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Roazzi L, Patelli G, Bencardino KB, Amatu A, Bonazzina E, Tosi F, Amoruso B, Bombelli A, Mariano S, Stabile S, Porta C, Siena S, Sartore-Bianchi A. Ongoing Clinical Trials and Future Research Scenarios of Circulating Tumor DNA for the Treatment of Metastatic Colorectal Cancer. Clin Colorectal Cancer 2024:S1533-0028(24)00006-9. [PMID: 38519391 DOI: 10.1016/j.clcc.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/04/2024] [Accepted: 02/11/2024] [Indexed: 03/24/2024]
Abstract
Liquid biopsy using circulating tumor DNA (ctDNA) has emerged as a minimally invasive, timely approach to provide molecular diagnosis and monitor tumor evolution in patients with cancer. Since the molecular landscape of metastatic colorectal cancer (mCRC) is substantially heterogeneous and dynamic over space and time, ctDNA holds significant advantages as a biomarker for this disease. Numerous studies have demonstrated that ctDNA broadly recapitulates the molecular profile of the primary tumor and metastases, and have mainly focused on the genotyping of RAS and BRAF, that is propaedeutic for anti-EGFR treatment selection. However, ctDNA soon broadened its scope towards the assessment of early tumor response, as well as the identification of drug resistance biomarkers to drive potential molecular actionability. In this review article, we provide an overview of the current state-of-the-art of this methodology and its applications, focusing on ongoing clinical trials that employ ctDNA to prospectively guide treatment in patients with mCRC.
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Affiliation(s)
- Laura Roazzi
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy; Department of Hematology, Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giorgio Patelli
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy; Department of Hematology, Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy; IFOM ETS - The AIRC Institute of Molecular Oncology, Milan, Italy
| | - Katia Bruna Bencardino
- Department of Hematology, Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alessio Amatu
- Department of Hematology, Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Erica Bonazzina
- Department of Hematology, Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Federica Tosi
- Department of Hematology, Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Brunella Amoruso
- Division of Medical Oncology, A.O.U. Consorziale Policlinico di Bari, Bari, Italy; Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Anna Bombelli
- Department of Hematology, Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Sara Mariano
- Department of Hematology, Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Stefano Stabile
- Department of Hematology, Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Camillo Porta
- Division of Medical Oncology, A.O.U. Consorziale Policlinico di Bari, Bari, Italy; Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Salvatore Siena
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy; Department of Hematology, Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy.
| | - Andrea Sartore-Bianchi
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy; Department of Hematology, Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy; Division of Clinical Research and Innovation, Grande Ospedale Metropolitano Niguarda, Milan, Italy.
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Mauri G, Patelli G, Roazzi L, Valtorta E, Amatu A, Marrapese G, Bonazzina E, Tosi F, Bencardino K, Ciarlo G, Mariella E, Marsoni S, Bardelli A, Bonoldi E, Sartore-Bianchi A, Siena S. Clinicopathological characterisation of MTAP alterations in gastrointestinal cancers. J Clin Pathol 2024:jcp-2023-209341. [PMID: 38350716 DOI: 10.1136/jcp-2023-209341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 01/03/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND Methylthioadenosine phosphorylase (MTAP) is an essential metabolic enzyme in the purine and methionine salvage pathway. In cancer, MTAP gene copy number loss (MTAP loss) confers a selective dependency on the related protein arginine methyltransferase 5. The impact of MTAP alterations in gastrointestinal (GI) cancers remains unknown although hypothetically druggable. Here, we aim to investigate the prevalence, clinicopathological features and prognosis of MTAP loss GI cancers. METHODS Cases with MTAP alterations were retrieved from The Cancer Genome Atlas (TCGA) and a real-world cohort of GI cancers profiled by next-generation sequencing. If MTAP alterations other than loss were found, immunohistochemistry was performed. Finally, we set a case-control study to assess MTAP loss prognostic impact. RESULTS Findings across the TCGA dataset (N=1363 patients) and our cohort (N=508) were consistent. Gene loss was the most common MTAP alteration (9.4%), mostly co-occurring with CDKN2A/B loss (97.7%). Biliopancreatic and gastro-oesophageal cancers had the highest prevalence of MTAP loss (20.5% and 12.7%, respectively), being mostly microsatellite stable (99.2%). In colorectal cancer, MTAP loss was rare (1.1%), while most MTAP alterations were mutations (5/7, 71.4%); among the latter, only MTAP-CDKN2B truncation led to protein loss, thus potentially actionable. MTAP loss did not confer worse prognosis. CONCLUSIONS MTAP alterations are found in 5%-10% of GI cancers, most frequently biliopancreatic and gastro-oesophageal. MTAP loss is the most common alteration, identified almost exclusively in MSS, CDKN2A/B loss, upper-GI cancers. Other MTAP alterations were found in colorectal cancer, but unlikely to cause protein loss and drug susceptibility.
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Affiliation(s)
- Gianluca Mauri
- IFOM ETS - The AIRC Institute of Molecular Oncology, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Department of Hematology, Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giorgio Patelli
- IFOM ETS - The AIRC Institute of Molecular Oncology, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Department of Hematology, Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Laura Roazzi
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Department of Hematology, Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Emanuele Valtorta
- Department of Pathology, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alessio Amatu
- Department of Hematology, Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giovanna Marrapese
- Department of Hematology, Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Erica Bonazzina
- Department of Hematology, Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Federica Tosi
- Department of Hematology, Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Katia Bencardino
- Department of Hematology, Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Gabriele Ciarlo
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Department of Hematology, Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Elisa Mariella
- IFOM ETS - The AIRC Institute of Molecular Oncology, Milan, Italy
- Department of Oncology, Molecular Biotechnology Center, University of Torino, Turin, Italy
| | - Silvia Marsoni
- IFOM ETS - The AIRC Institute of Molecular Oncology, Milan, Italy
| | - Alberto Bardelli
- IFOM ETS - The AIRC Institute of Molecular Oncology, Milan, Italy
- Department of Oncology, Molecular Biotechnology Center, University of Torino, Turin, Italy
| | - Emanuela Bonoldi
- Department of Pathology, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Andrea Sartore-Bianchi
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Department of Hematology, Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Division of Research and Innovation, Department of Hematology, Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Salvatore Siena
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Department of Hematology, Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
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3
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Mauri G, Pedrani M, Ghezzi S, Bencardino K, Mariano S, Bonazzina E, Serra F, Pedrazzoli P, Caccialanza R, Cavestro GM, Siena S, Artale S, Sartore-Bianchi A. Young-onset colorectal cancer: treatment-related nausea, vomiting and diarrhoea. BMJ Support Palliat Care 2024; 13:e885-e889. [PMID: 37344158 PMCID: PMC10850832 DOI: 10.1136/spcare-2023-004203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 05/17/2023] [Indexed: 06/23/2023]
Abstract
OBJECTIVES Early-onset colorectal cancer (EO-CRC) incidence is increasing, raising a clinical challenge. Clinicians tend to treat EO-CRC patients with more intensive regimens despite the lack of survival benefits, based on an age-related bias. Limited evidence is available regarding treatment-related toxicities in this peculiar subset of patients. METHODS We performed a literature search in MEDLINE/PubMed, EMBASE and Scopus, looking for reporting of nausea, vomiting and diarrhoea occurring in patients with EO-CRC, defined by age lower than 50 years old at initial diagnosis, while receiving anticancer treatment. RESULTS 2318 records were screened and 9 full-text articles were considered eligible for inclusion for a total of 59 783 patients (of whom 8681 EO-CRC patients). We found nausea and vomiting occurring at higher incidence among EO-CRC compared with older patients, while no difference was reported as for diarrhoea. Peritoneal involvement, age younger than 40, female gender, suboptimal adherence to guidelines and oxaliplatin might represent potential risk factors for increased nausea and vomiting in patients with EO-CRC. CONCLUSION EO-CRC patients experience more nausea and vomiting but equal or less diarrhoea compared with older patients. Adherence to clinical guidelines is recommended, and more data are warranted to assess if an enhanced antiemetic approach might be required, particularly in case of specific risk factors.
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Affiliation(s)
- Gianluca Mauri
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milano, Italy
- Department of Hematology, Oncology and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Martino Pedrani
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milano, Italy
- Department of Hematology, Oncology and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Silvia Ghezzi
- Department of Hematology, Oncology and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Katia Bencardino
- Department of Hematology, Oncology and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Sara Mariano
- Department of Hematology, Oncology and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Erica Bonazzina
- Department of Hematology, Oncology and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Francesco Serra
- Medical Oncology Unit and Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Paolo Pedrazzoli
- Medical Oncology Unit and Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Riccardo Caccialanza
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giulia Martina Cavestro
- Gastroenterology and Gastrointestinal Endoscopy Unit, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Salvatore Siena
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milano, Italy
- Department of Hematology, Oncology and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Salvatore Artale
- Department of Medical Oncology, Vimercate Hospital, ASST Brianza, Vimercate, Italy
| | - Andrea Sartore-Bianchi
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milano, Italy
- Department of Hematology, Oncology and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milano, Italy
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4
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Patelli G, Mauri G, Tosi F, Amatu A, Bencardino K, Bonazzina E, Pizzutilo EG, Villa F, Calvanese G, Agostara AG, Stabile S, Ghezzi S, Crisafulli G, Di Nicolantonio F, Marsoni S, Bardelli A, Siena S, Sartore-Bianchi A. Circulating Tumor DNA to Drive Treatment in Metastatic Colorectal Cancer. Clin Cancer Res 2023; 29:4530-4539. [PMID: 37436743 PMCID: PMC10643999 DOI: 10.1158/1078-0432.ccr-23-0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/28/2023] [Accepted: 06/23/2023] [Indexed: 07/13/2023]
Abstract
In the evolving molecular treatment landscape of metastatic colorectal cancer (mCRC), the identification of druggable alterations is pivotal to achieve the best therapeutic opportunity for each patient. Because the number of actionable targets is expanding, there is the need to timely detect their presence or emergence to guide the choice of different available treatment options. Liquid biopsy, through the analysis of circulating tumor DNA (ctDNA), has proven safe and effective as a complementary method to address cancer evolution while overcoming the limitations of tissue biopsy. Even though data are accumulating regarding the potential for ctDNA-guided treatments applied to targeted agents, still major gaps in knowledge exist as for their application to different areas of the continuum of care. In this review, we recapitulate how ctDNA information could be exploited to drive different targeted treatment strategies in mCRC patients, by refining molecular selection before treatment by addressing tumor heterogeneity beyond tumor tissue biopsy; longitudinally monitoring early-tumor response and resistance mechanisms to targeted agents, potentially leading to tailored, molecular-driven, therapeutic options; guiding the molecular triage towards rechallenge strategies with anti-EGFR agents, suggesting the best time for retreatment; and providing opportunities for an "enhanced rechallenge" through additional treatments or combos aimed at overcoming acquired resistance. Besides, we discuss future perspectives concerning the potential role of ctDNA to fine-tune investigational strategies such as immuno-oncology.
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Affiliation(s)
- Giorgio Patelli
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
- Department of Hematology, Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
- IFOM ETS – The AIRC Institute of Molecular Oncology, Milan, Italy
| | - Gianluca Mauri
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
- Department of Hematology, Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
- IFOM ETS – The AIRC Institute of Molecular Oncology, Milan, Italy
| | - Federica Tosi
- Department of Hematology, Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alessio Amatu
- Department of Hematology, Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Katia Bencardino
- Department of Hematology, Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Erica Bonazzina
- Department of Hematology, Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Elio Gregory Pizzutilo
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
- Department of Hematology, Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Federica Villa
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
- Department of Hematology, Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Gabriele Calvanese
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
- Department of Hematology, Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alberto Giuseppe Agostara
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
- Department of Hematology, Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Stefano Stabile
- Department of Hematology, Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Silvia Ghezzi
- Department of Hematology, Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Federica Di Nicolantonio
- Candiolo Cancer Institute, Fondazione del Piemonte per l'Oncologia-IRCCS, Candiolo, Italy
- Department of Oncology, University of Torino, Candiolo, Italy
| | - Silvia Marsoni
- IFOM ETS – The AIRC Institute of Molecular Oncology, Milan, Italy
| | - Alberto Bardelli
- Candiolo Cancer Institute, Fondazione del Piemonte per l'Oncologia-IRCCS, Candiolo, Italy
- Department of Oncology, University of Torino, Candiolo, Italy
| | - Salvatore Siena
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
- Department of Hematology, Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Andrea Sartore-Bianchi
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
- Department of Hematology, Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Division of Clinical Research and Innovation, Grande Ospedale Metropolitano Niguarda, Milan, Italy
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Mauri G, Patelli G, Gori V, Lauricella C, Mussolin B, Amatu A, Bencardino K, Tosi F, Bonazzina E, Bonoldi E, Bardelli A, Siena S, Sartore-Bianchi A. Corrigendum: Case report: MAP2K1 K57N mutation is associated with primary resistance to anti-EGFR monoclonal antibodies in metastatic colorectal cancer. Front Oncol 2023; 13:1147497. [PMID: 37056342 PMCID: PMC10086435 DOI: 10.3389/fonc.2023.1147497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/07/2023] [Indexed: 03/30/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fonc.2022.1030232.].
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Affiliation(s)
- Gianluca Mauri
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
- IFOM, Istituto Fondazione di Oncologia Molecolare ETS, Milan, Italy
- Department of Hematology, Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giorgio Patelli
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
- Department of Hematology, Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Viviana Gori
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
- Department of Hematology, Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Calogero Lauricella
- Department of Hematology, Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Alessio Amatu
- Department of Hematology, Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Katia Bencardino
- Department of Hematology, Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Federica Tosi
- Department of Hematology, Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Erica Bonazzina
- Department of Hematology, Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Emanuela Bonoldi
- Department of Hematology, Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alberto Bardelli
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Torino, Italy
- Department of Oncology, Università degli Studi di Torino, Turin, Italy
| | - Salvatore Siena
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
- Department of Hematology, Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Andrea Sartore-Bianchi
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
- Department of Hematology, Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
- *Correspondence: Andrea Sartore-Bianchi,
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Mauri G, Patelli G, Gori V, Lauricella C, Mussolin B, Amatu A, Bencardino K, Tosi F, Bonazzina E, Bonoldi E, Bardelli A, Siena S, Sartore-Bianchi A. Case Report: MAP2K1 K57N mutation is associated with primary resistance to anti-EGFR monoclonal antibodies in metastatic colorectal cancer. Front Oncol 2022; 12:1030232. [PMID: 36419886 PMCID: PMC9676472 DOI: 10.3389/fonc.2022.1030232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 10/19/2022] [Indexed: 11/09/2022] Open
Abstract
BackgroundWe aim to identify the prevalence and the role of the MAP2K1 K57N mutation in predicting resistance to anti-EGFR agents in metastatic colorectal cancer (mCRC) patients.MethodsWe retrospectively reviewed tumor-based next generation sequencing (NGS) results from mCRC patients screened for enrollment in the GO40872/STARTRK-2 clinical trial between July 2019 and March 2021. Then, in patients harboring microsatellite stable (MSS) RAS and BRAF wild-type MAP2K1 mutant mCRC, we reviewed outcome to treatment with anti-EGFR monoclonal antibodies.ResultsA total of 246 mCRC patients were screened. Most of them, 215/220 (97.7%), were diagnosed with MSS mCRC and 112/215 (52.1%) with MSS, RAS and BRAF wild-type mCRC. Among the latter, 2/112 (1.8%) had MAP2K1 K57N mutant mCRC and both received anti-EGFR monotherapy as third line treatment. In both patients, MAP2K1 K57N mutant tumors proved primary resistant to anti-EGFR agent panitumumab monotherapy. Of interest, one of these patients was treated with anti-EGFR agents three times throughout his course of treatment, achieving some clinical benefit only when associated with other cytotoxic agents (FOLFOX or irinotecan).ConclusionWe verified in a clinical real-world setting that MAP2K1 K57N mutation is a resistance mechanism to anti-EGFR agents in mCRC. Thus, we suggest avoiding the administration of these drugs to MSS RAS and BRAF wild-type MAP2K1 N57K mutant mCRC.
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Affiliation(s)
- Gianluca Mauri
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
- IFOM, Istituto Fondazione di Oncologia Molecolare ETS, Milan, Italy
- Department of Hematology, Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giorgio Patelli
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
- Department of Hematology, Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Viviana Gori
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
- Department of Hematology, Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Calogero Lauricella
- Department of Hematology, Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Alessio Amatu
- Department of Hematology, Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Katia Bencardino
- Department of Hematology, Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Federica Tosi
- Department of Hematology, Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Erica Bonazzina
- Department of Hematology, Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Emanuela Bonoldi
- Department of Hematology, Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alberto Bardelli
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Torino, Italy
- Department of Oncology, Università degli Studi di Torino, Turin, Italy
| | - Salvatore Siena
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
- Department of Hematology, Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Andrea Sartore-Bianchi
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
- Department of Hematology, Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
- *Correspondence: Andrea Sartore-Bianchi,
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7
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Mauri G, Amatu A, Tosi F, Bencardino K, Bonazzina E, Gori V, Ruggieri L, Arena S, Bardelli A, Marsoni S, Siena S, Sartore-Bianchi A. Efficacy of retreatment with oxaliplatin-based regimens in metastatic colorectal cancer patients: The RETROX-CRC retrospective study. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.4_suppl.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
127 Background: Oxaliplatin in association with fluoropyrimidines is universally considered one of the most effective drugs for colorectal cancer and the mainstay of front-line treatment of metastatic patients. In contrast the efficacy and safety profile of oxaliplatin based regimens in the late-care treatment space have been poorly and conflictingly reported. Methods: We identified a real-world cohort of metastatic colorectal cancer (mCRC) patients undergoing repeated oxaliplatin treatments in a single institution and retrospectively analysed their clinicopathological features to identify potential efficacy-predictive determinants of oxaliplatin response at retreatment (RETROX-CRC Study). Results: Out of 2,606 consecutive mCRC patients referred to Niguarda Cancer Center, 119 fulfilled the eligibility criteria of the study. The response rate (RR) and the disease control rate (DCR) after oxaliplatin retreatments were respectively 21.6% (95% CI 14.4-31.0%), and 57.8% (95% CI 47.7-67.4). A trend towards better RR and DCR was observed among patients who were exposed to oxaliplatin in the adjuvant setting, while a significantly poorer outcome was observed when two or more intervening treatments were delivered in between oxaliplatin exposures. Median progression-free survival (PFS) was 5.1 months (95% CI 4.3-6.1), significantly lower if oxaliplatin was re-administered beyond the third line (HR 2.02; 1.25-3.25; p=0.004). Safety data were reliably retrieved in 65 patients (54,6%). Of these 18.5% (12/65) and 7.7% (5/65) of them had G3-4 toxicities. Overall, toxicity was the cause of treatment discontinuation in almost a third of cases (28.6%; 34/119), with hypersensitivity reactions as the most prevalent reason for stopping treatment (58.8%; 20/34). Conclusions: In this large real-world series of 2,606 mCRC patients, less than 5% were re-treated with oxaliplatin. A late-disease control was achieved in almost 60% of patients, with a clinically acceptable sustained PFS and safety. Given the low performance of current standard drugs in late care of mCRC, retreatment with oxaliplatin might be considered a viable alternative especially if hopefully biology-based predictive markers for improving patient selection could be found.
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Affiliation(s)
- Gianluca Mauri
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
| | - Alessio Amatu
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Federica Tosi
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Katia Bencardino
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Erica Bonazzina
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Viviana Gori
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
| | - Lorenzo Ruggieri
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
| | - Sabrina Arena
- Candiolo Cancer Institute, FPO-IRCCS, Department of Oncology, University of Torino, Candiolo (TO), Italy
| | | | - Silvia Marsoni
- Istituto di Candiolo, Fondazione del Piemonte per l'Oncologia, IRCCS, Candiolo, Italy
| | - Salvatore Siena
- Grande Ospedale Metropolitano Niguarda and Università degli Studi di Milano, Milan, Italy
| | - Andrea Sartore-Bianchi
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
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Patelli G, Vaghi C, Tosi F, Mauri G, Amatu A, Massihnia D, Ghezzi S, Bonazzina E, Bencardino K, Cerea G, Siena S, Sartore-Bianchi A. Liquid Biopsy for Prognosis and Treatment in Metastatic Colorectal Cancer: Circulating Tumor Cells vs Circulating Tumor DNA. Target Oncol 2021; 16:309-324. [PMID: 33738696 PMCID: PMC8105246 DOI: 10.1007/s11523-021-00795-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 02/06/2023]
Abstract
Liquid biopsy recently gained widespread attention as a noninvasive alternative/complementary technique to tissue biopsy in patients with cancer. As technological advances have improved both feasibility and turnaround time, liquid biopsy has expanded tumor molecular analysis with acknowledgement of both spatial and temporal heterogeneity, overcoming many limitations of traditional tissue biopsy. Because of its diagnostic, prognostic, and predictive value, liquid biopsy has been extensively studied also in metastatic colorectal cancer. Indeed, as personalized medicine establishes its role in cancer treatment, genetic biomarkers unveiling the emergence of early resistance are needed. Among the wide variety of tumor analytes amenable to collection, circulating DNA and circulating tumor cells are the most adopted approaches, and both carry clinical relevance in colorectal cancer. However, few studies focused on comparing feasibility between these two approaches. In this review, we discuss the potential implications of liquid biopsy in metastatic colorectal cancer, assessing the advantages and drawbacks of circulating DNA and circulating tumor cells, and highlighting the most relevant trials for clinical practice.
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Affiliation(s)
- Giorgio Patelli
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Dipartimento di Oncologia ed Emato-Oncologia, Università degli Studi di Milano (La Statale), Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Caterina Vaghi
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Dipartimento di Oncologia ed Emato-Oncologia, Università degli Studi di Milano (La Statale), Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Federica Tosi
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Gianluca Mauri
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Dipartimento di Oncologia ed Emato-Oncologia, Università degli Studi di Milano (La Statale), Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Alessio Amatu
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Daniela Massihnia
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Dipartimento di Oncologia ed Emato-Oncologia, Università degli Studi di Milano (La Statale), Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Silvia Ghezzi
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Erica Bonazzina
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Katia Bencardino
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giulio Cerea
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Salvatore Siena
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Dipartimento di Oncologia ed Emato-Oncologia, Università degli Studi di Milano (La Statale), Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Andrea Sartore-Bianchi
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy.
- Dipartimento di Oncologia ed Emato-Oncologia, Università degli Studi di Milano (La Statale), Piazza Ospedale Maggiore, 3, 20162, Milan, Italy.
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Patelli G, Vaghi C, Tosi F, Mauri G, Amatu A, Massihnia D, Ghezzi S, Bonazzina E, Bencardino K, Cerea G, Siena S, Sartore-Bianchi A. Correction to: Liquid Biopsy for Prognosis and Treatment in Metastatic Colorectal Cancer: Circulating Tumor Cells vs Circulating Tumor DNA. Target Oncol 2021; 16:413. [PMID: 33788137 DOI: 10.1007/s11523-021-00812-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Giorgio Patelli
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy.,Dipartimento di Oncologia ed Emato-Oncologia, Università degli Studi di Milano (La Statale), Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Caterina Vaghi
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy.,Dipartimento di Oncologia ed Emato-Oncologia, Università degli Studi di Milano (La Statale), Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Federica Tosi
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Gianluca Mauri
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy.,Dipartimento di Oncologia ed Emato-Oncologia, Università degli Studi di Milano (La Statale), Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Alessio Amatu
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Daniela Massihnia
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy.,Dipartimento di Oncologia ed Emato-Oncologia, Università degli Studi di Milano (La Statale), Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Silvia Ghezzi
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Erica Bonazzina
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Katia Bencardino
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giulio Cerea
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Salvatore Siena
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy.,Dipartimento di Oncologia ed Emato-Oncologia, Università degli Studi di Milano (La Statale), Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Andrea Sartore-Bianchi
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy. .,Dipartimento di Oncologia ed Emato-Oncologia, Università degli Studi di Milano (La Statale), Piazza Ospedale Maggiore, 3, 20162, Milan, Italy.
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10
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Mauri G, Bonazzina E, Amatu A, Tosi F, Bencardino K, Gori V, Massihnia D, Cipani T, Spina F, Ghezzi S, Siena S, Sartore-Bianchi A. The Evolutionary Landscape of Treatment for BRAFV600E Mutant Metastatic Colorectal Cancer. Cancers (Basel) 2021; 13:E137. [PMID: 33406649 PMCID: PMC7795863 DOI: 10.3390/cancers13010137] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/24/2020] [Accepted: 12/30/2020] [Indexed: 12/20/2022] Open
Abstract
The BRAFV600E mutation is found in 8-10% of metastatic colorectal cancer (mCRC) patients and it is recognized as a poor prognostic factor with a median overall survival inferior to 20 months. At present, besides immune checkpoint inhibitors (CPIs) for those tumors with concomitant MSI-H status, recommended treatment options include cytotoxic chemotherapy + anti-VEGF in the first line setting, and a combination of EGFR and a BRAF inhibitor (cetuximab plus encorafenib) in second line. However, even with the latter targeted approach, acquired resistance limits the possibility of more than an incremental benefit and survival is still dismal. In this review, we discuss current treatment options for this subset of patients and perform a systematic review of ongoing clinical trials. Overall, we identified six emerging strategies: targeting MAPK pathway (monotherapy or combinations), targeting MAPK pathway combined with cytotoxic agents, intensive cytotoxic regimen combinations, targeted agents combined with CPIs, oxidative stress induction, and cytotoxic agents combined with antiangiogenic drugs and CPIs. In the future, the integration of new therapeutic strategies targeting key players in the BRAFV600E oncogenic pathways with current treatment approach based on cytotoxic chemotherapy and surgery is likely to redefine the treatment landscape of these CRC patients.
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Affiliation(s)
- Gianluca Mauri
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy; (G.M.); (E.B.); (A.A.); (F.T.); (K.B.); (V.G.); (D.M.); (T.C.); (F.S.); (S.G.); (S.S.)
- Dipartimento di Oncologia ed Emato-Oncologia, Università degli Studi di Milano, 20122 Milano, Italy
| | - Erica Bonazzina
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy; (G.M.); (E.B.); (A.A.); (F.T.); (K.B.); (V.G.); (D.M.); (T.C.); (F.S.); (S.G.); (S.S.)
| | - Alessio Amatu
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy; (G.M.); (E.B.); (A.A.); (F.T.); (K.B.); (V.G.); (D.M.); (T.C.); (F.S.); (S.G.); (S.S.)
| | - Federica Tosi
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy; (G.M.); (E.B.); (A.A.); (F.T.); (K.B.); (V.G.); (D.M.); (T.C.); (F.S.); (S.G.); (S.S.)
| | - Katia Bencardino
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy; (G.M.); (E.B.); (A.A.); (F.T.); (K.B.); (V.G.); (D.M.); (T.C.); (F.S.); (S.G.); (S.S.)
| | - Viviana Gori
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy; (G.M.); (E.B.); (A.A.); (F.T.); (K.B.); (V.G.); (D.M.); (T.C.); (F.S.); (S.G.); (S.S.)
- Dipartimento di Oncologia ed Emato-Oncologia, Università degli Studi di Milano, 20122 Milano, Italy
| | - Daniela Massihnia
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy; (G.M.); (E.B.); (A.A.); (F.T.); (K.B.); (V.G.); (D.M.); (T.C.); (F.S.); (S.G.); (S.S.)
- Dipartimento di Oncologia ed Emato-Oncologia, Università degli Studi di Milano, 20122 Milano, Italy
| | - Tiziana Cipani
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy; (G.M.); (E.B.); (A.A.); (F.T.); (K.B.); (V.G.); (D.M.); (T.C.); (F.S.); (S.G.); (S.S.)
| | - Francesco Spina
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy; (G.M.); (E.B.); (A.A.); (F.T.); (K.B.); (V.G.); (D.M.); (T.C.); (F.S.); (S.G.); (S.S.)
| | - Silvia Ghezzi
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy; (G.M.); (E.B.); (A.A.); (F.T.); (K.B.); (V.G.); (D.M.); (T.C.); (F.S.); (S.G.); (S.S.)
| | - Salvatore Siena
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy; (G.M.); (E.B.); (A.A.); (F.T.); (K.B.); (V.G.); (D.M.); (T.C.); (F.S.); (S.G.); (S.S.)
- Dipartimento di Oncologia ed Emato-Oncologia, Università degli Studi di Milano, 20122 Milano, Italy
| | - Andrea Sartore-Bianchi
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy; (G.M.); (E.B.); (A.A.); (F.T.); (K.B.); (V.G.); (D.M.); (T.C.); (F.S.); (S.G.); (S.S.)
- Dipartimento di Oncologia ed Emato-Oncologia, Università degli Studi di Milano, 20122 Milano, Italy
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11
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Tosi F, Sartore-Bianchi A, Lonardi S, Amatu A, Leone F, Ghezzi S, Martino C, Bencardino K, Bonazzina E, Bergamo F, Fenocchio E, Martinelli E, Troiani T, Siravegna G, Mauri G, Torri V, Marrapese G, Valtorta E, Cassingena A, Cappello G, Bonoldi E, Vanzulli A, Regge D, Ciardiello F, Zagonel V, Bardelli A, Trusolino L, Marsoni S, Siena S. Long-term Clinical Outcome of Trastuzumab and Lapatinib for HER2-positive Metastatic Colorectal Cancer. Clin Colorectal Cancer 2020; 19:256-262.e2. [DOI: 10.1016/j.clcc.2020.06.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 06/12/2020] [Accepted: 06/21/2020] [Indexed: 02/07/2023]
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12
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Amatu A, Schirripa M, Tosi F, Lonardi S, Bencardino K, Bonazzina E, Palmeri L, Patanè DA, Pizzutilo EG, Mussolin B, Bergamo F, Alberti G, Intini R, Procaccio L, Arese M, Marsoni S, Nichelatti M, Zagonel V, Siena S, Bardelli A, Loupakis F, Di Nicolantonio F, Sartore-Bianchi A, Barault L. High Circulating Methylated DNA Is a Negative Predictive and Prognostic Marker in Metastatic Colorectal Cancer Patients Treated With Regorafenib. Front Oncol 2019; 9:622. [PMID: 31355139 PMCID: PMC6640154 DOI: 10.3389/fonc.2019.00622] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 06/24/2019] [Indexed: 12/12/2022] Open
Abstract
Background: Regorafenib improves progression free survival (PFS) in a subset of metastatic colorectal cancer (mCRC) patients, although no biomarkers of efficacy are available. Circulating methylated DNA (cmDNA) assessed by a five-gene panel was previously associated with outcome in chemotherapy treated mCRC patients. We hypothesized that cmDNA could be used to identify cases most likely to benefit from regorafenib (i.e., patients with PFS longer than 4 months). Methods: Plasma samples from mCRC patients were collected prior to (baseline samples N = 60) and/or during regorafenib treatment (N = 62) for the assessment of cmDNA and total amount of cell free DNA (cfDNA). Results: In almost all patients, treatment with regorafenib increased the total cfDNA, but decreased cmDNA warranting the normalization of cmDNA to the total amount of circulating DNA (i.e., cmDNA/ml). We report that cmDNA/ml dynamics reflects clinical response with an increase in cmDNA/ml associated with higher risk of progression (HR for progression = 1.78 [95%CI: 1.01-3.13], p = 0.028). Taken individually, high baseline cmDNA/ml (above median) was associated with worst prognosis (HR for death = 3.471 [95%CI: 1.83-6.57], p < 0.0001) and also predicted shorter PFS (<16 weeks with PPV 86%). In addition, high cmDNA/ml values during regorafenib treatment predicted with higher accuracy shorter PFS (<16 weeks with a PPV of 96%), therefore associated with increased risk of progression (HR for progression = 2.985; [95%CI: 1.63-5.46; p < 0.0001). Conclusions: Our data highlight the predictive and prognostic value of cmDNA/ml in mCRC patients treated with regorafenib.
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Affiliation(s)
- Alessio Amatu
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marta Schirripa
- Medical Oncology 1, Veneto Institute of Oncology, IRCCS, Padua, Italy
| | - Federica Tosi
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Sara Lonardi
- Medical Oncology 1, Veneto Institute of Oncology, IRCCS, Padua, Italy
| | - Katia Bencardino
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Erica Bonazzina
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Laura Palmeri
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | | | | | - Francesca Bergamo
- Medical Oncology 1, Veneto Institute of Oncology, IRCCS, Padua, Italy
| | - Giulia Alberti
- Medical Oncology 1, Veneto Institute of Oncology, IRCCS, Padua, Italy.,Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Rossana Intini
- Medical Oncology 1, Veneto Institute of Oncology, IRCCS, Padua, Italy
| | - Letizia Procaccio
- Medical Oncology 1, Veneto Institute of Oncology, IRCCS, Padua, Italy.,Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Marco Arese
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy.,Department of Oncology, University of Turin, Candiolo, Italy
| | - Silvia Marsoni
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy.,Department of Precision Oncology, FIRC Institute of Molecular Oncology (IFOM), Milan, Italy
| | - Michele Nichelatti
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Vittorina Zagonel
- Medical Oncology 1, Veneto Institute of Oncology, IRCCS, Padua, Italy
| | - Salvatore Siena
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy.,Dipartimento di Oncologia ed Emato-Oncologia, Università degli Studi di Milano, Milan, Italy
| | - Alberto Bardelli
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy.,Department of Oncology, University of Turin, Candiolo, Italy
| | - Fotios Loupakis
- Medical Oncology 1, Veneto Institute of Oncology, IRCCS, Padua, Italy
| | - Federica Di Nicolantonio
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy.,Department of Oncology, University of Turin, Candiolo, Italy
| | - Andrea Sartore-Bianchi
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy.,Dipartimento di Oncologia ed Emato-Oncologia, Università degli Studi di Milano, Milan, Italy
| | - Ludovic Barault
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy.,Department of Oncology, University of Turin, Candiolo, Italy
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13
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Siravegna G, Lazzari L, Crisafulli G, Sartore-Bianchi A, Mussolin B, Cassingena A, Martino C, Lanman RB, Nagy RJ, Fairclough S, Rospo G, Corti G, Bartolini A, Arcella P, Montone M, Lodi F, Lorenzato A, Vanzati A, Valtorta E, Cappello G, Bertotti A, Lonardi S, Zagonel V, Leone F, Russo M, Balsamo A, Truini M, Di Nicolantonio F, Amatu A, Bonazzina E, Ghezzi S, Regge D, Vanzulli A, Trusolino L, Siena S, Marsoni S, Bardelli A. Radiologic and Genomic Evolution of Individual Metastases during HER2 Blockade in Colorectal Cancer. Cancer Cell 2018; 34:148-162.e7. [PMID: 29990497 DOI: 10.1016/j.ccell.2018.06.004] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 04/18/2018] [Accepted: 06/07/2018] [Indexed: 02/07/2023]
Abstract
Targeting HER2 is effective in 24% of ERBB2 amplified metastatic colorectal cancer; however, secondary resistance occurs in most of the cases. We studied the evolution of individual metastases during treatment to discover spatially resolved determinants of resistance. Circulating tumor DNA (ctDNA) analysis identified alterations associated with resistance in the majority of refractory patients. ctDNA profiles and lesion-specific radiographic reports revealed organ- or metastasis-private evolutionary patterns. When radiologic assessments documented progressive disease in target lesions, response to HER2 blockade was retained in other metastases. Genomic and functional analyses on samples and cell models from eight metastases of a patient co-recruited to a postmortem study unveiled lesion-specific evolutionary trees and pharmacologic vulnerabilities. Lesion size and contribution of distinct metastases to plasma ctDNA were correlated.
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Affiliation(s)
| | - Luca Lazzari
- Candiolo Cancer Institute-FPO, IRCCS, Candiolo, TO, Italy; FIRC Institute of Molecular Oncology (IFOM), Milan, Italy; Department of Oncology, University of Torino, Candiolo, TO 10060, Italy
| | - Giovanni Crisafulli
- Candiolo Cancer Institute-FPO, IRCCS, Candiolo, TO, Italy; Department of Oncology, University of Torino, Candiolo, TO 10060, Italy
| | | | | | - Andrea Cassingena
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan 20162, Italy
| | - Cosimo Martino
- Candiolo Cancer Institute-FPO, IRCCS, Candiolo, TO, Italy
| | | | | | | | - Giuseppe Rospo
- Candiolo Cancer Institute-FPO, IRCCS, Candiolo, TO, Italy
| | - Giorgio Corti
- Candiolo Cancer Institute-FPO, IRCCS, Candiolo, TO, Italy
| | | | - Pamela Arcella
- Candiolo Cancer Institute-FPO, IRCCS, Candiolo, TO, Italy
| | - Monica Montone
- Candiolo Cancer Institute-FPO, IRCCS, Candiolo, TO, Italy
| | - Francesca Lodi
- Department of Oncology, University of Torino, Candiolo, TO 10060, Italy
| | | | - Alice Vanzati
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan 20162, Italy
| | - Emanuele Valtorta
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan 20162, Italy
| | | | - Andrea Bertotti
- Candiolo Cancer Institute-FPO, IRCCS, Candiolo, TO, Italy; Department of Oncology, University of Torino, Candiolo, TO 10060, Italy
| | - Sara Lonardi
- Istituto Oncologico Veneto - IRCCS, Oncologia Medica 1, Padova 35128, Italy
| | - Vittorina Zagonel
- Istituto Oncologico Veneto - IRCCS, Oncologia Medica 1, Padova 35128, Italy
| | - Francesco Leone
- Candiolo Cancer Institute-FPO, IRCCS, Candiolo, TO, Italy; Department of Oncology, University of Torino, Candiolo, TO 10060, Italy
| | | | | | - Mauro Truini
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan 20162, Italy
| | - Federica Di Nicolantonio
- Candiolo Cancer Institute-FPO, IRCCS, Candiolo, TO, Italy; Department of Oncology, University of Torino, Candiolo, TO 10060, Italy
| | - Alessio Amatu
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan 20162, Italy
| | - Erica Bonazzina
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan 20162, Italy
| | - Silvia Ghezzi
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan 20162, Italy
| | - Daniele Regge
- Candiolo Cancer Institute-FPO, IRCCS, Candiolo, TO, Italy
| | - Angelo Vanzulli
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan 20162, Italy; Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan 20122, Italy
| | - Livio Trusolino
- Candiolo Cancer Institute-FPO, IRCCS, Candiolo, TO, Italy; Department of Oncology, University of Torino, Candiolo, TO 10060, Italy
| | - Salvatore Siena
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan 20162, Italy; Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan 20122, Italy
| | - Silvia Marsoni
- Candiolo Cancer Institute-FPO, IRCCS, Candiolo, TO, Italy; FIRC Institute of Molecular Oncology (IFOM), Milan, Italy; Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan 20162, Italy
| | - Alberto Bardelli
- Candiolo Cancer Institute-FPO, IRCCS, Candiolo, TO, Italy; Department of Oncology, University of Torino, Candiolo, TO 10060, Italy.
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14
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Siravegna G, Lazzari L, Sartore-Bianchi A, Crisafulli G, Mussolin B, Cassingena A, Martino C, Lanman R, Nagy R, Corti G, Bartolini A, Arcella P, Montone M, Lodi F, Vanzati A, Valtorta E, Cappello G, Bertotti A, Lonardi S, Zagonel V, Leone F, Russo M, Balsamo A, Truini M, Nicolantonio FD, Amatu A, Bonazzina E, Ghezzi S, Regge D, Vanzulli A, Trusolino L, Siena S, Marsoni S, Bardelli A. Abstract 2848: Radiographic and genomic evolution of individual metastases during HER2 blockade in colorectal cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-2848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Targeting HER2 with trastuzumab and lapatinib is effective in ERBB2 amplified metastatic colorectal cancer (mCRC). Although at least 30% of the patients initially respond, secondary resistance occurs in most of the cases.
Since the drivers of secondary resistance to trastuzumab and lapatinib in ERBB2 amplified mCRC are unknown, we exploited longitudinal plasma collections and patient-derived cell models to define the molecular bases of resistance to HER2 blockade. Levels of ERBB2 amplification in plasma circulating tumor DNA (ctDNA) paralleled response and relapse. The emergence of EGFR, ERBB2, RAS, BRAF and PIK3CA variants in ctDNA was associated with resistance. Radiographic measurements of individual metastases coupled with longitudinal liquid biopsies unveiled lesion-specific patterns of heterogeneous response in several patients. Phylogenetic tracking and functional analyses on tissue samples and patient-derived cell models established from eight metastases of a single case revealed new druggable oncogenic dependencies and genomic evolution associated with resistance. These data highlight the relevance of coupling imaging and liquid biopsies analyses in precision oncology and provide the rationale for additional lines of therapies in HER2 positive mCRC relapsing upon HER2 blockade.
Citation Format: Giulia Siravegna, Luca Lazzari, Andrea Sartore-Bianchi, Giovanni Crisafulli, Benedetta Mussolin, Andrea Cassingena, Cosimo Martino, Richard Lanman, Rebecca Nagy, Giorgio Corti, Alice Bartolini, Pamela Arcella, Monica Montone, Francesca Lodi, Alice Vanzati, Emanuele Valtorta, Giovanni Cappello, Andrea Bertotti, Sara Lonardi, Vittorina Zagonel, Francesco Leone, Mariangela Russo, Antonella Balsamo, Mauro Truini, Federica Di Nicolantonio, Alessio Amatu, Erica Bonazzina, Silvia Ghezzi, Daniele Regge, Angelo Vanzulli, Livio Trusolino, Salvatore Siena, Silvia Marsoni, Alberto Bardelli. Radiographic and genomic evolution of individual metastases during HER2 blockade in colorectal cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 2848.
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Affiliation(s)
| | - Luca Lazzari
- 1Inst. for Cancer Research and Treatment, Candiolo, Italy
| | | | | | | | | | - Cosimo Martino
- 1Inst. for Cancer Research and Treatment, Candiolo, Italy
| | | | | | - Giorgio Corti
- 1Inst. for Cancer Research and Treatment, Candiolo, Italy
| | | | - Pamela Arcella
- 1Inst. for Cancer Research and Treatment, Candiolo, Italy
| | - Monica Montone
- 1Inst. for Cancer Research and Treatment, Candiolo, Italy
| | - Francesca Lodi
- 1Inst. for Cancer Research and Treatment, Candiolo, Italy
| | - Alice Vanzati
- 2Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | | | | | | | - Sara Lonardi
- 4Istituto Oncologico Veneto - IRCCS, Padova, Italy
| | | | | | | | | | - Mauro Truini
- 2Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | | | - Alessio Amatu
- 2Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | | | - Silvia Ghezzi
- 2Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Daniele Regge
- 1Inst. for Cancer Research and Treatment, Candiolo, Italy
| | | | | | | | - Silvia Marsoni
- 1Inst. for Cancer Research and Treatment, Candiolo, Italy
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15
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Sartore-Bianchi A, Amatu A, Bonazzina E, Stabile S, Giannetta L, Cerea G, Schiavetto I, Bencardino K, Funaioli C, Ricotta R, Cipani T, Schirru M, Gambi V, Palmeri L, Carlo-Stella G, Rusconi F, Di Bella S, Burrafato G, Cassingena A, Valtorta E, Lauricella C, Pazzi F, Gambaro A, Ghezzi S, Marrapese G, Tarenzi E, Veronese S, Truini M, Vanzulli A, Siena S. Pooled Analysis of Clinical Outcome of Patients with Chemorefractory Metastatic Colorectal Cancer Treated within Phase I/II Clinical Studies Based on Individual Biomarkers of Susceptibility: A Single-Institution Experience. Target Oncol 2018; 12:525-533. [PMID: 28669023 PMCID: PMC5524857 DOI: 10.1007/s11523-017-0505-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Patients with metastatic colorectal cancer (mCRC) refractory to standard therapies have a poor prognosis. In this setting, recruitment into clinical trials is warranted, and studies driven by selection according to individual tumor molecular characteristics are expected to provide added value. Objective We retrospectively analyzed data from patients with mCRC refractory to or following failure of standard therapies who were enrolled into phase I/II clinical studies at the Niguarda Cancer Center based on the presence of a specific molecular profile expected to represent the target of susceptibility to the experimental drug(s). Patients and Methods From June 2011 to May 2016, 2044 patients with mCRC underwent molecular screening. Eighty patients (3.9%) were enrolled in ad hoc studies; the median age was 60 years (range 36–86) and the median number of previous treatment lines was five (range 2–8). Molecular characteristics exploited within these studies were MGMT promoter hypermethylation (48.7%), HER2 amplification (28.8%), BRAFV600E mutation (20%), and novel gene fusions involving ALK or NTRK (2.5%). Results One patient (1%) had RECIST (Response Evaluation Criteria In Solid Tumors) complete response (CR), 13 patients (16.5%) experienced a partial response (PR), and 28 (35%) stable disease (SD). Median progression-free survival (PFS) was 2.8 months (range 2.63–3.83), with 24% of patients displaying PFS >5 months. Median growth modulation index (GMI) was 0.85 (range 0–15.61) and 32.5% of patients had GMI >1.33. KRAS exon 2 mutations were found in 38.5% of patients, and among the 78 patients with known KRAS status, those with wild-type tumors had longer PFS than those with mutated tumors (3.80 [95% CI 2.80–5.03] vs. 2.13 months [95% CI 1.77–2.87], respectively, p = 0.001). Median overall survival (OS) was 7.83 months (range 7.17–9.33) for all patients, and patients with KRAS wild-type tumors had longer OS than those with mutated tumors (7.83 [95% CI 7.33–10.80] vs. 7.18 months [95% CI 5.63–9.33], respectively, p = 0.06). Conclusions This single-institution retrospective study indicates that in a heavily pretreated population approximately 4% of mCRC tumors display a potential actionable molecular context suitable for therapeutic intervention. Application of molecular selection is challenging but improves clinical outcome even in later lines of treatment.![]()
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Affiliation(s)
- Andrea Sartore-Bianchi
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Alessio Amatu
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Erica Bonazzina
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Stefano Stabile
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Laura Giannetta
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Giulio Cerea
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Ilaria Schiavetto
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Katia Bencardino
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Chiara Funaioli
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Riccardo Ricotta
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Tiziana Cipani
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Michele Schirru
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Valentina Gambi
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Laura Palmeri
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Giulia Carlo-Stella
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Francesca Rusconi
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Sara Di Bella
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Giovanni Burrafato
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Andrea Cassingena
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Emanuele Valtorta
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Calogero Lauricella
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Federica Pazzi
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Alessandra Gambaro
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Silvia Ghezzi
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Giovanna Marrapese
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Emiliana Tarenzi
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Silvio Veronese
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Mauro Truini
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Angelo Vanzulli
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy.,Dipartimento di Oncologia e Emato-Oncologia, Università degli Studi di Milano, Milan, Italy
| | - Salvatore Siena
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy. .,Dipartimento di Oncologia e Emato-Oncologia, Università degli Studi di Milano, Milan, Italy.
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16
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Bencardino K, Mauri G, Amatu A, Tosi F, Bonazzina E, Palmeri L, Querques M, Ravera F, Menegotto A, Boiani E, Sartore-Bianchi A, Siena S. Oxaliplatin Immune-Induced Syndrome Occurs With Cumulative Administration and Rechallenge: Single Institution Series and Systematic Review Study. Clin Colorectal Cancer 2016; 15:213-21. [DOI: 10.1016/j.clcc.2016.02.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 12/22/2015] [Accepted: 02/03/2016] [Indexed: 01/27/2023]
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17
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Sartore-Bianchi A, Valtorta E, Amatu A, Veronese S, Lauricella C, Bonazzina E, Siravegna G, Truini M, Bardelli A, Siena S. Clonal evolution and KRAS- MET coamplification during secondary resistance to EGFR-targeted therapy in metastatic colorectal cancer. ESMO Open 2016; 1:e000079. [PMID: 27843629 PMCID: PMC5070243 DOI: 10.1136/esmoopen-2016-000079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 06/13/2016] [Indexed: 12/14/2022] Open
Affiliation(s)
| | - Emanuele Valtorta
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda , Milano , Italy
| | - Alessio Amatu
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda , Milano , Italy
| | - Silvio Veronese
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda , Milano , Italy
| | - Calogero Lauricella
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda , Milano , Italy
| | - Erica Bonazzina
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda , Milano , Italy
| | - Giulia Siravegna
- Istituto di Candiolo, Fondazione del Piemonte per l'Oncologia-IRCCS, Candiolo, Italy; Dipartimento di Oncologia, Università di Torino, Torino, Italy
| | - Mauro Truini
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda , Milano , Italy
| | - Alberto Bardelli
- Istituto di Candiolo, Fondazione del Piemonte per l'Oncologia-IRCCS, Candiolo, Italy; Dipartimento di Oncologia, Università di Torino, Torino, Italy
| | - Salvatore Siena
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milano, Italy; Dipartimento di Oncologia e Emato-Oncologia, Università degli Studi di Milano, Milano, Italy
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18
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Amatu A, Barault L, Moutinho C, Cassingena A, Bencardino K, Ghezzi S, Palmeri L, Bonazzina E, Tosi F, Ricotta R, Cipani T, Crivori P, Gatto R, Chirico G, Marrapese G, Truini M, Bardelli A, Esteller M, Di Nicolantonio F, Sartore-Bianchi A, Siena S. Tumor MGMT promoter hypermethylation changes over time limit temozolomide efficacy in a phase II trial for metastatic colorectal cancer. Ann Oncol 2016; 27:1062-1067. [PMID: 26916096 DOI: 10.1093/annonc/mdw071] [Citation(s) in RCA: 29] [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] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 02/09/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Objective response to dacarbazine, the intravenous form of temozolomide (TMZ), in metastatic colorectal cancer (mCRC) is confined to tumors harboring O(6)-methylguanine-DNA-methyltransferase (MGMT) promoter hypermethylation. We conducted a phase II study of TMZ enriched by MGMT hypermethylation in archival tumor (AT), exploring dynamic of this biomarker in baseline tumor (BT) biopsy and plasma (liquid biopsy). PATIENTS AND METHODS We screened 150 mCRC patients for MGMT hypermethylation with methylation-specific PCR on AT from FFPE specimens. Eligible patients (n = 29) underwent BT biopsy and then received TMZ 200 mg/m(2) days 1-5 q28 until progression. A Fleming single-stage design was used to determine whether progression-free survival (PFS) rate at 12 weeks would be ≥35% [H0 ≤ 15%, type I error = 0.059 (one-sided), power = 0.849]. Exploratory analyses included comparison between MGMT hypermethylation in AT and BT, and MGMT methylation testing by MethylBEAMing in solid (AT, BT) and LB with regard to tumor response. RESULTS The PFS rate at 12 weeks was 10.3% [90% confidence interval (CI) 2.9-24.6]. Objective response rate was 3.4% (90% CI 0.2-15.3), disease control rate 48.3% (90% CI 32.0-64.8), median OS 6.2 months (95% CI 3.8-7.6), and median PFS 2.6 months (95% CI 1.4-2.7). We observed the absence of MGMT hypermethylation in BT in 62.7% of tumors. CONCLUSION Treatment of mCRC with TMZ driven by MGMT promoter hypermethylation in AT samples did not provide meaningful PFS rate at 12 weeks. This biomarker changed from AT to BT, indicating that testing BT biopsy or plasma is needed for refined target selection.
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Affiliation(s)
- A Amatu
- Department of Hematology & Oncology, Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan
| | - L Barault
- Experimental Clinical Molecular Oncology Cancer Epigenetics, Candiolo Cancer Institute-FPO, IRCCS, Candiolo, Turin, Italy
| | - C Moutinho
- Cancer Epigenetics and Biology Program (PEBC), Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - A Cassingena
- Department of Hematology & Oncology, Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan
| | - K Bencardino
- Department of Hematology & Oncology, Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan
| | - S Ghezzi
- Department of Hematology & Oncology, Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan
| | - L Palmeri
- Department of Hematology & Oncology, Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan
| | - E Bonazzina
- Department of Hematology & Oncology, Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan
| | - F Tosi
- Department of Hematology & Oncology, Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan
| | - R Ricotta
- Department of Hematology & Oncology, Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan
| | - T Cipani
- Department of Hematology & Oncology, Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan
| | - P Crivori
- Department of Oncology, CLIOSS s.r.l., Nerviano, Milan
| | - R Gatto
- Department of Oncology, CLIOSS s.r.l., Nerviano, Milan
| | - G Chirico
- Department of Hematology & Oncology, Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan
| | - G Marrapese
- Department of Hematology & Oncology, Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan
| | - M Truini
- Department of Hematology & Oncology, Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan
| | - A Bardelli
- Experimental Clinical Molecular Oncology Cancer Epigenetics, Candiolo Cancer Institute-FPO, IRCCS, Candiolo, Turin, Italy; Department of Oncology, University of Torino, Candiolo, Turin
| | - M Esteller
- Cancer Epigenetics and Biology Program (PEBC), Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - F Di Nicolantonio
- Experimental Clinical Molecular Oncology Cancer Epigenetics, Candiolo Cancer Institute-FPO, IRCCS, Candiolo, Turin, Italy; Department of Oncology, University of Torino, Candiolo, Turin
| | - A Sartore-Bianchi
- Department of Hematology & Oncology, Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan.
| | - S Siena
- Department of Hematology & Oncology, Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan; Department of Oncology, Università degli Studi di Milano, Milan, Italy
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19
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Sartore-Bianchi A, Ardini E, Bosotti R, Amatu A, Valtorta E, Somaschini A, Raddrizzani L, Palmeri L, Banfi P, Bonazzina E, Misale S, Marrapese G, Leone A, Alzani R, Luo D, Hornby Z, Lim J, Veronese S, Vanzulli A, Bardelli A, Martignoni M, Davite C, Galvani A, Isacchi A, Siena S. Sensitivity to Entrectinib Associated With a Novel LMNA-NTRK1 Gene Fusion in Metastatic Colorectal Cancer. J Natl Cancer Inst 2015; 108:djv306. [PMID: 26563355 PMCID: PMC4712682 DOI: 10.1093/jnci/djv306] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 09/25/2015] [Indexed: 12/15/2022] Open
Abstract
In metastatic colorectal cancer (CRC), actionable genetic lesions represent potential clinical opportunities. NTRK1, 2, and 3 gene rearrangements encode oncogenic fusions of the tropomyosin-receptor kinase (TRK) family of receptor tyrosine kinases in different tumor types. The TPM3-NTRK1 rearrangement is a recurring event in CRC that renders tumors sensitive to TRKA kinase inhibitors in preclinical models. We identified abnormal expression of the TRKA protein in tumor and liver metastases of a CRC patient refractory to standard therapy. Molecular characterization unveiled a novel LMNA-NTRK1 rearrangement within chromosome 1 with oncogenic potential, and the patient was treated with the pan-TRK inhibitor entrectinib, achieving partial response with decrease in hepatic target lesions from 6.8 and 8.2cm in longest diameter to 4.7 and 4.3cm, respectively. To our knowledge, this is the first clinical evidence of efficacy for therapeutic inhibition of TRKA in a solid tumor, illuminating a genomic-driven strategy to identify CRCs reliant on this oncogene to be clinically targeted with entrectinib.
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Affiliation(s)
- Andrea Sartore-Bianchi
- Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan, Italy (ASB, AA, EV, LP, EB, GM, SV, AV, SS); Nerviano Medical Sciences S.r.l Nerviano, Milan, Italy (EA, RB, AS, LR, PB, AL, RA, AG, AI); Candiolo Cancer Institute - FPO, IRCCS, Candiolo, Torino, Italy (SM, AB); University of Torino, Department of Oncology, Candiolo, Torino, Italy (AB); FIRC Institute of Molecular Oncology (IFOM), Milano, Italy (SM); Ignyta, Inc., San Diego, CA (DL, ZH, JL); Clioss S.r.l. Nerviano, Milan, Italy (MM, CD); Università degli Studi di Milano, Milan, Italy (SS)
| | - Elena Ardini
- Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan, Italy (ASB, AA, EV, LP, EB, GM, SV, AV, SS); Nerviano Medical Sciences S.r.l Nerviano, Milan, Italy (EA, RB, AS, LR, PB, AL, RA, AG, AI); Candiolo Cancer Institute - FPO, IRCCS, Candiolo, Torino, Italy (SM, AB); University of Torino, Department of Oncology, Candiolo, Torino, Italy (AB); FIRC Institute of Molecular Oncology (IFOM), Milano, Italy (SM); Ignyta, Inc., San Diego, CA (DL, ZH, JL); Clioss S.r.l. Nerviano, Milan, Italy (MM, CD); Università degli Studi di Milano, Milan, Italy (SS)
| | - Roberta Bosotti
- Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan, Italy (ASB, AA, EV, LP, EB, GM, SV, AV, SS); Nerviano Medical Sciences S.r.l Nerviano, Milan, Italy (EA, RB, AS, LR, PB, AL, RA, AG, AI); Candiolo Cancer Institute - FPO, IRCCS, Candiolo, Torino, Italy (SM, AB); University of Torino, Department of Oncology, Candiolo, Torino, Italy (AB); FIRC Institute of Molecular Oncology (IFOM), Milano, Italy (SM); Ignyta, Inc., San Diego, CA (DL, ZH, JL); Clioss S.r.l. Nerviano, Milan, Italy (MM, CD); Università degli Studi di Milano, Milan, Italy (SS)
| | - Alessio Amatu
- Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan, Italy (ASB, AA, EV, LP, EB, GM, SV, AV, SS); Nerviano Medical Sciences S.r.l Nerviano, Milan, Italy (EA, RB, AS, LR, PB, AL, RA, AG, AI); Candiolo Cancer Institute - FPO, IRCCS, Candiolo, Torino, Italy (SM, AB); University of Torino, Department of Oncology, Candiolo, Torino, Italy (AB); FIRC Institute of Molecular Oncology (IFOM), Milano, Italy (SM); Ignyta, Inc., San Diego, CA (DL, ZH, JL); Clioss S.r.l. Nerviano, Milan, Italy (MM, CD); Università degli Studi di Milano, Milan, Italy (SS)
| | - Emanuele Valtorta
- Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan, Italy (ASB, AA, EV, LP, EB, GM, SV, AV, SS); Nerviano Medical Sciences S.r.l Nerviano, Milan, Italy (EA, RB, AS, LR, PB, AL, RA, AG, AI); Candiolo Cancer Institute - FPO, IRCCS, Candiolo, Torino, Italy (SM, AB); University of Torino, Department of Oncology, Candiolo, Torino, Italy (AB); FIRC Institute of Molecular Oncology (IFOM), Milano, Italy (SM); Ignyta, Inc., San Diego, CA (DL, ZH, JL); Clioss S.r.l. Nerviano, Milan, Italy (MM, CD); Università degli Studi di Milano, Milan, Italy (SS)
| | - Alessio Somaschini
- Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan, Italy (ASB, AA, EV, LP, EB, GM, SV, AV, SS); Nerviano Medical Sciences S.r.l Nerviano, Milan, Italy (EA, RB, AS, LR, PB, AL, RA, AG, AI); Candiolo Cancer Institute - FPO, IRCCS, Candiolo, Torino, Italy (SM, AB); University of Torino, Department of Oncology, Candiolo, Torino, Italy (AB); FIRC Institute of Molecular Oncology (IFOM), Milano, Italy (SM); Ignyta, Inc., San Diego, CA (DL, ZH, JL); Clioss S.r.l. Nerviano, Milan, Italy (MM, CD); Università degli Studi di Milano, Milan, Italy (SS)
| | - Laura Raddrizzani
- Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan, Italy (ASB, AA, EV, LP, EB, GM, SV, AV, SS); Nerviano Medical Sciences S.r.l Nerviano, Milan, Italy (EA, RB, AS, LR, PB, AL, RA, AG, AI); Candiolo Cancer Institute - FPO, IRCCS, Candiolo, Torino, Italy (SM, AB); University of Torino, Department of Oncology, Candiolo, Torino, Italy (AB); FIRC Institute of Molecular Oncology (IFOM), Milano, Italy (SM); Ignyta, Inc., San Diego, CA (DL, ZH, JL); Clioss S.r.l. Nerviano, Milan, Italy (MM, CD); Università degli Studi di Milano, Milan, Italy (SS)
| | - Laura Palmeri
- Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan, Italy (ASB, AA, EV, LP, EB, GM, SV, AV, SS); Nerviano Medical Sciences S.r.l Nerviano, Milan, Italy (EA, RB, AS, LR, PB, AL, RA, AG, AI); Candiolo Cancer Institute - FPO, IRCCS, Candiolo, Torino, Italy (SM, AB); University of Torino, Department of Oncology, Candiolo, Torino, Italy (AB); FIRC Institute of Molecular Oncology (IFOM), Milano, Italy (SM); Ignyta, Inc., San Diego, CA (DL, ZH, JL); Clioss S.r.l. Nerviano, Milan, Italy (MM, CD); Università degli Studi di Milano, Milan, Italy (SS)
| | - Patrizia Banfi
- Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan, Italy (ASB, AA, EV, LP, EB, GM, SV, AV, SS); Nerviano Medical Sciences S.r.l Nerviano, Milan, Italy (EA, RB, AS, LR, PB, AL, RA, AG, AI); Candiolo Cancer Institute - FPO, IRCCS, Candiolo, Torino, Italy (SM, AB); University of Torino, Department of Oncology, Candiolo, Torino, Italy (AB); FIRC Institute of Molecular Oncology (IFOM), Milano, Italy (SM); Ignyta, Inc., San Diego, CA (DL, ZH, JL); Clioss S.r.l. Nerviano, Milan, Italy (MM, CD); Università degli Studi di Milano, Milan, Italy (SS)
| | - Erica Bonazzina
- Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan, Italy (ASB, AA, EV, LP, EB, GM, SV, AV, SS); Nerviano Medical Sciences S.r.l Nerviano, Milan, Italy (EA, RB, AS, LR, PB, AL, RA, AG, AI); Candiolo Cancer Institute - FPO, IRCCS, Candiolo, Torino, Italy (SM, AB); University of Torino, Department of Oncology, Candiolo, Torino, Italy (AB); FIRC Institute of Molecular Oncology (IFOM), Milano, Italy (SM); Ignyta, Inc., San Diego, CA (DL, ZH, JL); Clioss S.r.l. Nerviano, Milan, Italy (MM, CD); Università degli Studi di Milano, Milan, Italy (SS)
| | - Sandra Misale
- Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan, Italy (ASB, AA, EV, LP, EB, GM, SV, AV, SS); Nerviano Medical Sciences S.r.l Nerviano, Milan, Italy (EA, RB, AS, LR, PB, AL, RA, AG, AI); Candiolo Cancer Institute - FPO, IRCCS, Candiolo, Torino, Italy (SM, AB); University of Torino, Department of Oncology, Candiolo, Torino, Italy (AB); FIRC Institute of Molecular Oncology (IFOM), Milano, Italy (SM); Ignyta, Inc., San Diego, CA (DL, ZH, JL); Clioss S.r.l. Nerviano, Milan, Italy (MM, CD); Università degli Studi di Milano, Milan, Italy (SS)
| | - Giovanna Marrapese
- Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan, Italy (ASB, AA, EV, LP, EB, GM, SV, AV, SS); Nerviano Medical Sciences S.r.l Nerviano, Milan, Italy (EA, RB, AS, LR, PB, AL, RA, AG, AI); Candiolo Cancer Institute - FPO, IRCCS, Candiolo, Torino, Italy (SM, AB); University of Torino, Department of Oncology, Candiolo, Torino, Italy (AB); FIRC Institute of Molecular Oncology (IFOM), Milano, Italy (SM); Ignyta, Inc., San Diego, CA (DL, ZH, JL); Clioss S.r.l. Nerviano, Milan, Italy (MM, CD); Università degli Studi di Milano, Milan, Italy (SS)
| | - Antonella Leone
- Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan, Italy (ASB, AA, EV, LP, EB, GM, SV, AV, SS); Nerviano Medical Sciences S.r.l Nerviano, Milan, Italy (EA, RB, AS, LR, PB, AL, RA, AG, AI); Candiolo Cancer Institute - FPO, IRCCS, Candiolo, Torino, Italy (SM, AB); University of Torino, Department of Oncology, Candiolo, Torino, Italy (AB); FIRC Institute of Molecular Oncology (IFOM), Milano, Italy (SM); Ignyta, Inc., San Diego, CA (DL, ZH, JL); Clioss S.r.l. Nerviano, Milan, Italy (MM, CD); Università degli Studi di Milano, Milan, Italy (SS)
| | - Rachele Alzani
- Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan, Italy (ASB, AA, EV, LP, EB, GM, SV, AV, SS); Nerviano Medical Sciences S.r.l Nerviano, Milan, Italy (EA, RB, AS, LR, PB, AL, RA, AG, AI); Candiolo Cancer Institute - FPO, IRCCS, Candiolo, Torino, Italy (SM, AB); University of Torino, Department of Oncology, Candiolo, Torino, Italy (AB); FIRC Institute of Molecular Oncology (IFOM), Milano, Italy (SM); Ignyta, Inc., San Diego, CA (DL, ZH, JL); Clioss S.r.l. Nerviano, Milan, Italy (MM, CD); Università degli Studi di Milano, Milan, Italy (SS)
| | - David Luo
- Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan, Italy (ASB, AA, EV, LP, EB, GM, SV, AV, SS); Nerviano Medical Sciences S.r.l Nerviano, Milan, Italy (EA, RB, AS, LR, PB, AL, RA, AG, AI); Candiolo Cancer Institute - FPO, IRCCS, Candiolo, Torino, Italy (SM, AB); University of Torino, Department of Oncology, Candiolo, Torino, Italy (AB); FIRC Institute of Molecular Oncology (IFOM), Milano, Italy (SM); Ignyta, Inc., San Diego, CA (DL, ZH, JL); Clioss S.r.l. Nerviano, Milan, Italy (MM, CD); Università degli Studi di Milano, Milan, Italy (SS)
| | - Zachary Hornby
- Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan, Italy (ASB, AA, EV, LP, EB, GM, SV, AV, SS); Nerviano Medical Sciences S.r.l Nerviano, Milan, Italy (EA, RB, AS, LR, PB, AL, RA, AG, AI); Candiolo Cancer Institute - FPO, IRCCS, Candiolo, Torino, Italy (SM, AB); University of Torino, Department of Oncology, Candiolo, Torino, Italy (AB); FIRC Institute of Molecular Oncology (IFOM), Milano, Italy (SM); Ignyta, Inc., San Diego, CA (DL, ZH, JL); Clioss S.r.l. Nerviano, Milan, Italy (MM, CD); Università degli Studi di Milano, Milan, Italy (SS)
| | - Jonathan Lim
- Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan, Italy (ASB, AA, EV, LP, EB, GM, SV, AV, SS); Nerviano Medical Sciences S.r.l Nerviano, Milan, Italy (EA, RB, AS, LR, PB, AL, RA, AG, AI); Candiolo Cancer Institute - FPO, IRCCS, Candiolo, Torino, Italy (SM, AB); University of Torino, Department of Oncology, Candiolo, Torino, Italy (AB); FIRC Institute of Molecular Oncology (IFOM), Milano, Italy (SM); Ignyta, Inc., San Diego, CA (DL, ZH, JL); Clioss S.r.l. Nerviano, Milan, Italy (MM, CD); Università degli Studi di Milano, Milan, Italy (SS)
| | - Silvio Veronese
- Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan, Italy (ASB, AA, EV, LP, EB, GM, SV, AV, SS); Nerviano Medical Sciences S.r.l Nerviano, Milan, Italy (EA, RB, AS, LR, PB, AL, RA, AG, AI); Candiolo Cancer Institute - FPO, IRCCS, Candiolo, Torino, Italy (SM, AB); University of Torino, Department of Oncology, Candiolo, Torino, Italy (AB); FIRC Institute of Molecular Oncology (IFOM), Milano, Italy (SM); Ignyta, Inc., San Diego, CA (DL, ZH, JL); Clioss S.r.l. Nerviano, Milan, Italy (MM, CD); Università degli Studi di Milano, Milan, Italy (SS)
| | - Angelo Vanzulli
- Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan, Italy (ASB, AA, EV, LP, EB, GM, SV, AV, SS); Nerviano Medical Sciences S.r.l Nerviano, Milan, Italy (EA, RB, AS, LR, PB, AL, RA, AG, AI); Candiolo Cancer Institute - FPO, IRCCS, Candiolo, Torino, Italy (SM, AB); University of Torino, Department of Oncology, Candiolo, Torino, Italy (AB); FIRC Institute of Molecular Oncology (IFOM), Milano, Italy (SM); Ignyta, Inc., San Diego, CA (DL, ZH, JL); Clioss S.r.l. Nerviano, Milan, Italy (MM, CD); Università degli Studi di Milano, Milan, Italy (SS)
| | - Alberto Bardelli
- Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan, Italy (ASB, AA, EV, LP, EB, GM, SV, AV, SS); Nerviano Medical Sciences S.r.l Nerviano, Milan, Italy (EA, RB, AS, LR, PB, AL, RA, AG, AI); Candiolo Cancer Institute - FPO, IRCCS, Candiolo, Torino, Italy (SM, AB); University of Torino, Department of Oncology, Candiolo, Torino, Italy (AB); FIRC Institute of Molecular Oncology (IFOM), Milano, Italy (SM); Ignyta, Inc., San Diego, CA (DL, ZH, JL); Clioss S.r.l. Nerviano, Milan, Italy (MM, CD); Università degli Studi di Milano, Milan, Italy (SS)
| | - Marcella Martignoni
- Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan, Italy (ASB, AA, EV, LP, EB, GM, SV, AV, SS); Nerviano Medical Sciences S.r.l Nerviano, Milan, Italy (EA, RB, AS, LR, PB, AL, RA, AG, AI); Candiolo Cancer Institute - FPO, IRCCS, Candiolo, Torino, Italy (SM, AB); University of Torino, Department of Oncology, Candiolo, Torino, Italy (AB); FIRC Institute of Molecular Oncology (IFOM), Milano, Italy (SM); Ignyta, Inc., San Diego, CA (DL, ZH, JL); Clioss S.r.l. Nerviano, Milan, Italy (MM, CD); Università degli Studi di Milano, Milan, Italy (SS)
| | - Cristina Davite
- Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan, Italy (ASB, AA, EV, LP, EB, GM, SV, AV, SS); Nerviano Medical Sciences S.r.l Nerviano, Milan, Italy (EA, RB, AS, LR, PB, AL, RA, AG, AI); Candiolo Cancer Institute - FPO, IRCCS, Candiolo, Torino, Italy (SM, AB); University of Torino, Department of Oncology, Candiolo, Torino, Italy (AB); FIRC Institute of Molecular Oncology (IFOM), Milano, Italy (SM); Ignyta, Inc., San Diego, CA (DL, ZH, JL); Clioss S.r.l. Nerviano, Milan, Italy (MM, CD); Università degli Studi di Milano, Milan, Italy (SS)
| | - Arturo Galvani
- Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan, Italy (ASB, AA, EV, LP, EB, GM, SV, AV, SS); Nerviano Medical Sciences S.r.l Nerviano, Milan, Italy (EA, RB, AS, LR, PB, AL, RA, AG, AI); Candiolo Cancer Institute - FPO, IRCCS, Candiolo, Torino, Italy (SM, AB); University of Torino, Department of Oncology, Candiolo, Torino, Italy (AB); FIRC Institute of Molecular Oncology (IFOM), Milano, Italy (SM); Ignyta, Inc., San Diego, CA (DL, ZH, JL); Clioss S.r.l. Nerviano, Milan, Italy (MM, CD); Università degli Studi di Milano, Milan, Italy (SS)
| | - Antonella Isacchi
- Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan, Italy (ASB, AA, EV, LP, EB, GM, SV, AV, SS); Nerviano Medical Sciences S.r.l Nerviano, Milan, Italy (EA, RB, AS, LR, PB, AL, RA, AG, AI); Candiolo Cancer Institute - FPO, IRCCS, Candiolo, Torino, Italy (SM, AB); University of Torino, Department of Oncology, Candiolo, Torino, Italy (AB); FIRC Institute of Molecular Oncology (IFOM), Milano, Italy (SM); Ignyta, Inc., San Diego, CA (DL, ZH, JL); Clioss S.r.l. Nerviano, Milan, Italy (MM, CD); Università degli Studi di Milano, Milan, Italy (SS)
| | - Salvatore Siena
- Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan, Italy (ASB, AA, EV, LP, EB, GM, SV, AV, SS); Nerviano Medical Sciences S.r.l Nerviano, Milan, Italy (EA, RB, AS, LR, PB, AL, RA, AG, AI); Candiolo Cancer Institute - FPO, IRCCS, Candiolo, Torino, Italy (SM, AB); University of Torino, Department of Oncology, Candiolo, Torino, Italy (AB); FIRC Institute of Molecular Oncology (IFOM), Milano, Italy (SM); Ignyta, Inc., San Diego, CA (DL, ZH, JL); Clioss S.r.l. Nerviano, Milan, Italy (MM, CD); Università degli Studi di Milano, Milan, Italy (SS).
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Sartore-Bianchi A, Amatu A, Stabile S, Tosi F, Bonazzina E, Maiolani M, Rusconi F, Galbiati D, Orlando V, Pietrogiovanna L, Gambaro A, Ghezzi S, Mastroianni D, Marrapese G, Lauricella C, Valtorta E, Veronese S, Truini M, Siena S. Pooled analysis of clinical outcome of patients with chemorefractory metastatic colorectal cancer treated within clinical studies based on individual molecular alterations at Niguarda Cancer Center. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv340.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Vincenzi B, Cremolini C, Sartore-Bianchi A, Russo A, Mannavola F, Perrone G, Pantano F, Loupakis F, Rossini D, Ongaro E, Bonazzina E, Zoccoli A, De Maglio G, Fontanini G, Falcone A, Santini D, Onetti-Muda A, Siena S, Tonini G, Aprile G. Prognostic significance of KRAS mutation rate in metastatic colorectal cancer patients. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv340.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Vincenzi B, Loupakis F, Sartore Bianchi A, Russo A, Mannavola F, Perrone G, Cremolini C, Rossini D, Ongaro E, Bonazzina E, Dell'Aquila E, Imperatori M, De Maglio G, Falcone A, Santini D, Onetti-Muda A, Siena S, Aprile G, Tonini G. Prognostic significance of KRAS mutation rate in metastatic colorectal cancer (mCRC) patients (pts). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e22075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Bruno Vincenzi
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Fotios Loupakis
- Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | | | - Antonio Russo
- Unit of Medical Oncology - Department of Oncology - AOUP, Palermo, Italy
| | | | - Giuseppe Perrone
- Department of Anatomical Pathology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Chiara Cremolini
- Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | | | | | - Erica Bonazzina
- Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan, Italy
| | | | - Marco Imperatori
- Department of Medical Oncology, Università Campus Bio-Medico, Rome, Rome, Italy
| | | | - Alfredo Falcone
- Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | - Daniele Santini
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Andrea Onetti-Muda
- Department of Anatomical Pathology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Salvatore Siena
- Niguarda Cancer Center, Ospedale Niguarda Ca Granda, Milan, Italy
| | - Giuseppe Aprile
- Dipartimento di Oncologia, Azienda Ospedaliero-Universitaria, Udine, Italy
| | - Giuseppe Tonini
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy
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Amatu A, Bencardino K, Barault L, Cassingena A, Bonazzina E, Ghezzi S, Moutinho C, Tosi F, Ricotta R, Magni E, Gatto R, Marrapese G, Esteller M, Bardelli A, Di Nicolantonio F, Sartore-Bianchi A, Siena S. Phase II study of temozolomide (TMZ) in metastatic colorectal cancer (mCRC) patients molecularly selected by MGMT promoter hypermethylation. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.3_suppl.583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
583 Background: O(6)-methylguanine-DNA-methyltransferase (MGMT) is a DNA repair protein. About 40% of mCRC display MGMT deficiency due to promoter hypermethylation, leading to susceptibility to treatment with cytotoxic alkylating agents. We previously reported that objective clinical response to dacarbazine is confined to tumors harboring MGMT promoter hypermethylation (Amatu et al. Clin Cancer Res 2013). Based on these findings, we conducted a phase II study with TMZ in MGMT-deficient mCRCs after failure of standard therapies (EudraCT 2012-003338-17). Methods: We screened mCRC patients for MGMT promoter hypermethylation on archival FFPE specimens by methylation-specific PCR (MSP). All eligible patients underwent tumor biopsy prior to start of treatment. Patients received TMZ 200 mg/m2 po qd days 1-5 q28 until progression or intolerable toxicity. We used a Fleming single-stage design to determine whether PFS rate at 12 week would be ≥35% (H0≤15%, type I error=0.059 (1-sided) and power=0.849). Secondary endpoints included response rate (RR), disease control rate (DCR), overall survival (OS), and association of clinical outcomes with quantitative MGMT evaluation in serum and fresh tissue. Results: 150 patients were screened: 54 (36%) presented MGMT promoter hypermethylation and 29 were eligible and enrolled from December 2012 to May 2014 (M 69%, median age 60y [38-77], mean number of previous treatment lines 5.6). A median of 2 cycles of TMZ were administered (range 1-5). Primary endpoint was not achieved, since PFS rate at 12 weeks was 10.3% (90% CI: 2.9-24.6). DCR was 48.3% (90% CI: 32.0-64.8), median OS 6.2 months (95% CI: 3.7-7.6), and median PFS 2.6 months (95% CI: 1.4-2.7). G3/4 toxicities occurring in ≥10% of patients included: thrombocytopenia (10.3/13.8%), neutropenia (0/10.3%) and increased bilirubin (11.1/0%). Exploratory MGMT quantitative analysis is in progress. Conclusions: In mCRC patients treated with TMZ, selection according to MGMT promoter hypermethylation by MSP did not provide meaningful PFS rate at 12 weeks. Biomarkers analyses on serum and fresh tumor biopsy are ongoing to identify the subgroup of mCRCs benefiting from treatment. Clinical trial information: 2012-003338-17.
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Affiliation(s)
- Alessio Amatu
- Niguarda Cancer Center, Ospedale Niguarda Ca’ Granda, Milan, Italy
| | - Katia Bencardino
- Niguarda Cancer Center, Ospedale Niguarda Ca’ Granda, Milan, Italy
| | | | | | - Erica Bonazzina
- Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Silvia Ghezzi
- Niguarda Cancer Center, Ospedale Niguarda Ca’ Granda, Milan, Italy
| | - Catia Moutinho
- Institut d’Investigación Biomedica de Bellvitge, Barcelona, Spain
| | - Federica Tosi
- Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Riccardo Ricotta
- Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Elena Magni
- Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan, Italy
| | | | | | - Manel Esteller
- Institut d’Investigación Biomedica de Bellvitge, Barcelona, Spain
| | - Alberto Bardelli
- Istituto di Candiolo, Fondazione del Piemonte per l’Oncologia-IRCCS, Candiolo, Italy
| | | | | | - Salvatore Siena
- Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan, Italy
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Amatu A, Sartore Bianchi A, Moutinho C, Bencardino K, Bonazzina E, Pietrogiovanna L, Venturini F, Gambaro A, Marrapese G, Belotti A, Esteller M, Siena S. Phase II study of dacarbazine for metastatic colorectal cancer: Final results with MGMT analysis. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.3581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3581 Background: O6-methylguanine-DNA-methyltransferase (MGMT) is a DNA repair protein removing mutagenic and cytotoxic adducts from O6-guanine in DNA. Approximately 40% of colorectal cancers (CRCs) display MGMT deficiency due to promoter hypermethylation leading to silencing of the gene. Alkylating agents, such as dacarbazine, exert their antitumor activity by DNA methylation at the O6–guanine site, inducing base pair mismatch, therefore activity of dacarbazine could be enhanced in CRCs lacking MGMT. We conducted a phase II study with dacarbazine in CRCs who had failed standard therapies (oxaliplatin, irinotecan, fluoropyrimidines, and cetuximab or panitumumab if KRAS wild type). Methods: All patients had tumor tissue assessed for MGMT as promoter hypermethylation in double-blind for treatment outcome. Patients received dacarbazine 250 mg/m2 i.v. qd for 4 consecutive days q21 until PD or intolerable toxicity. We employed a Simon two-stage design to determinate if the ORR would be ≥ 10%. Secondary endpoints included association of response, PFS and disease control rate with MGMT status. Results: Sixty-eight patients were enrolled from May 2011 to March 2012. Patients received a median of 3 cycles of dacarbazine [range 1-12]. Grade 3-4 toxicities included: fatigue (41%), nausea/vomiting (29%), constipation (25%), platelet count decrease (19%), anemia (18%). Overall, 2 patients (3%) achieved partial response (PR) and 8 patients (12%) had stable disease (SD). Disease control rate (PR+SD) was significantly associated with MGMT promoter hypermethylation in the corresponding tumors. Conclusions: Objective clinical responses to dacarbazine in metastatic CRC patients are confined to those tumors harbouring epigenetic inactivation of the DNA repair enzyme MGMT. Clinical trial information: 2011-002080-21.
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Affiliation(s)
- Alessio Amatu
- Dipartimento Oncologico, Ospedale Niguarda Ca' Granda, Milano, Italy
| | | | - Catia Moutinho
- Institut d’Investigación Biomedica de Bellvitge, Barcelona, Spain
| | - Katia Bencardino
- Dipartimento Oncologico, Ospedale Niguarda Ca' Granda, Milano, Italy
| | - Erica Bonazzina
- Dipartimento Oncologico, Ospedale Niguarda Ca' Granda, Milano, Italy
| | | | - Filippo Venturini
- Dipartimento Oncologico, Ospedale Niguarda Ca' Granda, Milano, Italy
| | | | | | | | - Manel Esteller
- Institut d’Investigación Biomedica de Bellvitge, Barcelona, Spain
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