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Piccari L, Wort SJ, Meloni F, Rizzo M, Price LC, Martino L, Salvaterra E, Scelsi L, López Meseguer M, Blanco I, Callari A, Pérez González V, Tuzzolino F, McCabe C, Rodríguez Chiaradía DA, Vitulo P. The Effect of Borderline Pulmonary Hypertension on Survival in Chronic Lung Disease. Respiration 2022; 101:717-727. [PMID: 35462365 PMCID: PMC9533441 DOI: 10.1159/000524263] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/09/2022] [Indexed: 11/19/2022] Open
Abstract
Background The impact of the new “borderline” hemodynamic class for pulmonary hypertension (PH) (mean pulmonary artery pressure [mPAP], 21–24 mm Hg and pulmonary vascular resistance, [PVR], ≥3 wood units, [WU]) in chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD) is unclear. Objectives The aim of this study was to assess the effect of borderline PH (BLPH) on survival in COPD and ILD patients. Method Survival was analyzed from retrospective data from 317 patients in 12 centers (Italy, Spain, UK) comparing four hemodynamic groups: the absence of PH (NoPH; mPAP <21 mm Hg or 21–24 mm Hg and PVR <3 WU), BLPH (mPAP 21–24 mm Hg and PVR ≥3 WU), mild-moderate PH (MPH; mPAP 25–35 mm Hg and cardiac index [CI] ≥2 L/min/m2), and severe PH (SPH; mPAP ≥35 mm Hg or mPAP ≥25 mm Hg and CI <2 L/min/m2). Results BLPH affected 14% of patients; hemodynamic severity did not predict survival when COPD and ILD patients were analyzed together. However, survival in the ILD cohort for any PH level was worse than in NoPH (3-year survival: NoPH 58%, BLPH 32%, MPH 28%, SPH 33%, p = 0.002). In the COPD cohort, only SPH had reduced survival compared to the other groups (3-year survival: NoPH 82%, BLPH 86%, MPH 87%, SPH 57%, p = 0.005). The mortality risk correlated significantly with mPAP in ILD (hazard ratio [HR]: 2.776, 95% CI: 2.057–3.748, p < 0.001) and notably less in COPD patients (HR: 1.015, 95% CI: 1.003–1.027, p = 0.0146). Conclusions In ILD, any level of PH portends worse survival, while in COPD, only SPH presents a worse outcome.
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Affiliation(s)
- Lucilla Piccari
- Department of Pulmonary Medicine, Hospital del Mar, Barcelona, Spain
- Medicine and Translational Research, University of Barcelona, Barcelona, Spain
- *Lucilla Piccari,
| | - Stephen John Wort
- National Pulmonary Hypertension Service, Royal Brompton Hospital, London, United Kingdom
| | - Federica Meloni
- Department of Respiratory Diseases, IRCCS San Matteo and University of Pavia, Pavia, Italy
- Italian Pulmonary Hypertension Network, IPHNET, Rome, Italy
| | - Monica Rizzo
- Department of Pulmonary Medicine, IRCCS Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy
| | - Laura C. Price
- National Pulmonary Hypertension Service, Royal Brompton Hospital, London, United Kingdom
| | - Lavinia Martino
- Department of Pulmonary Medicine, IRCCS Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy
| | - Elena Salvaterra
- Department of Internal Medicine and Therapeutics, Section of Pneumology, University of Pavia, Pavia, Italy
| | - Laura Scelsi
- Italian Pulmonary Hypertension Network, IPHNET, Rome, Italy
- Division of Cardiology, IRCCS San Matteo of Pavia, Pavia, Italy
| | | | - Isabel Blanco
- Medicine and Translational Research, University of Barcelona, Barcelona, Spain
- Department of Pulmonary Medicine, Hospital Clínic, Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Biomedical Research Networking Centre on Respiratory Diseases (CIBERES), Madrid, Spain
| | - Adriana Callari
- Department of Pulmonary Medicine, IRCCS Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy
| | | | - Fabio Tuzzolino
- Department of Pulmonary Medicine, IRCCS Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy
| | - Colm McCabe
- National Pulmonary Hypertension Service, Royal Brompton Hospital, London, United Kingdom
| | - Diego Agustín Rodríguez Chiaradía
- Department of Pulmonary Medicine, Hospital del Mar, Barcelona, Spain
- Biomedical Research Networking Centre on Respiratory Diseases (CIBERES), Madrid, Spain
- Department of Medicine and Life Sciences, University Pompeu Fabra, Barcelona, Spain
| | - Patrizio Vitulo
- Italian Pulmonary Hypertension Network, IPHNET, Rome, Italy
- Department of Pulmonary Medicine, IRCCS Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy
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Esposito CM, D'Agostino A, Dell Osso B, Fiorentini A, Prunas C, Callari A, Oldani L, Fontana E, Gargano G, Viscardi B, Giordano B, D'Angelo S, Wiedenmann F, Macellaro M, Giorgetti F, Turtulici N, Gambini O, Brambilla P. Impact of the first Covid-19 pandemic wave on first episode psychosis in Milan, italy. Psychiatry Res 2021; 298:113802. [PMID: 33592401 PMCID: PMC7874958 DOI: 10.1016/j.psychres.2021.113802] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 02/08/2021] [Indexed: 01/22/2023]
Abstract
The ongoing Corona Virus Disease 2019 (COVID-19) pandemic appears to increase risk for mental illness, either directly due to inflammation caused by the virus or indirectly due to related psychosocial stress, resulting in the development of both anxious-depressive and psychotic symptoms. The purpose of the present study was to assess the frequency and characteristics of all patients with First Episodes Psychosis (FEP) without COVID-19 infection hospitalized in the first four months since lockdown in Milan. We recruited sixty-two patients hospitalized between March 8 to July 8, 2020 versus those first hospitalized in the same period in 2019. The two subgroups were compared for sociodemographic variables and clinical characteristics of the episodes. Patients with FEP in 2020 were significantly older than patients with FEP in 2021, and presented with significantly less substances abuse. Interestingly, patients presenting with FEP in 2020 were significantly older than patients with FEP in 2019. These data are compatible with the greater vulnerability to stressful factors during the pandemic, as well as with the greater concern regarding a possible COVID-19 infection producing brain damage causing the FEP.
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Affiliation(s)
- C M Esposito
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - A D'Agostino
- Department of Mental Health, San Paolo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - B Dell Osso
- Department of Scienze Biomediche e Cliniche 'Luigi Sacco', Università degli Studi di Milano, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Department of Psychiatry and Behavioural Sciences, Bipolar Disorders Clinic, Stanford Medical School, Stanford University, CA, USA
| | - A Fiorentini
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - C Prunas
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - A Callari
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - L Oldani
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - E Fontana
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - G Gargano
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - B Viscardi
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - B Giordano
- Department of Scienze Biomediche e Cliniche 'Luigi Sacco', Università degli Studi di Milano, Milan, Italy
| | - S D'Angelo
- Department of Scienze Biomediche e Cliniche 'Luigi Sacco', Università degli Studi di Milano, Milan, Italy
| | - F Wiedenmann
- Department of Scienze Biomediche e Cliniche 'Luigi Sacco', Università degli Studi di Milano, Milan, Italy
| | - M Macellaro
- Department of Scienze Biomediche e Cliniche 'Luigi Sacco', Università degli Studi di Milano, Milan, Italy
| | - F Giorgetti
- Department of Scienze Biomediche e Cliniche 'Luigi Sacco', Università degli Studi di Milano, Milan, Italy
| | - Ne Turtulici
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - O Gambini
- Department of Mental Health, San Paolo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
- CRC "Aldo Ravelli" for Neurotechnology and Experimental Brain Therapeutics, University of Milan Medical School, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - P Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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3
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Vitulo P, Beretta M, Martucci G, Hernandez Baravoglia CM, Romano G, Bertani A, Martino L, Callari A, Panarello G, Pilato M, Arcadipane A. Challenge of Pregnancy in Patients With Pre-Capillary Pulmonary Hypertension: Veno-Arterial Extracorporeal Membrane Oxygenation as an Innovative Support for Delivery. J Cardiothorac Vasc Anesth 2017; 31:2152-2155. [DOI: 10.1053/j.jvca.2017.04.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Indexed: 11/11/2022]
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Murru A, Torra M, Callari A, Pacchiarotti I, Romero S, Gonzalez de la Presa B, Varo C, Goikolea JM, Pérez-Sola V, Vieta E, Colom F. A study on the bioequivalence of lithium and valproate salivary and blood levels in the treatment of bipolar disorder. Eur Neuropsychopharmacol 2017; 27:744-750. [PMID: 28666638 DOI: 10.1016/j.euroneuro.2017.06.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 05/11/2017] [Accepted: 06/10/2017] [Indexed: 01/17/2023]
Abstract
Lithium (Li) and valproate (VPA) are used in the treatment of bipolar disorder (BD), with narrow therapeutic window requiring periodic control of serum levels. This prevents intoxication, lack of efficacy due to low serum concentrations, and allows monitoring adherence. We aimed at evaluating the bioequivalence of salivary and blood levels of LI or VPA in a sample of adult BD patients. Secondarily, lithium bioequivalence was evaluated across different patients' lifespans. BD patients treated with either Li or VPA underwent contemporary standard serum and salivary measurements. Blood levels of both drugs were taken according to standard procedures. Li salivary levels were performed by an adapted potentiometric method on the AVL9180 electrolyte analyzer. VPA salivary levels were taken with an immune-assay method with turbidimetric inhibition. A total of 50 patients (38 on Li, 12 on VPA) were enrolled. Blood-saliva bioequivalence for VPA was not found due to a high variability in salivary measures. Li measures resulted in a high correlation (r=0.767, p<0.001), showing no partial correlation with age (r=0.147, p=0.380). Li salivary test is a reliable method of measuring Li availability and is equivalent to serum levels. Potential advantages of Li salivary testing are its non-invasive nature and the possibility of doing the test during the usual appointment with the psychiatrist.
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Affiliation(s)
- A Murru
- Bipolar Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Villarroel 170, Barcelona 08036, Catalonia, Spain
| | - M Torra
- Pharmacology and Toxicology, Biomedical Diagnosis Department, Hospital Clínic, University of Barcelona, IDIBAPS, Villarroel 170, Barcelona 08036, Catalonia, Spain
| | - A Callari
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Lungarno Pacinotti 44, I-56126 Pisa, Italy
| | - I Pacchiarotti
- Bipolar Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Villarroel 170, Barcelona 08036, Catalonia, Spain
| | - S Romero
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, CIBERSAM, Hospital Clínic of Barcelona, Villarroel 170, Barcelona 08036, Catalonia, Spain
| | - B Gonzalez de la Presa
- CORE Laboratory - Centre de Diagnòstic Biomédic Hospital Clinic, IDIBAPS, Villarroel 170, Barcelona 08036, Catalonia, Spain
| | - C Varo
- Bipolar Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Villarroel 170, Barcelona 08036, Catalonia, Spain
| | - J M Goikolea
- Bipolar Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Villarroel 170, Barcelona 08036, Catalonia, Spain
| | - V Pérez-Sola
- Mental Health Group, IMIM Hospital del Mar, CIBERSAM, Plaza Charles Darwin, sn, 08003 Barcelona, Catalonia, Spain
| | - E Vieta
- Bipolar Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Villarroel 170, Barcelona 08036, Catalonia, Spain
| | - F Colom
- Mental Health Group, IMIM Hospital del Mar, CIBERSAM, Plaza Charles Darwin, sn, 08003 Barcelona, Catalonia, Spain.
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Bertani A, Vitulo P, Mularoni A, Grossi P, De Monte L, Russo E, Beretta M, Martino L, Callari A. A Prophylaxis-Free, Pre-Emptive Approach to the Management of CMV After Lung Transplantation: Single Center Results. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.1534] [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: 10/19/2022] Open
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Miraglia R, Vitulo P, Maruzzelli L, Burgio G, Caruso S, Bertani A, Callari A, Luca A. Successful Recanalization of a Complete Lobar Bronchial Stenosis in a Lung Transplant Patient Using a Combined Percutaneous and Bronchoscopic Approach. Cardiovasc Intervent Radiol 2015; 39:462-6. [DOI: 10.1007/s00270-015-1219-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 09/11/2015] [Indexed: 12/19/2022]
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Bertani A, Vitulo P, Soresi S, DeMonte L, Tuzzolino F, Callari A, Gridelli B. 711 Changes in Pulmonary Volumes in Patients Who Underwent Lung Transplantation for Pulmonary Fibrosis. J Heart Lung Transplant 2012. [DOI: 10.1016/j.healun.2012.01.726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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8
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Bertani A, DeMonte L, Vitulo P, Soresi S, Callari A, Tuzzolino F, Di Paola G, Arcadipane A, Gridelli B. 640 The Administration of Exogenous Surfactant during Cold Preservation Can Improve Pulmonary Function after Lung Transplantation in a Swine Model of Prolonged Ischemia. J Heart Lung Transplant 2012. [DOI: 10.1016/j.healun.2012.01.654] [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: 11/28/2022] Open
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Scichilone N, Callari A, Augugliaro G, Marchese M, Togias A, Bellia V. The impact of age on prevalence of positive skin prick tests and specific IgE tests. Respir Med 2011; 105:651-8. [PMID: 21220195 DOI: 10.1016/j.rmed.2010.12.014] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Revised: 11/16/2010] [Accepted: 12/20/2010] [Indexed: 10/18/2022]
Abstract
Aging is associated with modifications of the immune system, defined as immunosenescence. This could contribute to a reduced prevalence of allergic disease in the elderly population. In this regard, atopy has rarely been considered in the clinical assessment of the geriatric respiratory patient. This article is a review of the available literature assessing the impact of age on atopy. In the majority of papers, we found a lower prevalence of atopy in the most advanced ages, both in healthy subjects and in individuals affected by allergic respiratory diseases. Unfortunately, no large, longitudinal studies performed in the general population have been conducted to further explore this observation. Although available data seem to favor the decline of allergen sensitization with age, the prevalence of allergic sensitizations in the elderly population with respiratory symptoms is substantial enough to warrant evaluation of the atopic condition. From a clinical perspective, allergic reactions in older adults can have the same or even worse manifestations compared to young people. For this reasons, the evaluation of the atopic condition also in the geriatric patient is recommended. Thus, the role of atopy as it pertains to the diagnosis, therapy (adoption of preventive measure such as removal of environmental allergen or immunotherapy), and prognosis (influence on morbidity and mortality) of chronic respiratory illnesses in the elderly is addressed.
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Affiliation(s)
- Nicola Scichilone
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Sezione di Pneumologia, University of Palermo, Villa Sofia-Cervello Hospital, Palermo, Italy.
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Gebbia V, Verderame F, Ferraù F, Bordonaro R, Callari A, Caruso M, Tirrito ML, Valenza R, Cicero G, Borsellino N, Tralongo P. Raltitrexed plus levofolinic acid and bolus/continuous infusion 5-fluorouracil on a biweekly schedule for elderly patients with advanced colorectal carcinomas. Ann Oncol 2006; 17 Suppl 7:vii60-5. [PMID: 16760296 DOI: 10.1093/annonc/mdl953] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The aim of the study was to evaluate the safety and efficacy of the raltitrexed/5-fluorouracil/levofolinic acid combination regimen as first-line chemotherapy for elderly patients with advanced/metastatic colorectal cancer. PATIENTS AND METHODS Previously untreated patients with metastatic colorectal cancer received raltitrexed 2 mg/m(2) i.v. plus levofolinic acid and 5-fluorouracil according to the De Gramont' schedule given every 2 weeks as first-line chemotherapy. Patients were re-evaluated after six cycles and chemotherapy was continued up to tolerance or disease progression. RESULTS Seventy patients aged >/=65 years were accrued from 11 centers between September 2001 and July 2002. According to the intention-to-treat analysis, the overall response rate was 35% (95% CI 29.5% to 40.5%) including one complete response (1%) and 24 partial responses (34%). Twenty patients (31%) showed a stabilization of disease for a tumor growth control rate of 64% (95% CI 57% to 71%). The median overall survival was 12.5 months and the median time to disease progression was 6.5 months. No toxic deaths or allergic reaction were recorded. Grade 4 toxicities were non-existent. The main hematological toxicity was grade 3 neutropenia, which occurred in 9% of patients, and grade 3 anemia in only one case, while no case of graded 3 thrombocytopenia was observed. Grade 3 non-hematological toxicities were asthenia (11%), transient increase of transaminases (10%) and diarrhea (4%). CONCLUSIONS The results of this study suggest that the raltitrexed/5-fluorouracil/levolofinic acid combination is an effective and well tolerated regimen for the treatment of elderly patients with advanced colorectal cancer. Its ease of administration and patient's tolerance warrant further investigation over 5-fluorouracil/folinic acid regimens.
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Affiliation(s)
- V Gebbia
- Medical Oncology Units of the: Department of Experimental Oncology and Clinical Applications, University of Palermo, Italy.
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Strippoli V, Dauria FD, Tecca M, Callari A, Simonetti G. Propyl gallate increases in vitro antifungal imidazole activity against Candida albicans. Int J Antimicrob Agents 2000; 16:73-6. [PMID: 11185418 DOI: 10.1016/s0924-8579(00)00200-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [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: 10/18/2022]
Abstract
We looked at the in vitro effect of an antioxidant, propyl gallate (PG), on the antifungal activity of miconazole sulphosalicylate, econazole sulphosalicylate and ketoconazole against 40 clinical isolates of Candida albicans. The combination of imidazole and PG gave MIC values 10-150 times lower than those of imidazole alone. The optimal conditions for this enhanced activity were pH 6.2-8.0 and a fungal cell concentration lower than 3 x 10(5) cells/ml. The mechanism of the interaction between imidazole and PG is not known but may be as a result of an effect of PG on the P-450 cytochrome. Theoretically this combination could reduce the side effects of long treatment with imidazoles and lower the risk of resistance to these antifungal drugs.
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Affiliation(s)
- V Strippoli
- Institute of Microbiology, Faculty of Medicine and Surgery, University of Rome La Sapienza, Italy
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Callari A, Gebbia V, Testa A, Cusimano MP, Cipolla C, Amato C, Cannata G, Latteri MA, Garascia C, Gebbia N. A phase I-II study of cyclophosphamide, epidoxorubicin, levofolinic acid/5-fluorouracil and recombinant human granulocyte colony stimulating factor in metastatic breast carcinoma. Acta Oncol 1994; 33:925-9. [PMID: 7529516 DOI: 10.3109/02841869409098458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Thirty patients with measurable metastatic breast carcinoma were treated with a combination of cyclophosphamide 600 mg/m2 on day 1, levofolinic acid 100 mg/m2 plus 5-fluorouracil 375 mg/m2 on days 1-3, and epidoxorubicin (EDXR) in three refracted doses on days 1-3 with G-CSF rescue for 10 days. In the phase I part of the study, groups of 3 patients received EDXR 20, 25, 30, 35, and 40 mg/m2/day until the dose limiting toxicity (DLT) was reached. At the dose of 40 mg/m2/day prolonged grade 4 leukopenia, severe proctitis, and grade 3 diarrhea represented the DLT. All subsequent patients were treated at the maximal tolerated dose of EDXR (35 mg/m2/day). In the group of 18 patients treated at 35 mg/m2/day the overall response rate was 78%, with 22% CR and 56% PR. Four patients did not respond. Objective responses were seen at all tumor sites including bone and viscera, which usually are rather chemotherapy insensitive. Toxicity was generally acceptable. Although the response rate was quite high, the duration of objective tumor regression and patients' survival were not impressive. In conclusion, we do not recommend routine use of such an aggressive regimen for palliation of advanced breast cancer. Results of the present and similar studies may, however, be useful for planning of neoadjuvant or adjuvant trials with curative intent.
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Affiliation(s)
- A Callari
- Service of Chemotherapy, Oncological Hospital M. Ascoli, Palermo, Italy
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13
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Gebbia V, Agostara B, Callari A, Zerillo G, Restivo G, Speciale R, Cupido G, Ingria F, Spatafora G, Fazio L. Head and neck carcinoma with distant metastases: a retrospective analysis of 44 cases treated with cisplatin-based chemotherapeutic regimens. Anticancer Res 1993; 13:1129-31. [PMID: 8352535] [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: 01/30/2023]
Abstract
The rarity of medical reports on the chemotherapeutic management of head and neck cancer metastatic to distant organs prompted us to review the effect of cisplatin-based regimens in this clinical setting. Out of 44 eligible patients, 10 patients (23%) achieved a CR, 16 patients (36%) has a PR, 7 (16%) no change, and 11 (25%) progressed. Patients with rhinopharyngeal carcinoma showed a 69% overall response rate, while those with other head and neck carcinomas had a 54% overall response rate. No preferential site of response was detected. The difference in mean survival of responding patients between the rhinopharyngeal group and the non-rhinopharyngeal group was statistically significant (P < 0.05). Responding patients survived longer than non responders (P < 0.05 in both groups). Interestingly, 3 patients in the rhinopharyngeal cancer group survived more than 2 years from the start of chemotherapy for metastatic disease. These data strengthen the observation that rhinopharyngeal carcinoma, even with distant metastases, responds to chemotherapy better than other carcinomas arising in the head and neck region. Moreover, although survival is still dismal, cisplatin-based systemic chemotherapy seems an effective palliative treatment for metastatic head and neck cancer.
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Affiliation(s)
- V Gebbia
- Chair of Chemotherapy, Oncological Hospital Maurizio Ascoli, Palermo, Italy
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14
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Gebbia V, Zerillo G, Gebbia N, Agostara B, Callari A, Rausa L. Chemotherapy in head and neck cancer (I): Management of recurrent or metastatic disease. J Chemother 1992; 4:244-59. [PMID: 1403082 DOI: 10.1080/1120009x.1992.11739173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- V Gebbia
- Chair of Chemotherapy, University of Palermo, Italy
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15
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Gebbia V, Gebbia N, Testa A, Valenza R, Borsellino N, Rausa L, Agostara B, Callari A, Latteri M, Florena M, Cipolla C, Leto G. Subcutaneous recombinant-human-erythropoietin prevents chemotherapy-related anemia in patients with advanced cancer. Int J Oncol 1992; 1:341-345. [PMID: 21584553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
Nineteen patients with advanced cancer were randomly allocated to receive: (i) rhEpo 150 UI/kg subcutanously three times/week starting 24 hours after the completion of cisplatin- or carboplatin-based chemotherapy; or (ii) normal saline. There were 17 patients with advanced head and neck carcinoma and 2 patients with small cell lung cancer. Patients were monitored for hemoglobin level, hematocrit, WBC, PLT and reticulocytes. Patients who received rhEpo overall showed a 7.2 +/- 6.3% mean increase in Hb level over their pretreatment values, while control patients had a 26.4 +/- 12% decrease. This difference was statistically significant (p<0.001). No patients in the rhEpo group required transfusion, while 4 patients in the control group received packed red cell transfusion. No significant side-effects attributable to rhEpo were recorded, but 1 patient showed a transitory increase in PLT count. In conclusion, subcutaneous rhEpo may be safely administered to patients with advanced cancer and effectively prevents cisplatin- or carboplatin-related anemia.
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Affiliation(s)
- V Gebbia
- UNIV PALERMO,INST PHARMACOL,CHAIR CHEMOTHERAPY,I-90134 PALERMO,ITALY. UNIV PALERMO,INST PHARMACOL,CLIN ONCOL SECT,I-90134 PALERMO,ITALY. UNIV PALERMO,DEPT SURG & ANAT,I-90134 PALERMO,ITALY. OSPED ONCOL MAURIZIO ASCOLI,SERV CHEMOTHERAPY,PALERMO,ITALY
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