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Fanotto V, Rossini D, Casagrande M, Bergamo F, Spagnoletti A, Santini D, Antoniotti C, Cupini S, Daniel F, Nasca V, Vetere G, Zaniboni A, Borelli B, Carullo M, Conca V, Passardi A, Tamburini E, Masi G, Pella N, Cremolini C. Primary Tumor Resection in Synchronous Metastatic Colorectal Cancer Patients Treated with Upfront Chemotherapy plus Bevacizumab: A Pooled Analysis of TRIBE and TRIBE2 Studies. Cancers (Basel) 2023; 15:5451. [PMID: 38001711 PMCID: PMC10670103 DOI: 10.3390/cancers15225451] [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: 10/07/2023] [Revised: 11/08/2023] [Accepted: 11/11/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND The decision to resect or not the primary tumor in asymptomatic patients with synchronous metastatic colorectal cancer (mCRC) is a complex and challenging issue for oncologists, especially when an antiangiogenic-based therapy is planned. METHODS Patients enrolled in the phase III TRIBE and TRIBE2 studies that compared upfront FOLFOXIRI + bevacizumab to FOLFIRI or FOLFOX + bevacizumab, respectively, were included. We assessed the association of primary tumor resection (PTR) with progression-free survival (PFS), overall survival (OS), response rate (ORR), rate of grade > 2 adverse events (AEs), and serious gastrointestinal and surgical AEs in the overall population and according to the treatment arm. RESULTS Of the 999 patients included, 513 (51%) underwent PTR at baseline. Longer PFS and OS were observed in resected patients compared to those with unresected primary tumors: 11.2 vs. 10.0 months (p < 0.001) and 26.6 vs. 22.5 (p < 0.001), respectively. In multivariate models, PTR was confirmed as an independent prognostic factor for better PFS (p = 0.032) and OS (p = 0.018). Patients with PTR experienced a higher incidence of grade 3 or 4 diarrhea (p = 0.055) and lower incidence of anemia (p = 0.053), perforation (p = 0.015), and serious gastrointestinal and surgical AEs (p < 0.001). No statistically significant differences were noted in incidence of bleeding (p = 0.39). The benefit of FOLFOXIRI + bevacizumab in terms of PFS (p for interaction: 0.46), OS (p for interaction: 0.80), ORR (p for interaction: 0.36), and incidence of grade 3 or 4 AEs was independent of PTR. CONCLUSIONS PTR at baseline was independently associated with good prognosis in synchronous mCRC patients and with lower incidence of serious gastrointestinal and surgical AEs during upfront chemotherapy plus bevacizumab. The benefit and toxicity profile of FOLFOXIRI plus bevacizumab was independent of PTR.
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Affiliation(s)
- Valentina Fanotto
- Department of Oncology, Academic Hospital of Udine, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), 33100 Udine, Italy; (V.F.); (M.C.); (N.P.)
| | - Daniele Rossini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Savi 10, 56126 Pisa, Italy; (D.R.); (C.A.); (G.V.); (B.B.); (M.C.); (V.C.); (G.M.)
- UO Oncologia 2 Universitaria, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy
| | - Mariaelena Casagrande
- Department of Oncology, Academic Hospital of Udine, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), 33100 Udine, Italy; (V.F.); (M.C.); (N.P.)
| | - Francesca Bergamo
- Medical Oncology 1, Veneto Institute of Oncology IOV—IRCCS, 35128 Padua, Italy; (F.B.); (F.D.)
| | - Andrea Spagnoletti
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori, 20133 Milan, Italy; (A.S.); (V.N.)
| | - Daniele Santini
- Medical Oncology Unit A, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy;
| | - Carlotta Antoniotti
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Savi 10, 56126 Pisa, Italy; (D.R.); (C.A.); (G.V.); (B.B.); (M.C.); (V.C.); (G.M.)
- UO Oncologia 2 Universitaria, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy
| | - Samanta Cupini
- Department of Oncology, Division of Medical Oncology, Azienda USL Toscana Nord Ovest, 57124 Livorno, Italy;
| | - Francesca Daniel
- Medical Oncology 1, Veneto Institute of Oncology IOV—IRCCS, 35128 Padua, Italy; (F.B.); (F.D.)
| | - Vincenzo Nasca
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori, 20133 Milan, Italy; (A.S.); (V.N.)
| | - Guglielmo Vetere
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Savi 10, 56126 Pisa, Italy; (D.R.); (C.A.); (G.V.); (B.B.); (M.C.); (V.C.); (G.M.)
- UO Oncologia 2 Universitaria, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy
| | - Alberto Zaniboni
- Oncology Department, Istituto Ospedaliero Fondazione Poliambulanza, 25124 Brescia, Italy;
| | - Beatrice Borelli
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Savi 10, 56126 Pisa, Italy; (D.R.); (C.A.); (G.V.); (B.B.); (M.C.); (V.C.); (G.M.)
- UO Oncologia 2 Universitaria, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy
| | - Martina Carullo
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Savi 10, 56126 Pisa, Italy; (D.R.); (C.A.); (G.V.); (B.B.); (M.C.); (V.C.); (G.M.)
- UO Oncologia 2 Universitaria, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy
| | - Veronica Conca
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Savi 10, 56126 Pisa, Italy; (D.R.); (C.A.); (G.V.); (B.B.); (M.C.); (V.C.); (G.M.)
- UO Oncologia 2 Universitaria, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy
| | - Alessandro Passardi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy;
| | - Emiliano Tamburini
- Oncology Department and Palliative Care, Cardinale Panico Tricase City Hospital, 73039 Tricase, Italy;
| | - Gianluca Masi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Savi 10, 56126 Pisa, Italy; (D.R.); (C.A.); (G.V.); (B.B.); (M.C.); (V.C.); (G.M.)
- UO Oncologia 2 Universitaria, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy
| | - Nicoletta Pella
- Department of Oncology, Academic Hospital of Udine, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), 33100 Udine, Italy; (V.F.); (M.C.); (N.P.)
| | - Chiara Cremolini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Savi 10, 56126 Pisa, Italy; (D.R.); (C.A.); (G.V.); (B.B.); (M.C.); (V.C.); (G.M.)
- UO Oncologia 2 Universitaria, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy
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Moretto R, Germani MM, Giordano M, Conca V, Proietti A, Niccoli C, Pietrantonio F, Lonardi S, Tamburini E, Zaniboni A, Passardi A, Latiano TP, Fanotto V, Di Donato S, Prisciandaro M, Bergamo F, Masi G, Fontanini G, Ugolini C, Cremolini C. Trop-2 and Nectin-4 immunohistochemical expression in metastatic colorectal cancer: searching for the right population for drugs' development. Br J Cancer 2023; 128:1391-1399. [PMID: 36759721 PMCID: PMC10049995 DOI: 10.1038/s41416-023-02180-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 01/19/2023] [Accepted: 01/23/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Trop-2 and Nectin-4 are transmembrane proteins overexpressed in many tumours and targets of antibody-drug conjugates (ADC). In metastatic colorectal cancer (mCRC), the role of Trop-2 and Nectin-4 has been poorly investigated. METHODS Tumour samples of patients randomised in the phase III TRIBE2 were assessed for Trop-2 and Nectin-4 expression. RESULTS Three hundred eighty-six tumours were assessed for Trop-2 expression. 90 (23%), 115 (30%) and 181 (47%) were Trop-2 high, medium and low, respectively. Patients with low Trop-2 tumours achieved longer PFS (12 versus 9.9 months, p = 0.047) and OS (27.3 versus 21.3 months, p = 0.015) than those with high/medium Trop-2 tumours. These findings were confirmed in multivariate analysis (p = 0.022 and p = 0.023, respectively). A greater OS benefit from treatment intensification with FOLFOXIRI/bevacizumab was observed in patients with high/medium Trop-2 tumours (p-for-interaction = 0.041). Two hundred fifty-one tumours were assessed for Nectin-4 expression. Fourteen (5%), 67 (27%) and 170 (68%) were high, medium and low, respectively. No prognostic impact was observed based on Nectin-4 expression and no interaction effect was reported between Nectin-4 expression groups and treatment arm. CONCLUSIONS In mCRC, expression levels of Trop-2 and Nectin-4 are heterogeneous, suggesting a target-driven development of anti-Trop2 and anti-Nectin-4 ADCs. Medium/high Trop-2 expression is associated with worse prognosis and higher benefit from chemotherapy intensification.
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Affiliation(s)
- Roberto Moretto
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Marco Maria Germani
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
- Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Mirella Giordano
- Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Veronica Conca
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
- Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Agnese Proietti
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Cristina Niccoli
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Filippo Pietrantonio
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sara Lonardi
- Medical Oncology Unit 3, Veneto Institute of Oncology-IRCCS, Padua, Italy
| | - Emiliano Tamburini
- Oncology Unit, Ospedale degli Infermi, Rimini, Italy
- Department of Oncology and Palliative Care, Cardinale Panico Tricase City Hospital, Tricase, Italy
| | | | - Alessandro Passardi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per Lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Tiziana Pia Latiano
- Oncology Unit, Foundation IRCCS, Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Valentina Fanotto
- Department of Oncology, ASUFC University Hospital of Udine, Udine, Italy
| | - Samantha Di Donato
- Department of Medical Oncology, Santo Stefano General Hospital, Prato, Italy
| | - Michele Prisciandaro
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Francesca Bergamo
- Medical Oncology Unit 3, Veneto Institute of Oncology-IRCCS, Padua, Italy
| | - Gianluca Masi
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
- Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Gabriella Fontanini
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Clara Ugolini
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Chiara Cremolini
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
- Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy.
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Fanotto V, Salani F, Vivaldi C, Scartozzi M, Ribero D, Puzzoni M, Montagnani F, Leone F, Vasile E, Bencivenga M, De Manzoni G, Basile D, Fornaro L, Masi G, Aprile G. Primary Tumor Resection for Metastatic Colorectal, Gastric and Pancreatic Cancer Patients: In Search of Scientific Evidence to Inform Clinical Practice. Cancers (Basel) 2023; 15:cancers15030900. [PMID: 36765854 PMCID: PMC9913845 DOI: 10.3390/cancers15030900] [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: 12/23/2022] [Revised: 01/24/2023] [Accepted: 01/28/2023] [Indexed: 02/05/2023] Open
Abstract
The management of the primary tumor in metastatic colorectal, gastric and pancreatic cancer patients may be challenging. Indeed, primary tumor progression could be associated with severe symptoms, compromising the quality of life and the feasibility of effective systemic therapy, and might result in life-threatening complications. While retrospective series have suggested that surgery on the primary tumor may confer a survival advantage even in asymptomatic patients, randomized trials seem not to definitively support this hypothesis. We discuss the evidence for and against primary tumor resection for patients with metastatic gastrointestinal (colorectal, gastric and pancreatic) cancers treated with systemic therapies and put in context the pros and cons of the onco-surgical approach in the time of precision oncology. We also evaluate current ongoing trials on this topic, anticipating how these will influence both research and everyday practice.
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Affiliation(s)
- Valentina Fanotto
- Department of Oncology, Academic Hospital of Udine, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Piazzale Santa Maria della Misericordia, 33100 Udine, Italy
| | - Francesca Salani
- Unit of Oncology 2, Azienda Ospedaliero-Universitaria Pisana, 56126 Pisa, Italy
- Institute of Interdisciplinary Research “Health Science”, Scuola Superiore Sant’Anna, Piazza Martiri della Libertà 33, 56124 Pisa, Italy
| | - Caterina Vivaldi
- Unit of Oncology 2, Azienda Ospedaliero-Universitaria Pisana, 56126 Pisa, Italy
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Mario Scartozzi
- Unit of Medical Oncology, University Hospital, University of Cagliari, 09124 Cagliari, Italy
| | - Dario Ribero
- Division of General and Oncologic Surgery Multimedica, A.O. Santa Croce e Carle, 12100 Cuneo, Italy
| | - Marco Puzzoni
- Unit of Medical Oncology, University Hospital, University of Cagliari, 09124 Cagliari, Italy
| | - Francesco Montagnani
- Department of Oncology, Azienda Sanitaria Locale di Biella, 13900 Ponderano, Italy
| | - Francesco Leone
- Department of Oncology, Azienda Sanitaria Locale di Biella, 13900 Ponderano, Italy
| | - Enrico Vasile
- Unit of Oncology 2, Azienda Ospedaliero-Universitaria Pisana, 56126 Pisa, Italy
| | - Maria Bencivenga
- General and Upper GI Surgery Division, Verona University (VR), 37134 Verona, Italy
| | - Giovanni De Manzoni
- General and Upper GI Surgery Division, Verona University (VR), 37134 Verona, Italy
| | - Debora Basile
- Department of Oncology, San Bortolo General Hospital, ULSS 8 Berica-Vicenza, 36100 Vicenza, Italy
| | - Lorenzo Fornaro
- Unit of Oncology 2, Azienda Ospedaliero-Universitaria Pisana, 56126 Pisa, Italy
- Correspondence: ; Tel.: +39-050992466
| | - Gianluca Masi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Giuseppe Aprile
- Department of Oncology, San Bortolo General Hospital, ULSS 8 Berica-Vicenza, 36100 Vicenza, Italy
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Di Nardo P, Garattini SK, Torrisi E, Fanotto V, Miolo G, Buonadonna A, Puglisi F. Systemic Treatments for Advanced Small Bowel Adenocarcinoma: A Systematic Review. Cancers (Basel) 2022; 14:cancers14061502. [PMID: 35326652 PMCID: PMC8945891 DOI: 10.3390/cancers14061502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/10/2022] [Accepted: 03/10/2022] [Indexed: 01/13/2023] Open
Abstract
Simple Summary Small bowel adenocarcinoma is a rare disease that is usually treated following the protocols in use for colorectal cancer. The aim of this systematic review was to identify the optimal treatment for this disease according to the currently available evidence. We concluded that there is some evidence regarding the use of chemotherapy doublets in this setting, but not to support the use of biological agents. There are encouraging results regarding the use of immunotherapy in selected patients. Abstract Small bowel adenocarcinoma (SBA) is a rare disease for which scarce evidence is available. We summarized data available on systemic treatment of advanced SBA. Methods: Scientific literature was evaluated to find phase II or phase III clinical trials on systemic treatment for advanced SBA. MeSH terms were selected and combined for the initial search, then inclusion and exclusion criteria were set in a search protocol. Four medical oncologists looked for evidence on Medline, EMBASE and Cochrane databases. Moreover, abstracts from 2016 to June 2021 from the American Society for Clinical Oncology, European Society for Medical Oncology, Gastrointestinal Cancer Symposium and World Congress on Gastrointestinal Cancer were browsed. The selected studies, matching the inclusion and exclusion criteria, were finally tabulated and analyzed. Results: The trials finally selected were 18 phase II/III clinical trials. Four small phase II trials support the activity of oxaliplatin-based doublets in first-line treatment (CAPOX and mFOLFOX). Conclusion: No good level evidence is available on the use of bevacizumab, anti-epidermal growth factor receptor, targeted agents or immunotherapy. First-line treatments are largely derived from colorectal cancer protocols, mainly oxaliplatin-based doublets.
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Affiliation(s)
- Paola Di Nardo
- Department of Medical Oncology, CRO Aviano, National Cancer Institute, IRCCS, 33081 Aviano, Italy; (G.M.); (A.B.); (F.P.)
- Correspondence:
| | - Silvio Ken Garattini
- Department of Oncology, ASUFC University Hospital of Udine, 33100 Udine, Italy; (S.K.G.); (V.F.)
| | - Elena Torrisi
- Department of Medical Oncology, P.O. San Vincenzo, 98039 Taormina, Italy;
| | - Valentina Fanotto
- Department of Oncology, ASUFC University Hospital of Udine, 33100 Udine, Italy; (S.K.G.); (V.F.)
| | - Gianmaria Miolo
- Department of Medical Oncology, CRO Aviano, National Cancer Institute, IRCCS, 33081 Aviano, Italy; (G.M.); (A.B.); (F.P.)
| | - Angela Buonadonna
- Department of Medical Oncology, CRO Aviano, National Cancer Institute, IRCCS, 33081 Aviano, Italy; (G.M.); (A.B.); (F.P.)
| | - Fabio Puglisi
- Department of Medical Oncology, CRO Aviano, National Cancer Institute, IRCCS, 33081 Aviano, Italy; (G.M.); (A.B.); (F.P.)
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
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5
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Zanchetta M, Iacuzzi V, Posocco B, Bortolin G, Poetto AS, Orleni M, Canil G, Guardascione M, Foltran L, Fanotto V, Puglisi F, Gagno S, Toffoli G. A rapid, simple and sensitive LC-MS/MS method for lenvatinib quantification in human plasma for therapeutic drug monitoring. PLoS One 2021; 16:e0259137. [PMID: 34699578 PMCID: PMC8547652 DOI: 10.1371/journal.pone.0259137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/13/2021] [Indexed: 12/01/2022] Open
Abstract
Lenvatinib (LENVA) is an oral antineoplastic drug used for the treatment of hepatocellular carcinoma and thyroid carcinoma. LENVA therapeutic drug monitoring (TDM) should be mandatory for a precision medicine to optimize the drug dosage. To this end, the development of a sensitive and robust quantification method to be applied in the clinical setting is essential. The aim of this work was to develop and validate a sensitive, rapid, and cost-effective LC-MS/MS method for the quantification of LENVA in human plasma. On this premise, sample preparation was based on a protein precipitation and the chromatographic separation was achieved on a Synergi Fusion RP C18 column in 4 min. The method was completely and successfully validated according to European Medicines Agency (EMA) and Food and Drug Administration (FDA) guidelines, with good linearity in the range of 0.50–2000 ng/mL (R≥0.9968). Coefficient of variation (CV) for intra- and inter-day precision was ≤11.3% and accuracy ranged from 96.3 to 109.0%, internal standard normalized matrix effect CV% was ≤2.8% and recovery was ≥95.6%. Successful results were obtained for sensitivity (signal to noise (S/N) ratio >21) and selectivity, dilution integrity (CV% ≤ 4.0% and accuracy 99.9–102%), and analyte stability under various handling and storage conditions both in matrix and solvents. This method was applied to quantify LENVA in patient’s plasma samples and covered the concentration range achievable in patients. In conclusion, a sensitive and robust quantification method was developed and validated to be applied in the clinical setting.
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Affiliation(s)
- Martina Zanchetta
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy.,Department of Chemical and Pharmaceutical Sciences, University of Trieste, Trieste, Italy
| | - Valentina Iacuzzi
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Bianca Posocco
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Giorgia Bortolin
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Ariana Soledad Poetto
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy.,Doctoral School in Pharmacological Sciences, University of Padova, Padova, Italy
| | - Marco Orleni
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Giovanni Canil
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Michela Guardascione
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Luisa Foltran
- Unit of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Valentina Fanotto
- Unit of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Fabio Puglisi
- Unit of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy.,Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Sara Gagno
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Giuseppe Toffoli
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
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6
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Michelotti A, de Scordilli M, Sperti E, Mazzeo R, Corvaja C, Aimar G, Gerratana L, Guardascione M, Rampin F, Buriolla S, Di Nardo P, Fanotto V, Andreotti V, Bartoletti M, Bertoli E, Noto C, Buonadonna A, Di Maio M, Ongaro E, Puglisi F. LDH as prognostic factor in second line treatment for advanced gastric cancer: The LINE study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e16102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16102 Background: Lactate dehydrogenase (LDH) is recognized as indirect marker of tumor hypoxia and angiogenesis for several solid tumors. Ramucirumab is the first antiangiogenic agent approved for second-line therapy in advanced gastric cancer (GC), alone or in association with chemotherapy. To date, no reliable biomarkers can predict the potential benefit from anti-VEGFR2 treatment. This retrospective multicenter study aimed to assess the prognostic role of baseline LDH levels in patients (pts) undergoing second-line treatment for advanced GC. Methods: The study analyzed a retrospective cohort of consecutive advanced GC pts treated with second line therapy at IRCCS, CRO of Aviano and at Mauriziano Hospital of Torino, Italy, from 2010 to 2020. LDH levels prior to second-line treatment were classified as low-normal or high and standardized according to the upper limit of the reference range. To better determine the optimal LDH cut-off value, ROC analysis was performed (using PFS < 3 months as binary outcome). Normalized LDH values were subsequently sorted according to the ROC curve cut-off in order to test the association with overall survival (OS) through the Kaplan-Meier method and compared using the Log-Rank test. A multivariate Cox regression analysis assessed the prognostic impact of normalized LDH levels for OS calculated from the start of second line treatment. Results: Overall, 125 pts were enrolled. Of these, 81 pts (64.80%) received ramucirumab alone or plus paclitaxel as second line treatment, while 44 (35.20%) had taxanes or fluoropyrimidines combined with irinotecan. Median age was 68 years, 93% had an ECOG PS ≤ 1, 64.80% was first diagnosed with metastatic disease and 40.80% underwent primary tumor resection. Median second line PFS and OS were 4.2 and 7.9 months, respectively. Baseline LDH values were available for 99 pts. ROC analysis identified a normalized LDH value of 0.83 as the optimized cut-off point to define pts with poor prognosis. At univariate analyses, surgery of the primary tumor (HR 0.51, 95% CI 0.31-0.82, p = 0.005) was associated with better OS, while low-normal BMI ( < 25 kg/m2) at second line start (HR 1.99, 95% CI 1.21-3.28, p = 0.007), normalized LDH values ≥ 0.83 (HR 1.86, 95% CI 1.13-3.07, p = 0.015) and PS > 1 (HR 5.65, 95% CI 2.29-13.92, p < 0.001) were associated with poorer outcome. At multivariable model, only PS > 1 was independently associated with poor prognosis (HR 9.93, 95% CI 3.27-30.08, p < 0.001). Subgroup analyses showed no significant heterogeneity in OS outcome according to normalized LDH levels between patients treated with or without ramucirumab. Conclusions: Elevated LDH levels are indicators of worse outcome in advanced gastric cancer pts. Notably, the LDH cut-off value identified a poor prognosis subgroup among pts with normal baseline levels, suggesting that current laboratory ranges could be suboptimal for patient stratification.
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Affiliation(s)
- Anna Michelotti
- Department of Medical Area, University of Udine; Department of Medical Oncology, IRCCS, CRO of Aviano, Udine, Italy
| | - Marco de Scordilli
- Department of Medical Area, University of Udine; Department of Medical Oncology, IRCCS, CRO of Aviano, Udine, Italy
| | - Elisa Sperti
- Medical Oncology, Ordine Mauriziano Hospital, Turin, Italy
| | - Roberta Mazzeo
- Department of Medical Area, University of Udine; Department of Medical Oncology, IRCCS, CRO of Aviano, Udine, Italy
| | - Carla Corvaja
- Department of Oncology, University Hospital of Udine (ASUFC); Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Giacomo Aimar
- Universita degli Studi di Torino Dipartimento di Oncologia, Torino, Italy
| | - Lorenzo Gerratana
- Department of Medicine-Hematology and Oncology, Feinberg School of Medicine, Northwestern University; Department of Medicine (DAME), University of Udine, Chicago, IL
| | - Michela Guardascione
- Department of Medical Oncology, Clinical and Experimental Pharmacology, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano, Italy
| | - Federica Rampin
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, Torino, Italy
| | - Silvia Buriolla
- Department of Medical Area, University of Udine; Department of Medical Oncology, IRCCS, CRO of Aviano, Udine, Italy
| | - Paola Di Nardo
- Dipartimento di Oncologia Medica, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Valentina Fanotto
- Department of Medical Oncology, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano, Italy
| | - Victoria Andreotti
- Department of Medicine, University of Udine and Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Michele Bartoletti
- Department of Medicine (DAME), University of Udine; Dipartimento di Oncologia Medica, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Udine, Italy
| | - Elisa Bertoli
- Department of Medicine (DAME) - University of Udine, Udine, Italy
| | - Claudia Noto
- Department of Medicine (DAME), University of Udine; Department of Medical Oncology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Angela Buonadonna
- Oncologia Medica e Prevenzione Oncologica, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano (PN), Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, Torino, Italy
| | - Elena Ongaro
- Department of Oncology, Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico (CRO) di Aviano, IRCCS, Aviano, Italy
| | - Fabio Puglisi
- Department of Medicine (DAME), University of Udine; Dipartimento di Oncologia Medica, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Udine, Italy
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7
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Basile D, Bartoletti M, Polano M, Bortot L, Gerratana L, Di Nardo P, Borghi M, Fanotto V, Pelizzari G, Lisanti C, Garutti M, Buriolla S, Ongaro E, Andreuzzi E, Montico M, Balestreri L, Miolo G, Toffoli G, Aprile G, Puglisi F, Buonadonna A. Prognostic role of visceral fat for overall survival in metastatic colorectal cancer: A pilot study. Clin Nutr 2021; 40:286-294. [DOI: 10.1016/j.clnu.2020.05.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 04/29/2020] [Accepted: 05/13/2020] [Indexed: 02/07/2023]
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8
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Bonotto M, Basile D, Gerratana L, Bartoletti M, Lisanti C, Pelizzari G, Vitale MG, Fanotto V, Poletto E, Minisini AM, Russo S, Andreetta C, Mansutti M, Fasola G, Puglisi F. Clinico-radiological monitoring strategies in patients with metastatic breast cancer: a real-world study. Future Oncol 2020; 16:2059-2073. [DOI: 10.2217/fon-2020-0020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: A monitoring strategy for metastatic breast cancer patients (M-MBC) has been little studied. Materials & methods: This retrospective study analyzed a consecutive cohort of 382 MBC patients to analyze different M-MBC strategies to identify factors influencing intensive M-MBC. Results: Elevated baseline serum tumor markers (STM) was the strongest factor associated with increased use of STM tests. Having more frequent oncology office visits was associated with more intensive chemotherapy/magnetic resonance imaging (MRI) using. Increased use of imaging tests was associated with participation to clinical trial. Single and elderly patients were less likely to have frequent testing. Having clinically measurable disease was less likely to have more intensive M-MBC. Conclusion: STM testing and scans were frequently ordered in M-MBC. In the present study, strategies are little influenced by clinico-pathological characteristics.
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Affiliation(s)
- Marta Bonotto
- Department of Oncology, University Academic Hospital, Udine, Italy
| | - Debora Basile
- Department of Oncology, University Academic Hospital, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
| | - Lorenzo Gerratana
- Department of Oncology, University Academic Hospital, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
| | - Michele Bartoletti
- Department of Oncology, University Academic Hospital, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
| | - Camilla Lisanti
- Department of Oncology, University Academic Hospital, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
| | - Giacomo Pelizzari
- Department of Oncology, University Academic Hospital, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
| | - Maria Grazia Vitale
- Department of Oncology, University Academic Hospital, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
| | - Valentina Fanotto
- Department of Oncology, University Academic Hospital, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
| | - Elena Poletto
- Department of Oncology, University Academic Hospital, Udine, Italy
| | | | - Stefania Russo
- Department of Oncology, University Academic Hospital, Udine, Italy
| | | | - Mauro Mansutti
- Department of Oncology, University Academic Hospital, Udine, Italy
| | - Gianpiero Fasola
- Department of Oncology, University Academic Hospital, Udine, Italy
| | - Fabio Puglisi
- Department of Medicine, University of Udine, Udine, Italy
- Department of Medical Oncology, Unit of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico (CRO), IRCCS, National Cancer Institute, 33081 Aviano, Italy
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9
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Di Nardo P, Guardascione M, Basile D, Foltran L, Ongaro E, Miolo G, Fanotto V, Lisanti C, Michele B, Parnofiello A, Cortiula F, Bertoli E, Buriolla S, De Scordilli M, Michelotti A, Puglisi F, Buonadonna A. P-246 Taxane cross-resistance: An exploratory analysis of second-line chemotherapy for metastatic gastric cancer. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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10
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De Re V, Caggiari L, De Zorzi M, Fanotto V, Miolo G, Puglisi F, Cannizzaro R, Canzonieri V, Steffan A, Farruggia P, Lopci E, d'Amore ESG, Burnelli R, Mussolin L, Mascarin M. Epstein-Barr virus BART microRNAs in EBV- associated Hodgkin lymphoma and gastric cancer. Infect Agent Cancer 2020; 15:42. [PMID: 32582365 PMCID: PMC7310352 DOI: 10.1186/s13027-020-00307-6] [Citation(s) in RCA: 24] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 06/11/2020] [Indexed: 12/19/2022] Open
Abstract
Background EBV produces miRNAs with important functions in cancer growth, tumor invasion and host immune surveillance. The discovery of EBV miR-BARTs is recent, and most of their functions are still unknown. Nonetheless, some new studies underline their key roles in EBV-associated malignancies. Main body In EBV-associated tumors, the expression profile of miR-BARTs varies according to the cell type, autophagic process and signals received from the tumor microenvironment. By the same way of interest is the interaction between tumor cells and the tumor environment by the release of selected EBV miR-BARTs in addition to the tumor proteins trough tumor exosomes. Conclusion In this review, we discuss new findings regarding EBV miR-BARTs in Hodgkin lymphoma and gastric cancer. The recent discovery that miRNAs are released by exosomes, including miR-BARTs, highlights the importance of tumor and microenvironment interplay with more specific effects on the host immune response.
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Affiliation(s)
- Valli De Re
- Immunopathology and Cancer Biomarkers, Department of Translational Research, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, PN Italy
| | - Laura Caggiari
- Immunopathology and Cancer Biomarkers, Department of Translational Research, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, PN Italy
| | - Mariangela De Zorzi
- Immunopathology and Cancer Biomarkers, Department of Translational Research, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, PN Italy
| | - Valentina Fanotto
- Medical Oncology and Cancer Prevention, Department of Medical Oncology, IRCCS, Centro di Riferimento Oncologico di Aviano (CRO), Aviano, PN Italy
| | - Gianmaria Miolo
- Medical Oncology and Cancer Prevention, Department of Medical Oncology, IRCCS, Centro di Riferimento Oncologico di Aviano (CRO), Aviano, PN Italy
| | - Fabio Puglisi
- Medical Oncology and Cancer Prevention, Department of Medical Oncology, IRCCS, Centro di Riferimento Oncologico di Aviano (CRO), Aviano, PN Italy.,Department of Medicine, University of Udine, Udine, Italy
| | - Renato Cannizzaro
- Gastroenterology, Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, PN Italy.,Pathology, Department of Translational Research, Centro di Riferimento Oncologico di Aviano (CRO), Aviano, PN Italy
| | - Vincenzo Canzonieri
- Department of Medical, Surgical and Health Sciences, University of Trieste Medical School, Trieste, Italy
| | - Agostino Steffan
- Immunopathology and Cancer Biomarkers, Department of Translational Research, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, PN Italy
| | - Piero Farruggia
- Pediatric Hematology and Oncology Unit, Oncology, Department, A.R.N.A.S. Ospedali Civico Di Cristina e Benfratelli, Palermo, PN Italy
| | - Egesta Lopci
- Nuclear Medicine Department, Humanitas Clinical and Research Hospital, Via Manzoni 56, 20089 Rozzano, MI Italy
| | | | - Roberta Burnelli
- Pediatric Hematology-Oncology, Azienda Ospedaliera Universitaria, Ospedale Sant'Anna, Ferrara, FE Italy
| | - Lara Mussolin
- Pediatric Hemato-Oncology Clinic, Department of Women's and Children's Health, University of Padua, Institute of Paediatric Research Fondazione Città della Speranza, Padua, PD Italy
| | - Maurizio Mascarin
- Pediatric Radiotherapy Unit, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, PN Italy
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11
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Basile D, Garattini SK, Corvaja C, Montico M, Cortiula F, Pelizzari G, Gerratana L, Audisio M, Lisanti C, Fanotto V, Ongaro E, Iacono D, Cardellino GG, Foltran L, Pella N, Buonadonna A, Aprile G, Di Maio M, Fasola G, Puglisi F. The MIMIC Study: Prognostic Role and Cutoff Definition of Monocyte-to-Lymphocyte Ratio and Lactate Dehydrogenase Levels in Metastatic Colorectal Cancer. Oncologist 2020; 25:661-668. [PMID: 32202020 DOI: 10.1634/theoncologist.2019-0780] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 02/05/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Monocyte-to-lymphocyte ratio (MLR) and lactate dehydrogenase (LDH) levels are circulating biomarkers that provide information about tumor-related inflammation and immune suppression. This study aimed to evaluate the prognostic role of MLR and LDH in metastatic colorectal cancer (mCRC). MATERIAL AND METHODS This multicentric study analyzed a consecutive cohort of 528 patients with mCRC treated in 2009-2017. The whole population was randomly divided in training and validation cohort. The first was used to identify a threshold for MLR and to create the prognostic model with MLR and MLR-LDH combined (group 1: MLR-LDH low; group 2: MLR or LDH high; group 3: MLR-LDH high). The second cohort was used to validate the model. RESULTS At the median follow-up of 55 months, median overall survival (OS) was 22 months. By multivariate analysis, high MLR >0.49 (hazard ratio [HR], 2.37; 95% confidence interval [C.I.], 1.39-4.04), high LDH (HR, 1.73; 95% C.I., 1.03-2.90) in the first model, group 2 (HR, 2.74; 95% C.I.; 1.62-4.66), and group 3 (HR, 3.73; 95% C.I., 1.94-7.18) in the combined model, had a worse prognosis in terms of OS. These data were confirmed both in the validation set and then in the whole cohort. CONCLUSION MLR and LDH are circulating cost-effective biomarkers, readily available in clinical practice, that can be useful for predicting the prognosis of patients with mCRC. IMPLICATIONS FOR PRACTICE High monocyte-to-lymphocyte ratio (MLR) and lactate dehydrogenase (LDH) levels could be a sign of a tumor's recruitment of suppressive and inflammatory cells worsening prognosis of different types of cancer, including colorectal cancer (CRC). Currently, no data are available for metastatic CRC regarding a cutoff definition for MLR or the prognostic impact of MLR and MLR-LDH combined. The present study showed in the training cohort and confirmed in the validation and whole cohort that MLR is a reliable and independent laboratory biomarker, which is easy to use, to predict clinical outcomes in patients with mCRC. Moreover, MLR and composite MLR-LDH could potentially result in an incremental improvement in the prognostic value of these biomarkers, being used as stratification tools for patients with mCRC.
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Affiliation(s)
- Debora Basile
- Department of Medicine, University of Udine, Udine, Italy
- Department of Medical Oncology, Unit of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Silvio Ken Garattini
- Department of Medicine, University of Udine, Udine, Italy
- Department of Oncology, ASUIUD University Hospital of Udine, Udine, Italy
| | - Carla Corvaja
- Department of Medicine, University of Udine, Udine, Italy
- Department of Medical Oncology, Unit of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Marcella Montico
- Scientific Directorate, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Francesco Cortiula
- Department of Medicine, University of Udine, Udine, Italy
- Department of Oncology, ASUIUD University Hospital of Udine, Udine, Italy
| | - Giacomo Pelizzari
- Department of Medicine, University of Udine, Udine, Italy
- Department of Medical Oncology, Unit of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Lorenzo Gerratana
- Department of Medicine, University of Udine, Udine, Italy
- Department of Medical Oncology, Unit of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Marco Audisio
- Department of Oncology, University of Turin at Umberto I "Ordine Mauriziano" Hospital, Turin, Italy
| | - Camilla Lisanti
- Department of Medicine, University of Udine, Udine, Italy
- Department of Medical Oncology, Unit of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Valentina Fanotto
- Department of Medicine, University of Udine, Udine, Italy
- Department of Medical Oncology, Unit of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Elena Ongaro
- Department of Medical Oncology, Unit of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Donatella Iacono
- Department of Oncology, ASUIUD University Hospital of Udine, Udine, Italy
| | | | - Luisa Foltran
- Department of Medical Oncology, Unit of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Nicoletta Pella
- Department of Oncology, ASUIUD University Hospital of Udine, Udine, Italy
| | - Angela Buonadonna
- Department of Medical Oncology, Unit of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Giuseppe Aprile
- Department of Oncology, San Bortolo General Hospital, Vicenza, Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin at Umberto I "Ordine Mauriziano" Hospital, Turin, Italy
| | - Gianpiero Fasola
- Department of Oncology, ASUIUD University Hospital of Udine, Udine, Italy
| | - Fabio Puglisi
- Department of Medicine, University of Udine, Udine, Italy
- Department of Medical Oncology, Unit of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
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12
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Salati M, Orsi G, Smyth E, Aprile G, Beretta G, De Vita F, Di Bartolomeo M, Fanotto V, Lonardi S, Morano F, Pietrantonio F, Pinto C, Rimassa L, Vasile E, Vivaldi C, Zaniboni A, Ziranu P, Cascinu S. Corrigendum to "Gastric cancer: Translating novels concepts into clinical practice" [Cancer Treatm. Rev. 79C (2019) 101889]. Cancer Treat Rev 2019; 81:101932. [PMID: 31771795 DOI: 10.1016/j.ctrv.2019.101932] [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: 10/25/2022]
Affiliation(s)
- Massimiliano Salati
- Department of Medical Oncology, Universita' di Modena e Reggio Emilia, Modena, Italy.
| | - Giulia Orsi
- Department of Medical Oncology, Universita' di Modena e Reggio Emilia, Modena, Italy
| | - Elisabeth Smyth
- Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - Giuseppe Aprile
- Dipartimento di Oncologia Clinica, Ospedale San Bortolo, AULSS8, Vicenza, Italy
| | | | - Fernando De Vita
- Oncologia Medica - Dipartimento di Medicina di Precisione, Università della Campania "Luigi Vanvitelli", Napoli, Italy
| | - Maria Di Bartolomeo
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Valentina Fanotto
- Department of Medicine (DAME), University of Udine, Piazzale Kolbe, 4, 33100 Udine, Italy
| | - Sara Lonardi
- SSD Sperimentazioni Cliniche di Fase Precoce, Dipartimento di Oncologia, Istituto Oncologico Veneto, IRCCS via Gattamelata, 64, 35128 Padova, Italy
| | - Federica Morano
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Filippo Pietrantonio
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Italy
| | - Carmine Pinto
- Medical Oncology, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Lorenza Rimassa
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Enrico Vasile
- Oncologia, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Caterina Vivaldi
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
| | | | - Pina Ziranu
- Department of Medical Oncology, University of Cagliari, Cagliari, Italy
| | - Stefano Cascinu
- Department of Medical Oncology, Universita' di Modena e Reggio Emilia, Modena, Italy
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13
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Fanotto V, Zucchelli G, Germani M, Rossini D, Sensi E, Lupi C, Ugolini C, Antoniotti C, Marmorino F, Moretto R, Boccaccino A, Borelli B, Conca V, Ongaro E, Masi G, Fontanini G, Falcone A, Cremolini C. PIK3CA mutation in metastatic colorectal cancer (mCRC): Association with clinico-pathological features and outcome. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz246.108] [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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14
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Borghi M, Bartoletti M, Basile D, Bertuzzi C, Bodecchi S, Bortot L, Brescia F, Corvaja C, Fanotto V, Favarato M, Garattini S, Gerratana L, Lisanti C, Pelizzari G, Puglisi F, Solfrini V, Valoriani F, Fabiani F. CACHEXIA AND MALNUTRITION IN CANCER PATIENTS: INFLAMMATION INDEXES EVALUATION AND NUTRITIONAL INTERVENTION. Nutrition 2019. [DOI: 10.1016/j.nut.2019.08.007] [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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15
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Basile D, Borghi M, Lisanti C, Bartoletti M, Gerratana L, Bortot L, Corvaja C, Garattini S, Pelizzari G, Fanotto V, Da Ros L, Nardo PD, Torrisi E, Guardascione M, Bertuzzi C, Fabiani F, Miolo G, Buonadonna A, Puglisi F. THE SLICE STUDY: THE PROGNOSTIC ROLE OF VISCERAL FAT IN METASTATIC COLORECTAL CANCER. Nutrition 2019. [DOI: 10.1016/j.nut.2019.08.003] [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: 11/15/2022]
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16
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Salati M, Orsi G, Smyth E, Aprile G, Beretta G, De Vita F, Di Bartolomeo M, Fanotto V, Lonardi S, Morano F, Pietrantonio F, Pinto C, Rimassa L, Vasile E, Vivaldi C, Zaniboni A, Ziranu P, Cascinu S. Gastric cancer: Translating novels concepts into clinical practice. Cancer Treat Rev 2019; 79:101889. [PMID: 31445415 DOI: 10.1016/j.ctrv.2019.101889] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [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: 06/17/2019] [Revised: 08/10/2019] [Accepted: 08/12/2019] [Indexed: 01/23/2023]
Abstract
The overall 5-year survival of gastric cancer (GC) has change only little in the last decades and it remains the fifth leading cause of cancer-related death worldwide. However, in the past few years a more effective combination chemotherapy has raised the bar of curability of about 10% in resectable disease. Morever, a deeper knowledge of GC biology have unveiled biomarkers to help personalize adjunctive treatments in patients candidate to surgery. Despite a plateau in efficacy of fist-line treatment, incremental survival advantages have been recorded in unresectable advanced disease. The growing number of effective drugs in second and later lines along with a more judicious delivery of cytotoxics and early supportive interventions have enabled more patients to proceed beyond first-line. The continuum of care has become a reality in a considerable proportion of patients that offer opportunities to improve outcomes. Finally, the advent of the immune checkpoint inhibitors has brought great expectations in molecularly-defined subset of patients. This Review summarizes the state-of-the art in the management of GC together with novel concepts that have entered clinical development with the potential of change practice in the foreseeable future.
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Affiliation(s)
- Massimiliano Salati
- Department of Medical Oncology, Universita' di Modena e Reggio Emilia, Modena, Italy.
| | - Giulia Orsi
- Department of Medical Oncology, Universita' di Modena e Reggio Emilia, Modena, Italy
| | - Elisabeth Smyth
- Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | | | | | - Fernando De Vita
- Oncologia Medica- Dipartimento di Medicina di Precisione, Università della Campania "Luigi Vanvitelli", Napoli, Italy
| | - Maria Di Bartolomeo
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Valentina Fanotto
- Department of Medicine (DAME), University of Udine, Piazzale Kolbe, 4 - 33100 Udine, Italy
| | - Sara Lonardi
- SSD Sperimentazioni Cliniche di Fase Precoce, Dipartimento di Oncologia, Istituto Oncologico Veneto, IRCCS via Gattamelata, 64 35128 Padova, Italy
| | - Federica Morano
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Filippo Pietrantonio
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Italy
| | - Carmine Pinto
- Medical Oncology, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Lorenza Rimassa
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Enrico Vasile
- Oncologia, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Caterina Vivaldi
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
| | | | - Pina Ziranu
- Department of Medical Oncology, University of Cagliari, Cagliari, Italy
| | - Stefano Cascinu
- Department of Medical Oncology, Universita' di Modena e Reggio Emilia, Modena, Italy
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Basile D, Parnofiello A, Vitale MG, Cortiula F, Gerratana L, Fanotto V, Lisanti C, Pelizzari G, Ongaro E, Bartoletti M, Garattini SK, Andreotti VJ, Bacco A, Iacono D, Bonotto M, Casagrande M, Ermacora P, Puglisi F, Pella N, Fasola G, Aprile G, Cardellino GG. The IMPACT study: early loss of skeletal muscle mass in advanced pancreatic cancer patients. J Cachexia Sarcopenia Muscle 2019; 10:368-377. [PMID: 30719874 PMCID: PMC6463465 DOI: 10.1002/jcsm.12368] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 11/03/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Pancreatic cancer (PC) patients have multiple risk factors for sarcopenia and loss of skeletal muscle mass (LSMM), which may cause greater treatment toxicities, reduced response to cancer therapy, prolonged hospitalization, impaired quality of life, and worse prognosis. METHODS This is a retrospective study on advanced PC patients treated at the Department of Oncology of Udine, Italy, from January 2012 to November 2017. Among 162 patients who received chemotherapy, 94 consecutive patients with an available computed tomography (CT) scan were retrospectively analyzed. The primary objective of our study was to explore if an early LSMM ≥ 10% (measured at first radiological evaluation and compared with baseline) and/or baseline sarcopenia may impact prognosis. Baseline sarcopenia was defined according to Prado's criteria. Skeletal muscle area was measured as cross-sectional areas (cm2 ) using CT scan data through the Picture archiving and communication system (PACS) image system. RESULTS In the whole cohort, 48% of patients were ≤70 years old, and 50% had metastatic disease. At baseline, 73% of patients had sarcopenia, and 16% presented a visceral fat area ≥ 44 cm2 /m2 . Overall, 21% experienced an early LSMM ≥ 10%. Approximately 33% of sarcopenic patients at baseline and ~35% of patients with early LSMM ≥ 10% had a body mass index > 25 kg/m2 . Of note, 71% of patients were evaluated by a nutritionist, and 56% received a dietary supplementation (oral and/or parenteral). After a median follow-up of 30.44 months, median overall survival (OS) was 11.28 months, whereas median progression-free survival (PFS) was 5.72 months. By multivariate analysis, early LSMM ≥ 10% was significantly associated with worse OS [hazard ratio (HR): 2.16; 95% confidence interval (CI) 1.23-3.78; P = 0.007] and PFS (HR: 2.31; 95% CI 1.30-4.09; P = 0.004). Moreover, an exploratory analysis showed that inflammatory indexes, such as neutrophil-lymphocyte ratio variation, impact early LSMM ≥ 10% (odds ratio 1.31, 95% CI 1.06-1.61, P = 0.010). CONCLUSIONS Early LSMM ≥ 10% has a negative prognostic role in advanced PC patients. Further prospective investigations are needed to confirm these preliminary data.
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Affiliation(s)
- Debora Basile
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Annamaria Parnofiello
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Maria Grazia Vitale
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Francesco Cortiula
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Lorenzo Gerratana
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Valentina Fanotto
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Camilla Lisanti
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Giacomo Pelizzari
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Elena Ongaro
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Michele Bartoletti
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Silvio Ken Garattini
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Victoria Josephine Andreotti
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Anna Bacco
- Department of Endocrinology, University Hospital of Udine, Udine, UD, Italy
| | - Donatella Iacono
- Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Marta Bonotto
- Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | | | - Paola Ermacora
- Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Fabio Puglisi
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Unit of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano, PN, Italy
| | - Nicoletta Pella
- Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Gianpiero Fasola
- Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Giuseppe Aprile
- Department of Oncology, San Bortolo General Hospital, ULSS8 Berica, East District, Vicenza, VI, Italy
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Fanotto V, Fornaro L, Bordonaro R, Rosati G, Rimassa L, Di Donato S, Santini D, Tomasello G, Leone F, Silvestris N, Stragliotto S, Scartozzi M, Giampieri R, Nichetti F, Antonuzzo L, Cinieri S, Avallone A, Pellegrino A, Melisi D, Vasile E, Gerratana L, Aprile G. Second-line treatment efficacy and toxicity in older vs. non-older patients with advanced gastric cancer: A multicentre real-world study. J Geriatr Oncol 2018; 10:591-597. [PMID: 30551958 DOI: 10.1016/j.jgo.2018.11.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 11/04/2018] [Accepted: 11/28/2018] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Although gastric cancer (GC) incidence rises with age, older patients are poorly represented in clinical trials, whose results are therefore difficult to translate into standard management of older patients. Purpose of this study was to compare clinico-pathological features and survival outcomes between older and non-older patients with advanced GC treated with at least two chemotherapy lines. MATERIALS AND METHODS Clinico-pathological characteristics, basal values, and treatment data of older (≥70 years at second-line start) and non-older patients were compared using chi-square test or 2-tailed Fisher exact test. The Kaplan-Meier estimation was used to calculate progression-free survival (PFS) and overall survival (OS), which were examined by log-rank test. RESULTS Older patients represented 31.8% of the population (N = 868). Intestinal type was more frequent in older patients (P = .02). Poorly differentiated tumours were more often observed in non-older patients (P = .009). At stage IV diagnosis, the rate of liver metastases was higher in older patients (P = .02), while peritoneal spread was more represented in non-older patients (P = .002). Although older patients were more often treated with monotherapy (P = .001), they had similar PFS (HR 0.86, 95%CI 0.71-1.03, P = .102) and OS (HR 0.82, 95%CI 0.65-1.02, P = .08) compared to the non-older counterpart. No statistical differences were observed in treatment-related adverse events, hospital admissions, or further treatment lines between age groups. CONCLUSION In our large cohort study, despite some differences in tumour characteristics and treatment intensity, no survival difference was found between older and non-older patients with advanced GC treated with at least two chemotherapy lines. Incidence of adverse events was similar between age groups.
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Affiliation(s)
- Valentina Fanotto
- Department of Oncology, University and General Hospital, Udine, Italy
| | - Lorenzo Fornaro
- Unit of Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | | | | | - Lorenza Rimassa
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center-IRCCS, Rozzano(MI), Italy
| | | | | | | | - Francesco Leone
- Medical Oncology, University of Turin, Candiolo Cancer Institute, FPO, IRCCS, Turin, Italy
| | - Nicola Silvestris
- Medical Oncology Unit, National Cancer Institute IRCCS "Giovanni Paolo II", Bari, Italy
| | - Silvia Stragliotto
- UOC Oncologia Medica 1, Dip. di Oncologia, Istituto Oncologico Veneto - IRCCS, Padova, Italy
| | - Mario Scartozzi
- Medical Oncology, University of Cagliari, University Hospital, Cagliari, Italy
| | | | - Federico Nichetti
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | | | - Antonio Avallone
- Experimental Abdomen Medical Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Napoli, Italy
| | | | | | - Enrico Vasile
- Unit of Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Lorenzo Gerratana
- Department of Oncology, University and General Hospital, Udine, Italy
| | - Giuseppe Aprile
- Department of Oncology, University and General Hospital, Udine, Italy; Department of Oncology, San Bortolo General Hospital, ULSS8 Berica - East District, Vicenza, Italy.
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Basile D, Gerratana L, Corvaja C, Pelizzari G, Garattini S, Lisanti C, Bartoletti M, Bortot L, Fanotto V, Ongaro E, Cortiula F, Parnofiello A, Vitale M, Da Ros L, Di Nardo P, Torrisi E, Guardascione M, Miolo G, Buonadonna A, Puglisi F. Monocyte-to-lymphocye ratio (MLR) and LDH level in metastatic colorectal cancer (mCRC) patients (pts). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy493.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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20
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Basile D, Lisanti C, Borghi M, Bartoletti M, Gerratana L, Bortot L, Pelizzari G, Corvaja C, Ongaro E, Garattini S, Fanotto V, Parnofiello A, Cortiula F, Cattaneo M, Andreotti V, Bertoli E, Guardascione M, Miolo G, Puglisi F, Buonadonna A. The SLICE study: The prognostic role of visceral fat in metastatic colorectal cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy281.125] [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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21
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Pelizzari G, Gerratana L, Basile D, Zago S, Vitale M, Bartoletti M, Lisanti C, Fanotto V, Corvaja C, Bortot L, Liguori A, Cinausero M, Russo S, Andreetta C, Bonotto M, Mansutti M, Minisini A, Curcio F, Fasola G, Puglisi F. A risk score integrating lymphocytes ratios (LRs) and lactate dehydrogenase (LDH) levels to predict prognosis in metastatic breast cancer (MBC) patients. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy272.292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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22
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Pietrantonio F, Barretta F, Fanotto V, Park SH, Morano F, Fucà G, Niger M, Prisciandaro M, Silvestris N, Bergamo F, Fornaro L, Bordonaro R, Rimassa L, Santini D, Tomasello G, Antonuzzo L, Noventa S, Avallone A, Leone F, Faloppi L, Di Donato S, de Braud F, Lee J, De Vita F, Di Bartolomeo M, Miceli R, Aprile G. Estimating Survival Probabilities of Advanced Gastric Cancer Patients in the Second-Line Setting: The Gastric Life Nomogram. Oncology 2018; 95:344-352. [PMID: 30130791 DOI: 10.1159/000491753] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 04/06/2018] [Accepted: 07/02/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We built and externally validated a nomogram for predicting the overall survival (OS) probability of advanced gastric cancer patients receiving second-line treatment. METHODS The nomogram was developed on a set of 320 Italian patients and validated on two independent sets (295 Italian and 172 Korean patients). Putative prognostic variables were selected using a random forest model and included in the multivariable Cox model. The nomogram's performance was evaluated by calibration plot and C index. RESULTS ECOG performance status, neutrophils to lymphocytes ratio, and peritoneal involvement were selected and included into the multivariable model. The C index was 0.72 (95% CI 0.68-0.75) in the development set, 0.69 (95% CI 0.65-0.73) in the Italian validation set, but only 0.57 (95% CI 0.52-0.62) in the Korean set. While Italian calibrations were quite good, the Korean one was poor. Regarding 6-month OS predictions, calibration was best in both Caucasian cohorts and worst the in Asian one. CONCLUSIONS Our nomogram may be a useful tool to predict 3- or 6-month OS in Caucasian gastric cancer patients eligible for second-line therapy. Based on three easy-to-collect variables, the Gastric Life nomogram may help clinicians improve patient selection for second-line treatments and assist in clinical trial enrollment.
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Affiliation(s)
- Filippo Pietrantonio
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, .,Department of Oncology and Hemato-Oncology, University of Milan, Milan,
| | - Francesco Barretta
- Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Valentina Fanotto
- Department of Oncology, University and General Hospital of Udine, Udine, Italy
| | - Se Hoon Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Federica Morano
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanni Fucà
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Monica Niger
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Michele Prisciandaro
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Nicola Silvestris
- Medical Oncology Unit, National Cancer Institute IRCCS "Giovanni Paolo II,", Bari, Italy
| | - Francesca Bergamo
- Medical Oncology Unit 1, Istituto Oncologico Veneto - IRCCS, Padova, Italy
| | - Lorenzo Fornaro
- Medical Oncology Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | | | - Lorenza Rimassa
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Italy
| | | | | | - Lorenzo Antonuzzo
- Medical Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | - Silvia Noventa
- Medical Oncology Unit, Fondazione Poliambulanza, Brescia, Italy
| | - Antonio Avallone
- Department of Abdominal Oncology, Istituto Nazionale, Tumori di Napoli "G. Pascale" IRCCS, Napoli, Italy
| | - Francesco Leone
- Department of Oncology, University of Turin, FPO-IRCCS, Candiolo, Italy
| | - Luca Faloppi
- Medical Oncology Unit, Macerata General Hospital, ASUR Marche AV3, Macerata, Italy
| | - Samantha Di Donato
- Medical Oncology Department, Nuovo Ospedale-Santo Stefano, Istituto Toscano Tumori, Prato, Italy
| | - Filippo de Braud
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Jeeyun Lee
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ferdinando De Vita
- Division of Medical Oncology, "F. Magrassi" Department of Clinical and Experimental Medicine, University of Campania "Luigi Vanvitelli,", Napoli, Italy
| | - Maria Di Bartolomeo
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Rosalba Miceli
- Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giuseppe Aprile
- Department of Oncology, San Bortolo General Hospital, Vicenza, Italy
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Basile D, Bacco A, Parnofiello A, Vitale M, Cortiula F, Garattini S, Gerratana L, Andreotti V, Lisanti C, Bartoletti M, Bonotto M, Fanotto V, Cattaneo M, Iacono D, Ermacora P, Puglisi F, Aprile G, Pella N, Cardellino G, Fasola G. Early loss of skeletal muscle mass as prognostic factor in metastatic pancreatic cancer patients. Nutrition 2018. [DOI: 10.1016/j.nut.2018.03.039] [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: 10/28/2022]
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Pelizzari G, Gerratana L, Basile D, Vitale MG, Bartoletti M, Lisanti C, Fanotto V, Liguori A, Cinausero M, Bozza C, Poletto E, Pascoletti G, Russo S, Andreetta C, Bonotto M, Mansutti M, Minisini AM, Curcio F, Fasola G, Puglisi F. Prognostic role of alkaline phosphatase (ALP) and lactate dehydrogenase (LDH) in metastatic breast cancer (MBC) patients: First clues for cost-effective biomarkers. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e13079] [Citation(s) in RCA: 2] [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] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Lorenzo Gerratana
- Department of Medicine-Hematology and Oncology, Feinberg School of Medicine, Northwestern University; Department of Medicine (DAME), University of Udine; Department of Oncology, University Hospital of Udine, Chicago, IL
| | - Debora Basile
- Department of Medicine (DAME) - University of Udine, Udine, Italy
| | | | | | - Camilla Lisanti
- Department of Medicine (DAME) - University of Udine, Udine, Italy
| | | | - Alessia Liguori
- Medical Oncology Unit, Department of Human Pathology "G. Barresi" - University of Messina, Messina, Italy
| | - Marika Cinausero
- Department of Medicine (DAME) - University of Udine, Udine, Italy
| | - Claudia Bozza
- Department of Oncology - ASUI Udine University Hospital, Udine, Italy
| | - Elena Poletto
- Department of Oncology - University Hospital of Udine, Udine, Italy
| | | | - Stefania Russo
- Department of Oncology - University Hospital of Udine, Udine, Italy
| | | | - Marta Bonotto
- Department of Oncology - University Hospital of Udine, Udine, Italy
| | - Mauro Mansutti
- Department of Oncology - ASUI Udine University Hospital, Udine, Italy
| | | | - Francesco Curcio
- Department of Medicine (DAME) - University of Udine and Clinical Pathology Institute - University Hospital of Udine, Udine, Italy
| | - Gianpiero Fasola
- Department of Oncology - ASUI Udine University Hospital, Udine, Italy
| | - Fabio Puglisi
- Department of Medicine (DAME) - University of Udine and Department of Clinical Oncology - CRO Aviano National Cancer Institute, Aviano, Italy
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Fanotto V, Uccello M, Pecora I, Rimassa L, Leone F, Rosati G, Santini D, Giampieri R, Di Donato S, Tomasello G, Silvestris N, Pietrantonio F, Battaglin F, Avallone A, Scartozzi M, Lutrino ES, Melisi D, Antonuzzo L, Pellegrino A, Ferrari L, Bordonaro R, Vivaldi C, Gerratana L, Bozzarelli S, Filippi R, Bilancia D, Russano M, Aprile G. Outcomes of Advanced Gastric Cancer Patients Treated with at Least Three Lines of Systemic Chemotherapy. Oncologist 2018; 23:272. [PMID: 29449512 PMCID: PMC5813760 DOI: 10.1634/theoncologist.2017-0158erratum] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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26
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Fornaro L, Fanotto V, Musettini G, Uccello M, Rimassa L, Vivaldi C, Fontanella C, Leone F, Giampieri R, Rosati G, Lencioni M, Santini D, Di Donato S, Tomasello G, Brunetti O, Pietrantonio F, Bergamo F, Scartozzi M, Avallone A, Lutrino SE, Melisi D, Antonuzzo L, Pellegrino A, Gerratana L, Cordio S, Vasile E, Aprile G. Selecting patients for gastrectomy in metastatic esophago-gastric cancer: clinics and pathology are not enough. Future Oncol 2017; 13:2265-2275. [PMID: 28976226 DOI: 10.2217/fon-2017-0246] [Citation(s) in RCA: 7] [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] [Indexed: 12/29/2022] Open
Abstract
AIM To evaluate the impact on overall survival (OS) of gastrectomy in asymptomatic metastatic esophago-gastric cancer. PATIENTS & METHODS Five hundred and thirteen patients were included. The role of surgery and other clinico-pathological factors was evaluated by univariate and Cox regression analyses. OS was the primary end point. RESULTS Multivariate analysis confirmed that gastrectomy was a predictor of longer OS (p < 0.001), as well as preserved performance status and benefit from first-line chemotherapy. None of the investigated clinico-pathological variables identified preferable candidates for surgery (all p > 0.05). CONCLUSION Palliative gastrectomy might play a role in asymptomatic metastatic esophago-gastric cancer patients with good performance status who received benefit from first-line chemotherapy. Future prospective trials integrating tumor biology among inclusion criteria may help defining the optimal candidates.
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Affiliation(s)
- Lorenzo Fornaro
- Unit of Medical Oncology 2-Azienda Ospedaliero-Universitaria Pisana, 56126 Pisa, Italy
| | - Valentina Fanotto
- Department of Oncology, University & General Hospital, 33100 Udine, Italy
| | - Gianna Musettini
- Unit of Medical Oncology 2-Azienda Ospedaliero-Universitaria Pisana, 56126 Pisa, Italy
| | - Mario Uccello
- Department of Oncology, Garibaldi Nesima Hospital, 95122 Catania, Italy
| | - Lorenza Rimassa
- Medical Oncology & Hematology Unit, Humanitas Cancer Center, Humanitas Clinical & Research Center, 20089 Rozzano (MI), Italy
| | - Caterina Vivaldi
- Unit of Medical Oncology 2-Azienda Ospedaliero-Universitaria Pisana, 56126 Pisa, Italy
| | | | - Francesco Leone
- Institute for Cancer Research & Treatment, IRCCS, 10060 Candiolo (TO), Italy
| | | | - Gerardo Rosati
- Unit of Medical Oncology, San Carlo Hospital, 85100 Potenza, Italy
| | - Monica Lencioni
- Unit of Medical Oncology 2-Azienda Ospedaliero-Universitaria Pisana, 56126 Pisa, Italy
| | - Daniele Santini
- Medical Oncology, Campus Biomedico University, 00128 Roma, Italy
| | | | - Gianluca Tomasello
- Medical Oncology Division, Istituti Ospitalieri di Cremona, 26100 Cremona, Italy
| | - Oronzo Brunetti
- Unit of Medical Oncology, National Cancer Institute IRCCS "Giovanni Paolo II", 70124 Bari, Italy
| | | | | | - Mario Scartozzi
- Unit of Medical Oncology, University Hospital, University of Cagliari, 09124 Cagliari, Italy
| | - Antonio Avallone
- Gastrointestinal Oncology, National Cancer Institute, IRCCS "Fondazione G. Pascale", 80131 Napoli, Italy
| | | | - Davide Melisi
- Unit of Medical Oncology, University of Verona, 37126 Verona, Italy
| | - Lorenzo Antonuzzo
- Unit of Medical Oncology, Careggi University Hospital, 50134 Firenze, Italy
| | | | - Lorenzo Gerratana
- Department of Oncology, University & General Hospital, 33100 Udine, Italy
| | - Stefano Cordio
- Department of Oncology, Garibaldi Nesima Hospital, 95122 Catania, Italy
| | - Enrico Vasile
- Unit of Medical Oncology 2-Azienda Ospedaliero-Universitaria Pisana, 56126 Pisa, Italy
| | - Giuseppe Aprile
- Department of Oncology, University & General Hospital, 33100 Udine, Italy.,Department of Oncology, San Bortolo General Hospital, ULSS 8 Berica-East District, 36100 Vicenza, Italy
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Ongaro E, De Maglio G, Gerratana L, Bonotto M, Garattini S, Basile D, Cattaneo M, Andreotti V, Cortiula F, Parnofiello A, Fanotto V, Pizzolitto S, Cardellino G, Casagrande M, Ermacora P, Giovannoni M, Iacono D, Puglisi F, Aprile G, Pella N, Fasola G. Mutational status and metastatic patteRn in a cohort Of ADvanced colorectal cancer patients: the ROAD study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx422.023] [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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28
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Bettini A, Gerratana L, Pelizzari G, Bonotto M, Basile D, Vitale M, Bozza C, Bartoletti M, Fanotto V, Lisanti C, Cinausero M, Mansutti M, Minisini A, Fasola G, Puglisi F. Small luminal-like breast cancer: determinants of adjuvant chemotherapy use. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx424.028] [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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Morano F, Pietrantonio F, Barretta F, Fanotto V, Niger M, Nichetti F, Bergamo F, Silvestris N, Fornaro L, Bordonaro R, Baretti M, Santini D, Tomasello G, Antonuzzo L, Noventa S, Avallone A, Di Donato S, Maiello E, De Vita F, Aprile G. Estimation of 12-weeks life expectancy in patients (pts) with metastatic gastric cancer (mGC) candidated for second-line treatment: the “Gastric Life” nomogram. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx425.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Bonotto M, Basile D, Gerratana L, Pelizzari G, Bartoletti M, Vitale M, Fanotto V, Lisanti C, Bozza C, Cinausero M, Andreetta C, Russo S, Mansutti M, Minisini A, Merlini L, De Laurentiis M, Montemurro F, Fasola G, Del Mastro L, Puglisi F. Monitoring metastatic breast cancer (M-MBC) during treatment: a GIM (Gruppo Italiano Mammella) survey. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx424.018] [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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Fanotto V, Uccello M, Fornaro L, Rimassa L, Leone F, Rosati G, Santini D, Giampieri R, Di Donato S, Tomasello G, Silvestris N, Peverelli G, Battaglin F, Avallone A, Scartozzi M, Cinieri S, Melisi D, Antonuzzo L, Pellegrino A, Gerratana L, Aprile G. Second-line treatment efficacy in elderly vs. non-elderly advanced gastric cancer patients: an Italian multicentre real-world study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx425.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Vitale M, Bonotto M, Gerratana L, Basile D, Bartoletti M, Pelizzari G, Fanotto V, Lisanti C, Bozza C, Cinausero M, Iacono D, Poletto E, Barban S, Mansutti I, Minisini A, Russo S, Andreetta C, Mansutti M, Fasola G, Puglisi F. Strategy of monitoring metastatic breast cancer (M-MBC) in clinical practice: more or less intensive? Ann Oncol 2017. [DOI: 10.1093/annonc/mdx424.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Bartoletti M, Gerratana L, Zago S, Basile D, Fanotto V, Vitale M, Pelizzari G, Bonotto M, Bozza C, Lisanti C, Cinausero M, Barban S, Lera M, Venuti I, Mansutti M, Minisini A, Fasola G, Curcio F, Puglisi F. Neutrophil-to-lymphocyte ratio in metastatic breast cancer patients: relationship with tumor characteristics and survival. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx424.029] [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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Gerratana L, Zago S, Basile D, Vitale M, Pelizzari G, Bonotto M, Bozza C, Bartoletti M, Fanotto V, Lisanti C, Cinausero M, Barban S, Lera M, Venuti I, Mansutti M, Minisini A, Fasola G, Curcio F, Puglisi F. Neutrophil-to-lymphocyte and lymphocyte-to-monocyte ratios in breast cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx424.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bozza C, Gerratana L, Basile D, De Carlo E, Cortiula F, Pella N, Vitale M, Bartoletti M, Russo S, Bonotto M, Cinausero M, Fanotto V, Pelizzari G, Minisini A, Andreetta C, Mansutti M, Iacono D, Sottile R, Fasola G, Puglisi F. Final results from CAMEO-PRO study: complementary and alternative medicine in oncology. physicians inform oncological patients. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx436.005] [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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Basile D, Parnofiello A, Vitale M, Cortiula F, Garattini S, Gerratana L, Andreotti V, Ongaro E, Lisanti C, Bartoletti M, Bonotto M, Fanotto V, Cattaneo M, Iacono D, Bacco A, Ermacora P, Puglisi F, Aprile G, Pella N, Cardellino G, Fasola G. Early loss of skeletal muscle mass (LSMM) as prognostic factor in metastatic pancreatic cancer (PC) patients. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx425.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Cortiula F, Basile D, Gerratana L, Bonotto M, Ongaro E, Garattini S, Fanotto V, Cattaneo M, Andreotti V, Parnofiello A, Cocconi R, Pecori D, Cardellino G, Casagrande M, Ermacora P, Giovannoni M, Iacono D, Puglisi F, Aprile G, Pella N, Fasola G. Blood stream infection in cancer patients—device management and epidemiology: the BSIDE study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx436.012] [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: 11/12/2022] Open
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Pietrantonio F, Barretta F, Fanotto V, Niger M, Morano F, Bergamo F, Silvestris N, Fornaro L, Bordonaro R, Baretti M, Santini D, Tomasello G, Antonuzzo L, Noventa S, Avallone A, Di Donato S, Maiello E, De Vita F, Miceli R, Aprile G. Estimating 12-weeks life expectancy in metastatic gastric cancer (mGC) patients (pts) candidates for second-line treatment: The “Gastric Life” nomogram. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx369.052] [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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Ongaro E, De Maglio G, Gerratana L, Bonotto M, Garattini S, Basile D, Cattaneo M, Andreotti V, Cortiula F, Parnofiello A, Fanotto V, Pizzolitto S, Cardellino G, Casagrande M, Puglisi F, Aprile G, Pella N, Fasola G. Mutational status and metastatic patteRn in a cohort Of ADvanced colorectal cancer (aCRC) patients (pts): The ROAD study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx393.078] [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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Gerratana L, Basile D, Zago S, Vitale M, Pelizzari G, Bonotto M, Bozza C, Bartoletti M, Fanotto V, Lisanti C, Cinausero M, Barban S, Lera M, Venuti I, Mansutti M, Minisini A, Fasola G, Curcio F. Neutrophil-to-lymphocyte and lymphocyte-to-monocyte ratios in breast cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx362.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Fanotto V, Cordio S, Pasquini G, Fontanella C, Rimassa L, Leone F, Rosati G, Santini D, Giampieri R, Di Donato S, Tomasello G, Silvestris N, Pietrantonio F, Battaglin F, Avallone A, Scartozzi M, Lutrino ES, Melisi D, Antonuzzo L, Pellegrino A, Torri V, Aprile G. Prognostic factors in 868 advanced gastric cancer patients treated with second-line chemotherapy in the real world. Gastric Cancer 2017; 20:825-833. [PMID: 28028664 DOI: 10.1007/s10120-016-0681-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 12/08/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although second-line therapy is often considered for advanced gastric cancer patients, the optimal candidates are not well defined. METHODS We retrospectively collected baseline parameters, tumour features, and treatment data for 868 advanced gastric cancer patients exposed to multiple treatment lines at 19 Italian centres. Cross-tables and chi-square tests were used to describe categorical features. To predict the impact of clinical variables on progression-free survival and overall survival, Kaplan-Meier and Cox regression analyses were performed. RESULTS At the start of second-line therapy, median age was 64.8 years (25th-75th percentiles: 55.2-71.9 years). Overall, 43% of patients received single-agent chemotherapy, 47.4% a doublet, and 7.3% a triplet. Median second-line progression-free survival was 2.8 months (25th-75th percentiles: 1.8-5.2 months) and median second-line overall survival was 5.6 months (25th-75th percentiles: 2.9-10.0 months). Multivariate analysis showed that performance status, LDH level, neutrophils/lymphocytes ratio, and progression-free survival in the first-line therapy all impacted on prognosis. Based on these four prognostic factors, a prognostic index was constructed that divided patients into good, intermediate, and poor risk groups; median second-line overall survival for each group was 7.7, 4.5, and 2.0 months, respectively (log-rank p < 0.0001). CONCLUSIONS Advanced gastric cancer patients with a favourable ECOG performance status, lower LDH levels, and a lower neutrophils/lymphocytes ratio at the start of second-line therapy seem to have better outcomes, regardless of age and intensity of treatment. A longer progression-free survival in the first-line therapy also had positive prognostic value. Our real-life study might help clinicians to identify the patients who may benefit most from a second-line therapy.
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Affiliation(s)
- Valentina Fanotto
- Dipartimento di Oncologia, Azienda Ospedaliero-Universitaria "Santa Maria della Misericordia" Piazzale Santa Maria della Misericordia 15, 33100, Udine, Italy
| | - Stefano Cordio
- Department of Oncology, Garibaldi Nesima Hospital, Catania, Italy
| | - Giulia Pasquini
- UO Oncologia Medica 2 Universitaria, Ospedale S. Chiara-Azienda Ospedaliero-Universitaria Pisana Istituto Toscano Tumori, Pisa, Italy
| | - Caterina Fontanella
- Dipartimento di Oncologia, Azienda Ospedaliero-Universitaria "Santa Maria della Misericordia" Piazzale Santa Maria della Misericordia 15, 33100, Udine, Italy
| | - Lorenza Rimassa
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, MI, Italy
| | - Francesco Leone
- Institute for Cancer Research and Treatment IRCCS, Candiolo, TO, Italy
| | | | | | | | | | - Gianluca Tomasello
- Medical Oncology Division, Istituti Ospitalieri di Cremona, Cremona, Italy
| | - Nicola Silvestris
- Medical Oncology Unit, National Cancer Institute IRCCS "Giovanni Paolo II", Bari, Italy
| | | | - Francesca Battaglin
- UOC Oncologia Medica 1, Dipartimento di Oncologia Clinica e Sperimentale, Istituto Oncologico Veneto-IRCCS, Padua, Italy
| | - Antonio Avallone
- Gastrointestinal Oncology, National Cancer Institute, IRCCS "Fondazione G. Pascale", Naples, Italy
| | - Mario Scartozzi
- Medical Oncology, University Hospital, University of Cagliari, Cagliari, Italy
| | | | - Davide Melisi
- Medical Oncology, University of Verona, Verona, Italy
| | | | | | - Valter Torri
- Oncology Unit, IRCCS Mario Negri Institute, Milan, Italy
| | - Giuseppe Aprile
- Dipartimento di Oncologia, Azienda Ospedaliero-Universitaria "Santa Maria della Misericordia" Piazzale Santa Maria della Misericordia 15, 33100, Udine, Italy.
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Bartoletti M, Gerratana L, Zago S, Basile D, Vitale M, Pelizzari G, Bonotto M, Bozza C, Fanotto V, Lisanti C, Cinausero M, Barban S, Lera M, Venuti I, Mansutti M, Minisini A, Fasola G, Curcio F, Puglisi F. Neutrophil-to-lymphocyte ratio in metastatic breast cancer: Association with clinico-pathological features and outcome. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx365.050] [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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43
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Fanotto V, Uccello M, Pecora I, Rimassa L, Leone F, Rosati G, Santini D, Giampieri R, Di Donato S, Tomasello G, Silvestris N, Pietrantonio F, Battaglin F, Avallone A, Scartozzi M, Lutrino ES, Melisi D, Antonuzzo L, Pellegrino A, Ferrari L, Bordonaro R, Vivaldi C, Gerratana L, Bozzarelli S, Filippi R, Bilancia D, Russano M, Aprile G. Outcomes of Advanced Gastric Cancer Patients Treated with at Least Three Lines of Systemic Chemotherapy. Oncologist 2017; 22:1463-1469. [PMID: 28860412 DOI: 10.1634/theoncologist.2017-0158] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 07/14/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Second-line therapy has consistently demonstrated survival benefit if compared with best supportive care; however, there is limited evidence whether further lines of treatment may improve the prognosis of advanced gastric cancer (AGC) patients. MATERIALS AND METHODS Starting from a real-world cohort of 868 AGC patients, we retrospectively analyzed baseline parameters, tumor characteristics, and treatment data of those treated with at least three lines. Categorical features were described through cross-tables and chi-square test. We explored the impact of treatment intensity and progression-free survival (PFS) experienced in previous lines on PFS and overall survival in third-line by uni- and multivariate Cox regression models and described by Kaplan-Meier estimator plot with log-rank test. RESULTS Overall, 300 patients were included in the analysis. The most common site of primary tumor was gastric body; 45.3% of cancers had an intestinal histotype, 14% were human epidermal growth receptor 2 positive. In third-line, 45.7% of patients received a single-agent chemotherapy, 49.7% a combination regimen. Patients who had experienced a first-line PFS ≥6.9 months had a better prognosis compared with those who had achieved a shorter one. Consistently, a second-line PFS ≥3.5 months positively influenced the prognosis. Patients receiving a third-line combination regimen had better outcomes compared with those treated with a single-agent chemotherapy. CONCLUSION Our real-world study confirms that selected AGC patients may receive third-line treatment. Longer PFS in previous lines or a more intense third-line treatment positively influenced prognosis. Further efforts are warranted to define the best therapeutic sequences, and to identify the optimal candidate for treatment beyond second-line. IMPLICATIONS FOR PRACTICE The benefit of third-line treatment to advanced gastric cancer patients is controversial. This study depicts a real scenario of the clinical practice in Italy, confirming that a non-negligible proportion of patients receive a third-line therapy. Longer progression-free survival in previous treatment lines or higher third-line treatment intensity positively influenced prognosis. Including a large number of real-world patients, this study provides information on third-line treatment from the daily clinical practice; moreover, its results help in defining the best therapeutic sequence and offer some hints to select the optimal candidate for treatment beyond second-line.
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Affiliation(s)
- Valentina Fanotto
- Department of Oncology, University and General Hospital, Udine, Italy
| | - Mario Uccello
- Department of Oncology, Garibaldi Nesima Hospital, Catania, Italy
| | - Irene Pecora
- Department of Oncology, University Hospital, Pisa, Italy
| | - Lorenza Rimassa
- UO Oncologia Medica, Humanitas Cancer Center, Humanitas Research Hospital-IRCCS, Rozzano, (MI), Italy
| | - Francesco Leone
- Institute for Cancer Research and Treatment, IRCCS Candiolo (TO), Italy
| | | | | | | | | | | | - Nicola Silvestris
- Medical Oncology Unit, National Cancer Institute IRCCS "Giovanni Paolo II", Bari, Italy
| | | | | | - Antonio Avallone
- Abdomen Medical Oncology, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Napoli, Italy
| | - Mario Scartozzi
- Medical Oncology, University of Cagliari, University Hospital, Cagliari, Italy
| | | | - Davide Melisi
- Medical Oncology, University of Verona, Verona, Italy
| | | | | | - Laura Ferrari
- Department of Oncology, University and General Hospital, Udine, Italy
| | | | | | - Lorenzo Gerratana
- Department of Oncology, University and General Hospital, Udine, Italy
| | - Silvia Bozzarelli
- UO Oncologia Medica, Humanitas Cancer Center, Humanitas Research Hospital-IRCCS, Rozzano, (MI), Italy
| | - Roberto Filippi
- Institute for Cancer Research and Treatment, IRCCS Candiolo (TO), Italy
| | | | - Marco Russano
- Medical Oncology, Campus Biomedico University, Roma, Italy
| | - Giuseppe Aprile
- Department of Oncology, University and General Hospital, Udine, Italy
- Department of Oncology, San Bortolo General Hospital, ULSS8 Berica-East District, Vicenza, Italy
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Cinausero M, Gerratana L, De Carlo E, Iacono D, Bonotto M, Fanotto V, Buoro V, Basile D, Vitale MG, Rihawi K, Fasola G, Puglisi F. Determinants of Last-line Treatment in Metastatic Breast Cancer. Clin Breast Cancer 2017; 18:205-213. [PMID: 28781022 DOI: 10.1016/j.clbc.2017.07.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 07/03/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND In metastatic breast cancer (MBC) patients, the identification of factors helping clinicians in the choice between active therapy versus best supportive care is needed clinically. The aim of the present study was to identify the clinicopathologic factors that could improve the prognostic valuation of MBC patients and clinical decision-making at the end of life. PATIENTS AND METHODS The present study analyzed data from a retrospective series of 522 MBC patients treated at the oncology department (University Hospital of Udine) from January 2004 to June 2014. The association between clinicopathologic features and death within 30 or 90 days since last-line treatment prescription was explored. Differences between lightly (≤ 3 lines) and heavily (> 3 lines) pretreated patients and the factors affecting treatment choice were investigated. RESULTS The event "death" occurred in 410 patients. The median last-line survival was 100 days. The median number of therapeutic lines was 3. On multivariate analysis, worse Eastern Cooperative Oncology Group performance status was significantly associated with death within 90 and 30 days since last-line treatment prescription. Among the heavily pretreated patients, liver function impairment and evaluation by a breast cancer specialist were significantly associated with a greater and lower risk of death within 30 days, respectively. Among the lightly pretreated patients with luminal disease, age < 70 years, luminal B-like disease, and number of previous lines were associated with a greater chance of receiving chemotherapy. CONCLUSION In the present study, the Eastern Cooperative Oncology Group performance status was the most robust independent factor driving the last-line therapeutic choice for MBC patients. In addition, the molecular subtype and oncologist subspecialization also influenced the decision-making process.
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Affiliation(s)
- Marika Cinausero
- Department of Medicine (DAME), University of Udine, Udine, Italy; Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Lorenzo Gerratana
- Department of Medicine (DAME), University of Udine, Udine, Italy; Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Elisa De Carlo
- Department of Medicine (DAME), University of Udine, Udine, Italy; Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Donatella Iacono
- Department of Medicine (DAME), University of Udine, Udine, Italy; Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Marta Bonotto
- Department of Medicine (DAME), University of Udine, Udine, Italy; Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Valentina Fanotto
- Department of Medicine (DAME), University of Udine, Udine, Italy; Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Vanessa Buoro
- Department of Medicine (DAME), University of Udine, Udine, Italy; Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Debora Basile
- Department of Medicine (DAME), University of Udine, Udine, Italy; Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Maria Grazia Vitale
- Department of Medicine (DAME), University of Udine, Udine, Italy; Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Karim Rihawi
- Division of Oncology, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Gianpiero Fasola
- Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Fabio Puglisi
- Department of Medicine (DAME), University of Udine, Udine, Italy; Department of Clinical Oncology, CRO Aviano National Cancer Institute, Aviano, Italy.
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Ongaro E, Buoro V, Cinausero M, Caccialanza R, Turri A, Fanotto V, Basile D, Vitale MG, Ermacora P, Cardellino GG, Nicoletti L, Fornaro L, Casadei-Gardini A, Aprile G. Sarcopenia in gastric cancer: when the loss costs too much. Gastric Cancer 2017; 20:563-572. [PMID: 28477106 DOI: 10.1007/s10120-017-0722-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 04/23/2017] [Indexed: 02/07/2023]
Abstract
Sarcopenia is a complex syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength. Malignancy is a major determinant of sarcopenia, and gastric cancer (GC) is among the most common causes of this phenomenon. As sarcopenia is a well-recognized poor prognostic feature in GC and has been associated with worse tolerance of surgical and medical treatments, members of the multidisciplinary team should be aware of the clinical relevance, pathogenic mechanisms, and potential treatments for this syndrome. The importance of sarcopenia is often underestimated in everyday practice and clinical trials, particularly among elderly or fragile patients. As treatment options are improving in all disease stages, deeper knowledge and greater attention to the metabolic balance in GC patients could further increase the benefit of novel therapeutic strategies and dramatically impact on quality of life. In this review, we describe the role of sarcopenia in different phases of GC progression. Our aim is to provide oncologists and surgeons dealing with GC patients with a useful tool for comprehensive assessment and timely management of this potentially life-threatening condition.
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Affiliation(s)
- Elena Ongaro
- Department of Oncology, University and General Hospital, Udine, Italy
| | - Vanessa Buoro
- Department of Oncology, University and General Hospital, Udine, Italy
| | - Marika Cinausero
- Department of Oncology, University and General Hospital, Udine, Italy
| | - Riccardo Caccialanza
- Clinical Nutrition Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Annalisa Turri
- Clinical Nutrition Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Valentina Fanotto
- Department of Oncology, University and General Hospital, Udine, Italy
| | - Debora Basile
- Department of Oncology, University and General Hospital, Udine, Italy
| | | | - Paola Ermacora
- Department of Oncology, University and General Hospital, Udine, Italy
| | | | - Laura Nicoletti
- Department of Oncology, San Bortolo General Hospital, Azienda ULSS8 Berica, East District, Viale Rodolfi 37, 36100, Vicenza, Italy
| | - Lorenzo Fornaro
- Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Andrea Casadei-Gardini
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, FC, Italy
| | - Giuseppe Aprile
- Department of Oncology, University and General Hospital, Udine, Italy.
- Department of Oncology, San Bortolo General Hospital, Azienda ULSS8 Berica, East District, Viale Rodolfi 37, 36100, Vicenza, Italy.
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Cinausero M, Aprile G, Ermacora P, Basile D, Vitale MG, Fanotto V, Parisi G, Calvetti L, Sonis ST. New Frontiers in the Pathobiology and Treatment of Cancer Regimen-Related Mucosal Injury. Front Pharmacol 2017. [PMID: 28642709 PMCID: PMC5462992 DOI: 10.3389/fphar.2017.00354] [Citation(s) in RCA: 133] [Impact Index Per Article: 19.0] [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] [Indexed: 12/12/2022] Open
Abstract
Mucositis is a common complication of chemotherapy, radiotherapy and targeted agents. It often affects compliance to anticancer therapies as it frequently causes schedule delays, interruptions or discontinuations of treatment. Moreover, the economic impact related to the management of mucositis is topical and several estimations of additional hospital costs due to this clinical condition have been recently reported. The ability to determine risk factors for mucositis, to early detect its onset, to assess correctly the degree of this toxicity and to plan its multidisciplinary management are all key elements to guarantee the quality of life of patients and to avoid useless dose reduction or interruption of treatment. The pathogenesis of mucositis is multifactorial and it is classily subdivided into oral and gastrointestinal mucositis according to its anatomic presentation. Treatment and patients’ related factors might help in predicting the frequency and the potential degree of symptoms onset. Here we discuss about clinical presentation and pathogenesis of mucositis in relation to different kinds of treatments. Moreover, we focus on therapeutic and prevention strategies, describing past and present management according to international guidelines and the most promising new data about agents potentially able to further improve the treatment of mucositis in the next future.
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Affiliation(s)
- Marika Cinausero
- Department of Oncology, University and General HospitalUdine, Italy
| | - Giuseppe Aprile
- Department of Oncology, University and General HospitalUdine, Italy.,Department of Oncology, San Bortolo General HospitalVicenza, Italy
| | - Paola Ermacora
- Department of Oncology, University and General HospitalUdine, Italy
| | - Debora Basile
- Department of Oncology, University and General HospitalUdine, Italy
| | - Maria G Vitale
- Department of Oncology, University and General HospitalUdine, Italy
| | | | - Giuseppe Parisi
- Department of Oncology, University and General HospitalUdine, Italy
| | - Lorenzo Calvetti
- Department of Oncology, San Bortolo General HospitalVicenza, Italy
| | - Stephen T Sonis
- Divisions of Oral Medicine, Brigham and Women's Hospital, BostonMA, United States.,Dana-Farber Cancer InstituteBoston, MA, United States.,Biomodels LLC, WatertownMA, United States
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Fanotto V, Uccello M, Pecora I, Rimassa L, Leone F, Rosati G, Santini D, Giampieri R, Di Donato S, Tomasello G, Silvestris N, Pietrantonio F, Battaglin F, Avallone A, Scartozzi M, Lutrino S, Melisi D, Antonuzzo L, Pellegrino A, Aprile G. Real-world gastric cancer patients treated with at least three lines of chemotherapy: Outcomes and predictors for efficacy. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx261.103] [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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Bozza C, Gerratana L, Basile D, Vitale MG, Bartoletti M, Agostinetto E, Russo S, Bonotto M, Cinausero M, Fanotto V, Pelizzari G, Lisanti C, Minisini AM, Andreetta C, Mansutti M, Poletto E, Iacono D, Sottile R, Fasola G, Puglisi F. Preliminary results from CAMEO-PRO study: Complementary and alternative medicine in oncology—Physicians inform oncological patients. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e21632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e21632 Background: It is estimated that about half of cancer patients (pts) use at least one form of (CAM) Complementary and Alternative Medicine in their life but there is a strong reticence of pts in talking about CAM with their oncologist. Aim of this study is to inform pts about CAM. Methods:From April to December 2016, the observational pilot trial “CAMEO-PRO” prospectively enrolled 200 cancer pts that were invited to attend a tutorial about CAM at the Department of Oncology, University Hospital of Udine (Italy). Before and after the seminar, pts were asked to fill a questionnaire reporting their knowledge and opinion about CAM . Results:Median age was 61 years, 141 (72%) women and 53 (28%) men. At study entry, 139 (72%) pts declared they have never been interested in this topic before; 22 pts (12%) revealed the use of a type of alternative therapy and 53 (31%) revealed the use of complementary therapy. Overall, 111 (55.5%) pts participated to the tutorial. Table 1 shows the percentage of response and the opinion’s change about CAM before and after the tutorial. Conclusions:Informative seminars seem to have an impact on patients’ perceptions and opinions about CAM. [Table: see text]
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Affiliation(s)
- Claudia Bozza
- Department of Medicine, University of Udine and Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Lorenzo Gerratana
- Department of Medicine, University of Udine and Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Debora Basile
- Department of Medicine, University of Udine and Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Maria Grazia Vitale
- Department of Medicine, University of Udine and Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Michele Bartoletti
- Department of Medicine, University of Udine and Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Elisa Agostinetto
- Department of Medicine, University of Udine - Humanitas Cancer Center, Milan, Italy
| | - Stefania Russo
- Department of Oncology, University Hospital Udine, Udine, Italy
| | - Marta Bonotto
- Department of Medicine, University of Udine and Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Marika Cinausero
- Department of Medicine, University of Udine and Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Valentina Fanotto
- Department of Medicine, University of Udine and Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Giacomo Pelizzari
- Department of Medicine, University of Udine and Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Camilla Lisanti
- Department of Medicine, University of Udine and Department of Oncology, University Hospital of Udine, Udine, Italy
| | | | | | - Mauro Mansutti
- Department of Oncology, University Hospital Udine, Udine, Italy
| | - Elena Poletto
- Department of Oncology, University Hospital Udine, Udine, Italy
| | | | - Roberta Sottile
- Department of Oncology, University Hospital Udine, Udine, Italy
| | | | - Fabio Puglisi
- Department of Medicine, University of Udine and Department of Oncology, University Hospital of Udine, Udine, Italy
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Bonotto M, Gerratana L, Bettini A, Cinausero M, Basile D, Pelizzari G, Vitale MG, Bozza C, Lisanti C, Fanotto V, Bartoletti M, Andreetta C, Russo S, Poletto E, Iacono D, Mansutti M, Minisini AM, Fasola G, Puglisi F. Determinants of adjuvant chemotherapy use in small luminal-like breast cancer. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e12010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e12010 Background: The use of adjuvant chemotherapy (CT) in small luminal-like breast cancer (BC) is still heavily debated. International guidelines identify endocrine therapy as the backbone of adjuvant treatment for these patients (pts), while the addition of CT should be limited to high risk cases. The aim of this study was to evaluate the association between patient- or disease-related factors with the prescription of adjuvant CT. Methods: This retrospective study reviewed data from 559 consecutive pts with pT1 ( < 2 cm) luminal-like BC treated between 2004 and 2015 at the Department of Oncology of Udine (Italy). No restrictions were applied regarding lymph node status. The cut-off point of 1% was used to define ER and/or PgR positivity. Factors influencing the prescription of CT were investigated through uni- and multivariate logistic regression with odds ratio (OR) calculation. Prognosis was explored through Cox regression. Results: About thirty percent (173/559) of pts received adjuvant CT. By multivariate analysis, lymph node involvement was highly associated with CT prescription (OR 16.94, 95% CI 7.86-36.50, P < 0.001 for pN1; OR 3.92, 95% CI 1.45-10.58, P = 0.007 for pNmi). Tumor size drove towards the use of CT among pts with pT1c tumors (OR 12.87, 95% CI 1.49-110.88, P = 0.020) but not in pts with pT1b BC (OR 2.38, 95% CI 0.26-21.38, P = 0.437). In addition, a higher CT use was observed in pts with luminal B-like disease (OR 3.79, 95% CI 2.16-6.65, P < 0.001) or in presence of a Ki67 > 14% (OR 1.05, 95% CI 1.03-1.07, P < 0.001). On the contrary, pts with age > 60 years had a very low chance of receiving adjuvant CT (OR 0.09, 95% CI 0.04-0.20, P < 0.001). Notably, the use of CT was not associated with Disease Free Survival or Overall Survival (HR 1.3, 95% CI 0.77-2.17, P = 0.320; HR 1.05, 95% CI 0.56-2, P = 0.866; respectively). Conclusions: Nodal status, tumor size, disease sub-type, Ki67 expression and age are determinants of adjuvant CT prescription in pts with small luminal-like BC. Prospective studies are needed to identify which pts could safely avoid CT without influencing prognosis.
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Affiliation(s)
- Marta Bonotto
- Department of Medicine, University of Udine and Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Lorenzo Gerratana
- Department of Medicine, University of Udine and Department of Oncology, University Hospital of Udine, Udine, Italy
| | | | - Marika Cinausero
- Department of Medicine, University of Udine and Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Debora Basile
- Department of Medicine, University of Udine and Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Giacomo Pelizzari
- Department of Medicine, University of Udine and Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Maria Grazia Vitale
- Department of Medicine, University of Udine and Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Claudia Bozza
- Department of Medicine, University of Udine and Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Camilla Lisanti
- Department of Medicine, University of Udine and Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Valentina Fanotto
- Department of Medicine, University of Udine and Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Michele Bartoletti
- Department of Medicine, University of Udine and Department of Oncology, University Hospital of Udine, Udine, Italy
| | | | - Stefania Russo
- Department of Oncology, University Hospital Udine, Udine, Italy
| | - Elena Poletto
- Department of Oncology, University Hospital Udine, Udine, Italy
| | | | - Mauro Mansutti
- Department of Oncology, University Hospital Udine, Udine, Italy
| | | | | | - Fabio Puglisi
- Department of Medicine, University of Udine and Department of Oncology, University Hospital of Udine, Udine, Italy
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Garattini SK, Basile D, Cattaneo M, Fanotto V, Ongaro E, Bonotto M, Negri FV, Berenato R, Ermacora P, Cardellino GG, Giovannoni M, Pella N, Scartozzi M, Antonuzzo L, Silvestris N, Fasola G, Aprile G. Molecular classifications of gastric cancers: Novel insights and possible future applications. World J Gastrointest Oncol 2017; 9:194-208. [PMID: 28567184 PMCID: PMC5434387 DOI: 10.4251/wjgo.v9.i5.194] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 12/04/2016] [Accepted: 03/17/2017] [Indexed: 02/05/2023] Open
Abstract
Despite some notable advances in the systemic management of gastric cancer (GC), the prognosis of patients with advanced disease remains overall poor and their chance of cure is anecdotic. In a molecularly selected population, a median overall survival of 13.8 mo has been reached with the use of human epidermal growth factor 2 (HER2) inhibitors in combination with chemotherapy, which has soon after become the standard of care for patients with HER2-overexpressing GC. Moreover, oncologists have recognized the clinical utility of conceiving cancers as a collection of different molecularly-driven entities rather than a single disease. Several molecular drivers have been identified as having crucial roles in other tumors and new molecular classifications have been recently proposed for gastric cancer as well. Not only these classifications allow the identification of different tumor subtypes with unique features, but also they serve as springboard for the development of different therapeutic strategies. Hopefully, the application of standard systemic chemotherapy, specific targeted agents, immunotherapy or even surgery in specific cancer subgroups will help maximizing treatment outcomes and will avoid treating patients with minimal chance to respond, therefore diluting the average benefit. In this review, we aim at elucidating the aspects of GC molecular subtypes, and the possible future applications of such molecular analyses.
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