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Edmondson RJ, O'Connell RL, Banerjee S, Mileshkin L, Sykes P, Beale P, Fisher A, Bonaventura A, Millan D, Nottley S, Benson C, Hamilton A, Sjoquist K, Alexander L, Kelly C, Carty K, Divers L, Bradshaw N, Friedlander M. Phase 2 study of anastrozole in rare cohorts of patients with estrogen receptor/progesterone receptor positive leiomyosarcomas and carcinosarcomas of the uterine corpus: The PARAGON trial (ANZGOG 0903). Gynecol Oncol 2021; 163:524-530. [PMID: 34625284 DOI: 10.1016/j.ygyno.2021.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Aromatase inhibitors have been used empirically to treat a subset of patients with hormone receptor positive uterine leiomyosarcomas(LMS) and carcinosarcomas (UCS) mainly supported by retrospective data. We evaluated the activity of anastrozole in two rare cohorts; patients with recurrent/metastatic LMS and UCS enrolled in PARAGON, a basket trial of anastrozole in estrogen receptor (ER+)/progesterone receptor positive (PR+) gynecological cancers. METHOD An investigator-initiated, single-arm, prospective open-label trial of anastrozole 1 mg/day in patients with ER &/or PR + ve LMS or UCS with measurable disease, treated until progression or unacceptable toxicity. Primary endpoint was clinical benefit (complete/partial response + stable disease) rate (CBR) at 3 months. Secondary endpoints include progression-free survival (PFS), quality of life and toxicity. RESULTS 39 eligible patients were enrolled, 32 with LMS and 7 with UCS. For the LMS cohort CBR at 3 months was 35% (95% CI: 21-53%) with a median duration of clinical benefit of 5.8 months. Best response was a partial response in one patient. Two patients remained on treatment for more than one year. The median progression-free survival was 2.8 months (95% CI: 2.6-4.9). For the UCS cohort CBR at 3 months was 43% (95% CI: 16-75%) with a median duration of clinical benefit of 5.6 months. Stable disease was seen in 3 patients but no objective responses were seen. The median progression-free survival was 2.7 months (95% CI, 1.1-8.2). Safety was acceptable with 5/39 evaluable patients showing grade 3 toxicities. CONCLUSION Whilst objective response rates with anastrozole are low, the clinical benefit rate and good tolerance suggests that aromatase inhibitor therapy may have a role in a subset of patients with metastatic LMS and UCS.
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Affiliation(s)
- R J Edmondson
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St Mary's Hospital, Manchester, UK; Department of Obstetrics and Gynaecology, Manchester Academic Health Science Centre, St Mary's Hospital, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Level 5, Research, Oxford Road, Manchester, UK.
| | - R L O'Connell
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - S Banerjee
- The Royal Marsden NHS Foundation Trust, London, UK
| | - L Mileshkin
- Peter MacCallum Cancer Centre and The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - P Sykes
- Dept of Obstetrics and Gynaecology, University of Otago, New Zealand
| | - P Beale
- Chris O'Brien Lifehouse, Sydney, NSW, Australia
| | - A Fisher
- Queen Elizabeth Hospital, Gateshead, UK
| | - A Bonaventura
- School of Medicine & Public Health, University of Newcastle, Australia
| | - D Millan
- Queen Elizabeth University Hospital, Glasgow, UK
| | - S Nottley
- Royal Hospital for Women/Prince of Wales Hospital and Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - C Benson
- The Royal Marsden NHS Foundation Trust, London, UK
| | - A Hamilton
- Peter MacCallum Cancer Centre and The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - K Sjoquist
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - L Alexander
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, UK
| | - C Kelly
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, UK
| | - K Carty
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, UK
| | - L Divers
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, UK
| | - N Bradshaw
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
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Vecchié A, Bonaventura A, Meessen J, Novelli D, Minetti S, Elia E, Ferrara D, Ansaldo AM, Scaravilli V, Villa S, Ferla L, Caironi P, Latini R, Carbone F, Montecucco F. PCSK9 is associated with mortality in patients with septic shock: data from the ALBIOS study. J Intern Med 2021; 289:179-192. [PMID: 32686253 DOI: 10.1111/joim.13150] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [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: 02/25/2020] [Revised: 05/31/2020] [Accepted: 06/05/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Pro-protein convertase subtilisin/kexin 9 (PCSK9) is a proenzyme primarily known to regulate low-density lipoprotein receptor re-uptake on hepatocytes. Whether PCSK9 can concurrently trigger inflammation or not remains unclear. Here, we investigated the potential association between circulating levels of PCSK9 and mortality in patients with severe sepsis or septic shock. METHODS Plasma PCSK9 levels at days 1, 2 and 7 were measured in 958 patients with severe sepsis or septic shock previously enrolled in the Albumin Italian Outcome Sepsis (ALBIOS) trial. Correlations between levels of PCSK9 and pentraxin 3 (PTX3), a biomarker of disease severity, were evaluated with ranked Spearman's coefficients. Cox proportional hazards models were used to assess the association of PCSK9 levels at day 1 with 28- and 90-day mortality. RESULTS Median plasma PCSK9 levels were 278 [182-452] ng mL-1 on day 1. PCSK9 correlated positively with PTX3 at the three time-points, and patients with septic shock within the first quartile of PCSK9 showed higher levels of PTX3. Similar mortality rates were observed in patients with severe sepsis across PCSK9 quartiles. Patients with septic shock with lower PCSK9 levels on day 1 (within the first quartile) showed the highest 28- and 90-day mortality rate as compared to other quartiles. CONCLUSION In our sub-analysis of the ALBIOS trial, we found that patients with septic shock presenting with lower plasma PCSK9 levels experienced higher mortality rate. Further studies are warranted to better evaluate the pathophysiological role of PCSK9 in sepsis.
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Affiliation(s)
- A Vecchié
- From the, First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy.,Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - A Bonaventura
- From the, First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy.,Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - J Meessen
- Department of Cardiovascular Medicine, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - D Novelli
- Department of Cardiovascular Medicine, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - S Minetti
- From the, First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino Genova - Italian Cardiovascular Network, Genoa, Italy
| | - E Elia
- From the, First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - D Ferrara
- From the, First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - A M Ansaldo
- From the, First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - V Scaravilli
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milano, Italy
| | - S Villa
- Dipartimento di Anestesia e Rianimazione, Università degli Studi Milano Bicocca, ASST Monza, Monza, Italy
| | - L Ferla
- Dipartimento Emergenza Urgenza - Rianimazione, Azienda Socio Sanitaria Territoriale - Ovest Milanese, Ospedale di Legnano, Legnano, Italy
| | - P Caironi
- Department of Anesthesia and Critical Care, AOU San Luigi Gonzaga, Department of Oncology, University of Turin, Orbassano, Turin, Italy
| | - R Latini
- Department of Cardiovascular Medicine, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - F Carbone
- From the, First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino Genova - Italian Cardiovascular Network, Genoa, Italy
| | - F Montecucco
- IRCCS Ospedale Policlinico San Martino Genova - Italian Cardiovascular Network, Genoa, Italy.,First Clinic of Internal Medicine, Department of Internal Medicine and Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
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Bonaventura A, Grossi F, Carbone F, Vecchié A, Minetti S, Bardi N, Elia E, Ansaldo AM, Ferrara D, Rijavec E, Dal Bello MG, Rossi G, Biello F, Tagliamento M, Alama A, Coco S, Spallarossa P, Dallegri F, Genova C, Montecucco F. Resistin is associated with overall survival in non-small cell lung cancer patients during nivolumab treatment. Clin Transl Oncol 2020; 22:1603-1610. [DOI: 10.1007/s12094-020-02305-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 01/18/2020] [Indexed: 12/16/2022]
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Bonaventura A, Carbone S, Dixon DL, Abbate A, Montecucco F. Pharmacologic strategies to reduce cardiovascular disease in type 2 diabetes mellitus: focus on SGLT-2 inhibitors and GLP-1 receptor agonists. J Intern Med 2019; 286:16-31. [PMID: 30888088 DOI: 10.1111/joim.12890] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Patients with type 2 diabetes mellitus (T2D) present an increased risk for cardiovascular (CV) complications. In addition to improvement in glycaemic control, glucose-lowering therapies, such as glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-dependent glucose cotransporter (SGLT)-2 inhibitors, have been shown to significantly reduce CV events. In 2008, the US Food and Drug Administration mandated that all new glucose-lowering drugs undergo CV outcomes trials (CVOTs) to determine their CV safety. These trials have largely demonstrated no major CV safety concerns. Most notably, the GLP-1RAs and SGLT-2 inhibitors have been found to be not only safe, but also cardioprotective compared to placebo. The SGLT-2 inhibitors have opened a new perspective for clinicians treating patients with T2D and established CV disease in light of their 'pleiotropic' effects, specifically on heart failure, while GLP-1RAs seem to present more favourable effects on atherosclerotic events. In this review, we discuss the role of GLP-1RAs and SGLT-2 inhibitors to reduce CV risk in T2D patients and suggest an individualized therapeutic approach in this population based on the presence of metabolic and CV comorbidities.
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Affiliation(s)
- A Bonaventura
- the First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy.,Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Pauley Heart Center, Richmond, Virginia, USA
| | - S Carbone
- Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Pauley Heart Center, Richmond, Virginia, USA
| | - D L Dixon
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, Richmond, VA, USA
| | - A Abbate
- Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Pauley Heart Center, Richmond, Virginia, USA
| | - F Montecucco
- First Clinic of Internal Medicine, Department of Internal Medicine and Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino -Italian Cardiovascular Network, Genoa, Italy
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5
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Carbone F, Adami G, Liberale L, Bonaventura A, Bertolotto M, Andraghetti G, Scopinaro N, Camerini GB, Papadia FS, Cordera R, Dallegri F, Montecucco F. Serum levels of osteopontin predict diabetes remission after bariatric surgery. Diabetes Metab 2018; 45:356-362. [PMID: 30268840 DOI: 10.1016/j.diabet.2018.09.007] [Citation(s) in RCA: 15] [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] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 08/27/2018] [Accepted: 09/15/2018] [Indexed: 12/16/2022]
Abstract
AIM Bariatric surgery has been shown to effectively improve glycaemic control in morbidly obese subjects. However, the molecular bases of this association are still elusive and may act independently of weight loss. Here, our retrospective study has investigated the inflammatory molecule osteopontin (OPN) as a potential predictor of type 2 diabetes mellitus (T2DM) remission. METHODS Baseline serum levels of OPN were analyzed in 41 T2DM patients who underwent bariatric surgery. Anthropometric measures and biochemical variables, including insulin sensitivity indices (HOMA2), were assessed at baseline and at 1 and 3 years after surgery. RESULTS At baseline, patients who experienced T2DM remission had increased waist circumference, body weight and BMI, and higher serum OPN, compared with non-remitters. Patients with and without T2DM remission improved their lipid and glucose profiles, although insulin resistance indices were only improved in the T2DM remission group. In the overall cohort of both T2DM remission and non-remission patients, baseline circulating levels of OPN significantly correlated with reductions of body weight and BMI over time, and insulin sensitivity improved as well. However, only the HOMA2-%S remained independently associated with serum OPN on multivariate linear regression analysis (B: 0.227, 95% CI: 0.067-0.387, β = 0.831; P = 0.010). Baseline values of OPN predicted 3-year T2DM remission independently of body weight loss, lower BMI and duration of diabetes (OR: 1.046, 95% CI: 1.004-1.090; P = 0.033). CONCLUSION Although larger studies are still needed to confirm our preliminary results, pre-operative OPN serum levels might be useful for predicting 3-year T2DM remission independently of weight loss in patients undergoing bariatric surgery.
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Affiliation(s)
- F Carbone
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy.
| | - G Adami
- Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy
| | - L Liberale
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy; Centre for Molecular Cardiology, University of Zürich, 12 Wagistrasse, 8952 Schlieren, Switzerland
| | - A Bonaventura
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy
| | - M Bertolotto
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy
| | - G Andraghetti
- Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy
| | - N Scopinaro
- Department of Surgery, University of Genoa, 10 Largo Benzi, 16132 Genoa, Italy
| | - G B Camerini
- Department of Surgery, University of Genoa, 10 Largo Benzi, 16132 Genoa, Italy
| | - F S Papadia
- Department of Surgery, University of Genoa, 10 Largo Benzi, 16132 Genoa, Italy
| | - R Cordera
- Diabetology Unit, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy
| | - F Dallegri
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy; First Clinic of Internal Medicine, Ospedale Policlinico San Martino, 10 Largo Benzi, 16132, Genoa, Italy
| | - F Montecucco
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy; First Clinic of Internal Medicine, Ospedale Policlinico San Martino, 10 Largo Benzi, 16132, Genoa, Italy; Centre of Excellence for Biomedical Research (CEBR), University of Genoa, 9 viale Benedetto XV, 16132 Genoa, Italy
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6
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Affiliation(s)
- A Bonaventura
- Department of Internal Medicine, First Clinic of Internal Medicine, University of Genoa, Genoa, Italy
| | - F Montecucco
- Department of Internal Medicine, First Clinic of Internal Medicine, University of Genoa, Genoa, Italy.,Ospedale Policlinico San Martino, Genoa, Italy.,Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
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7
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Carbone F, Nulli Migliola E, Bonaventura A, Vecchié A, De Vuono S, Ricci MA, Vaudo G, Boni M, Dallegri F, Montecucco F, Lupattelli G. High serum levels of C-reactive protein (CRP) predict beneficial decrease of visceral fat in obese females after sleeve gastrectomy. Nutr Metab Cardiovasc Dis 2018; 28:494-500. [PMID: 29502925 DOI: 10.1016/j.numecd.2018.01.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 01/10/2018] [Accepted: 01/25/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND & AIMS Gender-related differences represent an emerging investigation field to better understand obesity heterogeneity and paradoxically associated cardiovascular (CV) risk. Here, we investigated if high-sensitivity C-reactive protein (hs-CRP) might differently affect adiposity and predict the clinical response to bariatric surgery in obese males and females. METHODS AND RESULTS In 110 morbidly obese patients undergoing laparoscopic sleeve gastrectomy, hs-CRP as well as anthropometric assessment of adiposity, completed by electric bioimpedance and ultrasonography quantification of visceral fat area (VFA), were measured before and one year after surgery. As compared to males, obese female showed less severe overweight and prevalent subcutaneous fat deposition, but higher circulating hs-CRP. In obese females, hs-CRP was associated with VFA at baseline, independently of body mass index (BMI) and visceral adiposity index (OR 1.022 [95% CI 1.001-1.044]; p = 0.039). Based on decreases and increases in hs-CRP levels after surgery, two distinct subgroups of females were identified. Post-surgery decreases in hs-CRP was predominantly observed in patients with higher baseline levels of hs-CRP and associated with greater reduction of weight, BMI, fat and lean mass, VFA and visceral to subcutaneous fat ratio. Finally, we observed that high baseline values of hs-CRP were able to predict VFA reduction one-year after surgery, independently of BMI and visceral adiposity index (VAI) loss (OR 1.031 [95% CI 1.009-1.053]; p = 0.005). CONCLUSION In obese females, hs-CRP levels might be a promising biomarker of visceral fat amount and dysfunction, in addition to predict the effectiveness of bariatric surgery in terms of loss of VFA one-year after surgery.
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Affiliation(s)
- F Carbone
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa School of Medicine, 6 viale Benedetto XV, 16132, Genoa, Italy.
| | - E Nulli Migliola
- Internal Medicine Department, "Santa Maria della Misericordia" Hospital, University of Perugia, Piazzale Menghini, Sant'Andrea delle Fratte, 06132, Perugia, Italy
| | - A Bonaventura
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa School of Medicine, 6 viale Benedetto XV, 16132, Genoa, Italy
| | - A Vecchié
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa School of Medicine, 6 viale Benedetto XV, 16132, Genoa, Italy
| | - S De Vuono
- Internal Medicine Department, "Santa Maria della Misericordia" Hospital, University of Perugia, Piazzale Menghini, Sant'Andrea delle Fratte, 06132, Perugia, Italy
| | - M A Ricci
- Internal Medicine Department, "Santa Maria della Misericordia" Hospital, University of Perugia, Piazzale Menghini, Sant'Andrea delle Fratte, 06132, Perugia, Italy
| | - G Vaudo
- Internal Medicine Department, "Santa Maria della Misericordia" Hospital, University of Perugia, Piazzale Menghini, Sant'Andrea delle Fratte, 06132, Perugia, Italy
| | - M Boni
- Surgery Department, San Giovanni Battista Hospital, Via Massimo Arcamone, 06034, Foligno, Italy
| | - F Dallegri
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa School of Medicine, 6 viale Benedetto XV, 16132, Genoa, Italy; Ospedale Policlinico San Martino, 10 Largo Benzi, 16132, Genoa, Italy
| | - F Montecucco
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa School of Medicine, 6 viale Benedetto XV, 16132, Genoa, Italy; Ospedale Policlinico San Martino, 10 Largo Benzi, 16132, Genoa, Italy; Centre of Excellence for Biomedical Research (CEBR), University of Genoa, 9 viale Benedetto XV, 16132, Genoa, Italy
| | - G Lupattelli
- Internal Medicine Department, "Santa Maria della Misericordia" Hospital, University of Perugia, Piazzale Menghini, Sant'Andrea delle Fratte, 06132, Perugia, Italy
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Bonaventura A, Montecucco F. Comment on "Diabetes remission after bariatric surgery is characterized by high glycemic variability and high oxidative stress". Nutr Metab Cardiovasc Dis 2018; 28:195-196. [PMID: 29289572 DOI: 10.1016/j.numecd.2017.11.004] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 10/18/2017] [Accepted: 11/13/2017] [Indexed: 10/18/2022]
Affiliation(s)
- A Bonaventura
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132, Genoa, Italy.
| | - F Montecucco
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132, Genoa, Italy; Ospedale Policlinico San Martino, 10 Largo Benzi, 16132, Genoa, Italy; Centre of Excellence for Biomedical Research (CEBR), University of Genoa, 9 viale Benedetto XV, 16132, Genoa, Italy
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Vasista A, Martin A, Pavlakis N, Sjoquist K, Snow S, Jonker D, Chua Y, Epstein R, Bonaventura A, Khasraw M, Varma S, Singhal N, Ransom D, Aubin F, Burkes R, Lim H, Lemay F, Begbie S, Stockler M, Kiely B. Accuracy and prognostic significance of oncologists’ estimates and scenarios for survival time in a randomised Phase 2 trial of regorafenib in advanced gastric cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx369.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Bonaventura A, Liberale L, Carbone F, Scopinaro N, Camerini G, Papadia FS, Cordera R, Dallegri F, Adami GF, Montecucco F. High baseline C-reactive protein levels predict partial type 2 diabetes mellitus remission after biliopancreatic diversion. Nutr Metab Cardiovasc Dis 2017; 27:423-429. [PMID: 28284664 DOI: 10.1016/j.numecd.2017.01.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 01/20/2017] [Accepted: 01/25/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIMS Several studies demonstrated that surgery can improve inflammation parameters, such as C-reactive protein (CRP). Few biomarkers have been investigated to potentially predict type 2 diabetes mellitus (T2DM) remission. We aimed at determining whether pre-surgery serum CRP levels could predict T2DM remission after 3 years in patients undergoing bariatric surgery, especially biliopancreatic diversion (BPD). METHODS AND RESULTS This study was conducted from 2007 to 2009 at the Surgical Department of the University of Genoa, Italy. Forty-four patients with T2DM undergoing BPD (n = 38) or Roux-en-Y gastric bypass (n = 6) were enrolled. The primary endpoint was to evaluate whether pre-surgery CRP levels could predict T2DM partial remission at 3-year follow-up. Secondary endpoints were to assess whether glycaemic, lipid, and inflammatory parameters modified during the follow-up. At baseline, patients with T2DM ranged from overweight to morbid obesity, had mild dyslipidaemia, and a low-grade inflammation. Bariatric surgery improved body weight, lipid and glycaemic profile both at 1- and 3-year follow-up. Pre-surgery CRP levels progressively decreased at 1- and 3-year follow-up. Among inflammatory pre-surgery parameters, only high CRP levels were shown to predict T2DM partial remission after 3 years. Multivariate analysis confirmed the predictive value of pre-surgery CRP levels independently of age, gender, type of surgery, and body mass index. CONCLUSION Bariatric surgery, in particular BPD, improved both metabolic and inflammatory biomarkers at 1- and 3-year follow-up. Pre-surgery high CRP levels predicted 3-year T2DM partial remission, indicating a promising target population to be especially treated with BPD.
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Affiliation(s)
- A Bonaventura
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy.
| | - L Liberale
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy
| | - F Carbone
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy
| | - N Scopinaro
- International Federation of Surgery for Obesity, Genoa, Italy; Department of Surgery, University of Genoa, IRCCS AOU San Martino - IST, 10 Largo Benzi, 16132 Genoa, Italy
| | - G Camerini
- Department of Surgery, University of Genoa, IRCCS AOU San Martino - IST, 10 Largo Benzi, 16132 Genoa, Italy
| | - F S Papadia
- Department of Surgery, University of Genoa, IRCCS AOU San Martino - IST, 10 Largo Benzi, 16132 Genoa, Italy
| | - R Cordera
- Diabetology Unit, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy
| | - F Dallegri
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy; IRCCS AOU San Martino - IST, 10 Largo Benzi, 16132 Genoa, Italy
| | - G F Adami
- International Federation of Surgery for Obesity, Genoa, Italy; Department of Surgery, University of Genoa, IRCCS AOU San Martino - IST, 10 Largo Benzi, 16132 Genoa, Italy
| | - F Montecucco
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy; IRCCS AOU San Martino - IST, 10 Largo Benzi, 16132 Genoa, Italy; Centre of Excellence for Biomedical Research (CEBR), University of Genoa, 9 viale Benedetto XV, 16132 Genoa, Italy
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11
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Bonaventura A, Montecucco F, Dallegri F. Comment on "Costs associated with emergency care and hospitalization for severe hypoglycemia". Nutr Metab Cardiovasc Dis 2017; 27:86-87. [PMID: 27484752 DOI: 10.1016/j.numecd.2016.06.014] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 06/23/2016] [Indexed: 11/26/2022]
Affiliation(s)
- A Bonaventura
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy.
| | - F Montecucco
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy; IRCCS AOU San Martino - IST, Genoa, 10 Largo Benzi, 16132 Genoa, Italy; Centre of Excellence for Biomedical Research (CEBR), University of Genoa, 9 viale Benedetto XV, 16132 Genoa, Italy
| | - F Dallegri
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy; IRCCS AOU San Martino - IST, Genoa, 10 Largo Benzi, 16132 Genoa, Italy
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Derosa G, Bonaventura A, Bianchi L, Romano D, Fogari E, D'Angelo A, Maffioli P. Comparison of vildagliptin and glimepiride: effects on glycaemic control, fat tolerance and inflammatory markers in people with type 2 diabetes. Diabet Med 2014; 31:1515-23. [PMID: 24824633 DOI: 10.1111/dme.12499] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 03/01/2014] [Accepted: 05/09/2014] [Indexed: 01/04/2023]
Abstract
AIMS To compare the effects of vildagliptin with those of glimepiride on glycaemic control, fat tolerance and inflammatory markers in people with Type 2 diabetes mellitus receiving metformin treatment. METHODS A total of 167 participants were randomized to vildagliptin 50 mg twice a day or glimepiride 2 mg three times a day, for 6 months. We evaluated the following variables: BMI; glycaemic control; fasting plasma insulin; homeostatic model assessment of insulin resistance index; fasting plasma proinsulin; glucagon; lipid profile; adiponectin; high-sensitivity C-reactive protein; interleukin-6; and tumour necrosis factor-α. A euglycaemic-hyperinsulinaemic clamp procedure and an oral fat load test were also performed. RESULTS Despite a similar decrease in HbA1c levels (P = 0.009, and P = 0.008, respectively), body weight increased with glimepiride (P = 0.048 vs baseline) and decreased with vildagliptin (P = 0.041 vs baseline and vs glimepiride). Fasting plasma insulin and homeostatic model assessment of insulin resistance index were significantly lower with vildagliptin compared with glimepiride (P = 0.035 and 0.047). M value, an index of insulin sensitivity, increased with vildagliptin, both compared with baseline and with glimepiride (P = 0.028 and 0.039, respectively). Vildagliptin improved all post-oral fat load peaks of lipid profile compared with glimepiride. Adiponectin levels were higher (P = 0.035) and high-sensitivity C-reactive protein levels were lower (P = 0.038) with vildagliptin vs glimepiride. During the oral fat load test, interleukin-6, high-sensitivity C-reactive protein and tumour necrosis factor-α peaks were lower and adiponectin peak was higher in the vildagliptin group than in the glimepiride group. There was a higher dropout rate as a result of hypoglycaemia in the glimepiride group than in the vildagliptin group. CONCLUSIONS Vildagliptin was more effective than glimepiride in reducing post-oral fat load peaks of lipid-trafficking adipocytokines and inflammatory markers.
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Affiliation(s)
- G Derosa
- Department of Internal Medicine and Therapeutics, University of Pavia and, Fondazione IRCCS Policlinico S. Matteo; Centre for the Study of Endocrine-Metabolic Pathophysiology and Clinical Research, University of Pavia, Pavia, Italy
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13
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Derosa G, Bonaventura A, Bianchi L, Romano D, D'Angelo A, Fogari E, Maffioli P. A randomized, placebo-controlled study on the effects of a nutraceutical combination of red yeast rice, silybum marianum and octasonol on lipid profile, endothelial and inflammatory parameters. J BIOL REG HOMEOS AG 2014; 28:317-24. [PMID: 25001663] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The aim of this study was to evaluate the effects of a combination of red yeast rice, Silybum marianum and octasonol compared to placebo on lipid profile, endothelial, and inflammatory parameters in low risk dislipidemic patients. One hundred and thirty-four dislipidemic patients were randomised to take placebo or a patented nutraceutical association in tablet form (Zeta ColestRT), 1 tablet /day (immediately after the dinner), for three months in a double-blind, placebo-controlled trial. At baseline and after 3 months the following were evaluated: body weight, body mass index (BMI), fasting plasma glucose (FPG), lipid profile, soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1 (sVCAM-1), soluble E-selectin (sE-selectin), metalloprotineases-2 and -9 (MMP-2 and MMP-9), high sensitivity C-reactive protein (Hs-CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-alpha). The nutraceutical combination decreased total cholesterol and low density lipoprotein cholesterol compared to baseline (p = 0.042, and p = 0.041, respectively) and to placebo (p = 0.039, and p = 0.037, respectively). Triglycerides were reduced by the active treatment (p = 0.039), but not by placebo, even if, in group to group comparison, no differences were recorded (p = 0.061). All adipocytokines were reduced by the nutraceutical combination, in particular p = 0.044 for sICAM-1, p = 0.045 for sVCAM-1, p = 0.040 for sE-selectin, p = 0.035 for MMP-2, p = 0.039 for MMP-9, p = 0.038 for Hs-CRP, p = 0.036 for TNF-α, and p = 0.036 for IL-6 compared to baseline, and p = 0.042 for sICAM-1, p = 0.043 for sVCAM-1, p = 0.042 for sE-selectin, p = 0.031 for MMP-2, p = 0.038 for MMP-9, p =0.038 for Hs-CRP, and p = 0.043 for TNF-alpha, espectively, compared to placebo. We can conclude that a combination of red yeast rice, Silybum marianum and octasonol was effective in improving lipid profile, endothelial, and inflammatory parameters in low risk dislipidemic patients.
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Affiliation(s)
- G Derosa
- Department of Internal Medicine and Therapeutics, University of Pavia, and Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - A Bonaventura
- Department of Internal Medicine and Therapeutics, University of Pavia, and Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - L Bianchi
- Department of Internal Medicine and Therapeutics, University of Pavia, and Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - D Romano
- Department of Internal Medicine and Therapeutics, University of Pavia, and Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - A D'Angelo
- Department of Internal Medicine and Therapeutics, University of Pavia, and Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - E Fogari
- Department of Internal Medicine and Therapeutics, University of Pavia, and Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - P Maffioli
- Department of Internal Medicine and Therapeutics, University of Pavia, and Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
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Derosa G, Bonaventura A, Romano D, Bianchi L, Fogari E, D'Angelo A, Maffioli P. Effects of enalapril/lercanidipine combination on some emerging biomarkers in cardiovascular risk stratification in hypertensive patients. J Clin Pharm Ther 2014; 39:277-85. [DOI: 10.1111/jcpt.12139] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Accepted: 01/14/2014] [Indexed: 01/29/2023]
Affiliation(s)
- G. Derosa
- Department of Internal Medicine and Therapeutics; University of Pavia and Fondazione IRCCS Policlinico S. Matteo; Pavia Italy
- Center for the Study of Endocrine-Metabolic Pathophysiology and Clinical Research; University of Pavia; Pavia Italy
| | - A. Bonaventura
- Department of Internal Medicine and Therapeutics; University of Pavia and Fondazione IRCCS Policlinico S. Matteo; Pavia Italy
| | - D. Romano
- Department of Internal Medicine and Therapeutics; University of Pavia and Fondazione IRCCS Policlinico S. Matteo; Pavia Italy
| | - L. Bianchi
- Department of Internal Medicine and Therapeutics; University of Pavia and Fondazione IRCCS Policlinico S. Matteo; Pavia Italy
| | - E. Fogari
- Department of Internal Medicine and Therapeutics; University of Pavia and Fondazione IRCCS Policlinico S. Matteo; Pavia Italy
| | - A. D'Angelo
- Department of Internal Medicine and Therapeutics; University of Pavia and Fondazione IRCCS Policlinico S. Matteo; Pavia Italy
| | - P. Maffioli
- Department of Internal Medicine and Therapeutics; University of Pavia and Fondazione IRCCS Policlinico S. Matteo; Pavia Italy
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Zdenkowski N, Cavenagh J, Ku YC, Bisquera A, Bonaventura A. Administration of chemotherapy with palliative intent in the last 30 days of life: the balance between palliation and chemotherapy. Intern Med J 2013; 43:1191-8. [DOI: 10.1111/imj.12245] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 07/05/2013] [Indexed: 11/27/2022]
Affiliation(s)
- N. Zdenkowski
- Department of Medical Oncology; Mercy Hospice; Calvary Mater Newcastle; Newcastle New South Wales Australia
- Hunter Cancer Research Alliance; Hunter Medical Research Institute; Newcastle New South Wales Australia
| | - J. Cavenagh
- Department of Palliative Care; Mercy Hospice; Calvary Mater Newcastle; Newcastle New South Wales Australia
- Hunter Cancer Research Alliance; Hunter Medical Research Institute; Newcastle New South Wales Australia
| | - Y. C. Ku
- Hunter Cancer Research Alliance; Hunter Medical Research Institute; Newcastle New South Wales Australia
- Clinical Systems Team; Information Technology and Telecommunication Department; Hunter New England Local Health District; Newcastle New South Wales Australia
| | - A. Bisquera
- Hunter Cancer Research Alliance; Hunter Medical Research Institute; Newcastle New South Wales Australia
- Clinical Research Design, IT and Statistical Support; Hunter Medical Research Institute; Newcastle New South Wales Australia
| | - A. Bonaventura
- Department of Medical Oncology; Mercy Hospice; Calvary Mater Newcastle; Newcastle New South Wales Australia
- Hunter Cancer Research Alliance; Hunter Medical Research Institute; Newcastle New South Wales Australia
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Derosa G, Cicero AFG, D'Angelo A, Bonaventura A, Bianchi L, Romano D, Maffioli P. Effects of an olmesartan/amlodipine combination compared to olmesartan or amlodipine monotherapies on some insulin resistance parameters in hypertensive patients. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.1832] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Derosa G, Bonaventura A, Bianchi L, Romano D, D' Angelo A, Fogari E, Maffioli P. Effects of Berberis aristata/Silybum marianum association on metabolic parameters and adipocytokines in overweight dyslipidemic patients. J BIOL REG HOMEOS AG 2013; 27:717-28. [PMID: 24152839] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Nutraceuticals and functional foods have attracted considerable interest as potential alternative therapies for treatment of different cardiovascular disorders and insulin resistance. We evaluated the efficacy of a combination of Berberis Aristata/Silybum Marianum extract (Berberol®) in a sample of overweight, dyslipidemic patients at low cardiovascular risk. We enrolled 105 Caucasian, euglycemic, overweight, dyslipidemic patients, of either sex. At baseline all patients underwent a 6 months run-in period during which they followed an adequate diet and practiced physical activity. At the end of the run-in period, patients were randomised to take placebo or a combination of Berberis aristata/Silybum marianum, 1 tablet during the lunch and 1 tablet during the dinner, for three months, in a double-blind, placebo-controlled design. Berberis aristata/Silybum marianum and placebo were then interrupted for 2 months (wash-out period), and all patients continued with only diet and physical activity. At the end of the wash-out period, patients re-started Berberis aristata/Silybum marianum or placebo twice a day for further 3 months. We evaluated during the run-in period, at randomisation, before and after the wash-out period these parameters: body weight and BMI, fasting plasma glucose, lipid profile, insulin resistance, retinol binding protein-4 (RBP-4), adiponectin (ADN), resistin. Total cholesterol, LDL-C, and Tg decreased, and HDL-C increase after 3 months of Berberis aristata/Silybum marianum, both compared to baseline and placebo. Berberis aristata/Silybum marianum decreased fasting plasma insulin, and HOMA-IR, both compared to baseline and to placebo. Moreover, there was a decrease of RBP-4, and resistin, and an increase of ADN after 3 months of Berberis aristata/Silybum marianum. All these positive effects disappeared after the wash-out period, and re-appeared after the re-introduction of the drug. We observed a significant correlation between HOMA-index decrease and resistin, and RBP-4 decrease, and between HOMA-index decrease and ADN increase in Berberis aristata/Silybum marianum group, but not in placebo group. Berberis aristata/Silybum marianum fixed combination seems to be safe and effective in improving lipid profile, but also in improving insulin resistance and adipocytokines levels.
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Affiliation(s)
- G Derosa
- Department of Internal Medicine and Therapeutics, University of Pavia, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
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Steckiph D, Calabrese G, Bertucci A, Mazzotta A, Vagelli G, Gonella M, Stamopoulos D, Manios E, Papachristos N, Grapsa E, Papageorgiou G, Gogola V, So B, Dey V, Spalding EM, Libetta C, Esposito P, Margiotta E, Maffioli P, Bonaventura A, Bianchi L, Romano D, Rampino T, De Rosa G, Mauric A, Haug U, Enzinger G, Kern-Derstvenscheg E, Sluga A, Ausserwinkler C, Beck W, Rosenkranz AR, Maheshwari V, Haroon S, Loy Y, Samavedham L, Rangaiah GP, Lau T, Stamopoulos D, Mpakirtzi N, Panagiotou M, Barbarousi D, Matsouka C, Grapsa E, Bunani AD, Kowalczyk M, Bartnicki P, Banach M, Rysz J, Lentini P, Zanoli L, Granata A, Contestabile A, Basso A, Berlingo G, Pellanda V, de Cal M, Grazia V, Clementi A, Insalaco M, Dell'Aquila R, Karkar A, Abdelrahman M, Martins AR, Parreira L, Duque AS, Rodrigues I, Baffoun AB, Youssfi MA, Sayeh A, Beji M, Ben Khadra R, Hmida J, Akazawa M, Horiuchi H, Hori Y, Yamada A, Satou H, Odamaki S, Nakai S, Satou K, Aoki K, Saito I, Kamijo Y, Ogata S, Ishibashi Y, Basso F, Wojewodzka-Zelezniakowicz M, Cruz D, Giuliani A, Blanca Martos L, Piccinni P, Ronco C, Potier J, Queffeulou G, Bouet J, Nilsson A, Sternby J, Grundstrom G, Alquist M, Ferraresi M, Di Vico MC, Vigotti FN, Deagostini M, Scognamiglio S, Consiglio V, Clari R, Moro I, Mongilardi E, Piccoli GB, Hancock V, Huang S, Nilsson A, Grundstrom G, Nilsson Ekdahl K, Calabrese G, Steckiph D, Bertucci A, Baldin C, Petrarulo M, Mancuso D, Vagelli G, Gonella M, Inguaggiato P, Canepari G, Gigliola G, Ferrando C, Meinero S, Sicuso C, Pacitti A, Stamopoulos D, Mpakirtzi N, Manios E, Afentakis N, Grapsa E, Tomo T, Matsuyama K, Nakata T, Ishida K, Takeno T, Kadota JI, Minakuchi J, Kastl J, Merello M, Boccato C, Giordana G, Mazzone S, Moscardo V, Kastl J, Giordana G, Reinhardt B, Knaup R, Kruger W, Tovbin D, Kim S, Avnon L, Zlotnik M, Storch S, Umimoto K, Shimamoto Y, Suyama M, Miyata M, Bosch Benitez-Parodi E, Baamonde Laborda EE, Perez G, Ramirez JI, Ramirez Puga A, Guerra R, Garcia Canton C, Lago Alonso MM, Toledo A, Checa Andres MD, Latif FE, Mochida Y, Matsumoto K, Morita K, Tsutsumi D, Ishioka K, Maesato K, Oka M, Moriya H, Hidaka S, Ohtake T, Kobayashi S, Ficheux A, Gayrard N, Duranton F, Guzman C, Szwarc I, Bismuth-Mondolfo J, Brunet P, Servel MF, Argiles A, Tsikliras N, Mademtzoglou S, Balaskas E, Zeid M, Mostafa A, Mowafy MN, Abdo EI, Al Amin OM, Ksiazek A, Zaluska W, Waniewski J, Debowska M, Wojcik-Zaluska A, Elias M, Francois H, Obada E, Lorenzo HK, Charpentier B, Durrbach A, Beaudreuil S, Imamovic G, Marcelli D, Bayh I, Hrvacevic R, Kapun S, Grassmann A, Scatizzi L, Maslovaric J, Daelemans R, Mesens S, Mohamed EA, Wafae A, Kawtar H, Mohamed Amine H, Driss K, Mohammed B. Extracorporeal dialysis: techniques and adequacy - A. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Marth C, Alexandre J, Hanker LC, Brown C, Kaern J, Heywood M, Bonaventura A, Vergote IB, Pignata S, Ferrero A, Gebski V, Gropp M, Skeie-Jensen T, Giede C, Vasey PA, Schauer C, Reed N, Ferrandina G, Fossati R, Pujade-Lauraine E. Pegylated liposomal doxorubicin and carboplatin (C-PLD) versus paclitaxel and carboplatin (C-P) in platinum-sensitive ovarian cancer (OC) patients (pts): Treatment at recurrence and overall survival (OS) final analysis from CALYPSO phase III GCIG trial. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.5052] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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20
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Gershanovich M, Chaudri K, Campos D, Lurie H, Bonaventura A, Jeffrey M, Buzzi F, Bodrogi I, Ludwig H, Reichard P, O'Higgins NO, Romieu G, Friedrich P, Lassus M. [Letrozole (Femara), a new aromatase inhibitor for advanced breast cancer]. Vopr Onkol 1999; 45:361-8. [PMID: 10532092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
The study compares letrozole (Femara and aminoglutethimide (AG), a standard therapy for postmenopausal women with advanced breast cancer, previously treated with anti-estrogens. 555 women were randomly assigned letrozole 2.5 mg once daily (n = 185), letrozole 0.5 mg once daily (n = 192) or aminoglutethimide 250 mg twice daily with corticosteroid support (n = 178) in an open-label, multicenter trial. The primary end-point was objective response rate (ORR), with time events as secondary. ORR was analysed nine months after enrollment of the last patient, while survival was analysed 15 months after the last patients was enrolled. We report the results of these analyses plus an extended period of observation (covering a total duration of approximately 45 months) to determine the duration of response and clinical benefit. Overall objective response rates (complete + partial) of 19.5%, 16.7% and 12.4% were seen for letrozole 2.5 mg, 0.5 mg and AG respectively. Median duration of response and stable disease was longest for letrozole 2.5 mg (21 months) compared with letrozole 0.5 mg (18 months) and AG (14 months). Letrozole 2.5 mg was superior to AG in time to progression, time to treatment failure and overall survival. Treatment-related adverse events occurred in fewer patients on letrozole (33%) than on AG (46%). Letrozole 2.5 mg offers longer disease control than aminoglutethimide and letrozole 0.5 mg in the treatment of postmenopausal women with advanced breast cancer, previously treated with anti-estrogens.
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Affiliation(s)
- M Gershanovich
- N.N. Petrov Research Institute of Oncology, Ministry of Health of the RF, St. Petersburg, Russia
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De Santo M, Bonaventura A, Costanza L, Gentile C, Zulli S, Montanaro N, El Danasouri I, Bellati U. R-156. Luteal phase defect (LPD): clinical analysis of women with idiopathic infertility. Hum Reprod 1999. [DOI: 10.1093/humrep/14.suppl_3.348-a] [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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Lamb D, Atkinson C, Joseph D, O'Brien P, Ackland S, Bonaventura A, Dady P, Hamilton C, Spry N, Stewart J, Denham J. Simultaneous adjuvant radiotherapy and chemotherapy for stage I and II breast cancer. Australas Radiol 1999; 43:220-6. [PMID: 10901906 DOI: 10.1046/j.1440-1673.1999.00638.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The purpose of the present paper was to evaluate treatment outcome after conservative breast surgery or mastectomy followed by simultaneous adjuvant radiotherapy and cyclophosphamide, methotrexate and fluorouracil (CMF) therapy. Two hundred and sixty eight (268) patients were treated at two Australian and two New Zealand centres between 1981 and July 1995. One hundred and sixty-nine patients underwent conservation surgery and 99 had mastectomies. Median follow-up was 53 months. Conventionally fractionated radiation was delivered simultaneously during the first two cycles of CMF, avoiding radiation on the Fridays that the intravenous components of CMF were delivered. In conservatively treated patients, 5-year actuarial rates of any recurrence, distant recurrence and overall survival were 34.5 +/- 5.2%, 25.4 +/- 4.5% and 75.5 +/- 4.8%, respectively. Crude incidence of local relapse at 4 years was 6.3% and at regional/distant sites was 26.3%. Highest grades of granulocyte toxicity (< 0.5 x 10(9)/L), moist desquamation, radiation pneumonitis and persistent breast oedema were recorded in 10.7, 8.5, 8.9 and 17.2%, respectively. In patients treated by mastectomy, 5-year actuarial rates of any recurrence, distant recurrence and overall survival were 59.7 +/- 7.3%, 56.7 +/- 7.4% and 50.1 +/- 7%. The crude incidence of local relapse at 4 years was 5.6% and at regional/distant sites it was 45.7%. The issue of appropriate timing of adjuvant therapies has become particularly important with the increasing acknowledgement of the value of anthracycline-based regimens. For women in lower risk categories (e.g. 1-3 nodes positive or node negative), CMF may offer a potentially better therapy, particularly where breast-conserving surgical techniques have been used. In such cases CMF allows the simultaneous delivery of radiotherapy with the result of optimum local control, without compromise or regional or systemic relapse rates. Further randomized trials that directly address the optimal integration of the two modalities, such as the one carried out in Boston, are clearly necessary.
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Affiliation(s)
- D Lamb
- Wellington Hospital, New Zealand
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Newell S, Sanson-Fisher RW, Girgis A, Bonaventura A. How well do medical oncologists' perceptions reflect their patients' reported physical and psychosocial problems? Data from a survey of five oncologists. Cancer 1998; 83:1640-51. [PMID: 9781960] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Modern cancer treatments can cure or prolong patients' lives. However, the associated physical and psychosocial problems can detrimentally affect patients' compliance with treatment and, ultimately, their outcomes. Therefore, oncologists need to recognize the problems experienced by their patients and, when possible, help resolve these problems. METHODS The authors conducted a cross-sectional survey of physical symptoms, anxiety, depression, and perceived needs among 204 consenting patients visiting an outpatient medical oncology department. Immediately following consultations with consenting patients, medical oncologists and registrars also completed a survey in which they indicated their perception of each patient's level of each problem. These two data sets were then compared. RESULTS Five oncologists' perceptions of patients' levels of the major physical symptoms cited in the survey (fatigue, nausea, vomiting, and hair loss) demonstrated the highest levels of awareness, with sensitivity rates up to 80%. Although sensitivity was less than 50% for all other physical symptoms, specificity was greater than 78% for all symptoms except fatigue. Only 17% of patients classified as clinically anxious and 6% of those classified as clinically depressed were perceived as such by their oncologists. However, the oncologists perceived much higher levels of perceived needs than patients reported, resulting in high sensitivity but low specificity rates. Oncologists' knowledge of and rapport with their patients and the pressure of their workloads were associated with their awareness of their patients' reported problems. CONCLUSIONS Medical oncologists' perceptions may not accurately reflect their patients' reported physical and psychosocial experiences. Further interventions should be developed to assist oncologists in detecting such problems, especially psychosocial ones.
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Affiliation(s)
- S Newell
- New South Wales Cancer Council Cancer Education Research Program, Newcastle, Australia
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Gershanovich M, Chaudri HA, Campos D, Lurie H, Bonaventura A, Jeffrey M, Buzzi F, Bodrogi I, Ludwig H, Reichardt P, O'Higgins N, Romieu G, Friederich P, Lassus M. Letrozole, a new oral aromatase inhibitor: randomised trial comparing 2.5 mg daily, 0.5 mg daily and aminoglutethimide in postmenopausal women with advanced breast cancer. Letrozole International Trial Group (AR/BC3). Ann Oncol 1998; 9:639-45. [PMID: 9681078 DOI: 10.1023/a:1008226721932] [Citation(s) in RCA: 192] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The study compares letrozole and aminoglutethimide (AG), a standard therapy for postmenopausal women with advanced breast cancer, previously treated with antioestrogens. PATIENTS AND METHODS 555 women were randomly assigned letrozole 2.5 mg once daily (n = 185), letrozole 0.5 mg once daily (n = 192) or aminoglutethimide 250 mg twice daily with corticosteroid support (n = 178) in an open-label, multicentre trial. The primary endpoint was objective response rate (ORR), with time events as secondary. ORR was analysed nine months after enrollment of the last patient, while survival was analysed 15 months after the last patient was enrolled. We report the results of these analyses plus an extended period of observation (covering a total duration of approximately 45 months) to determine the duration of response and clinical benefit. RESULTS Overall objective response rates (complete + partial) of 19.5%, 16.7% and 12.4% were seen for letrozole 2.5 mg, 0.5 mg and AG respectively. Median duration of response and stable disease was longest for letrozole 2.5 mg (21 months) compared with letrozole 0.5 mg (18 months) and AG (14 months). Letrozole 2.5 mg was superior to AG in time to progression, time to treatment failure and overall survival. Treatment-related adverse events occurred in fewer patients on letrozole (33%) than on AG (46%). Transient nausea was the most frequent event with letrozole (7% on 0.5 mg, 10% on 2.5 mg, 10% on AG), rash with AG (11%, 1% on 0.5 mg, 3% on 2.5 mg letrozole). CONCLUSIONS Letrozole 2.5 mg offers longer disease control than aminoglutethimide and letrozole 0.5 mg in the treatment of postmenopausal women with advanced breast cancer, previously treated with anti-oestrogens.
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Affiliation(s)
- M Gershanovich
- N. N. Petrov Research Institute of Oncology, St. Petersburg, Russia
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Abstract
BACKGROUND Febrile neutropenia occurring in patients receiving chemotherapy for solid tumours or lymphoma is usually of short duration, and therefore may have a better outcome compared to patients with acute leukaemia or patients receiving myeloablative chemotherapy. AIMS To review retrospectively the outcomes for febrile neutropenia occurring in patients of the Medical Oncology Unit at our institution, and to identify factors associated with worse outcome, particularly prolonged admission or death. METHODS We reviewed 102 episodes of febrile neutropenia occurring in 85 patients treated between 1992 and 1994. Demographic factors, tumour-related factors and clinical aspects of the episodes were correlated with outcome. RESULTS The median age was 60 years (range, 18-87), with 56 (55%) episodes occurring in females. Twenty-eight (27%) episodes occurred in patients with lymphoma, with the remaining 74 (73%) occurring in patients with solid tumours. At presentation, the median absolute neutrophil count (ANC) was 0.14 x 10(9)/L with a median duration of significant neutropenia (ANC < 0.5 x 10(9)/L) of three days. The median duration of fever was two days. Twenty-nine (28%) episodes had positive cultures; of these 11 had bacteraemia. Forty-four (43%) episodes were classified as unexplained fevers. The remaining 29 episodes were associated with clinically documented infection but negative cultures. There was a high treatment success rate (81%) with first-line empirical antibiotics. Of 19 treatment failures, 13 were due to the necessity for antibiotic modification; the other six patients died from infection. Factors associated with a worse outcome (including prolonged admission and death) include: diagnosis of lymphoma; increasing number of chemotherapy courses; early onset of neutropenia; pneumonia; severe hypotension; and multiple co-morbidities. CONCLUSIONS Febrile neutropenia in adult patients with solid tumours or lymphoma is associated with a relatively good outcome, possibly due to the short duration of neutropenia. A future prospective study to validate the risk factors identified in this study would be useful for defining patients at low risk for the adverse outcomes examined, in whom less intensive management for this condition may be possible.
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Affiliation(s)
- D C Leong
- Newcastle Mater Misericordiae Hospital, NSW
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Salmaggi P, Costanza L, Bonaventura A, Ciminelli C. [Echography and hysteroscopy. 2 diagnostic technics compared in the identification of endometrial lesions in the postmenopause]. Minerva Ginecol 1997; 49:25-9. [PMID: 9162881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
METHODS In this study we compared ultrasonographic scanning of the endometrium and the hysteroscopic view with histology obtained by endometrial biopsy. RESULTS Forty six postmenopausal women were studied, 25 symptomatic and 21 asymptomatic. In 24 cases endometrial thickness was > 5 mm, it was considered abnormal, and in 12 cases was < 5 mm. Hysteroscopy detects the presence of 7 atrophic endometrium, 19 polyps, 8 myomas, 4 cancer, 5 synechiae. Echography had a sensitivity of 90.9%, specificity of 72% and positive predictive value of 90.9%. Hysteroscopy showed a sensitivity of 96.7%, a specificity of 92.8% and a positive predictive value of 96.8%. CONCLUSIONS In conclusion we may suggest that TV scanning allows detection of endometrial pathology with a high sensitivity so it may be used as the first diagnostic step in the screening of postmenopausal women, but it should be completed by hysteroscopic evaluation when endometrial thickness is > 5 mm also in asymptomatic women in order to detect cancer in a early stage.
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Affiliation(s)
- P Salmaggi
- Associazione Fondazione Italiana per lo Studio della Menopausa, Roma
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Denham JW, Hamilton CS, Christie D, O'Brien M, Bonaventura A, Stewart JF, Ackland SP, Lamb DS, Spry NA, Dady P. Simultaneous adjuvant radiation therapy and chemotherapy in high-risk breast cancer--toxicity and dose modification: a Transtasman Radiation Oncology Group Multi-Institution study. Int J Radiat Oncol Biol Phys 1995; 31:305-13. [PMID: 7836084 DOI: 10.1016/0360-3016(94)e0065-r] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE To establish the toxicity profile of simultaneously administered postoperative radiation therapy and CMF chemotherapy as a prelude to a randomized controlled study addressing the sequencing of the two modalities. METHODS AND MATERIALS One hundred and thirty eight breast cancer patients at high risk of locoregional, as well as systemic relapse, who were referred to three centers in Australia and New Zealand were treated with postoperative radiation therapy and chemotherapy simultaneously. Acute toxicity and dose modifications in these patients were compared with 83 patients treated over the same time frame with chemotherapy alone. In a separate study the long-term radiation and surgical effects in 24 patients treated simultaneously with radiation therapy and chemotherapy at Newcastle (Australia) following conservative surgery were compared with 23 matched patients treated at Newcastle with radiation therapy alone. RESULTS Myelotoxicity was increased in patients treated simultaneously with radiation therapy and chemotherapy. The effect was not great, but may have contributed to chemotherapy dose reductions. Lymphopenia was observed to be the largest factor in total white cell depressions caused by the simultaneous administration of radiation therapy. Postsurgical appearances were found to so dominate long-term treatment effects on the treated breast that the effect of radiation therapy dose and additional chemotherapy was difficult to detect. CONCLUSION Studies addressing the sequencing of radiation therapy and chemotherapy will necessarily be large because adverse effects from administering the two modalities simultaneously are not great. The present study has endorsed the importance in future studies of stratification according to the extent and type of surgery and adherence to a single strict policy of chemotherapy dose modification.
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Affiliation(s)
- J W Denham
- Radiation Oncology Department, Newcastle Mater Misericordiae Hospital, New South Wales, Australia
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Cooper SG, Bonaventura A, Ackland SP, Joseph DJ, Stewart JF, Hamilton CS, Denham JW. Pelvic radiotherapy with concurrent 5-fluorouracil modulated by leucovorin for rectal cancer: a phase II study. Clin Oncol (R Coll Radiol) 1993; 5:169-73. [PMID: 8347540 DOI: 10.1016/s0936-6555(05)80319-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Combined modality treatment for cancer of the rectum has been shown to reduce recurrences and improve overall survival. We wished to find out if we could safely give concurrent radiotherapy and 5-fluorouracil (5-FU) modulated by leucovorin (LV) in 3 settings: pre-operatively, adjuvantly and in recurrent disease. A total of 39 patients were treated, 11 preoperatively, 17 adjuvantly and 11 with recurrent disease. There were 26 males and 13 females with a median age of 64 years. The median radiotherapy (RT) dose was 45 Gy/25 fractions/1.8 Gy per fraction (range 25-63 Gy). Chemotherapy consisted of LV 80 mg/m2 i.v. infusion over 1.5 hours followed by 5-FU 400 mg/m2 i.v. bolus, both given once a week. The median number of cycles was 8 (range 3-12). Diarrhoea was the main toxicity, and was encountered in 30 patients (77%): grade 1 in 3 (8%), grade 2 in 12 (30%), grade 3 in 11 (28%), and grade 4 in 4 (10%). This required 18 (46%) patients to have modifications to their RT (20% had breaks and 26% ceased at doses < 45 Gy). Nine patients (23%) had modifications in the chemotherapy (10% had breaks and 13% received < 6 cycles). Encouraging responses were seen in the preoperative setting. Concurrent RT and 5-FU/LV, as given in this schedule, results in an unacceptable incidence of diarrhoea, limiting both the total dose of RT and chemotherapy that can be delivered, particularly in patients who have had previous surgery.
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Affiliation(s)
- S G Cooper
- Newcastle Mater Misericordiae Hospital, Waratah, NSW, Australia
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Bonaventura A, Stewart JF. Complete response of a transitional cell carcinoma of the renal pelvis to leucovorin/5 fluorouracil chemotherapy. Aust N Z J Med 1991; 21:244-5. [PMID: 1872754 DOI: 10.1111/j.1445-5994.1991.tb00452.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A 56-year-old female underwent treatment with leucovorin and 5-fluorouracil for extensive metastatic moderately differentiated transitional cell carcinoma (TCC) of the renal pelvis. This resulted in a complete response for 20+ months. This combination has not been reported before in TCCs of the urinary tract and requires further exploration.
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Affiliation(s)
- A Bonaventura
- Mater Misericordiae Hospital, Newcastle, NSW, Australia
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