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Melisi D, Casalino S, Pietrobono S, Quinzii A, Zecchetto C, Merz V. Integration of liposomal irinotecan in the first-line treatment of metastatic pancreatic cancer: try to do not think about the white bear. Ther Adv Med Oncol 2024; 16:17588359241234487. [PMID: 38584763 PMCID: PMC10996353 DOI: 10.1177/17588359241234487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 02/05/2024] [Indexed: 04/09/2024] Open
Abstract
The approval of novel therapeutic agents remains widely reliant on evidence derived from large phase III randomized controlled trials. Liposomal irinotecan (ONIVYDE®) stands out as the only drug that has demonstrated improved survival both as a first-line therapy in combination with oxaliplatin and 5-fluorouracil/leucovorin (5FU/LV) (NALIRIFOX) compared to the standard gemcitabine plus nab-paclitaxel in the NAPOLI3 trial, and as a second-line treatment in combination with 5FU/LV compared to the standard 5FU/LV in the NAPOLI1 trial. However, just as the white bear of the Dostoevsky's paradox, the judgment of these results is invariably distracted by the intrusive thought of how different they might be if compared to similar regimens containing standard-free irinotecan as FOLFIRINOX or FOLFIRI, respectively. Here, we present and thoroughly discuss the evidence encompassing the pharmacologic, preclinical, and clinical development of liposomal irinotecan that can dispel any intrusive thoughts and foster a rational and well-considered judgment of this agent and its potential integration into the therapeutic strategies for pancreatic ductal adenocarcinoma.
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Affiliation(s)
- Davide Melisi
- Investigational Cancer Therapeutics Clinical Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
- Digestive Molecular Clinical Oncology Research Unit, University of Verona, Piazzale L.A. Scuro, 10, Verona 37134, Italy
| | - Simona Casalino
- Digestive Molecular Clinical Oncology Research Unit, University of Verona, Verona, Italy
| | - Silvia Pietrobono
- Digestive Molecular Clinical Oncology Research Unit, University of Verona, Verona, Italy
| | - Alberto Quinzii
- Digestive Molecular Clinical Oncology Research Unit, University of Verona, Verona, Italy
| | - Camilla Zecchetto
- Digestive Molecular Clinical Oncology Research Unit, University of Verona, Verona, Italy
| | - Valeria Merz
- Digestive Molecular Clinical Oncology Research Unit, University of Verona, Verona, Italy
- Medical Oncology Unit, Santa Chiara Hospital, Trento, Italy
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Merz V, Messina C, Zecchetto C, Quinzii A, Frisinghelli M, Trentin C, Salati M, Caffo O, Melisi D. Is There Room for Liposomal Irinotecan in Biliary Tract Cancer? A Meta-analysis of Randomised Trials. Clin Oncol (R Coll Radiol) 2024; 36:87-97. [PMID: 38129199 DOI: 10.1016/j.clon.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/26/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023]
Abstract
AIMS The combination of 5-fluorouracil/leucovorin (5-FU/LV) plus oxaliplatin (FOLFOX) is widely acknowledged as the standard regimen for second-line treatment in patients with advanced biliary tract cancer. Nanoliposomal irinotecan (nal-IRI) has demonstrated its activity in patients with advanced pancreatic cancer. Recent studies have investigated the activity of nal-IRI in combination with 5-FU/LV for biliary tract cancer. However, the results have been contradictory. We conducted a meta-analysis to assess survival outcomes and response rates in randomised trials investigating the activity of nal-IRI in previously treated biliary tract cancer patients. MATERIALS AND METHODS We systematically collected potentially relevant findings from PubMed/Medline, the Cochrane library and EMBASE. Abstracts presented at major international oncological meetings were also reviewed. We extracted hazard ratios and 95% confidence intervals for progression-free survival and overall survival, as well as odds ratios and 95% confidence intervals for objective response rate. The outcomes of the accessible randomised studies evaluating the activity of nal-IRI plus 5-FU/LV were analysed. RESULTS The combination therapy exhibited a statistically significant decrease in the risk of progression (hazard ratio 0.70; 95% confidence interval 0.50-0.97) when compared with 5-FU/LV alone. Additionally, the dual regimen yielded longer overall survival and a higher objective response rate. CONCLUSION Our meta-analysis showed that nal-IRI plus 5-FU/LV had a superior activity in comparison with 5-FU/LV. Further investigations are required to elucidate the role of nal-IRI in this setting and to identify subgroups of patients who could derive the greatest benefit from its administration.
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Affiliation(s)
- V Merz
- Medical Oncology Unit, Santa Chiara Hospital, Trento, Italy; Digestive Molecular Clinical Oncology Research Unit, University of Verona, Verona, Italy.
| | - C Messina
- Oncology Unit, A.R.N.A.S. Civico, Palermo, Italy
| | - C Zecchetto
- Digestive Molecular Clinical Oncology Research Unit, University of Verona, Verona, Italy; Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata, Policlinico "G.B. Rossi", Verona, Italy
| | - A Quinzii
- Digestive Molecular Clinical Oncology Research Unit, University of Verona, Verona, Italy; Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata, Policlinico "G.B. Rossi", Verona, Italy
| | - M Frisinghelli
- Medical Oncology Unit, Santa Chiara Hospital, Trento, Italy
| | - C Trentin
- Medical Oncology Unit, Santa Chiara Hospital, Trento, Italy
| | - M Salati
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - O Caffo
- Medical Oncology Unit, Santa Chiara Hospital, Trento, Italy
| | - D Melisi
- Digestive Molecular Clinical Oncology Research Unit, University of Verona, Verona, Italy; Investigational Cancer Therapeutics Clinical Unit, Azienda Ospedaliera Universitaria Integrata, Policlinico "G.B. Rossi", Verona, Italy
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Pietrobono S, Sabbadini F, Bertolini M, Mangiameli D, De Vita V, Fazzini F, Lunardi G, Casalino S, Scarlato E, Merz V, Zecchetto C, Quinzii A, Di Conza G, Lahn M, Melisi D. Autotaxin Secretion Is a Stromal Mechanism of Adaptive Resistance to TGFβ Inhibition in Pancreatic Ductal Adenocarcinoma. Cancer Res 2024; 84:118-132. [PMID: 37738399 PMCID: PMC10758691 DOI: 10.1158/0008-5472.can-23-0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 08/11/2023] [Accepted: 09/20/2023] [Indexed: 09/24/2023]
Abstract
The TGFβ receptor inhibitor galunisertib demonstrated efficacy in patients with pancreatic ductal adenocarcinoma (PDAC) in the randomized phase II H9H-MC-JBAJ study, which compared galunisertib plus the chemotherapeutic agent gemcitabine with gemcitabine alone. However, additional stromal paracrine signals might confer adaptive resistance that limits the efficacy of this therapeutic strategy. Here, we found that autotaxin, a secreted enzyme that promotes inflammation and fibrosis by generating lysophosphatidic acid (LPA), mediates adaptive resistance to TGFβ receptor inhibition. Blocking TGFβ signaling prompted the skewing of cancer-associated fibroblasts (CAF) toward an inflammatory (iCAF) phenotype. iCAFs were responsible for a significant secretion of autotaxin. Paracrine autotaxin increased LPA-NFκB signaling in tumor cells that triggered treatment resistance. The autotaxin inhibitor IOA-289 suppressed NFκB activation in PDAC cells and overcame resistance to galunisertib and gemcitabine. In immunocompetent orthotopic murine models, IOA-289 synergized with galunisertib in restoring sensitivity to gemcitabine. Most importantly, treatment with galunisertib significantly increased plasma levels of autotaxin in patients enrolled in the H9H-MC-JBAJ study, and median progression-free survival was significantly longer in patients without an increase of autotaxin upon treatment with galunisertib compared with those with increased autotaxin. These results establish that autotaxin secretion by CAFs is increased by TGFβ inhibition and that circulating autotaxin levels predict response to the combination treatment approach of gemcitabine plus galunisertib. SIGNIFICANCE TGFβ inhibition skews cancer-associated fibroblasts toward an inflammatory phenotype that secretes autotaxin to drive adaptive resistance in PDAC, revealing autotaxin as a therapeutic target and biomarker of galunisertib response.
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Affiliation(s)
- Silvia Pietrobono
- Digestive Molecular Clinical Oncology Research Unit, Università degli studi di Verona, Verona, Italy
| | - Fabio Sabbadini
- Digestive Molecular Clinical Oncology Research Unit, Università degli studi di Verona, Verona, Italy
| | - Monica Bertolini
- Digestive Molecular Clinical Oncology Research Unit, Università degli studi di Verona, Verona, Italy
| | - Domenico Mangiameli
- Digestive Molecular Clinical Oncology Research Unit, Università degli studi di Verona, Verona, Italy
| | - Veronica De Vita
- Digestive Molecular Clinical Oncology Research Unit, Università degli studi di Verona, Verona, Italy
| | - Federica Fazzini
- Investigational Cancer Therapeutics Clinical Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Giulia Lunardi
- Digestive Molecular Clinical Oncology Research Unit, Università degli studi di Verona, Verona, Italy
| | - Simona Casalino
- Digestive Molecular Clinical Oncology Research Unit, Università degli studi di Verona, Verona, Italy
| | - Enza Scarlato
- Digestive Molecular Clinical Oncology Research Unit, Università degli studi di Verona, Verona, Italy
| | - Valeria Merz
- Digestive Molecular Clinical Oncology Research Unit, Università degli studi di Verona, Verona, Italy
| | - Camilla Zecchetto
- Digestive Molecular Clinical Oncology Research Unit, Università degli studi di Verona, Verona, Italy
| | - Alberto Quinzii
- Digestive Molecular Clinical Oncology Research Unit, Università degli studi di Verona, Verona, Italy
| | | | | | - Davide Melisi
- Digestive Molecular Clinical Oncology Research Unit, Università degli studi di Verona, Verona, Italy
- Investigational Cancer Therapeutics Clinical Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
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Melisi D, Zecchetto C, Merz V, Malleo G, Landoni L, Quinzii A, Casalino S, Fazzini F, Gaule M, Pesoni C, Casetti L, Esposito A, Marchegiani G, Piazzola C, D'Onofrio M, de Robertis R, Gabbrielli A, Bernardoni L, Crino SF, Pietrobono S, Luchini C, Aliberti C, Martignoni G, Milleri S, Butturini G, Scarpa A, Salvia R, Bassi C. Perioperative NALIRIFOX in patients with resectable pancreatic ductal adenocarcinoma: The open-label, multicenter, phase II nITRO trial. Eur J Cancer 2024; 196:113430. [PMID: 37995598 DOI: 10.1016/j.ejca.2023.113430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 10/28/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Upfront surgery followed by postoperative treatment is a commonly adopted treatment for resectable pancreatic ductal adenocarcinoma (rPDAC). However, the risk of positive surgical margins, the poor recovery that often impairs postoperative treatments, and the risk of recurrence might limit the outcome of this strategy. This study evaluated the safety and the activity of liposomal irinotecan 50 mg/m2 + 5-fluorouracil 2400 mg/m2 + leucovorin 400 mg/m2 + oxaliplatin 60 mg/m2 (NALIRIFOX) in the perioperative treatment of patients with rPDAC. METHODS Eligible patients had a rPDAC with < 180° interface with major veins' wall. Patients received 3 cycles before and 3 cycles after resection with NALIRIFOX, days 1 and 15 of a 28-day cycle. The primary endpoint was the proportion of patients undergoing an R0 resection. RESULTS 107 patients began preoperative treatment. Nine patients discontinued the treatment because of related or unrelated adverse events. Disease-control rate was 92.9%. 87 patients underwent surgical exploration, 11 had intraoperative evidence of metastatic disease, and 1 died for surgical complications. R0 resection rate was 65.3%. 49 patients completed the three postoperative cycles. The most common grade ≥ 3 adverse events were diarrhea and neutropenia. Median overall survival (OS) of ITT patients was 32.3 months (95% CI 27.8-44.3). Median disease-free and OS from surgery of resected patients were 19.3 (95% CI 12.6-34.1) and 40.3 months (95% CI 29-NA), respectively. CONCLUSION Perioperative NALIRIFOX was manageable and active, and deserves further investigation in randomized trials comparing it with standard upfront surgery followed by adjuvant therapy.
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Affiliation(s)
- Davide Melisi
- Investigational Cancer Therapeutics Clinical Unit, Azienda Ospedaliera Integrata, Verona, Italy; Digestive Molecular Clinical Oncology Research Unit, University of Verona, Verona, Italy.
| | - Camilla Zecchetto
- Medical Oncology Unit, Azienda Ospedaliera Integrata, Verona, Italy; Digestive Molecular Clinical Oncology Research Unit, University of Verona, Verona, Italy
| | - Valeria Merz
- Digestive Molecular Clinical Oncology Research Unit, University of Verona, Verona, Italy
| | - Giuseppe Malleo
- Pancreatic Surgery Unit, Azienda Ospedaliera Integrata, Verona, Italy
| | - Luca Landoni
- Pancreatic Surgery Unit, Azienda Ospedaliera Integrata, Verona, Italy
| | - Alberto Quinzii
- Medical Oncology Unit, Azienda Ospedaliera Integrata, Verona, Italy; Digestive Molecular Clinical Oncology Research Unit, University of Verona, Verona, Italy
| | - Simona Casalino
- Digestive Molecular Clinical Oncology Research Unit, University of Verona, Verona, Italy
| | - Federica Fazzini
- Investigational Cancer Therapeutics Clinical Unit, Azienda Ospedaliera Integrata, Verona, Italy
| | - Marina Gaule
- Medical Oncology Unit, Azienda Ospedaliera Integrata, Verona, Italy
| | - Camilla Pesoni
- Medical Oncology Unit, Azienda Ospedaliera Integrata, Verona, Italy
| | - Luca Casetti
- Pancreatic Surgery Unit, Azienda Ospedaliera Integrata, Verona, Italy
| | | | - Giovanni Marchegiani
- Investigational Cancer Therapeutics Clinical Unit, Azienda Ospedaliera Integrata, Verona, Italy; Hepatopancreatobiliary and Liver Transplant Surgery Unit, University of Padua, Padua, Italy
| | | | - Mirko D'Onofrio
- Radiology Unit, Azienda Ospedaliera Integrata, Verona, Italy
| | | | | | - Laura Bernardoni
- Digestive Endoscopy Unit, Azienda Ospedaliera Integrata, Verona, Italy
| | - Stefano F Crino
- Digestive Endoscopy Unit, Azienda Ospedaliera Integrata, Verona, Italy
| | - Silvia Pietrobono
- Digestive Molecular Clinical Oncology Research Unit, University of Verona, Verona, Italy
| | - Claudio Luchini
- Pathology Unit, Azienda Ospedaliera Universitaria Integrata, Azienda Ospedaliera Integrata, Verona, Italy
| | | | | | - Stefano Milleri
- Centro Ricerche Cliniche, Azienda Ospedaliera Integrata, Verona, Italy
| | | | - Aldo Scarpa
- Pathology Unit, Azienda Ospedaliera Universitaria Integrata, Azienda Ospedaliera Integrata, Verona, Italy
| | - Roberto Salvia
- Pancreatic Surgery Unit, Azienda Ospedaliera Integrata, Verona, Italy
| | - Claudio Bassi
- Pancreatic Surgery Unit, Azienda Ospedaliera Integrata, Verona, Italy
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5
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Bencivenga M, Torroni L, Dal Cero M, Quinzii A, Zecchetto C, Merz V, Casalino S, Taus F, Pietrobono S, Mangiameli D, Filippini F, Alloggio M, Castelli C, Iglesias M, Pera M, Melisi D. YAP Activation Is Associated with a Worse Prognosis of Poorly Cohesive Gastric Cancer. J Pers Med 2023; 13:1294. [PMID: 37763062 PMCID: PMC10532557 DOI: 10.3390/jpm13091294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023] Open
Abstract
Poorly cohesive (PC) gastric cancer (GC) is extremely aggressive in progression, and there is an urgent need to identify the molecular pathways involved. We hypothesized the essential role of the RhoA-YAP axis in these mechanisms. The present observational multicenter retrospective study included 133 patients with PC GC treated at two dedicated European surgical centers between 2004 and 2014. YAP nuclear localization was measured by immunohistochemical (IHC) analysis of tissue biopsies. The complete absence of nuclear reactivity was coded as negative expression; we considered "any positive" as low nuclear expression (>0% but <10% of cells) and high nuclear expression (≥10% of cells). Women represented about half of the present series (52%), and the median age was 64 years (p25-p75 range: 53-75). Neoadjuvant and adjuvant treatments were administered to 10% and 54% of the cases, respectively. Extended systemic lymphadenectomy (D2) was the most common (54%). In nearly all cases, the number of retrieved nodes was ≥15, i.e., adequate for tumor staging (94%). An R0 resection was achieved in 80% of the cases. Most patients were pathological T stage 3 and 4 (pT3/pT4 = 79.0%) and pathological N stage 2, 3a, and 3b (pN2/pN3a/pN3b = 47.0%) at the pathological examination. Twenty patients (15%) presented distant metastases. Five-year overall survival (OS) was significantly higher (p = 0.029) in patients with negative YAP (46%, 95% CI 31.1-60.0%) than in the other patients (27%, 17.5-38.1%). Moreover, when controlling for sex, age, pT, pN, and percentage of signet ring cells in the multivariable analysis, YAP expression was a significant predictor of OS (HR 2.03, 95% CI: 1.18-3.51, p = 0.011). Our results provide new insights into the role of the YAP signaling cascade, as its activation was associated with a worse prognosis in PC GC.
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Affiliation(s)
- Maria Bencivenga
- General and Upper GI Surgery, Department of Surgery, Verona University, 37126 Verona, Italy; (M.B.)
| | - Lorena Torroni
- General and Upper GI Surgery, Department of Surgery, Verona University, 37126 Verona, Italy; (M.B.)
- Unit of Epidemiology and Medical Statistics, Department of Diagnostic and Public Health, University of Verona, 37134 Verona, Italy
| | - Mariagiulia Dal Cero
- General and Upper GI Surgery, Department of Surgery, Verona University, 37126 Verona, Italy; (M.B.)
- Section of Gastrointestinal Surgery, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Department of Surgery, Universitat Autonoma de Barcelona, 08003 Barcelona, Spain
| | - Alberto Quinzii
- Investigational Cancer Therapeutics Clinical Unit, Azienda Ospedaliera Universitaria Integrata, 37134 Verona, Italy
- Digestive Molecular Clinical Oncology Research Unit, Università degli Studi di Verona, 37134 Verona, Italy
| | - Camilla Zecchetto
- Investigational Cancer Therapeutics Clinical Unit, Azienda Ospedaliera Universitaria Integrata, 37134 Verona, Italy
- Digestive Molecular Clinical Oncology Research Unit, Università degli Studi di Verona, 37134 Verona, Italy
| | - Valeria Merz
- Digestive Molecular Clinical Oncology Research Unit, Università degli Studi di Verona, 37134 Verona, Italy
| | - Simona Casalino
- Investigational Cancer Therapeutics Clinical Unit, Azienda Ospedaliera Universitaria Integrata, 37134 Verona, Italy
- Digestive Molecular Clinical Oncology Research Unit, Università degli Studi di Verona, 37134 Verona, Italy
| | - Francesco Taus
- Unit of Epidemiology and Medical Statistics, Department of Diagnostic and Public Health, University of Verona, 37134 Verona, Italy
- Unit of Forensic Medicine, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy
| | - Silvia Pietrobono
- Digestive Molecular Clinical Oncology Research Unit, Università degli Studi di Verona, 37134 Verona, Italy
| | - Domenico Mangiameli
- Digestive Molecular Clinical Oncology Research Unit, Università degli Studi di Verona, 37134 Verona, Italy
| | - Federica Filippini
- General and Upper GI Surgery, Department of Surgery, Verona University, 37126 Verona, Italy; (M.B.)
| | - Mariella Alloggio
- General and Upper GI Surgery, Department of Surgery, Verona University, 37126 Verona, Italy; (M.B.)
| | - Claudia Castelli
- Anatomical Pathology Unit, Azienda Ospedaliera Universitaria Integrata, 37134 Verona, Italy
| | - Mar Iglesias
- Department of Pathology, Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
| | - Manuel Pera
- Section of Gastrointestinal Surgery, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Department of Surgery, Universitat Autonoma de Barcelona, 08003 Barcelona, Spain
| | - Davide Melisi
- Investigational Cancer Therapeutics Clinical Unit, Azienda Ospedaliera Universitaria Integrata, 37134 Verona, Italy
- Digestive Molecular Clinical Oncology Research Unit, Università degli Studi di Verona, 37134 Verona, Italy
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6
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Procaccio L, Merz V, Fasano M, Vaccaro V, Giommoni E, Pretta A, Noventa S, Satolli MA, Giordano G, Zichi C, Pinto C, Zecchetto C, Barsotti G, De Vita F, Milella M, Antonuzzo L, Scartozzi M, Zaniboni A, Spadi R, Casalino S, Bergamo F, De Toni C, Melisi D, Lonardi S. The role of nanoliposomal irinotecan plus fluorouracil/leucovorin in the continuum of care of patients with metastatic pancreatic ductal adenocarcinoma. Cancer Med 2023. [PMID: 37278395 DOI: 10.1002/cam4.6111] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/01/2023] [Accepted: 05/07/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND The NAPOLI-I trial showed better outcome of nanoliposomal irinotecan (nal-IRI) plus 5-fluorouracil/leucovorin (5-FU/LV) compared to 5-FU/LV in patients with advanced pancreatic ductal adenocarcinoma cancer (advPDAC) progressed to gemcitabine-based therapy. This study aims to explore the real-world efficacy and safety of 5-FU/LV-nal-IRI. METHODS This is a retrospective multicenter analysis including advPDAC patients receiving 5-FU/LV-nal-IRI after failure of gemcitabine-based therapy. Survival analyses were performed using Kaplan-Meier method, univariate and multivariate analyses by Cox regression. RESULTS A total of 296 patients (median age 64.4 years, ECOG PS ≥1 in 56% of cases) were treated at 11 Italian institutions between 2016 and 2018. 34% of them underwent primary tumor resection, and 79% received gemcitabine-nabpaclitaxel as first line. 5-FU/LV-nal-IRI was administered as second-line in 73% of cases. Objective response and disease control rate were 12% and 41%, respectively. Treatment was well tolerated with dose reductions in 50% of patients but no one permanent discontinuation; the commonest grade ≥3 toxicities were neutropenia (14%) and diarrhea (12%). Median PFS and OS from 5-FU/LV-nal-IRI initiation was 3.2 and 7.1 months, respectively. CONCLUSIONS These real-world data confirm the 5-FU/LV-nal-IRI efficacy and safety in advPDAC patients progressed to gemcitabine-based therapy, with outcomes comparable to NAPOLI-1, even in a less-selected population and with more modern therapeutic algorithm.
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Affiliation(s)
- Letizia Procaccio
- Medical Oncology 1 Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Valeria Merz
- Digestive Molecular Clinical Oncology Research Unit, Università degli Studi di Verona, Verona, Italy
| | - Morena Fasano
- Medical Oncology Unit, Department of Precision Medicine, School of Medicine, University of study of Campania "L. Vanvitelli", Naples, Italy
| | | | - Elisa Giommoni
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - Andrea Pretta
- Medical Oncology Department, University Hospital, University of Cagliari, Cagliari, Italy
| | - Silvia Noventa
- Medical Oncology Unit, Casa di Cura Poliambulanza, Brescia, Italy
| | - Maria Antonietta Satolli
- Department of Oncology, University of Turin, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Turin, Italy
| | - Guido Giordano
- UO di Oncologia Medica, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Clizia Zichi
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, Turin, Italy
| | - Carmine Pinto
- High-Complexity Oncology Unit, Clinical Cancer Center, IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Camilla Zecchetto
- Digestive Molecular Clinical Oncology Research Unit, Università degli Studi di Verona, Verona, Italy
| | - Giulia Barsotti
- Medical Oncology 1 Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Ferdinando De Vita
- Medical Oncology Unit, Department of Precision Medicine, School of Medicine, University of study of Campania "L. Vanvitelli", Naples, Italy
| | | | - Lorenzo Antonuzzo
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Mario Scartozzi
- Medical Oncology Department, University Hospital, University of Cagliari, Cagliari, Italy
| | - Alberto Zaniboni
- Medical Oncology Unit, Casa di Cura Poliambulanza, Brescia, Italy
| | - Rosella Spadi
- Medical Oncology 1, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Turin, Italy
| | - Simona Casalino
- Digestive Molecular Clinical Oncology Research Unit, Università degli Studi di Verona, Verona, Italy
| | - Francesca Bergamo
- Medical Oncology 1 Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Chiara De Toni
- Medical Oncology 1 Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Davide Melisi
- Digestive Molecular Clinical Oncology Research Unit, Università degli Studi di Verona, Verona, Italy
- Investigational Cancer Therapeutics Clinical Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Sara Lonardi
- Medical Oncology 3 Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
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7
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van de Haar J, Ma X, Ooft SN, van der Helm PW, Hoes LR, Mainardi S, Pinato DJ, Sun K, Salvatore L, Tortora G, Zurlo IV, Leo S, Giampieri R, Berardi R, Gelsomino F, Merz V, Mazzuca F, Antonuzzo L, Rosati G, Stavraka C, Ross P, Rodriquenz MG, Pavarana M, Messina C, Iveson T, Zoratto F, Thomas A, Fenocchio E, Ratti M, Depetris I, Cergnul M, Morelli C, Libertini M, Parisi A, De Tursi M, Zanaletti N, Garrone O, Graham J, Longarini R, Gobba SM, Petrillo A, Tamburini E, La Verde N, Petrelli F, Ricci V, Wessels LFA, Ghidini M, Cortellini A, Voest EE, Valeri N. Codon-specific KRAS mutations predict survival benefit of trifluridine/tipiracil in metastatic colorectal cancer. Nat Med 2023; 29:605-614. [PMID: 36864254 PMCID: PMC10033412 DOI: 10.1038/s41591-023-02240-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 01/26/2023] [Indexed: 03/04/2023]
Abstract
Genomics has greatly improved how patients with cancer are being treated; however, clinical-grade genomic biomarkers for chemotherapies are currently lacking. Using whole-genome analysis of 37 patients with metastatic colorectal cancer (mCRC) treated with the chemotherapy trifluridine/tipiracil (FTD/TPI), we identified KRAS codon G12 (KRASG12) mutations as a potential biomarker of resistance. Next, we collected real-world data of 960 patients with mCRC receiving FTD/TPI and validated that KRASG12 mutations were significantly associated with poor survival, also in analyses restricted to the RAS/RAF mutant subgroup. We next analyzed the data of the global, double-blind, placebo-controlled, phase 3 RECOURSE trial (n = 800 patients) and found that KRASG12 mutations (n = 279) were predictive biomarkers for reduced overall survival (OS) benefit of FTD/TPI versus placebo (unadjusted interaction P = 0.0031, adjusted interaction P = 0.015). For patients with KRASG12 mutations in the RECOURSE trial, OS was not prolonged with FTD/TPI versus placebo (n = 279; hazard ratio (HR) = 0.97; 95% confidence interval (CI) = 0.73-1.20; P = 0.85). In contrast, patients with KRASG13 mutant tumors showed significantly improved OS with FTD/TPI versus placebo (n = 60; HR = 0.29; 95% CI = 0.15-0.55; P < 0.001). In isogenic cell lines and patient-derived organoids, KRASG12 mutations were associated with increased resistance to FTD-based genotoxicity. In conclusion, these data show that KRASG12 mutations are biomarkers for reduced OS benefit of FTD/TPI treatment, with potential implications for approximately 28% of patients with mCRC under consideration for treatment with FTD/TPI. Furthermore, our data suggest that genomics-based precision medicine may be possible for a subset of chemotherapies.
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Affiliation(s)
- Joris van de Haar
- Division of Molecular Oncology & Immunology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Division of Molecular Carcinogenesis, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Oncode Institute, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Xuhui Ma
- Division of Molecular Oncology & Immunology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Oncode Institute, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Salo N Ooft
- Division of Molecular Oncology & Immunology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Oncode Institute, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Pim W van der Helm
- Division of Molecular Oncology & Immunology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Oncode Institute, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Louisa R Hoes
- Division of Molecular Oncology & Immunology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Oncode Institute, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Sara Mainardi
- Division of Molecular Carcinogenesis, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Oncode Institute, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - David J Pinato
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
- Imperial College Healthcare NHS Trust, London, UK
| | - Kristi Sun
- Imperial College Healthcare NHS Trust, London, UK
| | - Lisa Salvatore
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Roma, Italy
- Oncologia Medica, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Giampaolo Tortora
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Roma, Italy
- Oncologia Medica, Università Cattolica del Sacro Cuore, Roma, Italy
| | | | - Silvana Leo
- Medical Oncology, 'Vito Fazzi' Hospital, Lecce, Italy
| | - Riccardo Giampieri
- Department of Oncology, Università Politecnica delle Marche, Azienda Ospedialiera Universitaria delle Marche, Ancona, Italy
| | - Rossana Berardi
- Department of Oncology, Università Politecnica delle Marche, Azienda Ospedialiera Universitaria delle Marche, Ancona, Italy
| | | | - Valeria Merz
- Medical Oncology Unit, Santa Chiara Hospital, Trento, Italy
| | - Federica Mazzuca
- Department of Clinical and Molecular Medicine, Sapienza University, Oncology Unit, Azienda Ospedialiera Universitaria Sant'Andrea, Rome, Italy
| | - Lorenzo Antonuzzo
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Gerardo Rosati
- Medical Oncology Unit, S. Carlo Hospital, Potenza, Italy
| | - Chara Stavraka
- School of Cancer & Pharmaceutical Sciences, King's College London, Guy's Hospital, London, UK
- Department of Medical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Paul Ross
- Department of Medical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Maria Grazia Rodriquenz
- Istituto di Ricovero e Cura a Carattere Scientifico Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Michele Pavarana
- Oncology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Carlo Messina
- Oncology Unit, ARNAS Civico Di Cristina Benfratelli Hospital, Palermo, Italy
| | | | - Federica Zoratto
- Unità Operativa Complessa Oncologia, Ospedale Santa Maria Goretti Latina, Latina, Italy
| | - Anne Thomas
- Leicester Cancer Research Centre, University of Leicester, Leicester Royal Infirmary, Leicester, UK
| | - Elisabetta Fenocchio
- Candiolo Cancer Institute FPO Istituto di Ricovero e Cura a Carattere Scientifico Candiolo, Candiolo, Italy
| | | | - Ilaria Depetris
- Division of Medical Oncology, ASL TO4, Ospedale Civile di Ivrea, Ivrea, Italy
| | - Massimiliano Cergnul
- Unità Operativa Oncologia Medica, Ospedale Civile di Legnano, Azienda Socio-Sanitaria Territoriale Ovest Milanese, Legnano, Italy
| | - Cristina Morelli
- Medical Oncology Unit, Department of Systems Medicine, Tor Vergata University Hospital, Rome, Italy
| | | | - Alessandro Parisi
- Department of Oncology, Università Politecnica delle Marche, Azienda Ospedialiera Universitaria delle Marche, Ancona, Italy
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Michele De Tursi
- Dipartimento di Tecnologie Innovative in Medicina & Odontoiatria, Università G. D'Annunzio, Chieti-Pescara, Chieti, Italy
| | - Nicoletta Zanaletti
- Experimental Clinical Abdominal Oncology Unit, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico, Fondazione G. Pascale, Naples, Italy
| | - Ornella Garrone
- Oncology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Janet Graham
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | | | - Stefania Maria Gobba
- Division of Clinical Oncology, Azienda Socio-Sanitaria Territoriale dei Sette Laghi Varese, Varese, Italy
| | | | | | - Nicla La Verde
- Luigi Sacco Hospital-Polo Universitario, Azienda Socio-Sanitaria Territoriale Fatebenefratelli Sacco, Milan, Italy
| | - Fausto Petrelli
- Oncology Unit, Azienda Socio-Sanitaria Territoriale Bergamo Ovest, Treviglio, Italy
| | - Vincenzo Ricci
- Medical Oncology Unit, Azienda Ospedaliera di Rilievo Nazionale 'San Pio', Benevento, Italy
| | - Lodewyk F A Wessels
- Division of Molecular Carcinogenesis, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Oncode Institute, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Faculty of Electrical Engineering, Mathematics and Computer Science, Delft University of Technology, Delft, the Netherlands
| | - Michele Ghidini
- Oncology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessio Cortellini
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK
- Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Emile E Voest
- Division of Molecular Oncology & Immunology, The Netherlands Cancer Institute, Amsterdam, the Netherlands.
- Oncode Institute, The Netherlands Cancer Institute, Amsterdam, the Netherlands.
| | - Nicola Valeri
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK.
- Centre for Evolution and Cancer, The Institute of Cancer Research, London, UK.
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8
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Melisi D, Zecchetto C, Merz V, Malleo G, Landoni L, Quinzii A, Casalino S, Gaule M, Pesoni C, Casetti L, Esposito A, Piazzola C, D'Onofrio M, de Robertis R, Gabbrielli A, Luchini C, Butturini G, Scarpa A, Salvia R, Bassi C. nITRO: A phase 2 study of perioperative liposomal irinotecan + 5-fluorouracil/leucovorin + oxaliplatin (NALIRIFOX) in patients with resectable pancreatic ductal adenocarcinoma (rPDAC). J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.4_suppl.701] [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: 01/25/2023] Open
Abstract
701 Background: Upfront surgery followed by adjuvant therapy is the standard treatment for patients with rPDAC. However, the risk of positive surgical margins, the poor recovery after surgery that often impairs postoperative treatment, and the high risk of relapse might limit the overall outcome of this strategy. This trial assessed the safety and the activity of liposomal irinotecan 50 mg/m2 + 5-FU 2400 mg/m2 + LV 400 mg/m2 + oxaliplatin 60 mg/m2 (NALIRIFOX) in the perioperative treatment of patients with rPDAC. Methods: nITRO is an investigator-initiated, Simon’s two-stages, single arm phase 2 study. Eligible patients had newly diagnosed rPDAC with <180° interface with major veins’ wall and a Karnofsky status ≥60. Patients received a perioperative treatment of 3 cycles before and 3 cycles after resection with NALIRIFOX, d1 and 15 of a 28 days cycle. The primary endpoint was the proportion of patients undergoing an R0 resection. Results: Between April 2018 and May 2022, 168 patients were referred by surgical units as potentially eligible for upfront resection. These patients were prescreened by CT and MRI scans within 4 weeks before treatment and 60 showed a rapid progression to a locally advanced or metastatic disease. One was not eligible because of heart failure. Among 107 patients who were enrolled and began preoperative treatment, 86 (80.4%) received all the 3 planned preoperative cycles. One patient (0.9%) obtained a radiological complete response, 22 (20.6%) a partial response, and 68 (63.6%) a stable disease, accounting for a disease control rate of 85.0%. Nine patients discontinued because of treatment related or unrelated adverse events. Seven patients had a radiological, and 2 a clinical progression. Two patients were defined as not resectable at surgical reevaluation. Most common adverse events of grade ≥3 during preoperative treatment included neutropenia (13.0%), diarrhea (9.4%) cholangitis (6.6%), mucositis (5.6%) and hypokaliemia (5.6%). One patient died for treatment-related neutropenia and sepsis. Thus, 87 (81.2%) patients underwent surgical exploration, 11 (12.6%) of them had intraoperative evidence of unresectable or metastatic disease, and 1 died for surgical complications. Among the 75 patients who underwent resection, 49 achieved an R0 resection accounting for a rate of 65.3%, largely exceeding the alternative hypothesis of 55%. Median disease-free and overall survival of resected patients were 31.3 (95% CI 17.0-45.6) and 44.9 months (95% CI 33.1-56.8), respectively. Conclusions: NALIRIFOX was manageable and active for patients with rPDAC. Perioperative NALIRIFOX allows to select those patients who may benefit from resection to the largest extent. Perioperative NALIRIFOX deserves further investigation in randomized trials comparing it with standard upfront surgery followed by adjuvant therapy. Clinical trial information: NCT03528785 .
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Affiliation(s)
- Davide Melisi
- Investigational Cancer Therapeutics Clinical Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Camilla Zecchetto
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Valeria Merz
- Digestive Molecular Clinical Oncology Research Unit, University of Verona, Verona, Italy
| | - Giuseppe Malleo
- General and Pancreatic Surgery Unit, Pancreas Institute, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Luca Landoni
- General and Pancreatic Surgery Unit, Pancreas Institute, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Alberto Quinzii
- Investigational Cancer Therapeutics Clinical Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Simona Casalino
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Marina Gaule
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Camilla Pesoni
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Luca Casetti
- General and Pancreatic Surgery Unit, Pancreas Institute, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Alessandro Esposito
- General and Pancreatic Surgery Unit, Pancreas Institute, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Cristiana Piazzola
- Centro Ricerche Cliniche, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Mirko D'Onofrio
- Radiology Unit, Pancreas Institute, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Riccardo de Robertis
- Radiology Unit, Pancreas Institute, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Armando Gabbrielli
- Digestive Endoscopy Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Claudio Luchini
- Department of Diagnostics and Public Health, Section of Pathology, and ARC-Net Research Center, Verona, Italy
| | | | - Aldo Scarpa
- Pathology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Roberto Salvia
- General and Pancreatic Surgery Unit, Pancreas Institute, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Claudio Bassi
- General and Pancreatic Surgery Unit, Pancreas Institute, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
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9
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Rizzo A, Salati M, Frega G, Merz V, Caputo F, Di Federico A, Palloni A, Carloni R, Ricci AD, Gadaleta-Caldarola G, Messina C, Spallanzani A, Gelsomino F, Benatti S, Luppi G, Melisi D, Dominici M, Brandi G. Second-Line Chemotherapy in Elderly Patients with Advanced Biliary Tract Cancer: A Multicenter Real-World Study. Medicina (Kaunas) 2022; 58:medicina58111543. [PMID: 36363500 PMCID: PMC9698581 DOI: 10.3390/medicina58111543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/14/2022] [Accepted: 10/26/2022] [Indexed: 11/07/2022]
Abstract
Objectives: The ABC-06 and the NIFTY trials recently established the role of second-line chemotherapy (2L) in patients with advanced biliary tract cancer (BTC). Our real-world study aimed to explore 2L in BTC patients aged ≥ 70 years old and to compare their outcomes with younger subjects. Methods: Institutional registries across three academic medical centers were retrospectively reviewed. The Kaplan−Meier methods were used to estimate survival, and the log-rank test was used to make comparisons. Results: A total of 190 BTC patients treated with 2L were identified and included in the analysis. Among them, 52 (27.3%) were aged ≥ 70 years (range 70−87 years). No statistically significant differences in both median overall survival (mOS) and median progression-free survival (mPFS) were recorded between the elderly and younger patients. Absolute lymphocyte count < 1000/mmc (p < 0.001) and albumin level < 3 g/dL (p < 0.001) were independently associated with worse prognoses. Conclusions: The results of this real-world study suggest that for patients aged ≥ 70 years, 2L could be equally effective for younger patients with survival outcomes aligned to those from the ABC-06 and NIFTY trials. The delivery of 2L should be carefully evaluated and monitored in this patient subset.
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Affiliation(s)
- Alessandro Rizzo
- Struttura Semplice Dipartimentale di Oncologia Medica per la Presa in Carico Globale del Paziente Oncologico “Don Tonino Bello”, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy
| | - Massimiliano Salati
- PhD Program Clinical and Experimental Medicine, University of Modena and Reggio Emilia, 41121 Modena, Italy
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, 41125 Modena, Italy
| | - Giorgio Frega
- Osteoncology, Bone and Soft Tissue Sarcomas, and Innovative Therapies, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Valeria Merz
- Department of Medical Oncology, Santa Chiara Hospital, 35127 Trento, Italy
- Digestive Molecular Clinical Oncology Research Unit, University of Verona, 37129 Verona, Italy
| | - Francesco Caputo
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, 41125 Modena, Italy
| | - Alessandro Di Federico
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni-15, 40138 Bologna, Italy
| | - Andrea Palloni
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni-15, 40138 Bologna, Italy
| | - Riccardo Carloni
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni-15, 40138 Bologna, Italy
| | - Angela Dalia Ricci
- Medical Oncology Unit, National Institute of Gastroenterology, “Saverio de Bellis” Research Hospital, 70013 Castellana Grotte, Italy
- Correspondence:
| | - Gennaro Gadaleta-Caldarola
- Medical Oncology Unit, ‘Mons. R. Dimiccoli’ Hospital, Barletta (BT), Azienda Sanitaria Locale Barletta, 76121 Barletta, Italy
| | - Carlo Messina
- Department of Medical Oncology, Santa Chiara Hospital, 35127 Trento, Italy
| | - Andrea Spallanzani
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, 41125 Modena, Italy
| | - Fabio Gelsomino
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, 41125 Modena, Italy
| | - Stefania Benatti
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, 41125 Modena, Italy
| | - Gabriele Luppi
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, 41125 Modena, Italy
| | - Davide Melisi
- Digestive Molecular Clinical Oncology Research Unit, University of Verona, 37129 Verona, Italy
| | - Massimo Dominici
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, 41125 Modena, Italy
| | - Giovanni Brandi
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni-15, 40138 Bologna, Italy
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10
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Caputo F, Gelsomino F, Spallanzani A, Pettorelli E, Benatti S, Ghidini M, Grizzi G, Ratti M, Merz V, Messina C, Tonelli R, Luppi G, Melisi D, Dominici M, Salati M. Multicentre match-paired analysis of advanced biliary cancer long-term survivors: The BILONG study. Clin Res Hepatol Gastroenterol 2022; 46:101955. [PMID: 35609824 DOI: 10.1016/j.clinre.2022.101955] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 03/23/2022] [Accepted: 05/11/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Advanced biliary cancers (ABC) are aggressive malignancies with a median overall survival (mOS) <12 months when treated with first-line chemotherapy. Nevertheless, a subset of patients experiencing longer survival has been described in the updated analysis of ABC-02 trial. We aimed to provide a real-world description of ABC long-term survivors (LS), identifying which factors impact on survival. METHODS Patients diagnosed with ABC at three Institutions between 2002 and 2019, and who survived ≥18 months, were retrospectively identified. We compared them with a control cohort (C) with a mOS <18 months, matched on age, gender, ECOG PS, disease status, primary tumor site, prior surgery, and treatment modality. Their clinical features, treatments, and outcome were analyzed. RESULTS A total of 78 patients was included, 39 in each group. Both LS and C cohorts had superimposable baseline characteristics, without significant differences. mOS was 29 (95%CI 24.6-33.5) and 9 months (95%CI 6.6-12.9) in the two groups, respectively. After performing a logistic regression analysis, three factors were significantly associated with long-term outcome: low neutrophil-to-lymphocyte ratio (NLR < 3) (Odds Ratio [OR] 0.38), achievement of objective response to treatment (OR 0.16), and the number of lines received (OR 0.29). CONCLUSIONS We described a considerable subset of ABC experiencing long-term survival with conventional chemotherapy in a real-world scenario. Beyond clinical factors, we identified low NLR as a prognostic determinant that may allow for a more accurate selection of long survivors. While waiting for a deeper molecular characterization of this subgroup, we propose NLR as a stratification factor for daily practice and clinical trials.
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Affiliation(s)
- Francesco Caputo
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Fabio Gelsomino
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Andrea Spallanzani
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Elisa Pettorelli
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Stefania Benatti
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Michele Ghidini
- Division of Medical Oncology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia Grizzi
- Oncology Unit, Oncology Department, ASST of Cremona, Cremona, Italy
| | - Margherita Ratti
- Oncology Unit, Oncology Department, ASST of Cremona, Cremona, Italy
| | - Valeria Merz
- Digestive Molecular Clinical Oncology Research Unit, University of Verona, Verona, Italy
| | - Carlo Messina
- Department of Medical Oncology, Santa Chiara Hospital, Trento, Italy
| | - Roberto Tonelli
- Department of Medical and Surgical Sciences, Respiratory Diseases Unit and Centre for Rare Lung Diseases, University Hospital of Modena, Modena, Italy; Clinical and Experimental Medicine PhD Program, University of Modena Reggio Emilia, Modena, Italy
| | - Gabriele Luppi
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Davide Melisi
- Digestive Molecular Clinical Oncology Research Unit, University of Verona, Verona, Italy
| | - Massimo Dominici
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Massimiliano Salati
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy; PhD Program Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena Cancer Center, Via del Pozzo 71, Modena 41125, Italy.
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11
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Merz V, Mangiameli D, Zecchetto C, Quinzii A, Pietrobono S, Messina C, Casalino S, Gaule M, Pesoni C, Vitale P, Trentin C, Frisinghelli M, Caffo O, Melisi D. Predictive Biomarkers for a Personalized Approach in Resectable Pancreatic Cancer. Front Surg 2022; 9:866173. [PMID: 35599791 PMCID: PMC9114435 DOI: 10.3389/fsurg.2022.866173] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 03/25/2022] [Indexed: 12/15/2022] Open
Abstract
The mainstay treatment for patients with immediate resectable pancreatic cancer remains upfront surgery, which represents the only potentially curative strategy. Nevertheless, the majority of patients surgically resected for pancreatic cancer experiences disease relapse, even when a combination adjuvant therapy is offered. Therefore, aiming at improving disease free survival and overall survival of these patients, there is an increasing interest in evaluating the activity and efficacy of neoadjuvant and perioperative treatments. In this view, it is of utmost importance to find biomarkers able to select patients who may benefit from a preoperative therapy rather than upfront surgical resection. Defined genomic alterations and a dynamic inflammatory microenvironment are the major culprits for disease recurrence and resistance to chemotherapeutic treatments in pancreatic cancer patients. Signal transduction pathways or tumor immune microenvironment could predict early recurrence and response to chemotherapy. In the last decade, distinct molecular subtypes of pancreatic cancer have been described, laying the bases to a tailored therapeutic approach, started firstly in the treatment of advanced disease. Patients with homologous repair deficiency, in particular with mutant germline BRCA genes, represent the first subgroup demonstrating to benefit from specific therapies. A fraction of patients with pancreatic cancer could take advantage of genome sequencing with the aim of identifying possible targetable mutations. These genomic driven strategies could be even more relevant in a potentially curative setting. In this review, we outline putative predictive markers that could help in the next future in tailoring the best therapeutic strategy for pancreatic cancer patients with a potentially curable disease.
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Affiliation(s)
- Valeria Merz
- Medical Oncology Unit, Santa Chiara Hospital, Trento, Italy
- Digestive Molecular Clinical Oncology Research Unit, Università degli Studi di Verona, Verona, Italy
| | - Domenico Mangiameli
- Digestive Molecular Clinical Oncology Research Unit, Università degli Studi di Verona, Verona, Italy
| | - Camilla Zecchetto
- Investigational Cancer Therapeutics Clinical Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Alberto Quinzii
- Investigational Cancer Therapeutics Clinical Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Silvia Pietrobono
- Digestive Molecular Clinical Oncology Research Unit, Università degli Studi di Verona, Verona, Italy
| | | | - Simona Casalino
- Investigational Cancer Therapeutics Clinical Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Marina Gaule
- Investigational Cancer Therapeutics Clinical Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Camilla Pesoni
- Investigational Cancer Therapeutics Clinical Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Chiara Trentin
- Medical Oncology Unit, Santa Chiara Hospital, Trento, Italy
| | | | - Orazio Caffo
- Medical Oncology Unit, Santa Chiara Hospital, Trento, Italy
| | - Davide Melisi
- Digestive Molecular Clinical Oncology Research Unit, Università degli Studi di Verona, Verona, Italy
- Investigational Cancer Therapeutics Clinical Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
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12
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Salati M, Marcheselli L, Messina C, Merz V, Messina M, Carotenuto P, Caputo F, Gelsomino F, Spallanzani A, Reggiani Bonetti L, Caramaschi S, Luppi G, Dominici M, Ghidini M. Development and Multicentre Validation of the Modena Score to Predict Survival in Advanced Biliary Cancers Undergoing Second-Line Chemotherapy. Cancer Manag Res 2022; 14:983-993. [PMID: 35283642 PMCID: PMC8906899 DOI: 10.2147/cmar.s346235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 02/23/2022] [Indexed: 12/24/2022] Open
Abstract
Background The role of second-line chemotherapy in advanced biliary cancers (ABCs) has only recently been established in phase III randomized trial and the optimal selection of patients most likely to benefit from it remains challenging. Methods A cohort of 98 ABC treated second-line chemotherapy was used as a developmental dataset to identify covariates independently associated with overall survival (OS). Kaplan–Meier analysis was used to investigate the association between variables and OS and those retaining statistically significance were combined in a multiplexed score. Results The following pretreatment variables were independently associated with OS: ECOG PS > 0, peritoneal disease, LDH > 430 UI/L, albumin <3.5 gr/dL, gamma-GT >100 UI/L, sodium <140 mEq/L, absolute lymphocyte count <1000/mmc, and PFS to first-line <6 months. Based on these results, a scoring system was developed that identified three subgroups with statistically different OS: low-risk (mOS 18 months), intermediate-risk (mOS 9.4 months) and high-risk (mOS 2.9 months) (p < 0.001). The prognostic model was both internally and externally validated in a multicentre cohort of 120 ABCs. Conclusion The Modena score is a multiplexed scoring system capable of accurately risk-stratified ABCs treated with second-line chemotherapy. Based on its reproducibility, usability and generalizability, it has the potential for assisting therapeutic decision-making in the clinic and risk-stratification in future trials.
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Affiliation(s)
- Massimiliano Salati
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
- PhD Program Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
- Correspondence: Massimiliano Salati, PhD Program Clinical and Experimental Medicine, University Hospital of Modena, Modena Cancer Centre, via del Pozzo 71, Modena, 41125, Italy, Tel +39/0594223808, Fax +39/0594222647, Email
| | - Luigi Marcheselli
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Carlo Messina
- Department of Medical Oncology, Santa Chiara Hospital, Trento, Italy
| | - Valeria Merz
- Department of Medical Oncology, Santa Chiara Hospital, Trento, Italy
- Digestive Molecular Clinical Oncology Research Unit, University of Verona, Verona, Italy
| | - Marco Messina
- Oncology Unit, Fondazione San Raffaele-Giglio, Cefalu’, Palermo, Italy
| | - Pietro Carotenuto
- Telethon Institute of Genetics and Medicine, Pozzuoli, 80078, Napoli, Italy
| | - Francesco Caputo
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Fabio Gelsomino
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Andrea Spallanzani
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | | | | | - Gabriele Luppi
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Massimo Dominici
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Michele Ghidini
- Medical Oncology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
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13
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Gaule M, Pesoni C, Quinzii A, Zecchetto C, Casalino S, Merz V, Contarelli S, Pietrobono S, Vissio E, Molinaro L, Manzin E, Volpatto R, Vellani G, Melisi D. Exceptional Clinical Response to Alectinib in Pancreatic Acinar Cell Carcinoma With a Novel ALK-KANK4 Gene Fusion. JCO Precis Oncol 2022; 6:e2100400. [PMID: 35005993 PMCID: PMC8769132 DOI: 10.1200/po.21.00400] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Marina Gaule
- Investigational Cancer Therapeutics Clinical Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.,Digestive Molecular Clinical Oncology Research Unit, Università degli Studi di Verona, Verona, Italy
| | - Camilla Pesoni
- Investigational Cancer Therapeutics Clinical Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.,Digestive Molecular Clinical Oncology Research Unit, Università degli Studi di Verona, Verona, Italy
| | - Alberto Quinzii
- Investigational Cancer Therapeutics Clinical Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.,Digestive Molecular Clinical Oncology Research Unit, Università degli Studi di Verona, Verona, Italy
| | - Camilla Zecchetto
- Investigational Cancer Therapeutics Clinical Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.,Digestive Molecular Clinical Oncology Research Unit, Università degli Studi di Verona, Verona, Italy
| | - Simona Casalino
- Investigational Cancer Therapeutics Clinical Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.,Digestive Molecular Clinical Oncology Research Unit, Università degli Studi di Verona, Verona, Italy
| | - Valeria Merz
- Digestive Molecular Clinical Oncology Research Unit, Università degli Studi di Verona, Verona, Italy.,Medical Oncology Unit, Santa Chiara Hospital, Trento, Italy
| | - Serena Contarelli
- Digestive Molecular Clinical Oncology Research Unit, Università degli Studi di Verona, Verona, Italy
| | - Silvia Pietrobono
- Digestive Molecular Clinical Oncology Research Unit, Università degli Studi di Verona, Verona, Italy
| | - Elena Vissio
- Pathology Unit, Department of Medical Sciences, University of Turin and Città della Salute e della Scienza Hospital, Turin, Italy
| | - Luca Molinaro
- Pathology Unit, Department of Medical Sciences, University of Turin and Città della Salute e della Scienza Hospital, Turin, Italy
| | | | | | | | - Davide Melisi
- Investigational Cancer Therapeutics Clinical Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.,Digestive Molecular Clinical Oncology Research Unit, Università degli Studi di Verona, Verona, Italy
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14
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Salati M, Rizzo A, Merz V, Messina C, Francesco C, Gelsomino F, Spallanzani A, Ricci AD, Palloni A, Frega G, De Lorenzo S, Carotenuto P, Pettorelli E, Benatti S, Luppi G, Melisi D, Brandi G, Dominici M. Third-line chemotherapy in advanced biliary cancers (ABC): pattern of care, treatment outcome and prognostic factors from a multicenter study. Expert Rev Gastroenterol Hepatol 2022; 16:73-79. [PMID: 34890512 DOI: 10.1080/17474124.2022.2017772] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Here, we aim at describing the pattern of care, survival outcome and prognostic factors of ABC patients (pts) receiving third-line chemotherapy. METHODS Institutional registries across three academic medical centers were retrospectively reviewed. Kaplan-Meier estimators were used to calculate survival, the log-rank test to make comparisons, and the Cox proportional hazard models to assess the progostic impact of variables. RESULTS Among 101 pts included in the analysis. 68 (67.3%), 19 (18.8%) and 14 (13.8%) had intrahepatic and extrahepatic cholangiocarcinoma and gallbladder cancer, respectively. Atotal of 63 (62.3%) pts received monochemotherapy, while 38 (37.6%) were treated with adoublet. The median OS and PFS were 5 and 3 months, respectively. Disease control rate was achieved in 23 (22.7%) pts, with 2 (2%) partial responses. Grade 3-4 treatment-related adverse events were reported in 22 (21.7%) pts. At multivariate analysis, ECOG PS (p < 0.001), tumor burden (p = 0.01) and lymphocyte-to-monocyte ratio (p =0.02) were independent predictors of survival. CONCLUSIONS Third-line chemotherapy displayed limited activity in this real-world cohort, although prognostic factors have been identified that may assist in treatment decision. The results of this multicenter experience, highlight the need for more effective therapies and provide a benchmark for future trials in this setting.
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Affiliation(s)
- Massimiliano Salati
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy.,PhD Program Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessandro Rizzo
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Valeria Merz
- Department of Medical Oncology, Santa Chiara Hospital, Trento, Italy.,Digestive Molecular Clinical Oncology Research Unit, University of Verona, Verona, Italy
| | - Carlo Messina
- Department of Medical Oncology, Santa Chiara Hospital, Trento, Italy
| | - Caputo Francesco
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Fabio Gelsomino
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Andrea Spallanzani
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Angela Dalia Ricci
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Andrea Palloni
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Giorgio Frega
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Stefania De Lorenzo
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Pietro Carotenuto
- Department of Cell and Disease Mechanisms, Telethon Institute of Genetics and Medicine, Pozzuoli, Napoli, Italy.,Medical Genetics, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Elisa Pettorelli
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Stefania Benatti
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Gabriele Luppi
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | | | - Giovanni Brandi
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Massimo Dominici
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
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15
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Vernuccio F, Messina C, Merz V, Cannella R, Midiri M. Resectable and Borderline Resectable Pancreatic Ductal Adenocarcinoma: Role of the Radiologist and Oncologist in the Era of Precision Medicine. Diagnostics (Basel) 2021; 11:2166. [PMID: 34829513 PMCID: PMC8623921 DOI: 10.3390/diagnostics11112166] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/22/2021] [Accepted: 11/19/2021] [Indexed: 12/24/2022] Open
Abstract
The incidence and mortality of pancreatic ductal adenocarcinoma are growing over time. The management of patients with pancreatic ductal adenocarcinoma involves a multidisciplinary team, ideally involving experts from surgery, diagnostic imaging, interventional endoscopy, medical oncology, radiation oncology, pathology, geriatric medicine, and palliative care. An adequate staging of pancreatic ductal adenocarcinoma and re-assessment of the tumor after neoadjuvant therapy allows the multidisciplinary team to choose the most appropriate treatment for the patient. This review article discusses advancement in the molecular basis of pancreatic ductal adenocarcinoma, diagnostic tools available for staging and tumor response assessment, and management of resectable or borderline resectable pancreatic cancer.
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Affiliation(s)
- Federica Vernuccio
- Radiology Unit, University Hospital "Paolo Giaccone", 90127 Palermo, Italy
| | - Carlo Messina
- Oncology Unit, A.R.N.A.S. Civico, 90127 Palermo, Italy
| | - Valeria Merz
- Department of Medical Oncology, Santa Chiara Hospital, 38122 Trento, Italy
| | - Roberto Cannella
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University Hospital of Palermo, Via del Vespro 129, 90127 Palermo, Italy
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - Massimo Midiri
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University Hospital of Palermo, Via del Vespro 129, 90127 Palermo, Italy
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16
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Messina C, Salati M, Messina M, Cattrini C, Merz V, Caffo O. Efficacy and safety of PD1/PDL1 blockade with platinum-based chemotherapy for extensive small cell lung cancer: A pooled analysis of randomized trials. Eur J Clin Invest 2021; 51:e13483. [PMID: 33382454 DOI: 10.1111/eci.13483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/26/2020] [Accepted: 12/28/2020] [Indexed: 12/26/2022]
Affiliation(s)
- Carlo Messina
- Department of Medical Oncology, Santa Chiara Hospital, Trento, Italy
| | - Massimiliano Salati
- Department of Medical Oncology, University Hospital of Modena and Reggio Emilia, Modena, Italy
| | - Marco Messina
- Oncology Unit, Ospedali Riuniti Villa Sofia, Cervello, Italy
| | - Carlo Cattrini
- Division of Oncology, Ospedale Maggiore della Carità, Novara, Italy.,Department of Internal Medicine and Medical Specialties (DIMI), University of Genova, Genova, Italy
| | - Valeria Merz
- Department of Medical Oncology, Santa Chiara Hospital, Trento, Italy
| | - Orazio Caffo
- Department of Medical Oncology, Santa Chiara Hospital, Trento, Italy
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17
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Melisi D, Cavaliere A, Gobbo S, Fasoli G, Allegrini V, Simionato F, Gaule M, Casalino S, Pesoni C, Zecchetto C, Merz V, Mambrini A, Barbi E, Girelli R, Giardino A, Frigerio I, Scalamogna R, Avitabile A, Castellani S, Milella M, Butturini G. Role of next-generation genomic sequencing in targeted agents repositioning for pancreaticoduodenal cancer patients. Pancreatology 2021; 21:S1424-3903(21)00143-5. [PMID: 33896692 DOI: 10.1016/j.pan.2021.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 04/07/2021] [Accepted: 04/12/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Pancreaticoduodenal cancer (PDC) is a group of malignant tumors arising in the ampullary region, which lack approved targeted therapies for their treatment. METHODS This retrospective, observational study is based on Secondary Data Use (SDU) previously collected during a multicenter collaboration, which were subsequently entered into a predefined database and analyzed. FoundationOne CDx or Liquid, a next-generation DNA sequencing (NGS) service, was used to identify genomic alterations of patients who failed standard treatments. Detected alterations were described according to ESMO Scale of Clinical Actionability for molecular Targets (ESCAT). RESULTS NGS analysis was performed in 68 patients affected by PDC. At least one alteration ranking tier I, II, III, or IV according to ESCAT classification was detected in 8, 1, 9, and 12 patients respectively (44.1%). Ten of them (33.3%) received a matched therapy. Patients with ESCAT tier I to IV were generally younger than the overall population (median = 54, range = 26-71 years), had an EGOG performance status score = 0 (83.3%), and an uncommon histological or clinical presentation. The most common mutations with clinical evidence of actionability (ESCAT tier I-III) involved genes of the RAF (10.3%), BRCA (5.9%) or FGFR pathways (5.9%). We present the activity of the RAF kinases inhibitor sorafenib in patients with RAF-mutated advanced PDC. CONCLUSIONS In advanced PDC, NGS is a feasible and valuable method for enabling precision oncology. This genomic profiling method might be considered after standard treatments failure, especially in young patients maintaining a good performance status, in order to detect potentially actionable mutations and offer molecularly targeted therapeutic approaches.
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Affiliation(s)
- Davide Melisi
- Digestive Molecular Clinical Oncology Research Unit, Università Degli Studi di Verona, Verona, Italy; Section of Medical Oncology, Università Degli Studi di Verona, Verona, Italy.
| | - Alessandro Cavaliere
- Digestive Molecular Clinical Oncology Research Unit, Università Degli Studi di Verona, Verona, Italy; Section of Medical Oncology, Università Degli Studi di Verona, Verona, Italy
| | - Stefano Gobbo
- Patological Anatomy Unit, Pederzoli Hospital, Peschiera Del Garda, Verona, Italy
| | - Giulia Fasoli
- Digestive Molecular Clinical Oncology Research Unit, Università Degli Studi di Verona, Verona, Italy
| | - Valentina Allegrini
- Pancreatic Surgical Unit, Pederzoli Hospital, Peschiera Del Garda, Verona, Italy
| | - Francesca Simionato
- Digestive Molecular Clinical Oncology Research Unit, Università Degli Studi di Verona, Verona, Italy; Section of Medical Oncology, Università Degli Studi di Verona, Verona, Italy
| | - Marina Gaule
- Digestive Molecular Clinical Oncology Research Unit, Università Degli Studi di Verona, Verona, Italy; Section of Medical Oncology, Università Degli Studi di Verona, Verona, Italy
| | - Simona Casalino
- Digestive Molecular Clinical Oncology Research Unit, Università Degli Studi di Verona, Verona, Italy; Section of Medical Oncology, Università Degli Studi di Verona, Verona, Italy
| | - Camilla Pesoni
- Digestive Molecular Clinical Oncology Research Unit, Università Degli Studi di Verona, Verona, Italy; Section of Medical Oncology, Università Degli Studi di Verona, Verona, Italy
| | - Camilla Zecchetto
- Digestive Molecular Clinical Oncology Research Unit, Università Degli Studi di Verona, Verona, Italy; Section of Medical Oncology, Università Degli Studi di Verona, Verona, Italy
| | - Valeria Merz
- Digestive Molecular Clinical Oncology Research Unit, Università Degli Studi di Verona, Verona, Italy; Section of Medical Oncology, Università Degli Studi di Verona, Verona, Italy
| | - Andrea Mambrini
- Medical Oncology Unit, Azienda USL Toscana Nord Ovest, Carrara, Massa Carrara, Italy
| | - Emilio Barbi
- Pancreatic Surgical Unit, Pederzoli Hospital, Peschiera Del Garda, Verona, Italy
| | - Roberto Girelli
- Pancreatic Surgical Unit, Pederzoli Hospital, Peschiera Del Garda, Verona, Italy
| | - Alessandro Giardino
- Pancreatic Surgical Unit, Pederzoli Hospital, Peschiera Del Garda, Verona, Italy
| | - Isabella Frigerio
- Pancreatic Surgical Unit, Pederzoli Hospital, Peschiera Del Garda, Verona, Italy
| | | | | | | | - Michele Milella
- Section of Medical Oncology, Università Degli Studi di Verona, Verona, Italy
| | - Giovanni Butturini
- Pancreatic Surgical Unit, Pederzoli Hospital, Peschiera Del Garda, Verona, Italy
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18
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Merz V, Gaule M, Zecchetto C, Cavaliere A, Casalino S, Pesoni C, Contarelli S, Sabbadini F, Bertolini M, Mangiameli D, Milella M, Fedele V, Melisi D. Targeting KRAS: The Elephant in the Room of Epithelial Cancers. Front Oncol 2021; 11:638360. [PMID: 33777798 PMCID: PMC7991835 DOI: 10.3389/fonc.2021.638360] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [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: 12/06/2020] [Accepted: 01/27/2021] [Indexed: 12/13/2022] Open
Abstract
Mutations of the proto-oncogene KRAS are the most frequent gain-of-function alterations found in cancer. KRAS is mutated in about 30% of all human tumors, but it could reach more than 90% in certain cancer types such as pancreatic adenocarcinoma. Although historically considered to be undruggable, a particular KRAS mutation, the G12C variant, has recently emerged as an actionable alteration especially in non-small cell lung cancer (NSCLC). KRASG12C and pan-KRAS inhibitors are being tested in clinical trials and have recently shown promising activity. Due to the difficulties in direct targeting of KRAS, other approaches are being explored. The inhibition of target upstream activators or downstream effectors of KRAS pathway has shown to be moderately effective given the evidence of emerging mechanisms of resistance. Various synthetic lethal partners of KRAS have recently being identified and the inhibition of some of those might prove to be successful in the future. The study of escape mechanisms to KRAS inhibition could support the utility of combination strategies in overcoming intrinsic and adaptive resistance and enhancing clinical benefit of KRASG12C inhibitors. Considering the role of the microenvironment in influencing tumor initiation and promotion, the immune tumor niche of KRAS mutant tumors has been deeply explored and characterized for its unique immunosuppressive skewing. However, a number of aspects remains to be fully understood, and modulating this tumor niche might revert the immunoresistance of KRAS mutant tumors. Synergistic associations of KRASG12C and immune checkpoint inhibitors are being tested.
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Affiliation(s)
- Valeria Merz
- Digestive Molecular Clinical Oncology Research Unit, University of Verona, Verona, Italy.,Medical Oncology Unit, Santa Chiara Hospital, Trento, Italy
| | - Marina Gaule
- Digestive Molecular Clinical Oncology Research Unit, University of Verona, Verona, Italy.,Section of Medical Oncology, Università degli Studi di Verona, Verona, Italy
| | - Camilla Zecchetto
- Digestive Molecular Clinical Oncology Research Unit, University of Verona, Verona, Italy.,Section of Medical Oncology, Università degli Studi di Verona, Verona, Italy
| | - Alessandro Cavaliere
- Digestive Molecular Clinical Oncology Research Unit, University of Verona, Verona, Italy.,Section of Medical Oncology, Università degli Studi di Verona, Verona, Italy
| | - Simona Casalino
- Digestive Molecular Clinical Oncology Research Unit, University of Verona, Verona, Italy.,Section of Medical Oncology, Università degli Studi di Verona, Verona, Italy
| | - Camilla Pesoni
- Digestive Molecular Clinical Oncology Research Unit, University of Verona, Verona, Italy.,Section of Medical Oncology, Università degli Studi di Verona, Verona, Italy
| | - Serena Contarelli
- Digestive Molecular Clinical Oncology Research Unit, University of Verona, Verona, Italy
| | - Fabio Sabbadini
- Digestive Molecular Clinical Oncology Research Unit, University of Verona, Verona, Italy
| | - Monica Bertolini
- Digestive Molecular Clinical Oncology Research Unit, University of Verona, Verona, Italy
| | - Domenico Mangiameli
- Digestive Molecular Clinical Oncology Research Unit, University of Verona, Verona, Italy
| | - Michele Milella
- Section of Medical Oncology, Università degli Studi di Verona, Verona, Italy
| | - Vita Fedele
- Digestive Molecular Clinical Oncology Research Unit, University of Verona, Verona, Italy
| | - Davide Melisi
- Digestive Molecular Clinical Oncology Research Unit, University of Verona, Verona, Italy.,Section of Medical Oncology, Università degli Studi di Verona, Verona, Italy
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19
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Melisi D, Oh DY, Hollebecque A, Calvo E, Varghese A, Borazanci E, Macarulla T, Merz V, Zecchetto C, Zhao Y, Gueorguieva I, Man M, Gandhi L, Estrem ST, Benhadji KA, Lanasa MC, Avsar E, Guba SC, Garcia-Carbonero R. Safety and activity of the TGFβ receptor I kinase inhibitor galunisertib plus the anti-PD-L1 antibody durvalumab in metastatic pancreatic cancer. J Immunother Cancer 2021; 9:jitc-2020-002068. [PMID: 33688022 PMCID: PMC7944986 DOI: 10.1136/jitc-2020-002068] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2021] [Indexed: 12/16/2022] Open
Abstract
Background We assessed the safety, efficacy, and pharmacokinetics of the transforming growth factor beta (TGFβ) receptor inhibitor galunisertib co-administered with the anti-programmed death-ligand 1 (PD-L1) antibody durvalumab in recurrent/refractory metastatic pancreatic cancer previously treated with ≤2 systemic regimens. Methods This was a two-part, single-arm, multinational, phase Ib study. In a dose-finding phase, escalating oral doses of galunisertib were co-administered on days 1–14 with fixed-dose intravenous durvalumab 1500 mg on day 1 every 4 weeks (Q4W), followed by an expansion cohort phase. Results The galunisertib recommended phase II dose (RP2D) when co-administered with durvalumab 1500 mg Q4W was 150 mg two times per day. No dose-limiting toxicities were recorded. Among 32 patients treated with galunisertib RP2D, 1 patient had partial response, 7 had stable disease, 15 had objective progressive disease, and 9 were not evaluable. Disease control rate was 25.0%. Median overall survival and progression-free survival were 5.72 months (95% CI: 4.01 to 8.38) and 1.87 months (95% CI: 1.58 to 3.09), respectively. Pharmacokinetic profiles for combination therapy were comparable to those published for each drug. There was no association between potential biomarkers and treatment outcomes. Conclusion Galunisertib 150 mg two times per day co-administered with durvalumab 1500 mg Q4W was tolerable. Clinical activity was limited. Studying this combination in patients in an earlier line of treatment or selected for predictive biomarkers of TGFβ inhibition might be a more suitable approach. Trial registration number ClinicalTrials.gov identifier: NCT02734160.
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Affiliation(s)
- Davide Melisi
- Digestive Molecular Clinical Oncology Research Unit, Section of Medical Oncology, Università degli Studi di Verona, Verona, Italy
| | - Do-Youn Oh
- Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | | | - Emiliano Calvo
- START Madrid-CIOCC, Centro Integral Oncológico Clara Campal, Madrid, Spain
| | - Anna Varghese
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Erkut Borazanci
- HonorHealth Research Institute, Scottsdale, Arizona, USA.,TGen, Phoenix, Arizona, USA
| | - Teresa Macarulla
- Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Valeria Merz
- Digestive Molecular Clinical Oncology Research Unit, Section of Medical Oncology, Università degli Studi di Verona, Verona, Italy.,Department of Medical Oncology, Santa Chiara Hospital, Trento, Italy
| | - Camilla Zecchetto
- Digestive Molecular Clinical Oncology Research Unit, Section of Medical Oncology, Università degli Studi di Verona, Verona, Italy
| | - Yumin Zhao
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | | | - Michael Man
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | | | | | | | | | - Emin Avsar
- Eli Lilly and Company, New York, New York, USA
| | - Susan C Guba
- Eli Lilly and Company, Indianapolis, Indiana, USA
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20
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Abstract
The prognosis of patients affected by cholangiocarcinoma is classically poor. Until recently, chemotherapeutic drugs were the only systemic treatment option available, leading to an overall survival lower than 1 year. In recent decades, different genetic alterations have been identified as playing a key role in the oncogenic signaling. A subgroup of intrahepatic cholangiocarcinoma is characterized by FGFR family mutations, more frequently represented by gene fusions of FGFR2. Based on the results of FIGHT-202 trial, in April 2020 the US FDA approved the FGFR inhibitor pemigatinib in advanced previously treated cholangiocarcinoma patients with FGFR2 rearrangements, opening the way to targeted therapy in this disease. This review summarizes the body of evidence about the efficacy of pemigatinib in cholangiocarcinoma.
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Affiliation(s)
- Valeria Merz
- Digestive Molecular Clinical Oncology Research Unit, Università degli Studi di Verona, Verona, Italy
- Medical Oncology Unit, Santa Chiara Hospital, Trento, Italy
| | - Camilla Zecchetto
- Digestive Molecular Clinical Oncology Research Unit, Università degli Studi di Verona, Verona, Italy
- Experimental Cancer Medicine Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Davide Melisi
- Digestive Molecular Clinical Oncology Research Unit, Università degli Studi di Verona, Verona, Italy
- Experimental Cancer Medicine Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
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21
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Rizzo A, Salati M, Frega G, Merz V, Caputo F, Ricci AD, Palloni A, Messina C, Spallanzani A, Saccoccio G, Mollica V, Gelsomino F, Benatti S, Luppi G, Melisi D, Dominici M, Brandi G. Second-line chemotherapy (2L) in elderly patients with advanced biliary tract cancer (ABC): A multicenter real-world study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.3_suppl.322] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
322 Background: The ABC-06 trial recently established the role of 2L in ABC progressing after platinum/gemcitabine combination. However, older patients are often under-represented in clinical trials and no data are currently available regarding 2L in elderly ABC. The aim of this real-world study was to explore the treatment pattern, safety and efficacy of 2L in ABC patients aged ≥ 70 years old and to compare their outcomes with younger subjects. Methods: Institutional registries across three academic medical centers were retrospectively reviewed and data of interest retrieved to identify ABC who had received 2L from October 2002 to July 2020. Patients older than 70 years were considered as elderly individuals. The Kaplan-Meier methods was used to estimate survival and the log-rank test to make comparison. The impact of variables on survival was assessed through univariate and multivariate analysis. Results: A total of 190 ABC patients treated with 2L were identified and included in the analysis. Among them, 27.3% (n = 52) were aged ≥ 70 years (range 70-87y), of whom 25 patients had iCCA (48%), 13 GBC (25%) and 15 eCCA (27%). 56% (n = 29) were female and 38 (73%) patients had an ECOG-PS 0-1. The most frequently administered 2L regimens were capecitabine monotherapy (n = 14, 27%), single-agent gemcitabine (n = 9, 17%) and gemcitabine/capecitabine combination (n = 9, 17%). No differences in terms of prior surgery (p = 0.64) and 2L treatment intensity (p = 0.34) were observed compared to patients aged < 70 years. The disease control rate of 2L was 28.8% and 29.7% in elderly and youngers, respectively. No statistically significant differences in both mOS (5.7 months in elderly vs 6.1 months in youngers, HR 0.97; p = 0.86) and mPFS (4.7 vs 4.8 months, HR 0.88; p = 0.44) were recorded. Regarding the safety profile of 2L, grade 3 or 4 treatment-related toxicities occurred more frequently in the older group (48.5% versus 8.2%; OR 6.31; p < 0.001). When looking at prognostic factors, absolute lymphocyte count < 1000/mmc (p < 0.001) and albumin level < 3 g/dL (p < 0.001) were independently associated with worse prognosis. Conclusions: The results of this real-world study, limited by its retrospective nature and small sample size, suggest that for patients aged ≥ 70 years, 2L could be equally effective as for youngers, with survival outcomes aligned to those from ABC-06 trial. Notably, based on the higher incidence of grade 3-4 adverse events, the delivery of 2L should be carefully evaluated and monitored in this patient subset.
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Affiliation(s)
- Alessandro Rizzo
- Department of Experimental, Diagnostic, and Specialty Medicine–DIMES, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Massimiliano Salati
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Giorgio Frega
- Department of Experimental, Diagnostic and Specialty Medicine, Policlinico S. Orsola Malpighi Hospital, Bologna, Italy
| | - Valeria Merz
- Digestive Molecular Clinical Oncology Research Unit, University of Verona, Verona, Italy
| | - Francesco Caputo
- Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Angela Dalia Ricci
- Department of Experimental, Diagnostic, and Specialty Medicine–DIMES, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Andrea Palloni
- Department of Experimental, Diagnostic, and Specialty Medicine–DIMES, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | | | - Andrea Spallanzani
- Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | | | - Veronica Mollica
- Department of Experimental, Diagnostic, and Specialty Medicine–DIMES, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | | | - Stefania Benatti
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | | | - Davide Melisi
- Medicine-Digestive Molecular Clinical Oncology Research Unit, University of Verona, Verona, Italy
| | - Massimo Dominici
- Department of Oncology, University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanni Brandi
- Department of Experimental, Diagnostic, and Specialty Medicine–DIMES, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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22
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Merz V, Ferro A, Piras EM, Zanutto A, Caffo O, Messina C. Electronic Medical Record-Assisted Telephone Follow-Up of Breast Cancer Survivors During the COVID-19 Pandemic: A Single Institution Experience. JCO Oncol Pract 2020; 17:e44-e52. [PMID: 33351674 DOI: 10.1200/op.20.00643] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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
PURPOSE The COVID-19 outbreak rapidly became a public health emergency and led to radical changes in patient management. From the start of the pandemic, we used electronic medical record-assisted telephone follow-up (E-TFU) of cancer survivors (CS) to minimize hospital exposure. The aim of this prospective study was to assess how breast cancer survivors (bCSs) perceived E-TFU. MATERIALS AND METHODS A 15-item survey was e-mailed to bCSs who had been managed with E-TFU. The responses were measured using Likert-like scales and were correlated with the main characteristics of the bCS using Pearson's test. RESULTS One hundred thirty-seven of 343 bCSs (40%) completed the survey between March 9 and June 2, 2020. Their median age was 59 years. Although 80.3% of bCSs were satisfied with E-TFU, only 43.8% would like to have E-TFU in the future. A low educational level was correlated with higher COVID-19-related anxiety (P = .025). An older age (P = .002) and a low educational level (P < .0001) were correlated with the need to be accompanied to reach the hospital. A personal history of second cancer was inversely correlated with understanding medical advice (P = .015) and the expectation of feeling relief after a follow-up visit (P = .0027). Furthermore, pandemic phase II was correlated with satisfaction with E-TFU (P = .010). CONCLUSION E-TFU was an important means of avoiding hospital contacts during the COVID-19 pandemic, and the majority of bCSs in the survey were satisfied with this procedure. Further studies are needed to investigate the implementation of telemedicine even outside an emergency situation.
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Affiliation(s)
- Valeria Merz
- Department of Medical Oncology, Santa Chiara Hospital, Trento, Italy
| | - Antonella Ferro
- Department of Medical Oncology, Santa Chiara Hospital, Trento, Italy
| | - Enrico Maria Piras
- Centre for Information and Communication Technology, Bruno Kessler Foundation, Trento, Italy
| | - Alberto Zanutto
- Centre for Information and Communication Technology, Bruno Kessler Foundation, Trento, Italy
| | - Orazio Caffo
- Department of Medical Oncology, Santa Chiara Hospital, Trento, Italy
| | - Carlo Messina
- Department of Medical Oncology, Santa Chiara Hospital, Trento, Italy
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23
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Ottaviano M, Curvietto M, Rescigno P, Tortora M, Palmieri G, Giannarelli D, Aieta M, Assalone P, Attademo L, Avallone A, Bloise F, Bosso D, Borzillo V, Buono G, Calderoni G, Caputo F, Cartenì G, Cavallero D, Cavo A, Ciardiello F, Conca R, Conteduca V, De Falco S, De Felice M, De Laurentiis M, De Placido P, De Placido S, De Santo I, De Stefano A, Della Corte CM, Di Franco R, Di Lauro V, Fabbrocini A, Federico P, Festino L, Giordano P, Giuliano M, Gridelli C, Grimaldi AM, Lia M, Marretta AL, Massa V, Mennitto A, Merler S, Merz V, Messina C, Messina M, Milano M, Minisini AM, Montesarchio V, Morabito A, Morgillo F, Mucci B, Nappi L, Napolitano F, Paciolla I, Pagliuca M, Palmieri G, Parola S, Pepe S, Petrillo A, Piantedosi F, Piccin L, Picozzi F, Pietroluongo E, Pignata S, Prati V, Riccio V, Rosanova M, Rossi A, Russo A, Salati M, Santabarbara G, Sbrana A, Simeone E, Silvestri A, Spada M, Tarantino P, Taveggia P, Tomei F, Vincenzo T, Trapani D, Trojanello C, Vanella V, Vari S, Ventriglia J, Vitale MG, Vitiello F, Vivaldi C, von Arx C, Zacchi F, Zampiva I, Zivi A, Daniele B, Ascierto PA. Impact of COVID-19 outbreak on cancer immunotherapy in Italy: a survey of young oncologists. J Immunother Cancer 2020; 8:jitc-2020-001154. [PMID: 33060148 PMCID: PMC7565202 DOI: 10.1136/jitc-2020-001154] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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] [Accepted: 08/08/2020] [Indexed: 01/20/2023] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has overwhelmed the health systems worldwide. Data regarding the impact of COVID-19 on cancer patients (CPs) undergoing or candidate for immune checkpoint inhibitors (ICIs) are lacking. We depicted the practice and adaptations in the management of patients with solid tumors eligible or receiving ICIs during the COVID-19 pandemic, with a special focus on Campania region. Methods This survey (25 questions), promoted by the young section of SCITO (Società Campana di ImmunoTerapia Oncologica) Group, was circulated among Italian young oncologists practicing in regions variously affected by the pandemic: high (group 1), medium (group 2) and low (group 3) prevalence of SARS-CoV-2–positive patients. For Campania region, the physician responders were split into those working in cancer centers (CC), university hospitals (UH) and general hospitals (GH). Percentages of agreement, among High (H) versus Medium (M) and versus Low (L) group for Italy and among CC, UH and GH for Campania region, were compared by using Fisher’s exact tests for dichotomous answers and χ2 test for trends relative to the questions with 3 or more options. Results This is the first Italian study to investigate the COVID-19 impact on cancer immunotherapy, unique in its type and very clear in the results. The COVID-19 pandemic seemed not to affect the standard practice in the prescription and delivery of ICIs in Italy. Telemedicine was widely used. There was high consensus to interrupt immunotherapy in SARS-CoV-2–positive patients and to adopt ICIs with longer schedule interval. The majority of the responders tended not to delay the start of ICIs; there were no changes in supportive treatments, but some of the physicians opted for delaying surgeries (if part of patients’ planned treatment approach). The results from responders in Campania did not differ significantly from the national ones. Conclusion Our study highlights the efforts of Italian oncologists to maintain high standards of care for CPs treated with ICIs, regardless the regional prevalence of COVID-19, suggesting the adoption of similar solutions. Research on patients treated with ICIs and experiencing COVID-19 will clarify the safety profile to continue the treatments, thus informing on the most appropriate clinical conducts.
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Affiliation(s)
- Margaret Ottaviano
- Oncology Unit, Ospedale del Mare, Napoli, Campania, Italy.,Department of Clinical Medicine and Surgery, Università degli Studi di Napoli Federico II and CRCTR Coordinating Rare Tumors Reference Center of Campania Region, AOU Federico II, Napoli, Italy
| | - Marcello Curvietto
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
| | - Pasquale Rescigno
- Clinical Studies, The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK
| | - Marianna Tortora
- CRCTR Coordinating Rare Tumors Reference Center of Campania Region, AOU Federico II, Napoli, Campania, Italy
| | - Giovannella Palmieri
- CRCTR Coordinating Rare Tumors Reference Center of Campania Region, AOU Federico II, Napoli, Campania, Italy
| | - Diana Giannarelli
- Biostatistics Unit, IRCCS Regina Elena National Cancer Institute, Roma, Lazio, Italy
| | - Michele Aieta
- Medical Oncology Unit, Department of Onco-Hematology, IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Basilicata, Italy
| | - Pasquale Assalone
- Oncology Unit, Ospedale Ferdinando Veneziale, Isernia, Molise, Italy
| | - Laura Attademo
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
| | - Antonio Avallone
- Abdominal Oncology Unit, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
| | | | | | - Valentina Borzillo
- Department of Radioterapia, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
| | - Giuseppe Buono
- Oncology Unit, San Rocco Hospital, Sessa Aurunca, Campania, Italy
| | | | - Francesca Caputo
- U.O.C. Oncologia, Azienda Ospedaliera dei Colli, Monaldi Hospital, Napoli, Campania, Italy
| | - Giacomo Cartenì
- Department of Medical Oncology, AORN "A. Cardarelli", Napoli, Campania, Italy
| | | | - Alessia Cavo
- Oncology Unit, Villa Scassi Hospital, Genova, Italy
| | - Fortunato Ciardiello
- Oncology, Department of Precision Medicine, Università della Campania "L. Vanvitelli", Napoli, Campania, Italy
| | - Raffaele Conca
- Medical Oncology Unit, Department of Onco-Hematology, IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Basilicata, Italy
| | - Vincenza Conteduca
- Medical Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Emilia-Romagna, Italy
| | - Stefano De Falco
- Oncology Unit, Sant'Ottone Frangipane Hospital, Avellino, Campania, Italy
| | - Marco De Felice
- Oncology, Department of Precision Medicine, Università della Campania "L. Vanvitelli", Napoli, Campania, Italy.,Oncology Unit, Sant'Anna e San Sebastiano, Caserta, Campania, Italy
| | | | - Pietro De Placido
- Department of Clinical Medicine and Surgery, Oncology Unit, Università degli Studi di Napoli Federico II, Napoli, Campania, Italy
| | - Sabino De Placido
- CRCTR Coordinating Rare Tumors Reference Center of Campania Region, AOU Federico II, Napoli, Campania, Italy.,Department of Clinical Medicine and Surgery, Oncology Unit, Università degli Studi di Napoli Federico II, Napoli, Campania, Italy
| | - Irene De Santo
- Oncology Unit, Gemelli Molise s.p.a, Campobasso, Molise, Italy
| | - Alfonso De Stefano
- Abdominal Oncology Unit, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
| | - Carminia Maria Della Corte
- Oncology, Department of Precision Medicine, Università della Campania "L. Vanvitelli", Napoli, Campania, Italy
| | - Rossella Di Franco
- Department of Radioterapia, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
| | - Vincenzo Di Lauro
- Breast Unit, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy.,Department of Clinical Medicine and Surgery, Oncology Unit, Università degli Studi di Napoli Federico II, Napoli, Campania, Italy
| | | | | | - Lucia Festino
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
| | | | - Mario Giuliano
- CRCTR Coordinating Rare Tumors Reference Center of Campania Region, AOU Federico II, Napoli, Campania, Italy.,Department of Clinical Medicine and Surgery, Oncology Unit, Università degli Studi di Napoli Federico II, Napoli, Campania, Italy
| | - Cesare Gridelli
- Division of Medical Oncology, "San Giuseppe Moscati" Hospital, Avellino, Campania, Italy
| | - Antonio Maria Grimaldi
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
| | - Michela Lia
- Oncology Unit, SS Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Piemonte, Italy
| | - Antonella Lucia Marretta
- Department of Clinical Medicine and Surgery, Oncology Unit, Università degli Studi di Napoli Federico II, Napoli, Campania, Italy
| | - Valentina Massa
- Medical Oncology Unit, University of Pisa, Pisa, Toscana, Italy
| | - Alessia Mennitto
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Lombardia, Italy
| | - Sara Merler
- Department of Oncology, University of Verona, Verona, Veneto, Italy
| | - Valeria Merz
- Department of Medical Oncology, Santa Chiara Hospital, Trento, Trentino Alto Adige, Italy
| | - Carlo Messina
- Department of Medical Oncology, Santa Chiara Hospital, Trento, Trentino Alto Adige, Italy
| | - Marco Messina
- UOC Oncologia Medica, Ospedali Riuniti Villa Sofia Cervello, Palermo, Sicilia, Italy
| | - Monica Milano
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Lombardia, Italy
| | - Alessandro Marco Minisini
- Department of Oncology, Azienda Sanitaria Universitaria Integrata del Friuli Centrale, Udine, Friuli Venezia Giulia, Italy
| | - Vincenzo Montesarchio
- U.O.C. Oncologia, Azienda Ospedaliera dei Colli, Monaldi Hospital, Napoli, Campania, Italy
| | - Alessandro Morabito
- Thoracic Medical Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
| | - Floriana Morgillo
- Oncology, Department of Precision Medicine, Università della Campania "L. Vanvitelli", Napoli, Campania, Italy
| | - Brigitta Mucci
- Department of Clinical Medicine and Surgery, Oncology Unit, Università degli Studi di Napoli Federico II, Napoli, Campania, Italy
| | - Lucia Nappi
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada and British Columbia Cancer Agency-Vancouver Center-Department of Medicine, Division of Medical Oncology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fabiana Napolitano
- Department of Clinical Medicine and Surgery, Oncology Unit, Università degli Studi di Napoli Federico II, Napoli, Campania, Italy
| | - Immacolata Paciolla
- Oncology Unit, Ospedale Sacro Cuore di Gesù Fatebenefratelli, Benevento, Campania, Italy
| | - Martina Pagliuca
- Department of Clinical Medicine and Surgery, Oncology Unit, Università degli Studi di Napoli Federico II, Napoli, Campania, Italy
| | - Giuseppe Palmieri
- Institute of Research on Genetics and Biomedicine (IRGB), National Research Council (CNR), Sassari, Sardegna, Italy
| | - Sara Parola
- Department of Clinical Medicine and Surgery, Oncology Unit, Università degli Studi di Napoli Federico II, Napoli, Campania, Italy
| | - Stefano Pepe
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Oncology Unit, University of Salerno, Baronissi, Campania, Italy
| | - Angelica Petrillo
- Oncology Unit, Ospedale del Mare, Napoli, Italy.,Oncology, Department of Precision Medicine, Università della Campania "L. Vanvitelli", Napoli, Campania, Italy
| | - Francovito Piantedosi
- U.O.C. Pneumologia Oncologica, Azienda Ospedaliera dei Colli, Monaldi Hospital, Naples, Campania, Italy
| | - Luisa Piccin
- Veneto Institute of Oncology IOV-IRCCS, Padova, Veneto, Italy
| | - Fernanda Picozzi
- Department of Clinical Medicine and Surgery, Oncology Unit, Università degli Studi di Napoli Federico II, Napoli, Campania, Italy
| | - Erica Pietroluongo
- Department of Clinical Medicine and Surgery, Oncology Unit, Università degli Studi di Napoli Federico II, Napoli, Campania, Italy
| | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
| | | | - Vittorio Riccio
- Department of Clinical Medicine and Surgery, Oncology Unit, Università degli Studi di Napoli Federico II, Napoli, Campania, Italy
| | | | - Alice Rossi
- Department of Oncology, University of Verona, Verona, Veneto, Italy
| | - Anna Russo
- Medical Oncology Unit, Fondazione IRCCS Giovanni Paolo II, Bari, Puglia, Italy
| | - Massimiliano Salati
- Medical Oncology Unit, University Hospital Modena, Modena, Emilia Romagna, Italy
| | - Giuseppe Santabarbara
- Division of Medical Oncology, "San Giuseppe Moscati" Hospital, Avellino, Campania, Italy
| | - Andrea Sbrana
- Medical Oncology Unit, University of Pisa, Pisa, Toscana, Italy
| | - Ester Simeone
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
| | | | - Massimiliano Spada
- Oncology Unit, Fondazione Istituto San Raffaele G Giglio di Cefalu, Cefalu, Sicilia, Italy
| | - Paolo Tarantino
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Milano, Lombardia, Italy
| | | | - Federica Tomei
- Oncology Unit, Ospedale Ferdinando Veneziale, Isernia, Molise, Italy
| | - Tortora Vincenzo
- Department of Clinical Medicine and Surgery, Oncology Unit, Università degli Studi di Napoli Federico II, Napoli, Campania, Italy.,Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Oncology Unit, University of Salerno, Baronissi, Campania, Italy
| | - Dario Trapani
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Milano, Lombardia, Italy
| | - Claudia Trojanello
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
| | - Vito Vanella
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
| | - Sabrina Vari
- Medical Oncology 1 Unit, IRCCS Regina Elena National Cancer Institute, Rome, Lazio, Italy
| | - Jole Ventriglia
- Oncology Division, ASL San Felice a Cancello, Caserta, Campania, Italy
| | - Maria Grazia Vitale
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy.,Department of Oncology, Azienda Sanitaria Universitaria Integrata del Friuli Centrale, Udine, Friuli Venezia Giulia, Italy
| | - Fabiana Vitiello
- U.O.C. Pneumologia Oncologica, Azienda Ospedaliera dei Colli, Monaldi Hospital, Naples, Campania, Italy
| | | | - Claudia von Arx
- Department of Surgery and Cancer, Imperial College, London, UK
| | - Francesca Zacchi
- Oncology Unit, Università degli Studi di Verona, sede Borgo Roma, Verona, Veneto, Italy
| | - Ilaria Zampiva
- Oncology Unit, Università degli Studi di Verona, sede Borgo Roma, Verona, Veneto, Italy
| | - Andrea Zivi
- Department of Surgery and Cancer, Imperial College, London, UK.,Medical Oncology Department, AOUI di Verona, Verona, Veneto, Italy
| | | | - Paolo Antonio Ascierto
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
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24
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Simionato F, Zecchetto C, Merz V, Cavaliere A, Casalino S, Gaule M, D'Onofrio M, Malleo G, Landoni L, Esposito A, Marchegiani G, Casetti L, Tuveri M, Paiella S, Scopelliti F, Giardino A, Frigerio I, Regi P, Capelli P, Gobbo S, Gabbrielli A, Bernardoni L, Fedele V, Rossi I, Piazzola C, Giacomazzi S, Pasquato M, Gianfortone M, Milleri S, Milella M, Butturini G, Salvia R, Bassi C, Melisi D. A phase II study of liposomal irinotecan with 5-fluorouracil, leucovorin and oxaliplatin in patients with resectable pancreatic cancer: the nITRO trial. Ther Adv Med Oncol 2020; 12:1758835920947969. [PMID: 33403007 PMCID: PMC7745557 DOI: 10.1177/1758835920947969] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 07/13/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Up-front surgery followed by postoperative chemotherapy remains the standard paradigm for the treatment of patients with resectable pancreatic cancer. However, the risk for positive surgical margins, the poor recovery after surgery that often impairs postoperative treatment, and the common metastatic relapse limit the overall clinical outcomes achieved with this strategy. Polychemotherapeutic combinations are valid options for postoperative treatment in patients with good performance status. liposomal irinotecan (Nal-IRI) is a novel nanoliposome formulation of irinotecan that accumulates in tumor-associated macrophages improving the therapeutic index of irinotecan and has been approved for the treatment of patients with metastatic pancreatic cancer after progression under gemcitabine-based therapy. Thus, it remains of the outmost urgency to investigate introduction of the most novel agents, such as nal-IRI, in perioperative approaches aimed at increasing the long-term effectiveness of surgery. Methods: The nITRO trial is a phase II, single-arm, open-label study to assess the safety and the activity of nal-IRI with fluorouracil/leucovorin (5-FU/LV) and oxaliplatin in the perioperative treatment of patients with resectable pancreatic cancer. The primary tumor must be resectable with no involvement of the major arteries and no involvement or <180° interface between tumor and vessel wall of the major veins. A total of 72 patients will be enrolled to receive a perioperative treatment of three cycles before and three cycles after surgical resection with nal-IRI 50 mg/m2, oxaliplatin 60 mg/m2, leucovorin 200 mg/m2, and 5-fluorouracil 2400 mg/m2, days 1 and 15 of a 28-day cycle. The primary objective is to improve from 40% to 55% the proportion of patients achieving R0 resection after preoperative treatment. Discussion: The nITRO trial will contribute to strengthen the clinical evidence supporting perioperative strategies in resectable pancreatic cancer patients. Moreover, this study represents a unique opportunity for translational analyses aimed to identify novel immune-related prognostic and predictive factors in this setting. Trial registration Clinicaltrial.gov: NCT03528785. Trial registration data: 1 January 2018 Protocol number: CRC 2017_01 EudraCT Number: 2017-000345-46
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Affiliation(s)
- Francesca Simionato
- Digestive Molecular Clinical Oncology Unit, Section of Medical Oncology, Department of Medicine, University of Verona, Verona, Italy
| | - Camilla Zecchetto
- Digestive Molecular Clinical Oncology Unit, Section of Medical Oncology, Department of Medicine, University of Verona, Verona, Italy
| | - Valeria Merz
- Digestive Molecular Clinical Oncology Unit, Section of Medical Oncology, Department of Medicine, University of Verona, Verona, Italy
| | - Alessandro Cavaliere
- Digestive Molecular Clinical Oncology Unit, Section of Medical Oncology, Department of Medicine, University of Verona, Verona, Italy
| | - Simona Casalino
- Digestive Molecular Clinical Oncology Unit, Section of Medical Oncology, Department of Medicine, University of Verona, Verona, Italy
| | - Marina Gaule
- Digestive Molecular Clinical Oncology Unit, Section of Medical Oncology, Department of Medicine, University of Verona, Verona, Italy
| | - Mirko D'Onofrio
- Department of Radiology, University and Hospital Trust of Verona, Verona, Italy
| | - Giuseppe Malleo
- Department of Surgery, University and Hospital Trust of Verona, Verona, Italy
| | - Luca Landoni
- Department of Surgery, University and Hospital Trust of Verona, Verona, Italy
| | - Alessandro Esposito
- Department of Surgery, University and Hospital Trust of Verona, Verona, Italy
| | | | - Luca Casetti
- Department of Surgery, University and Hospital Trust of Verona, Verona, Italy
| | - Massimiliano Tuveri
- Department of Surgery, University and Hospital Trust of Verona, Verona, Italy
| | - Salvatore Paiella
- Department of Surgery, University and Hospital Trust of Verona, Verona, Italy
| | - Filippo Scopelliti
- Department of Surgery, Pancreatic Surgery Unit, Hospital P. Pederzoli, Peschiera del Garda, Italy
| | - Alessandro Giardino
- Department of Surgery, Pancreatic Surgery Unit, Hospital P. Pederzoli, Peschiera del Garda, Italy
| | - Isabella Frigerio
- Department of Surgery, Pancreatic Surgery Unit, Hospital P. Pederzoli, Peschiera del Garda, Italy
| | - Paolo Regi
- Department of Surgery, Pancreatic Surgery Unit, Hospital P. Pederzoli, Peschiera del Garda, Italy
| | - Paola Capelli
- Department of Pathology, University and Hospital Trust of Verona, Verona, Italy
| | - Stefano Gobbo
- Department of Pathology, Hospital P. Pederzoli, Peschiera del Garda, Italy
| | | | - Laura Bernardoni
- Endoscopy Unit, University and Hospital Trust of Verona, Verona, Italy
| | - Vita Fedele
- Digestive Molecular Clinical Oncology Research Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Irene Rossi
- Centro Ricerche Cliniche di Verona, University and Hospital Trust of Verona, Verona, Italy
| | - Cristiana Piazzola
- Centro Ricerche Cliniche di Verona, University and Hospital Trust of Verona, Verona, Italy
| | - Serena Giacomazzi
- Centro Ricerche Cliniche di Verona, University and Hospital Trust of Verona, Verona, Italy
| | - Martina Pasquato
- Centro Ricerche Cliniche di Verona, University and Hospital Trust of Verona, Verona, Italy
| | - Morena Gianfortone
- Centro Ricerche Cliniche di Verona, University and Hospital Trust of Verona, Verona, Italy
| | - Stefano Milleri
- Centro Ricerche Cliniche di Verona, University and Hospital Trust of Verona, Verona, Italy
| | - Michele Milella
- Medical Oncology Unit, University and Hospital Trust of Verona, Verona, Italy
| | - Giovanni Butturini
- Department of Surgery, Pancreatic Surgery Unit, Hospital P. Pederzoli, Peschiera del Garda, Italy
| | - Roberto Salvia
- Department of Surgery, University and Hospital Trust of Verona, Verona, Italy
| | - Claudio Bassi
- Department of Surgery, University and Hospital Trust of Verona, Verona, Italy
| | - Davide Melisi
- Digestive Molecular Clinical Oncology Unit, Section of Medical Oncology, Department of Medicine, University of Verona, AOUI Verona - Policlinico "G.B. Rossi", Piazzale L.A. Scuro, 10, Verona 37134, Italy
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Caputo F, Gelsomino F, Spallanzani A, Pettorelli E, Benatti S, Ghidini M, Grizzi G, Ratti M, Merz V, Messina C, Tonelli R, Luppi G, Melisi D, Dominici M, Salati M. 63P Multicentre match-paired analysis of advanced biliary cancer (ABC) long-term survivors: The BILONG study. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.041] [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: 10/23/2022] Open
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26
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Merz V, Zecchetto C, Simionato F, Cavaliere A, Casalino S, Pavarana M, Giacopuzzi S, Bencivenga M, Tomezzoli A, Santoro R, Fedele V, Contarelli S, Rossi I, Giacomazzi S, Pasquato M, Piazzola C, Milleri S, de Manzoni G, Melisi D. A phase II trial of the FGFR inhibitor pemigatinib in patients with metastatic esophageal-gastric junction/gastric cancer trastuzumab resistant: the FiGhTeR trial. Ther Adv Med Oncol 2020; 12:1758835920937889. [PMID: 32684989 PMCID: PMC7346700 DOI: 10.1177/1758835920937889] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 03/21/2020] [Accepted: 06/05/2020] [Indexed: 01/12/2023] Open
Abstract
Background: Prognosis of patients affected by metastatic esophageal–gastric junction (EGJ) or gastric cancer (GC) remains dismal. Trastuzumab, an anti-HER2 monoclonal antibody, is the only targeted agent approved for the first-line treatment of patients with HER2-overexpressing advanced EGJ or GC in combination with chemotherapy. However, patients invariably become resistant during this treatment. We recently identified the overexpression of fibroblast growth factor (FGF) receptor 3 (FGFR3) as a molecular mechanism responsible for trastuzumab resistance in GC models, providing the rationale for the inhibition of this receptor as a potential second-line strategy in this disease. Pemigatinib is a selective, potent, oral inhibitor of FGFR1, 2, and 3. Methods: The FiGhTeR trial is a phase II, single-arm, open-label study to assess safety and activity of the FGFR inhibitor pemigatinib as second-line treatment strategy in metastatic EGJ/GC patients progressing under trastuzumab-containing therapies. The primary endpoint is the 12-week progression-free survival rate. Plasma and tumor tissue samples will be collected for translational research analyses at baseline, during treatment, and at progression on pemigatinib. Discussion: Co-alterations in genes coding for different tyrosine-kinase receptors are emerging as relevant mechanisms of acquired resistance to anti-HER2 therapeutic strategies in GC. In particular, our group has recently identified that in GC models the overexpression of FGFR3 sustains the acquired resistance to trastuzumab. This trial aims to assess the safety, tolerability and activity of the FGFR inhibitor pemigatinib as a second-line treatment in metastatic EGJ/GC patients refractory to first-line trastuzumab-containing therapies. Furthermore, this study offers the opportunity to prospectively study mechanisms and pathways involved in trastuzumab resistance. Protocol number: CRC2017_02 EudraCT Number: 2017-004522-14
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Affiliation(s)
- Valeria Merz
- Digestive Molecular Clinical Oncology Research Unit, Department of Medicine, Università degli studi di Verona, Verona, Italy
| | - Camilla Zecchetto
- Digestive Molecular Clinical Oncology Research Unit, Department of Medicine, Università degli studi di Verona, Verona, Italy
| | - Francesca Simionato
- Digestive Molecular Clinical Oncology Research Unit, Department of Medicine, Università degli studi di Verona, Verona, Italy
| | - Alessandro Cavaliere
- Digestive Molecular Clinical Oncology Research Unit, Department of Medicine, Università degli studi di Verona, Verona, Italy
| | - Simona Casalino
- Digestive Molecular Clinical Oncology Research Unit, Department of Medicine, Università degli studi di Verona, Verona, Italy
| | - Michele Pavarana
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Simone Giacopuzzi
- Esophageal and Gastric Surgery Unit, Department of Surgery, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Maria Bencivenga
- Esophageal and Gastric Surgery Unit, Department of Surgery, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Anna Tomezzoli
- Anatomical Pathology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Raffaela Santoro
- Digestive Molecular Clinical Oncology Research Unit, Department of Medicine, Università degli studi di Verona, Verona, Italy
| | - Vita Fedele
- Digestive Molecular Clinical Oncology Research Unit, Department of Medicine, Università degli studi di Verona, Verona, Italy
| | - Serena Contarelli
- Digestive Molecular Clinical Oncology Research Unit, Department of Medicine, Università degli studi di Verona, Verona, Italy
| | - Irene Rossi
- Centro Ricerche Cliniche di Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Serena Giacomazzi
- Centro Ricerche Cliniche di Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Martina Pasquato
- Centro Ricerche Cliniche di Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Cristiana Piazzola
- Centro Ricerche Cliniche di Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Stefano Milleri
- Centro Ricerche Cliniche di Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Giovanni de Manzoni
- Esophageal and Gastric Surgery Unit, Department of Surgery, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Davide Melisi
- Digestive Molecular Clinical Oncology unit, Section of Medical Oncology, Department of Medicine, University of Verona, AOUI Verona - Policlinico "G.B. Rossi", Piazzale L.A. Scuro,10, Verona, 37134, Italy
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Merz V, Cavaliere A, Messina C, Salati M, Zecchetto C, Casalino S, Milella M, Caffo O, Melisi D. Multicenter Retrospective Analysis of Second-Line Therapy after Gemcitabine Plus Nab-Paclitaxel in Advanced Pancreatic Cancer Patients. Cancers (Basel) 2020; 12:E1131. [PMID: 32366019 PMCID: PMC7281137 DOI: 10.3390/cancers12051131] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/17/2020] [Accepted: 04/26/2020] [Indexed: 12/17/2022] Open
Abstract
Pancreatic cancer is one of the most lethal solid tumors. In many European countries gemcitabine plus nab-paclitaxel is the preferred first-line treatment. An increasing number of patients are eligible for second-line therapy, but the best regimen is still controversial. This study aimed to evaluate the efficacy of oxaliplatin-based compared to irinotecan-based therapies in this setting. 181 advanced pancreatic cancer patients consecutively treated in three centers with a second-line therapy progressed on gemcitabine plus nab-paclitaxel were retrospectively enrolled. OS and PFS were calculated using the Kaplan-Meier method and survival of the two groups was compared using the log-rank test. The median PFS and OS were respectively 3.5 (95%CI 3.2-3.8) and 8.8 months (95%CI 7.9-9.8) from second-line therapy in the overall population. The median PFS and OS were respectively 3.3 (95%CI 3.1-3.5) and 8.2 months (95%CI 7.24-9.34) with an irinotecan-based combination compared to 4.0 (95%CI 2.4-5.7) and 10.3 months (95%CI 8.62-12.02) in patients receiving an oxaliplatin-based combination. We observed a clear trend for longer survival outcomes with platinum-based doublet compared to regimens including irinotecan or nal-IRI. Head-to-head trials are still lacking. The neutrophil-to-lymphocyte ratio and the presence of liver metastases could drive physicians in tailoring the treatment strategy.
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Affiliation(s)
- Valeria Merz
- Digestive Molecular Clinical Oncology Research Unit, University of Verona, 37134 Verona, Italy; (A.C.); (C.Z.); (S.C.)
- Department of Medical Oncology, Santa Chiara Hospital, 38122 Trento, Italy; (C.M.); (O.C.)
| | - Alessandro Cavaliere
- Digestive Molecular Clinical Oncology Research Unit, University of Verona, 37134 Verona, Italy; (A.C.); (C.Z.); (S.C.)
- Section of Medical Oncology, University of Verona, 37134 Verona, Italy;
| | - Carlo Messina
- Department of Medical Oncology, Santa Chiara Hospital, 38122 Trento, Italy; (C.M.); (O.C.)
| | - Massimiliano Salati
- Department of Medical Oncology, University Hospital of Modena, 4121 Modena, Italy;
- PhD Program Clinical and Experimental Medicine (CEM), University of Modena and Reggio Emilia, 4121 Modena, Italy
| | - Camilla Zecchetto
- Digestive Molecular Clinical Oncology Research Unit, University of Verona, 37134 Verona, Italy; (A.C.); (C.Z.); (S.C.)
| | - Simona Casalino
- Digestive Molecular Clinical Oncology Research Unit, University of Verona, 37134 Verona, Italy; (A.C.); (C.Z.); (S.C.)
- Section of Medical Oncology, University of Verona, 37134 Verona, Italy;
| | - Michele Milella
- Section of Medical Oncology, University of Verona, 37134 Verona, Italy;
| | - Orazio Caffo
- Department of Medical Oncology, Santa Chiara Hospital, 38122 Trento, Italy; (C.M.); (O.C.)
| | - Davide Melisi
- Digestive Molecular Clinical Oncology Research Unit, University of Verona, 37134 Verona, Italy; (A.C.); (C.Z.); (S.C.)
- Section of Medical Oncology, University of Verona, 37134 Verona, Italy;
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Pellino A, Manai C, Merz V, Scartozzi M, Milella M, De Vita F, Antonuzzo L, Zichi C, Satolli MA, Panebianco M, Noventa S, Giordano G, Nappo F, Zecchetto C, Puzzoni M, Vaccaro V, Pappalardo A, Giommoni E, Melisi D, Lonardi S. Observational retrospective evaluation of treatment with liposomal irinotecan plus fluorouracil/leucovorin for metastatic pancreatic cancer patients: An Italian large real-world analysis. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.4_suppl.660] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
660 Background: In the NAPOLI I phase III trial, Nanoliposomal irinotecan (nal-IRI) plus 5-fluorouracil/leucovorin (5-FU/LV) showed better outcome compared to 5FU/LV in patients with metastatic Pancreatic Cancer (MPC) progressed to 1st- line gemcitabine-based therapy. Aim of this study is to explore the real-world efficacy and safety of 5FU/LV-nal-IRI by a compassionate use programme and to identify potential prognostic factors that could affect survival in this setting. Methods: This is a retrospective multi-center analysis including patients with MPC who received 5FU/LV-nal-IRI after failure of a gemcitabine-based therapy. Survival analyses were carried out by the Kaplan-Meier method. Univariate and multivariate analyses were performed by using the log-rank test and the Cox regression. Results: A total of 296 pts (median age, 69 years, range 30-82; 50% male; ECOG PS 0, 44%) were treated at 11 Italian institutions from June 2016 and November 2018. 34% of the pts have been previously resected on their primary tumor, and 76% received gemcitabine-nabpaclitaxel as 1st - line treatment. 5FU/LV-nal-IRI has been administered as 2nd - line in 72% of the pts, while in 23% of the cases as 3rd - line or more. The median OS was 7.1 months [95% confidence interval (CI) 6.1 - 8.1] and the median PFS was 3.3 months (95% CI 2.9 - 3.6). At six months, OS and PFS rate were 53.4% and 31.4% respectively. ORR was 12% and DCR was 40%. 52% of pts received more than 4 cycle with dose reduction in 148 pts (50%). Most common grade 3 toxicities were neutropenia (14%), diarrhea (11%), anemia (3%), nausea (3%), fatigue (3%), mucositis (2%) and vomiting (1%). Baseline characteristics associated with better OS were ECOG PS 0, normal CEA, neutrophil-to-lymphocyte ratio ≤5 and haemoglobin ≥11 g/dL. Conclusions: These real-world data confirm the efficacy and safety of 5FU/LV-nal-IRI in patients with MPC progressed to a gemcitabine-based therapy, with outcome comparable to NAPOLI-1 even in a less selected population and with more active 1st - line combination therapy. In this cohort, well known prognostic markers has been confirmed, as expected.
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Affiliation(s)
- Antonio Pellino
- Department of Clinical and Experimental Oncology, Medical Oncology 1 Unit, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - Chiara Manai
- Department of Clinical and Experimental Oncology, Medical Oncology 1 Unit, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - Valeria Merz
- Unit of Medical Oncology, University of Verona Hospital Trust, Verona, TN, Italy
| | - Mario Scartozzi
- Medical Oncology Department, University Hospital, University of Cagliari, Cagliari, Italy
| | - Michele Milella
- Medical Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Ferdinando De Vita
- Division of Medical Oncology, Department of Precision Medicine, University of Study of Campania "L. Vanvitelli", Naples, Italy
| | - Lorenzo Antonuzzo
- Medical Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Clizia Zichi
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, Turin, Italy
| | | | - Michele Panebianco
- Medical Oncology Unit, Clinical Cancer Center, IRCCS-AUSL di Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Noventa
- Medical Oncology Unit, Casa di Cura Poliambulanza, Brescia, Italy
| | - Guido Giordano
- Fondazione IRCCS Casa Sollievo della Sofferenza, UO di Oncologia Medica, San Giovanni Rotondo, Italy
| | - Floriana Nappo
- Department of Clinical and Experimental Oncology, Medical Oncology 1 Unit, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - Camilla Zecchetto
- Unit of Medical Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Marco Puzzoni
- Medical Oncology Department, University Hospital, University of Cagliari, Cagliari, Italy
| | - Vanja Vaccaro
- Medical Oncology 1, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Annalisa Pappalardo
- Division of Medical Oncology, Department of Precision Medicine, University of Study of Campania "L. Vanvitelli", Naples, Italy
| | - Elisa Giommoni
- Medical Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Davide Melisi
- Medicine - Digestive Molecular Clinical Oncology Research Unit, University of Verona, Verona, Italy
| | - Sara Lonardi
- Department of Clinical and Experimental Oncology, Medical Oncology 1 Unit, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
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Cavaliere A, Merz V, Casalino S, Zecchetto C, Simionato F, Salt HL, Contarelli S, Santoro R, Melisi D. Novel Biomarkers for Prediction of Response to Preoperative Systemic Therapies in Gastric Cancer. J Gastric Cancer 2019; 19:375-392. [PMID: 31897341 PMCID: PMC6928085 DOI: 10.5230/jgc.2019.19.e39] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/02/2019] [Accepted: 09/17/2019] [Indexed: 12/13/2022] Open
Abstract
Preoperative chemo- and radiotherapeutic strategies followed by surgery are currently a standard approach for treating locally advanced gastric and esophagogastric junction cancer in Western countries. However, in a large number of cases, the tumor is extremely resistant to these treatments and the patients are exposed to unnecessary toxicity and delayed surgical therapy. The current clinical trials evaluating the combination of preoperative systemic therapies with modern targeted and immunotherapeutic agents represent a unique opportunity for identifying predictive biomarkers of response to select patients that would benefit the most from these treatments. However, it is of utmost importance that these potential biomarkers are corroborated by extensive preclinical and translational research. The aim of this review article is to present the most promising biomarkers of response to classic chemotherapeutic, anti-HER2, antiangiogenic, and immunotherapeutic agents that can be potentially useful for personalized preoperative systemic therapies in gastric cancer patients.
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Affiliation(s)
- Alessandro Cavaliere
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Valeria Merz
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Simona Casalino
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Camilla Zecchetto
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Francesca Simionato
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Hayley Louise Salt
- Digestive Molecular Clinical Oncology Research Unit, Section of Medical Oncology, Department of Medicine, University of Verona, Verona, Italy
| | - Serena Contarelli
- Digestive Molecular Clinical Oncology Research Unit, Section of Medical Oncology, Department of Medicine, University of Verona, Verona, Italy
| | - Raffaela Santoro
- Digestive Molecular Clinical Oncology Research Unit, Section of Medical Oncology, Department of Medicine, University of Verona, Verona, Italy
| | - Davide Melisi
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
- Digestive Molecular Clinical Oncology Research Unit, Section of Medical Oncology, Department of Medicine, University of Verona, Verona, Italy
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Maggino L, Malleo G, Marchegiani G, Viviani E, Nessi C, Ciprani D, Esposito A, Landoni L, Casetti L, Tuveri M, Paiella S, Casciani F, Sereni E, Binco A, Bonamini D, Secchettin E, Auriemma A, Merz V, Simionato F, Zecchetto C, D’Onofrio M, Melisi D, Bassi C, Salvia R. Outcomes of Primary Chemotherapy for Borderline Resectable and Locally Advanced Pancreatic Ductal Adenocarcinoma. JAMA Surg 2019; 154:932-942. [PMID: 31339530 PMCID: PMC6659151 DOI: 10.1001/jamasurg.2019.2277] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 05/17/2019] [Indexed: 12/21/2022]
Abstract
Importance Chemotherapy is the recommended induction strategy in borderline resectable and locally advanced pancreatic ductal adenocarcinoma. However, the associated results on an intention-to-treat basis are poorly understood. Objective To investigate pragmatically the treatment compliance, conversion to surgery, and survival outcomes of patients with borderline resectable and locally advanced pancreatic ductal adenocarcinoma undergoing primary chemotherapy. Design, Setting, and Participants This prospective study took place in a national referral center for pancreatic diseases in Italy. Consecutive patients with borderline resectable and locally advanced pancreatic ductal adenocarcinoma were enrolled at the time of diagnosis (January 2013 through December 2015) and followed up to June 2018. Exposures The chemotherapy regimen, assigned based on multidisciplinary evaluation, was delivered either at a hub center or at spoke centers. By convention, primary chemotherapy was considered completed after 6 months. After restaging, surgical candidates were selected based on radiologic and biochemical response. All surgeries were carried out at the hub center. Main Outcomes and Measures Rates of receipt and completion of chemotherapy, rates of conversion to surgery, and disease-specific survival. Results Of 680 patients, 267 (39.3%) had borderline resectable and 413 (60.7%) had locally advanced pancreatic ductal adenocarcinoma. Overall, 66 patients (9.7%) were lost to follow-up. The rate of chemotherapy receipt was 92.9% (n = 570). The chemotherapeutic regimens most commonly used included FOLFIRINOX (fluorouracil, leucovorin, oxaliplatin, and irinotecan) (260 [45.6%]) and gemcitabine plus nanoparticle albumin-bound-paclitaxel (123 [21.6%]). Nineteen patients (3.3%) receiving chemotherapy died within 6 months, mainly for disease progression. The treatment completion rate was 71.6% (408 of 570). The overall rate of resection was 15.1% (93 of 614) (borderline resectable, 60 of 249 [24.1%]; locally advanced, 33 of 365 [9%]; resection:exploration ratio, 63.3%). Independent predictors of resection were age, borderline resectable disease, chemotherapy completion, radiologic response, and biochemical response. The median survival for the whole cohort was 12.8 (95% CI, 11.7-13.9) months. Factors independently associated with survival were completion of chemotherapy, receipt of complementary radiation therapy, and resection. In patients who underwent resection, the median survival was 35.4 (95% CI, 27.0-43.7) months for initially borderline resectable and 41.8 (95% CI, 27.5-56.1) months for initially locally advanced disease. No pretreatment and posttreatment factors were associated with survival after pancreatectomy. Conclusions and Relevance This pragmatic observational cohort study with an intention-to-treat design provides real-world evidence of outcomes associated with the most current primary chemotherapy regimens used for borderline resectable and locally advanced pancreatic ductal adenocarcinoma.
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Affiliation(s)
- Laura Maggino
- Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Giuseppe Malleo
- Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Giovanni Marchegiani
- Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Elena Viviani
- Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Chiara Nessi
- Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Debora Ciprani
- Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Alessandro Esposito
- Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Luca Landoni
- Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Luca Casetti
- Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Massimiliano Tuveri
- Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Salvatore Paiella
- Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Fabio Casciani
- Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Elisabetta Sereni
- Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Alessandra Binco
- Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Deborah Bonamini
- Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Erica Secchettin
- Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Alessandra Auriemma
- Unit of Medical Oncology, Department of Surgery and Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Valeria Merz
- Unit of Medical Oncology, Department of Surgery and Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Francesca Simionato
- Unit of Medical Oncology, Department of Surgery and Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Camilla Zecchetto
- Unit of Medical Oncology, Department of Surgery and Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Mirko D’Onofrio
- Unit of Radiology, Department of Pathology and Diagnostics, University of Verona Hospital Trust, Verona, Italy
| | - Davide Melisi
- Unit of Medical Oncology, Department of Surgery and Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Claudio Bassi
- Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Roberto Salvia
- Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, University of Verona Hospital Trust, Verona, Italy
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Merz V, Zecchetto C, Santoro R, Simionato F, Piro G, Sabbadini F, Cavaliere A, Casalino S, Auriemma A, Melisi D. Plasmatic CXCL8 is a marker for TGFß-activated kinase 1 (TAK1) activation which may predict resistance to nanoliposomal irinotecan (nal-IRI) in gemcitabine-refractory pancreatic cancer (PC) patients. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz247.024] [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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Santoro R, Zanotto M, Simionato F, Zecchetto C, Merz V, Cavallini C, Piro G, Sabbadini F, Boschi F, Scarpa A, Melisi D. Modulating TAK1 Expression Inhibits YAP and TAZ Oncogenic Functions in Pancreatic Cancer. Mol Cancer Ther 2019; 19:247-257. [PMID: 31562256 DOI: 10.1158/1535-7163.mct-19-0270] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 07/19/2019] [Accepted: 09/18/2019] [Indexed: 11/16/2022]
Abstract
YAP and TAZ are central determinants of malignancy; however, their functions remain still undruggable. We identified TGFβ-activated kinase 1 (TAK1) as a central hub integrating the most relevant signals sustaining pancreatic cancer aggressiveness and chemoresistance. Glycogen synthase kinase (GSK)3 is known to stabilize TAK1, and its inhibition causes a reduction in TAK1 levels. Here, we hypothesized that TAK1 could sustain YAP/TAZ program, and thus, modulation of TAK1 expression through the inhibition of GSK3 could impair YAP/TAZ functions in pancreatic cancer.Differentially expressed transcripts between pancreatic cancer cells expressing scramble or TAK1-specific shRNA were annotated for functional interrelatedness by ingenuity pathway analysis. TAK1 expression was modulated by using different GSK3 inhibitors, including LY2090314. In vivo activity of LY2090314 alone or in combination with nab-paclitaxel was evaluated in an orthotopic nude mouse model.Differential gene expression profiling revealed significant association of TAK1 expression with HIPPO and ubiquitination pathways. We measured a significant downregulation of YAP/TAZ and their regulated genes in shTAK1 cells. TAK1 prevented YAP/TAZ proteasomal degradation in a kinase independent manner, through a complex with TRAF6, thereby fostering their K63-ubiquitination versus K48-ubiquitination. Pharmacologic modulation of TAK1 by using GSK3 inhibitors significantly decreased YAP/TAZ levels and suppressed their target genes and oncogenic functions. In vivo, LY2090314 plus nab-paclitaxel significantly prolonged mice survival duration.Our study demonstrates a unique role for TAK1 in controlling YAP/TAZ in pancreatic cancer. LY2090314 is a novel agent that warrants further clinical development in combination with nab-paclitaxel for the treatment of pancreatic cancer.
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Affiliation(s)
- Raffaela Santoro
- Digestive Molecular Clinical Oncology Research Unit, Department of Medicine, Università degli studi di Verona, Verona, Italy
| | - Marco Zanotto
- Digestive Molecular Clinical Oncology Research Unit, Department of Medicine, Università degli studi di Verona, Verona, Italy
| | - Francesca Simionato
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Camilla Zecchetto
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Valeria Merz
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Chiara Cavallini
- Research Center LURM, Interdepartmental Laboratory of Medical Research, Università degli studi di Verona, Verona, Italy
| | - Geny Piro
- Digestive Molecular Clinical Oncology Research Unit, Department of Medicine, Università degli studi di Verona, Verona, Italy
| | - Fabio Sabbadini
- Digestive Molecular Clinical Oncology Research Unit, Department of Medicine, Università degli studi di Verona, Verona, Italy
| | - Federico Boschi
- Department of Computer Science, Università degli studi di Verona, Verona, Italy
| | - Aldo Scarpa
- ARC-Net Research Centre, University and Hospital Trust of Verona and Department of Diagnostics and Public Health, Section of Anatomical Pathology, University and Hospital Trust of Verona, Verona, Italy
| | - Davide Melisi
- Digestive Molecular Clinical Oncology Research Unit, Department of Medicine, Università degli studi di Verona, Verona, Italy. .,Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
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Messina C, Merz V, Frisinghelli M, Trentin C, Grego E, Veccia A, Salati M, Messina M, Carnaghi C, Caffo O. Adjuvant chemotherapy in resected bile duct cancer: A systematic review and meta-analysis of randomized trials. Crit Rev Oncol Hematol 2019; 143:124-129. [PMID: 31563828 DOI: 10.1016/j.critrevonc.2019.09.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 09/03/2019] [Accepted: 09/04/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The role of adjuvant chemotherapy (ACT) for resected biliary tract cancer (BTC) is still unclear and there is no specific recommendation by international guidelines. AIM To perform a meta-analysis of randomized clinical trials (RCTs) to better define the clinical benefit and risks of ACT or observation in resected BTC. METHOD A systematic literature search of Pubmed, Embase, and the Cochrane Library was performed up to April 2019. A meta-analysis was carried out using the random effects model. RESULTS ACT provided a mild improvement in recurrence free survival (RFS) (HR:0.83, 95%CI 0.69-0.99) and no effect on overall survival (OS) (HR:0.91, 95%CI 0.75-1.09). Similarly, ACT showed no effect on OS in lymph-node positive subgroup (HR:0.84, 95% CI 0.65-1.08) and surgical margin positive subgroup (HR:0.95, 95%CI 0.69-1.31). Moreover, ACT led to a substantial increase of chemotherapy-associated adverse events (RR:3.03, 95%CI 2.22-4.15). CONCLUSION ACT for resected BTC patients modestly improved RFS with no effect on OS and a substantial increase in chemotherapy associated AEs.
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Affiliation(s)
- Carlo Messina
- Department of Medical Oncology, Santa Chiara Hospital, Trento, Italy.
| | - Valeria Merz
- Department of Medical Oncology, Santa Chiara Hospital, Trento, Italy; Unit of Medical Oncology, Department of Surgery and Oncology, University of Verona Hospital Trust, Verona, Italy
| | | | - Chiara Trentin
- Department of Medical Oncology, Santa Chiara Hospital, Trento, Italy
| | - Elisabetta Grego
- Department of Medical Oncology, Santa Chiara Hospital, Trento, Italy
| | - Antonello Veccia
- Department of Medical Oncology, Santa Chiara Hospital, Trento, Italy
| | - Massimiliano Salati
- Department of Medical Oncology, University Hospital of Modena and Reggio Emilia, Modena, Italy
| | - Marco Messina
- Oncology Unit, Fondazione San Raffaele-Giglio, Cefalu', Italy
| | - Carlo Carnaghi
- Division of Medical Oncology, Ospedale Centrale di Bolzano, Bolzano, Italy
| | - Orazio Caffo
- Department of Medical Oncology, Santa Chiara Hospital, Trento, Italy
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Carbone C, Piro G, Santoro R, Simionato F, Merz V, Zecchetto C, Scarpa A, Tortora G, Melisi D. Abstract 3501: Adipocytes sustain pancreatic cancer progression through a non-canonical WNT paracrine network inducing ROR2 nuclear shuttling. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-3501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Solid epidemiological evidences connect obesity with incidence, stage, and survival in pancreatic cancer. However, the underlying mechanistic basis linking adipocytes to pancreatic cancer progression remain largely elusive. We hypothesized that factors secreted by adipocytes could be responsible for epithelial-to-mesenchymal transition (EMT) induction and, in turn, a more aggressive phenotype in models of pancreatic preneoplastic lesions.
Methods: We studied the role of factors secreted by two adipogenic model systems from primary human Bone Marrow Stromal Cells (hBMSC) in an in vitro experimental cell transformation model system of human pancreatic ductal epithelial (HPDE) cell stably expressing activated KRAS (HPDE/KRAS).
Results: We measured a significant induction of EMT and aggressiveness in HPDE and HPDE/KRAS cell lines when cultured with medium conditioned by fully differentiated adipocytes (ADIPOCM) if compared with the same cells cultured with medium conditioned by hBMSC (hBMSCCM) from two different healthy donors. Several genes coding for soluble modulators of the non-canonical WNT signaling pathway, including FRZB, SFRP2, RSPO1, WNT5A and 5B were significantly overexpressed in fully differentiated adipocytes than in their respective in hBMSC. ADIPOCM induced the overexpression and the nuclear translocation of the Frizzled family member Receptor tyrosine kinase-like orphan receptor (Ror) 2 in HPDE and HPDE/KRAS cells. Vantictumab, an anti-Frizzled monoclonal antibody, reduced ROR2 nuclear translocation and in turn the EMT and aggressiveness in HPDE and HPDE/KRAS cells.
Conclusions: We demonstrated that adipocytes could induce EMT and aggressiveness in models of pancreatic preneoplastic lesions by orchestrating a complex paracrine signaling of soluble modulators of the non-canonical WNT signaling pathway that determine, in turn, the activation and nuclear translocation of ROR2. This signaling pathway could represent a novel target for pancreatic cancer chemoprevention. Most importantly, these factors could serve as novel biomarkers to
select a risk population among obese subjects for screening and, thus, early diagnosis of pancreatic cancer.
Citation Format: Carmine Carbone, Geny Piro, Raffaela Santoro, Francesca Simionato, Valeria Merz, Camilla Zecchetto, Aldo Scarpa, Giampaolo Tortora, Davide Melisi. Adipocytes sustain pancreatic cancer progression through a non-canonical WNT paracrine network inducing ROR2 nuclear shuttling [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 3501.
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Melisi D, Piro G, Simionato F, Carbone C, Frizziero M, Malleo G, Zanini S, Casolino R, Santoro R, Mina M, Zecchetto C, Merz V, Scarpa A, Bassi C, Tortora G. A circulating TH2 cytokines profile predicts survival in patients with resectable pancreatic adenocarcinoma. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx363.017] [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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Piro G, Simionato F, Carbone C, Frizziero M, Malleo G, Zanini S, Casolino R, Santoro R, Mina MM, Zecchetto C, Merz V, Scarpa A, Bassi C, Tortora G, Melisi D. A circulating T H2 cytokines profile predicts survival in patients with resectable pancreatic adenocarcinoma. Oncoimmunology 2017; 6:e1322242. [PMID: 28932629 PMCID: PMC5599089 DOI: 10.1080/2162402x.2017.1322242] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 04/19/2017] [Accepted: 04/19/2017] [Indexed: 01/07/2023] Open
Abstract
Surgery is the only potentially curative option for patients with pancreatic ductal adenocarcinoma (PDAC), but metastatic relapse remains common. We hypothesized that the expression levels of inflammatory cytokines could predict recurrence of PDAC, thus allowing to select patients who most likely could benefit from surgical resection. We prospectively collected plasma at diagnosis from 287 patients with pancreatic resectable neoplasms. The expression levels of 23 cytokines were measured in 90 patients with PDAC by using a multiplex analyte profiling assay. Levels higher than cutoff identified of the TH2 cytokines interleukin (IL)4, IL5, IL6 of macrophage inflammatory protein (MIP)1α, granulocyte-macrophage colony-stimulating factor (GM-CSF), and monocyte chemoattractant protein (MCP)1, and of IL17α, IFNγ-induced protein (IP)10, and IL1b were significantly associated with a shorter median OS. In particular, levels of IL4 and IP10 higher than cutoff identified, and level of TH1 cytokines TNFα and INFγ, and of IL9 and IL1Rα lower than cutoff identified were significantly associated with a shorter DFS. In the multivariate analysis, high IP10 was confirmed as negatively associated with OS (HR = 3.097, p = 0.014) and IL4 and TNFα remain negatively (HR = 2.75, p = 0.002) and positively (HR = 0.224, p = 0.049) associated with DFS, respectively. Simultaneous expression of low IL4 and high TNFα identified patients with best prognosis (HR = 0.313, p < 0.0001). In conclusion, we demonstrated that, among a series of cytokines, IL4 is the most significant independent prognostic factor for DFS in resectable PDAC patients, and it could be useful to select patients with high risk of early recurrence who may avoid an unnecessary resection.
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Affiliation(s)
- Geny Piro
- Digestive Molecular Clinical Oncology Research Unit, Department of Medicine, Università degli studi di Verona, Verona, Italy.,Laboratory of Oncology and Molecular Therapy, Department of Medicine, Università degli studi di Verona, Verona, Italy.,Comprehensive Cancer Center, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Francesca Simionato
- Comprehensive Cancer Center, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.,Unit of Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Carmine Carbone
- Digestive Molecular Clinical Oncology Research Unit, Department of Medicine, Università degli studi di Verona, Verona, Italy.,Comprehensive Cancer Center, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Melissa Frizziero
- Comprehensive Cancer Center, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.,Unit of Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Giuseppe Malleo
- Comprehensive Cancer Center, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.,Unit of General and Pancreatic Surgery, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Silvia Zanini
- Comprehensive Cancer Center, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.,Unit of Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Raffaella Casolino
- Comprehensive Cancer Center, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.,Unit of Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Raffaela Santoro
- Digestive Molecular Clinical Oncology Research Unit, Department of Medicine, Università degli studi di Verona, Verona, Italy.,Comprehensive Cancer Center, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Maria Mihaela Mina
- Laboratory of Oncology and Molecular Therapy, Department of Medicine, Università degli studi di Verona, Verona, Italy.,Comprehensive Cancer Center, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Camilla Zecchetto
- Comprehensive Cancer Center, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.,Unit of Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Valeria Merz
- Comprehensive Cancer Center, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.,Unit of Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Aldo Scarpa
- Comprehensive Cancer Center, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.,ARC-Net Research Centre and Department of Pathology and Diagnostics, Università degli studi di Verona, Verona, Italy
| | - Claudio Bassi
- Comprehensive Cancer Center, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.,Unit of General and Pancreatic Surgery, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Giampaolo Tortora
- Laboratory of Oncology and Molecular Therapy, Department of Medicine, Università degli studi di Verona, Verona, Italy.,Comprehensive Cancer Center, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.,Unit of Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Davide Melisi
- Digestive Molecular Clinical Oncology Research Unit, Department of Medicine, Università degli studi di Verona, Verona, Italy.,Comprehensive Cancer Center, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.,Unit of Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
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Carbone C, Piro G, Simionato F, Ligorio F, Cremolini C, Loupakis F, Alì G, Rossini D, Merz V, Santoro R, Zecchetto C, Zanotto M, Di Nicolantonio F, Bardelli A, Fontanini G, Tortora G, Melisi D. Homeobox B9 Mediates Resistance to Anti-VEGF Therapy in Colorectal Cancer Patients. Clin Cancer Res 2017; 23:4312-4322. [PMID: 28298545 DOI: 10.1158/1078-0432.ccr-16-3153] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 01/17/2017] [Accepted: 03/08/2017] [Indexed: 12/31/2022]
Abstract
Purpose: The identification of predictive biomarkers for antiangiogenic therapies remains an unmeet need. We hypothesized that the transcription factor Homeobox B9 (HOXB9) could be responsible for the tumor resistance to the anti-VEGF agent bevacizumab.Experimental Design: HOXB9 expression and activation were measured in eight models of colorectal and pancreatic cancer with different resistance to bevacizumab. Serum levels of Angiopoietin-like Protein (Angptl)2, CXC receptor ligand (CXCL)1, IL8, and TGFβ1 in tumor-bearing mice were measured by multiplex xMAP technology. HOXB9 expression was measured by immunohistochemical analysis in 81 pretreatment specimens from metastatic colorectal cancer patients. Differences in progression-free survival (PFS) were determined using a log-rank test.Results: HOXB9-positive tumors were resistant to bevacizumab, whereas mice bearing HOXB9-negative tumors were cured by this agent. Silencing HOXB9 in bevacizumab-resistant models significantly (P < 0.05) reduced Angptl2, CXCL1, IL8, and TGFβ1 levels, reverted their mesenchymal phenotype, reduced CD11b+ cells infiltration, and restored, in turn, sensitivity to bevacizumab. HOXB9 had no prognostic value in patients treated with a first-line chemotherapeutic regimen noncontaining bevacizumab. However, patients affected by an HOXB9-negative tumor had a significantly longer PFS compared with those with an HOXB9-positive tumor if treated with a first-line regimen containing bevacizumab (18.0 months vs. 10.4 months; HR 2.037; 95% confidence interval, 1.006-4.125; P = 0.048).Conclusions: These findings integrate the complexity of numerous mechanisms of anti-VEGF resistance into the single transcription factor HOXB9. Silencing HOXB9 could be a promising approach to modulate this resistance. Our results candidate HOXB9 as predictive biomarker for selecting colorectal cancer patients for antiangiogenic therapy. Clin Cancer Res; 23(15); 4312-22. ©2017 AACR.
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Affiliation(s)
- Carmine Carbone
- Digestive Molecular Clinical Oncology Research Unit, Department of Medicine, Università degli studi di Verona, Verona, Italy
| | - Geny Piro
- Digestive Molecular Clinical Oncology Research Unit, Department of Medicine, Università degli studi di Verona, Verona, Italy.,Laboratory of Oncology and Molecular Therapy, Department of Medicine, Università degli studi di Verona, Verona, Italy
| | - Francesca Simionato
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Francesca Ligorio
- Digestive Molecular Clinical Oncology Research Unit, Department of Medicine, Università degli studi di Verona, Verona, Italy
| | - Chiara Cremolini
- Polo Oncologico, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy University of Pisa, Pisa, Italy
| | - Fotios Loupakis
- Unit of Oncology 1, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Greta Alì
- Division of Pathology, Department of Surgical, Medical, Molecular Pathology, and Critical Area, University of Pisa, Pisa, Italy
| | - Daniele Rossini
- Polo Oncologico, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy University of Pisa, Pisa, Italy
| | - Valeria Merz
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Raffaela Santoro
- Digestive Molecular Clinical Oncology Research Unit, Department of Medicine, Università degli studi di Verona, Verona, Italy
| | - Camilla Zecchetto
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Marco Zanotto
- Digestive Molecular Clinical Oncology Research Unit, Department of Medicine, Università degli studi di Verona, Verona, Italy
| | - Federica Di Nicolantonio
- Department of Oncology, University of Torino, Candiolo, Italy.,Candiolo Cancer Institute-FPO, IRCCS, Candiolo, Italy
| | | | - Gabriella Fontanini
- Division of Pathology, Department of Surgical, Medical, Molecular Pathology, and Critical Area, University of Pisa, Pisa, Italy
| | - Giampaolo Tortora
- Laboratory of Oncology and Molecular Therapy, Department of Medicine, Università degli studi di Verona, Verona, Italy.,Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Davide Melisi
- Digestive Molecular Clinical Oncology Research Unit, Department of Medicine, Università degli studi di Verona, Verona, Italy. .,Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
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Piro G, Carbone C, Cataldo I, Di Nicolantonio F, Giacopuzzi S, Aprile G, Simionato F, Boschi F, Zanotto M, Mina MM, Santoro R, Merz V, Sbarbati A, de Manzoni G, Scarpa A, Tortora G, Melisi D. An FGFR3 Autocrine Loop Sustains Acquired Resistance to Trastuzumab in Gastric Cancer Patients. Clin Cancer Res 2016; 22:6164-6175. [PMID: 27267856 DOI: 10.1158/1078-0432.ccr-16-0178] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 05/26/2016] [Accepted: 06/01/2016] [Indexed: 12/20/2022]
Abstract
PURPOSE The majority of gastric cancer patients who achieve an initial response to trastuzumab-based regimens develop resistance within 1 year of treatment. This study was aimed at identifying the molecular mechanisms responsible for resistance. EXPERIMENTAL DESIGN A HER2+-trastuzumab sensitive NCI-N87 gastric cancer orthotopic nude mouse model was treated with trastuzumab until resistance emerged. Differentially expressed transcripts between trastuzumab-resistant and sensitive gastric cancer cell lines were annotated for functional interrelatedness by Ingenuity Pathway Analysis software. Immunohistochemical analyses were performed in pretreatment versus posttreatment biopsies from gastric cancer patients receiving trastuzumab-based treatments. All statistical tests were two-sided. RESULTS Four NCI-N87 trastuzumab-resistant (N87-TR) cell lines were established. Microarray analysis showed HER2 downregulation, induction of epithelial-to-mesenchymal transition, and indicated fibroblast growth factor receptor 3 (FGFR3) as one of the top upregulated genes in N87-TR cell lines. In vitro, N87-TR cell lines demonstrated a higher sensitivity than did trastuzumab-sensitive parental cells to the FGFR3 inhibitor dovitinib, which reduced expression of pAKT, ZEB1, and cell migration. Oral dovitinib significantly (P = 0.0006) reduced tumor burden and prolonged mice survival duration in N87-TR mouse models. A higher expression of FGFR3, phosphorylated AKT, and ZEB1 were observed in biopsies from patients progressing under trastuzumab-based therapies if compared with matched pretreatment biopsies. CONCLUSIONS This study identified the FGFR3/AKT axis as an escape pathway responsible for trastuzumab resistance in gastric cancer, thus indicating the inhibition of FGFR3 as a potential strategy to modulate this resistance. Clin Cancer Res; 22(24); 6164-75. ©2016 AACR.
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Affiliation(s)
- Geny Piro
- Digestive Molecular Clinical Oncology Research Unit, Department of Medicine, Università degli studi di Verona, Verona, Italy.,Laboratory of Oncology and Molecular Therapy, Department of Medicine, Università degli studi di Verona, Verona, Italy
| | - Carmine Carbone
- Digestive Molecular Clinical Oncology Research Unit, Department of Medicine, Università degli studi di Verona, Verona, Italy
| | - Ivana Cataldo
- ARC-Net Research Centre and Department of Pathology and Diagnostics, Università degli studi di Verona, Verona, Italy
| | - Federica Di Nicolantonio
- Department of Oncology, University of Turin, Candiolo, Italy.,Candiolo Cancer Institute-FPO, IRCCS, Candiolo, Torino, Italy
| | - Simone Giacopuzzi
- Esophageal and Gastric Surgery Unit, Department of Surgery, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Giuseppe Aprile
- Department of Medical Oncology, Azienda Ospedaliero-Universitaria, Udine, Italy
| | - Francesca Simionato
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Federico Boschi
- Department of Computer Science, Università degli studi di Verona, Verona, Italy
| | - Marco Zanotto
- Digestive Molecular Clinical Oncology Research Unit, Department of Medicine, Università degli studi di Verona, Verona, Italy
| | - Maria Mihaela Mina
- Laboratory of Oncology and Molecular Therapy, Department of Medicine, Università degli studi di Verona, Verona, Italy
| | - Raffaela Santoro
- Digestive Molecular Clinical Oncology Research Unit, Department of Medicine, Università degli studi di Verona, Verona, Italy
| | - Valeria Merz
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Andrea Sbarbati
- Section of Anatomy and Histology, Department of Neurological, Neuropsychological, Morphological and Movement Sciences, Università degli studi di Verona, Verona, Italy
| | - Giovanni de Manzoni
- Esophageal and Gastric Surgery Unit, Department of Surgery, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Aldo Scarpa
- ARC-Net Research Centre and Department of Pathology and Diagnostics, Università degli studi di Verona, Verona, Italy
| | - Giampaolo Tortora
- Laboratory of Oncology and Molecular Therapy, Department of Medicine, Università degli studi di Verona, Verona, Italy.,Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Davide Melisi
- Digestive Molecular Clinical Oncology Research Unit, Department of Medicine, Università degli studi di Verona, Verona, Italy. .,Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
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Piro G, Giacopuzzi S, Bencivenga M, Carbone C, Verlato G, Frizziero M, Mina MM, Zanotto M, Merz V, De Manzoni G, Tortora G, Melisi D. Abstract 579: TAK1-regulated expression of BIRC3 is responsible for chemoradiotherapy (CRT) resistance in esophagogastric junction (EGJ) adenocarcinoma. Cancer Res 2015. [DOI: 10.1158/1538-7445.am2015-579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Preoperative CRT followed by surgery is the most common approach for patients with resectable esophageal and EGJ cancers. Based on the histology, patients with adenocarcinoma consistently demonstrated significantly lower rate of pathological complete response if compared with patients with squamous cell carcinoma, thus the need for accurate biomarkers to select the patients with esophageal and EGJ adenocarcinoma most likely to benefit from preoperative CRT has become even more critical. We recently demonstrated that the MAP3K TGF-βeta-activated kinase-1 (TAK1) is responsible for the resistance to the proapoptotic effect of chemotherapeutic agents by increasing the transcription of the member of the inhibitor of apoptosis proteins family BIRC3 in preclinical models of pancreatic cancer. Here, we hypothesized that the TAK1-regulated expression of BIRC3 might be responsible for the resistance to CRT in EGJ adenocarcinoma.
Materials and methods: TAK1 kinase activity was targeted in FLO-1 and KYAE-1 esophageal cells by using (5Z)-7oxozeaenol. To test the effect of reducing BIRC3 expression on the resistance to CRT, FLO-1 and KYAE-1 cells were treated with increasing doses of cisplatin, 5-fluorouracil, paclitaxel, or radiotherapy in combination with (5Z)-7oxozeaenol. Drug interactions were studied for synergism according to Chou and Talalay method. Apoptotic induction was studied by western blot analysis of PARP and caspase 3 cleavages as well as by AnnexinV staining. BIRC3 expression was measured in 33 pretreatment biopsies from patients with EGJ adenocarcinoma and 34 from patients with esophageal squamous cell carcinoma receiving neoadjuvant CRT by Real-Time PCR. Tumor response was evaluated by Tumour regression grade (TRG) and by Size-based Pathological Response (SPR) scores. Correlation between BIRC3 expression and treatment response was analysed by ROC curve analysis.
Results: In vitro, (5Z)-7oxozeaenol significantly reduced BIRC3 expression in FLO-1 and KYAE-1 esophageal cells. Exposure to sublethal equitoxic doses of chemotherapeutic agents plus (5Z)-7oxozeaenol pretreatment resulted in a strong synergistic anti-proliferative effect. Baseline expression of BIRC3 was significantly higher in patients with EGJ adenocarcinoma if compared with the more sensitive squamous-cell carcinoma subtype. Moreover, patients with EGJ adenocarcinoma expressing higher pretreatment levels of BIRC3 had a significantly poorer treatment response than did those with lower expression, indicating that BIRC3 expression significantly correlates with response to preoperative CRT (AUC-ROC = 0.777 and 0.807 for SPR and TRG, respectively).
Conclusions: TAK1-regulated expression of BIRC3 might be a valid biomarker to predict resistance to CRT in EGJ adenocarcinoma patients.
Citation Format: Geny Piro, Simone Giacopuzzi, Maria Bencivenga, Carmine Carbone, Giuseppe Verlato, Melissa Frizziero, Maria Mihaela Mina, Marco Zanotto, Valeria Merz, Giovanni De Manzoni, Giampaolo Tortora, Davide Melisi. TAK1-regulated expression of BIRC3 is responsible for chemoradiotherapy (CRT) resistance in esophagogastric junction (EGJ) adenocarcinoma. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 579. doi:10.1158/1538-7445.AM2015-579
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Djonov V, Andres A, Altermatt H, Merz V. TGF-beta 3 expression correlates with epithelial cell death in normal, hyperplastic and malignant prostate. Int J Oncol 2012; 11:1185-90. [PMID: 21528320 DOI: 10.3892/ijo.11.6.1185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Cytokines of the TGF beta family are thought to be involved in cellular growth control and are therefore likely candidates to regulate homeostasis of the prostate. We have analyzed immunohistochemically the expression of TGF-beta 3 in normal prostate (NP), benign prostate hyperplasia (BPH) and prostate cancer (PCa). Its expression was correlated to cell death and cell proliferation using double labeling techniques with terminal transferase and anti-Ki67 antibodies, respectively. TGF-beta 3 expression, localized to the basal cell layer of glandular epithelium, was found in NP and BPH. In TGF-beta 3 positive regions cell death was frequently detected, while proliferating cells were only observed in TGF-beta 3 negative areas. Moreover, cell death was not observed in the absence of TGF-beta 3. PCa was characterized by high cell proliferation and the absence of cell death. TGF-beta 3 expression could not be detected in PCa. Hormonal ablation is the main therapeutic protocol used today suffering, however, from a high relapse rate. We have used the rat as a model system to show that castration, resulting in massive cell death of glandular epithelial cells, induces overall expression of TGF-beta 3 in the basal cell layers. Interestingly, investigation of tumor material from patients received after hormonal ablation revealed the simultaneous presence of TGF-beta 3 positive, hyperplastic regions undergoing cell death and TGF-beta 3 negative highly proliferating malignant foci. Our results suggest that the expression of TGF-beta 3 strictly correlates with cell death in normal and hyperplastic prostate and that disappearance of TGF-beta 3 indicates high cell proliferation and the establishment of the malignant phenotype.
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Affiliation(s)
- V Djonov
- UNIV BERN,DEPT CLIN RES,CH-3004 BERN,SWITZERLAND. INST PATHOL,CH-3010 BERN,SWITZERLAND. INSELSPITAL BERN,DEPT UROL,CH-3010 BERN,SWITZERLAND
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Ackermann D, Merz V, Danuser H, Zingg E. Endopyelotomie bei primärer Ureterabgangsstenose: Bedeutung der Nierenbeckenkelchsystemgröße. Aktuelle Urol 2008. [DOI: 10.1055/s-2008-1057769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Affiliation(s)
| | - V. Merz
- Universitätslaboratorium, Zürich
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Affiliation(s)
- V. Merz
- Universitätslaboratorium, Zürich
| | - W. Weith
- Universitätslaboratorium, Zürich
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Affiliation(s)
| | - V. Merz
- Chem. Univ.‐Laborat. zu Zürich
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Affiliation(s)
- V. Merz
- Universitätslaboratorium, Zürich
| | - W. Weith
- Universitätslaboratorium, Zürich
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Affiliation(s)
- V. Merz
- Universitätslaboratorium, Zürich
| | - C. Ris
- Universitätslaboratorium, Zürich
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Affiliation(s)
| | - V. Merz
- Universitätslaboratorium, Zürich
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Rentsch CA, Aebersold DM, Merz V, Studer UE. [Cancer of the prostate: importance of androgen deprivation and radiotherapy]. Rev Med Suisse 2005; 1:1303-6. [PMID: 15962630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Affiliation(s)
- C A Rentsch
- Clinique universitaire d'urologie Hôpital de I'lle 3010 Berne
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Schneider RP, Merz V, Meuli R, Anderegg A, Preitner J, Mosimann R. [Conservative treatment of splenic injuries in the adult]. Helv Chir Acta 1989; 56:195-8. [PMID: 2674062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Because of the risk of overwhelming post-splenectomy infection, the current trend favors conservative treatment for splenic trauma. Out of a total of 70 cases of splenic trauma in adults seen over the last 5 1/2 years, 19 spleens were preserved, 13 with, 6 without operations. Ten operated spleens were examined by Duplex-sonography, on average 38 months after surgery. The results show that in all cases, the spleen was morphologically and hemodynamically restored to normal.
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