta-regression analysis of 29 heterogeneous neoadjuvant trials does not support the use of pCR as a surrogate end point for DFS and OS in patients with breast cancer. However, pCR may potentially meet the criteria of surrogacy with specific systemic therapies.
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Affiliation(s)
- Alfredo Berruti
- Alfredo Berruti, Vito Amoroso, and Laura Ferrari, University of Brescia at Spedali Civili Hospital; Edda Simoncini and Rebecca Pedersini, Spedali Civili Hospital, Brescia; Fabio Gallo and Maria Pia Sormani, University of Genoa; Paolo Bruzzi, Istituto di Ricovero e Cura a Carattere Scientifico San Martino, Istituto Nazionale per la Ricerca sul Cancro, Genoa; Valentina Bertaglia, University of Turin, at San Luigi Gonzaga Hospital, Orbassano; and Alberto Bottini, Istituti Ospitalieri Hospital, Cremona, Italy.
| | - Vito Amoroso
- Alfredo Berruti, Vito Amoroso, and Laura Ferrari, University of Brescia at Spedali Civili Hospital; Edda Simoncini and Rebecca Pedersini, Spedali Civili Hospital, Brescia; Fabio Gallo and Maria Pia Sormani, University of Genoa; Paolo Bruzzi, Istituto di Ricovero e Cura a Carattere Scientifico San Martino, Istituto Nazionale per la Ricerca sul Cancro, Genoa; Valentina Bertaglia, University of Turin, at San Luigi Gonzaga Hospital, Orbassano; and Alberto Bottini, Istituti Ospitalieri Hospital, Cremona, Italy
| | - Fabio Gallo
- Alfredo Berruti, Vito Amoroso, and Laura Ferrari, University of Brescia at Spedali Civili Hospital; Edda Simoncini and Rebecca Pedersini, Spedali Civili Hospital, Brescia; Fabio Gallo and Maria Pia Sormani, University of Genoa; Paolo Bruzzi, Istituto di Ricovero e Cura a Carattere Scientifico San Martino, Istituto Nazionale per la Ricerca sul Cancro, Genoa; Valentina Bertaglia, University of Turin, at San Luigi Gonzaga Hospital, Orbassano; and Alberto Bottini, Istituti Ospitalieri Hospital, Cremona, Italy
| | - Valentina Bertaglia
- Alfredo Berruti, Vito Amoroso, and Laura Ferrari, University of Brescia at Spedali Civili Hospital; Edda Simoncini and Rebecca Pedersini, Spedali Civili Hospital, Brescia; Fabio Gallo and Maria Pia Sormani, University of Genoa; Paolo Bruzzi, Istituto di Ricovero e Cura a Carattere Scientifico San Martino, Istituto Nazionale per la Ricerca sul Cancro, Genoa; Valentina Bertaglia, University of Turin, at San Luigi Gonzaga Hospital, Orbassano; and Alberto Bottini, Istituti Ospitalieri Hospital, Cremona, Italy
| | - Edda Simoncini
- Alfredo Berruti, Vito Amoroso, and Laura Ferrari, University of Brescia at Spedali Civili Hospital; Edda Simoncini and Rebecca Pedersini, Spedali Civili Hospital, Brescia; Fabio Gallo and Maria Pia Sormani, University of Genoa; Paolo Bruzzi, Istituto di Ricovero e Cura a Carattere Scientifico San Martino, Istituto Nazionale per la Ricerca sul Cancro, Genoa; Valentina Bertaglia, University of Turin, at San Luigi Gonzaga Hospital, Orbassano; and Alberto Bottini, Istituti Ospitalieri Hospital, Cremona, Italy
| | - Rebecca Pedersini
- Alfredo Berruti, Vito Amoroso, and Laura Ferrari, University of Brescia at Spedali Civili Hospital; Edda Simoncini and Rebecca Pedersini, Spedali Civili Hospital, Brescia; Fabio Gallo and Maria Pia Sormani, University of Genoa; Paolo Bruzzi, Istituto di Ricovero e Cura a Carattere Scientifico San Martino, Istituto Nazionale per la Ricerca sul Cancro, Genoa; Valentina Bertaglia, University of Turin, at San Luigi Gonzaga Hospital, Orbassano; and Alberto Bottini, Istituti Ospitalieri Hospital, Cremona, Italy
| | - Laura Ferrari
- Alfredo Berruti, Vito Amoroso, and Laura Ferrari, University of Brescia at Spedali Civili Hospital; Edda Simoncini and Rebecca Pedersini, Spedali Civili Hospital, Brescia; Fabio Gallo and Maria Pia Sormani, University of Genoa; Paolo Bruzzi, Istituto di Ricovero e Cura a Carattere Scientifico San Martino, Istituto Nazionale per la Ricerca sul Cancro, Genoa; Valentina Bertaglia, University of Turin, at San Luigi Gonzaga Hospital, Orbassano; and Alberto Bottini, Istituti Ospitalieri Hospital, Cremona, Italy
| | - Alberto Bottini
- Alfredo Berruti, Vito Amoroso, and Laura Ferrari, University of Brescia at Spedali Civili Hospital; Edda Simoncini and Rebecca Pedersini, Spedali Civili Hospital, Brescia; Fabio Gallo and Maria Pia Sormani, University of Genoa; Paolo Bruzzi, Istituto di Ricovero e Cura a Carattere Scientifico San Martino, Istituto Nazionale per la Ricerca sul Cancro, Genoa; Valentina Bertaglia, University of Turin, at San Luigi Gonzaga Hospital, Orbassano; and Alberto Bottini, Istituti Ospitalieri Hospital, Cremona, Italy
| | - Paolo Bruzzi
- Alfredo Berruti, Vito Amoroso, and Laura Ferrari, University of Brescia at Spedali Civili Hospital; Edda Simoncini and Rebecca Pedersini, Spedali Civili Hospital, Brescia; Fabio Gallo and Maria Pia Sormani, University of Genoa; Paolo Bruzzi, Istituto di Ricovero e Cura a Carattere Scientifico San Martino, Istituto Nazionale per la Ricerca sul Cancro, Genoa; Valentina Bertaglia, University of Turin, at San Luigi Gonzaga Hospital, Orbassano; and Alberto Bottini, Istituti Ospitalieri Hospital, Cremona, Italy
| | - Maria Pia Sormani
- Alfredo Berruti, Vito Amoroso, and Laura Ferrari, University of Brescia at Spedali Civili Hospital; Edda Simoncini and Rebecca Pedersini, Spedali Civili Hospital, Brescia; Fabio Gallo and Maria Pia Sormani, University of Genoa; Paolo Bruzzi, Istituto di Ricovero e Cura a Carattere Scientifico San Martino, Istituto Nazionale per la Ricerca sul Cancro, Genoa; Valentina Bertaglia, University of Turin, at San Luigi Gonzaga Hospital, Orbassano; and Alberto Bottini, Istituti Ospitalieri Hospital, Cremona, Italy
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Tariq N, Bertaglia V, Shah N, Mele T, Alamgir R, Khan N, Summers Y, Taylor P, Harris M, Bayman N, Sheikh H, Chittalia A, Pemberton L, Lee L, Coote J, Faivre-Finn C, Scagliotti G, Blackhall F, Novello S, Califano R. Outcomes of Elderly Patients (≥70 Yo) with Advanced Non-Small Cell Lung Cancer (Nsclc): a Multi-Institutional Analysis. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu349.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Amoroso V, Berruti A, Gallo F, Bertaglia V, Paloja E, Simoncini EL, Generali D, Bottini A, Bruzzi P, Sormani MP. Abstract P3-14-03: Pathological complete response after primary chemotherapy as a surrogate end point of treatment efficacy in breast cancer patients: A trial-based meta-analysis. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p3-14-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: The relationship between pathological complete response (pCR) and improved long-term prognosis was first reported in the landmark NSABP B-18 and B-27 trials and then validated in large cohort studies and in meta-analyses. Whether pCR, as surrogate end point, should capture the full effect of neoadjuvant chemotherapy on survival is still unproven. To assess the role of pCR as surrogate of disease-free survival (DFS) and overall survival (OS) at a trial level, we performed a trial-based meta-regression of randomized studies comparing different neoadjuvant therapies with data on both pCR rates and outcome end points.
Methods: The systematic search included electronic databases and proceeding of international meetings. No restriction regarding treatment types was set up except for endocrine therapy trials that were excluded. We did not include studies comparing neoadjuvant versus adjuvant chemotherapy. Relevant data were extracted from each selected trial: patients randomly assigned to treatment and analyzed per arm, tumor stage, type of chemotherapy and targeted therapy, cycles number, additional post-surgical treatments, number of patients achieving pCR and number of outcome events per arm. For each trial, the experimental and the control arm were defined. Treatment effects on DFS and OS were expressed as hazard ratios (HRs) and on pCR as odd ratios (ORs). A weighted regression analysis was performed on log-transformed treatment effect estimates to test the association between the treatment effects on the surrogate outcome and the treatment effects on the clinical outcome.
Results: A final set of 28 trials, 57 arms and 29 contrasts for a total of 13,738 patients was included in the analysis. As one trial had 3 arms, it contributed two contrasts to the analysis. The regression of the logHR for DFS on the logOR for pCR, using the complete set of data, demonstrated a weak but significant association between the two effects (R2 = 0.16, p-value = 0.03). Sixteen% of the variability among the effects on DFS can be explained by the observed effects on pCR. The regression of the logHR for OS on the logOR for pCR demonstrated a weak association between the two effects (R2 = 0.15, p-value = 0.04).
Conclusions: This trial-based meta-regression showed a possible role of pCR as surrogate end point for DFS and OS in breast cancer patients treated with neoadjuvant chemotherapy. The surrogacy of pCR warrants to be further evaluated in more homogeneous subsets of clinical trials in the neoadjuvant chemotherapy-based setting.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-14-03.
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Affiliation(s)
- V Amoroso
- University of Brescia and Spedali Civili of Brescia, Brescia, Italy; University of Genoa, Genoa, Italy; University of Turin, San Luigi Hospital, Orbassano, Italy; Istituti Ospitalieri of Cremona, Cremona, Italy
| | - A Berruti
- University of Brescia and Spedali Civili of Brescia, Brescia, Italy; University of Genoa, Genoa, Italy; University of Turin, San Luigi Hospital, Orbassano, Italy; Istituti Ospitalieri of Cremona, Cremona, Italy
| | - F Gallo
- University of Brescia and Spedali Civili of Brescia, Brescia, Italy; University of Genoa, Genoa, Italy; University of Turin, San Luigi Hospital, Orbassano, Italy; Istituti Ospitalieri of Cremona, Cremona, Italy
| | - V Bertaglia
- University of Brescia and Spedali Civili of Brescia, Brescia, Italy; University of Genoa, Genoa, Italy; University of Turin, San Luigi Hospital, Orbassano, Italy; Istituti Ospitalieri of Cremona, Cremona, Italy
| | - E Paloja
- University of Brescia and Spedali Civili of Brescia, Brescia, Italy; University of Genoa, Genoa, Italy; University of Turin, San Luigi Hospital, Orbassano, Italy; Istituti Ospitalieri of Cremona, Cremona, Italy
| | - EL Simoncini
- University of Brescia and Spedali Civili of Brescia, Brescia, Italy; University of Genoa, Genoa, Italy; University of Turin, San Luigi Hospital, Orbassano, Italy; Istituti Ospitalieri of Cremona, Cremona, Italy
| | - D Generali
- University of Brescia and Spedali Civili of Brescia, Brescia, Italy; University of Genoa, Genoa, Italy; University of Turin, San Luigi Hospital, Orbassano, Italy; Istituti Ospitalieri of Cremona, Cremona, Italy
| | - A Bottini
- University of Brescia and Spedali Civili of Brescia, Brescia, Italy; University of Genoa, Genoa, Italy; University of Turin, San Luigi Hospital, Orbassano, Italy; Istituti Ospitalieri of Cremona, Cremona, Italy
| | - P Bruzzi
- University of Brescia and Spedali Civili of Brescia, Brescia, Italy; University of Genoa, Genoa, Italy; University of Turin, San Luigi Hospital, Orbassano, Italy; Istituti Ospitalieri of Cremona, Cremona, Italy
| | - MP Sormani
- University of Brescia and Spedali Civili of Brescia, Brescia, Italy; University of Genoa, Genoa, Italy; University of Turin, San Luigi Hospital, Orbassano, Italy; Istituti Ospitalieri of Cremona, Cremona, Italy
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Porpiglia F, Fiori C, Bertaglia V, Tucci M, Aroasio E, Poggio M, Buttigliero C, Grande S, Saini A, Berruti A. 939 PROGNOSTIC ROLE OF SERUM TESTOSTERONE LEVELS IN PROSTATE CANCER PATIENTS DURING ANDROGEN-DEPRIVATION THERAPY. J Urol 2012. [DOI: 10.1016/j.juro.2012.02.1037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Berruti A, Generali D, Bertaglia V, Brizzi MP, Mele T, Dogliotti L, Bruzzi P, Bottini A. Intermediate endpoints of primary systemic therapy in breast cancer patients. J Natl Cancer Inst Monogr 2012; 2011:142-6. [PMID: 22043062 DOI: 10.1093/jncimonographs/lgr036] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Primary systemic therapy (PST) in breast cancer offers the opportunity to explore interactions between tumor biology and administered treatment. Changes in clinical, tissue-based, or imaging markers can provide information on the mechanisms of PST activity (activity endpoints) or predict treatment efficacy (surrogate endpoints). The most frequently used intermediate endpoint for PST is pathological complete response, but its role as a surrogate parameter of efficacy has not yet been demonstrated. Changes in tumor biology after PST may occur already a few days after treatment start; this implies that new potential surrogates occurring much earlier than pathological complete response (ie, the proliferation marker Ki67) can be identified and that short-term preoperative trials (window-of-opportunity trials) can be designed using a biological parameter as a primary endpoint. From these small trials, crucial information can be gleaned about the activity of new drugs for the design of large clinical trials.
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Affiliation(s)
- Alfredo Berruti
- Oncologia Medica, Azienda Ospedaliero Universitaria San Luigi, 10043 Orbassano, Italy.
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Saini A, Berruti A, Cracco C, Sguazzotti E, Porpiglia F, Russo L, Bertaglia V, Picci RL, Negro M, Tosco A, Campagna S, Scarpa RM, Dogliotti L, Furlan PM, Ostacoli L. Psychological distress in men with prostate cancer receiving adjuvant androgen-deprivation therapy. Urol Oncol 2011; 31:352-8. [PMID: 21803612 DOI: 10.1016/j.urolonc.2011.02.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Revised: 02/08/2011] [Accepted: 02/08/2011] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To compare the occurrence of depression, anxiety, self body image perception, sleep disturbances, and diminished quality of life in prostate cancer patients undergoing adjuvant androgen-deprivation therapy (ADT) as opposed to patients in follow-up alone. METHODS AND MATERIALS Hospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index, Restless Legs Syndrome Study Group essential diagnostic criteria, Body Image Scale and Functional Assessment of Cancer Therapy Prostate were administered to consecutive prostate cancer patients who underwent radical prostatectomy or radiation therapy and are presently either under adjuvant ADT or included in a follow-up program. RESULTS Of the 103 patients enrolled, 49 (47.6%) were receiving adjuvant ADT and 54 (52.4%) were not. Compared with the controls, the patients undergoing ADT showed higher levels of depression (P = 0.002), worse self body image perception (P = 0.001), worse quality of life (P = 0.0001) and worse sleep quality (P = 0.04). ADT was significantly associated with depression at multivariate analysis after adjustment for age, stage, Gleason score, as well as demographic and social variables (P = 0.001). Depression scores showed a strong inverse correlation with quality of life scores (P < 0.01). CONCLUSIONS Adjuvant ADT is associated with depression, worse quality of life, and altered self body image in prostate cancer patients.
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Affiliation(s)
- Andrea Saini
- Medical Oncology, Department of Clinical and Biological Sciences, University of Torino, Italy.
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Berruti A, Vignani F, Russo L, Bertaglia V, Tullio M, Tucci M, Poggio M, Dogliotti L. Prognostic role of neuroendocrine differentiation in prostate cancer, putting together the pieces of the puzzle. Res Rep Urol 2010; 2:109-24. [PMID: 24198620 PMCID: PMC3818883 DOI: 10.2147/rru.s6573] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Neuroendocrine (NE) differentiation is a common feature in prostate cancer (PC). The clinical significance of this phenomenon is controversial; however preclinical and clinical data are in favor of an association with poor prognosis and early onset of a castrate resistant status. NE PC cells do not proliferate, but they can stimulate the proliferation of the exocrine component through the production of paracrine growth factors. The same paracrine signals may favor the outgrowth of castrate adapted tumors through androgen receptor dependent or independent mechanisms. Noteworthy, NE differentiation in PC is not a stable phenotype, being stimulated by several agents including androgen deprivation therapy, radiation therapy, and chemotherapy. The proportion of NE positive PC, therefore, is destined to increase during the natural history of the disease. This may complicate the assessment of the prognostic significance of this phenomenon. The majority of clinical studies have shown a significant correlation between NE differentiation and disease prognosis, confirming the preclinical rationale. In conclusion the NE phenotype is a prognostic parameter in PC. Whether this phenomenon is a pure prognostic factor or whether it can influence the prognosis by favoring the onset of a castrate resistance status is a matter of future research.
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Affiliation(s)
- Alfredo Berruti
- Oncologia Medica, Università di Torino, Azienda Ospedaliero Universitaria San Luigi, Orbassano, Italy
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