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Bironzo P, Melocchi L, Monica V, Trebeschi D, Barbieri F, Maiello E, Migliorino MR, Lombardi A, Tiseo M, Righi L, Graziano P, Rossi G, Novello S. Immunohistochemistry with 3 different clones in anaplastic lymphoma kinase fluorescence in situ hybridization positive non-small-cell lung cancer with thymidylate synthase expression analysis: a multicentre, retrospective, Italian study. Pathologica 2022; 114:278-287. [DOI: 10.32074/1591-951x-756] [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] [Received: 02/17/2022] [Accepted: 03/12/2022] [Indexed: 11/30/2022] Open
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Barbieri F, Spitaler P, Adukauskaite A, Rubatscher A, Schgoer W, Pfeifer B, Hintringer F, Dichtl W. Heart failure medication and its effect on response to cardiac resynchronisation therapy in patients with pacing-induced cardiomyopathy: an UPGRADE post hoc analysis. Europace 2022. [DOI: 10.1093/europace/euac053.487] [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: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): Austrian National Bank
Unlimited scientific grant from the Boston Scientific Investigator Sponsored Research (ISR) Committee
Background/Introduction
Current heart failure (HF) guidelines recommend optimal medical therapy (OMT) in patients with pacing-induced cardiomyopathy (PICM) prior upgrading to cardiac resynchronisation therapy (CRT). It is unknown, whether previous prescription of heart failure medication reduces the effect of CRT upgrading.
Purpose
To evaluate the effect of HF medication on CRT response in patients suffering from PICM receiving an upgrade to CRT.
Methods
The UPGRADE trial was a prospective investigator driven trial evaluating the effect of CRT upgrading in patients with PICM. Key inclusion criteria were symptomatic HF with left ventricular ejection fraction (LVEF) below 40% despite OMT and right ventricular pacing (RVP) above 40%. Device programming had to be adjusted to minimize RVP prior to enrolment. Echocardiographic examinations were performed prior to device implantation and 3-5 months after activation of CRT and were analyzed in blinded fashion. CRT response was defined by a reduction of > 15% in left ventricular end systolic volume (LVESV). Heart failure medication was assessed at implantation of the device.
Results
Overall, 54 patients were enrolled in the UPGRADE trial between 2014 and 2018. Beta-blockers (BB) were prescribed in 43 (79.6%), mineralcorticoid receptor antagonists (MRA) in 29 (53.7%) and either an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin II receptor blockers (ARB) in 45 (83.3%) of the patients. Therapy with CRT has led to significant improvement in LVEF (mean delta: 12.8 ± 7.8%) and LVESV (delta: 30.7 ± 33.2ml), whereas CRT response was achieved in 30 (55.6%) patients. There was no statistically significant difference in patients with BB intake regarding increase of LVEF (12.4 ± 7.5% vs. 14.6 ± 9.4%, p=0.431), decrease of LVESV (42.8 ± 32.8ml vs. 27.8 ± 33.0ml, p=0.201) or CRT response (22 (53.7%) vs. 8 (80%), p=0.167). Similar results were found regarding ACE inhibitor/ARB [LVEF: 13.1 ± 6.8% vs. 11.5 ± 11.8%, p=0.705; LVESV: 32.6 ± 32.6ml vs. 21.7 ± 36.3ml, p=0.373; CRT response: 26 (61.9%) vs. 4 (44.4%), p=0.460] and MRA intake [LVEF: 13.7 ± 7.3% vs. 11.8 ± 8.4%, p=0.382; LVESV: 34.3 ± 36.8ml vs. 26.7 ± 28.8ml, p=0.423; CRT response: 15 (55.6%) vs. 15 (62.5%), p=0.777].
Conclusion
Previous prescription of heart failure medication did not reduce the effect of CRT upgrading in patients suffering from PICM. It remains to be proven, whether similar results may be observed for newer HF agents like sodium-glucose co-transporter 2 inhibitors or angiotensin receptor-neprilysin inhibitors as both were not available in clinical routine at the time of study conduct.
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Affiliation(s)
- F Barbieri
- Charite Universitatsmedizin Berlin, Department of cardiology, Berlin, Germany
| | - P Spitaler
- Medical University of Innsbruck, Department of cardiology and angiology, Innsbruck, Austria
| | - A Adukauskaite
- Medical University of Innsbruck, Department of cardiology and angiology, Innsbruck, Austria
| | - A Rubatscher
- Medical University of Innsbruck, Department of cardiology and angiology, Innsbruck, Austria
| | - W Schgoer
- Medical University of Innsbruck, Department of cardiology and angiology, Innsbruck, Austria
| | - B Pfeifer
- University Teaching Hospital Hall in Tirol (UMIT), Division for health network and telehealth, Hall in Tyrol, Austria
| | - F Hintringer
- Medical University of Innsbruck, Department of cardiology and angiology, Innsbruck, Austria
| | - W Dichtl
- Medical University of Innsbruck, Department of cardiology and angiology, Innsbruck, Austria
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3
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Perrone F, Mazzaschi G, Minari R, Verzè M, Azzoni C, Bottarelli L, Nizzoli R, Pluchino M, Altimari A, Gruppioni E, Sperandi F, Andrini E, Guaitoli G, Bertolini F, Barbieri F, Bettelli S, Longo L, Pagano M, Bonelli C, Tagliavini E, Nicoli D, Ubiali A, Zangrandi A, Trubini S, Proietto M, Gnetti L, Tiseo M. Multicenter Observational Study on Metastatic Non-Small Cell Lung Cancer Harboring BRAF Mutations: Focus on Clinical Characteristics and Treatment Outcome of V600E and Non-V600E Subgroups. Cancers (Basel) 2022; 14:cancers14082019. [PMID: 35454926 PMCID: PMC9031288 DOI: 10.3390/cancers14082019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 12/29/2022] Open
Abstract
Simple Summary Around 2–4% of lung adenocarcinoma harbors BRAF mutations. Dabrafenib and Trametinib represent the first treatment-choice for BRAF V600Emut NSCLC, regardless of the line of therapy, while non-V600Emut receive standard immunotherapy or chemo-immunotherapy. Our real-life multicenter study on 44 BRAF mutant NSCLC responds to the urgent need to characterize this subset of patients in-depth, potentially offering new valuable biological and clinical insights. We specifically focused on similarities/discrepancies between V600E and non-V600E populations, providing consistent data about clinicopathologic characteristics, treatment response, and survival outcome. Abstract Introduction: BRAF mutation involved 2–4% of lung adenocarcinoma. Differences in clinicopathologic features and patient outcome exist between V600E and non-V600E BRAF mutated NSCLC. Thus, we sought to assess the frequency and clinical relevance of BRAF mutations in a real-life population of advanced-NSCLC, investigating the potential prognostic significance of distinct genetic alterations. Materials and Methods: The present multicenter Italian retrospective study involved advanced BRAF mutant NSCLC. Complete clinicopathologic data were evaluated for BRAF V600E and non-V600E patients. Results: A total of 44 BRAFmut NSCLC patients were included (V600E, n = 23; non-V600E, n = 21). No significant differences in survival outcome and treatment response were documented, according to V600E vs. non-V600E mutations, although a trend towards prolonged PFS was observed in the V600E subgroup (median PFS = 11.3 vs. 6.0 months in non-V600E). In the overall population, ECOG PS and age significantly impacted on OS, while bone lesions were associated with shorter PFS. Compared to immunotherapy, first-line chemotherapy was associated with longer OS in the overall population, and especially in the BRAF V600E subtype. Conclusions: Here, we report on real-life data from a retrospective cohort of advanced-NSCLC harboring BRAF alterations. Our study offers relevant clues on survival outcome, therapeutic response, and clinicopathologic correlations of BRAF-mutant NSCLC.
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Affiliation(s)
- Fabiana Perrone
- Medical Oncology Unit, University Hospital of Parma, 43126 Parma, Italy; (F.P.); (G.M.); (M.V.); (R.N.); (M.P.); (M.T.)
| | - Giulia Mazzaschi
- Medical Oncology Unit, University Hospital of Parma, 43126 Parma, Italy; (F.P.); (G.M.); (M.V.); (R.N.); (M.P.); (M.T.)
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Roberta Minari
- Medical Oncology Unit, University Hospital of Parma, 43126 Parma, Italy; (F.P.); (G.M.); (M.V.); (R.N.); (M.P.); (M.T.)
- Correspondence: ; Tel.: +39-0521-702316; Fax: +39-0521-995448
| | - Michela Verzè
- Medical Oncology Unit, University Hospital of Parma, 43126 Parma, Italy; (F.P.); (G.M.); (M.V.); (R.N.); (M.P.); (M.T.)
| | - Cinzia Azzoni
- Unit of Pathological Anatomy, University Hospital of Parma, 43126 Parma, Italy; (C.A.); (L.B.); (L.G.)
| | - Lorena Bottarelli
- Unit of Pathological Anatomy, University Hospital of Parma, 43126 Parma, Italy; (C.A.); (L.B.); (L.G.)
| | - Rita Nizzoli
- Medical Oncology Unit, University Hospital of Parma, 43126 Parma, Italy; (F.P.); (G.M.); (M.V.); (R.N.); (M.P.); (M.T.)
| | - Monica Pluchino
- Medical Oncology Unit, University Hospital of Parma, 43126 Parma, Italy; (F.P.); (G.M.); (M.V.); (R.N.); (M.P.); (M.T.)
| | - Annalisa Altimari
- Pathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (A.A.); (E.G.)
| | - Elisa Gruppioni
- Pathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (A.A.); (E.G.)
| | - Francesca Sperandi
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Elisa Andrini
- Department of Experimental Diagnostic and Specialized Medicine (DIMES), Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy;
| | - Giorgia Guaitoli
- Division of Medical Oncology, University Hospital of Modena, 41125 Modena, Italy; (G.G.); (F.B.); (F.B.)
- Ph.D. Program Clinical and Experimental Medicine (CEM), Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Federica Bertolini
- Division of Medical Oncology, University Hospital of Modena, 41125 Modena, Italy; (G.G.); (F.B.); (F.B.)
| | - Fausto Barbieri
- Division of Medical Oncology, University Hospital of Modena, 41125 Modena, Italy; (G.G.); (F.B.); (F.B.)
| | | | - Lucia Longo
- Medical Oncology Unit, Sassuolo Hospital, AUSL Modena, 41121 Modena, Italy;
| | - Maria Pagano
- Medical Oncology Unit, Clinical Cancer Centre, Azienda USL-IRCCS Reggio Emilia, 42122 Reggio Emilia, Italy; (M.P.); (C.B.)
| | - Candida Bonelli
- Medical Oncology Unit, Clinical Cancer Centre, Azienda USL-IRCCS Reggio Emilia, 42122 Reggio Emilia, Italy; (M.P.); (C.B.)
| | - Elena Tagliavini
- Pathology Unit, Clinical Cancer Centre, Azienda USL-IRCCS Reggio Emilia, 42122 Reggio Emilia, Italy;
| | - Davide Nicoli
- Molecular Biology, Oncology and Advanced Technology Unit, Azienda USL-IRCCS Reggio Emilia, 42122 Reggio Emilia, Italy;
| | - Alessandro Ubiali
- Pathology Unit, AUSL Piacenza, 29121 Piacenza, Italy; (A.U.); (A.Z.); (S.T.)
| | - Adriano Zangrandi
- Pathology Unit, AUSL Piacenza, 29121 Piacenza, Italy; (A.U.); (A.Z.); (S.T.)
| | - Serena Trubini
- Pathology Unit, AUSL Piacenza, 29121 Piacenza, Italy; (A.U.); (A.Z.); (S.T.)
| | | | - Letizia Gnetti
- Unit of Pathological Anatomy, University Hospital of Parma, 43126 Parma, Italy; (C.A.); (L.B.); (L.G.)
| | - Marcello Tiseo
- Medical Oncology Unit, University Hospital of Parma, 43126 Parma, Italy; (F.P.); (G.M.); (M.V.); (R.N.); (M.P.); (M.T.)
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
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Trudu L, Guaitoli G, Bertolini F, Maur M, Santini C, Papapietro VR, Talerico S, Natalizio S, Isca C, Dominici M, Barbieri F. Thyroid function impairment after chemo-immunotherapy for advanced NSCLC: a single institutional retrospective report. Immunotherapy 2022; 14:675-682. [PMID: 35416048 DOI: 10.2217/imt-2021-0165] [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] [Indexed: 12/24/2022] Open
Abstract
Introduction: Aims of the study were to explore outcomes and toxicities of chemotherapy-immunotherapy (CT-IT) for patients (pts) with metastatic nonsquamous non-small-cell lung cancer (mNSCLC) in a real-world population. Materials & methods: Clinical data of 26 pts with mNSCLC treated with CT-IT at our institution from January 2020 to January 2021 were collected retrospectively. Results: Median follow-up time was 7.7 months. Median progression-free survival was 9.5 months. The most frequent immune-related adverse event was thyroid dysfunction (ThD): 30.7%. Conclusion: There was a higher rate of ThD in this study population compared with the literature, with a possible correlation with clinical outcomes.
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Affiliation(s)
- Lucia Trudu
- Department of Oncology & Hematology, Division of Oncology, Modena University Hospital, Modena, 41124, Italy
| | - Giorgia Guaitoli
- PhD Program in Clinical & Experimental Medicine, University of Modena & Reggio Emilia, Modena, 41124, Italy
| | - Federica Bertolini
- Department of Oncology & Hematology, Division of Oncology, Modena University Hospital, Modena, 41124, Italy
| | - Michela Maur
- Department of Oncology & Hematology, Division of Oncology, Modena University Hospital, Modena, 41124, Italy
| | - Chiara Santini
- Department of Oncology & Hematology, Division of Oncology, Modena University Hospital, Modena, 41124, Italy
| | - Vito Roberto Papapietro
- Department of Oncology & Hematology, Division of Oncology, Modena University Hospital, Modena, 41124, Italy
| | - Sabrina Talerico
- Department of Oncology & Hematology, Division of Oncology, Modena University Hospital, Modena, 41124, Italy
| | - Salvatore Natalizio
- Department of Oncology & Hematology, Division of Oncology, Modena University Hospital, Modena, 41124, Italy
| | - Chrystel Isca
- Department of Oncology & Hematology, Division of Oncology, Modena University Hospital, Modena, 41124, Italy
| | - Massimo Dominici
- Department of Oncology & Hematology, Division of Oncology, Modena University Hospital, Modena, 41124, Italy
| | - Fausto Barbieri
- Department of Oncology & Hematology, Division of Oncology, Modena University Hospital, Modena, 41124, Italy
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5
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Bruni A, Bertolini F, D'Angelo E, Barbieri F, Imbrescia J, Trudu L, Cappelli A, Lohr F, Dominici M, Guaitoli G. 147P Chemo-immunotherapy with or without consolidative radiotherapy in extensive-stage small cell lung cancer: An initial report of clinical outcome and safety. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.02.178] [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: 11/29/2022] Open
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6
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Andrini E, Lamberti G, Mazzoni F, Riccardi F, Bonetti A, Follador A, Artioli F, Genova C, Barbieri F, Frassoldati A, Brighenti M, Colantonio I, Pasello G, Ficorella C, Cinieri S, Tiseo M, Gelsomino F, Tognetto M, Rihawi K, Ardizzoni A. A phase II, open-label, single-arm trial of carboplatin plus etoposide with bevacizumab and atezolizumab in patients with extended-stage small-cell lung cancer (CeLEBrATE study): background, design and rationale. Future Oncol 2022; 18:771-779. [PMID: 35068173 DOI: 10.2217/fon-2021-1027] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Based on improved survival from the addition of PD-L1 inhibitors in phase III trials, the combination of immunotherapy and platinum-doublet chemotherapy has become the new standard treatment for extended-stage small-cell lung cancer (ES-SCLC). Furthermore, the antiangiogenetic agent bevacizumab showed a longer progression-free survival by targeting VEGF that has pleiotropic effects, including immunosuppressive ones. We, therefore, hypothesized that targeting angiogenesis would improve the efficacy of chemoimmunotherapy. The CeLEBrATE trial is an open-label, multicenter, phase II study designed to assess the efficacy and safety of the combination of carboplatin and etoposide plus bevacizumab and atezolizumab in treatment-naive patients with ES-SCLC. The primary end point is overall survival rate at 1 year, while secondary end points include overall response rate, progression-free survival and toxicity.
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Affiliation(s)
- Elisa Andrini
- Department of Experimental, Diagnostic & Specialty Medicine (DIMES), University of Bologna, Bologna 40138, Italy
| | - Giuseppe Lamberti
- Department of Experimental, Diagnostic & Specialty Medicine (DIMES), University of Bologna, Bologna 40138, Italy
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna 40138, Italy
| | - Francesca Mazzoni
- Medical Oncology Unit, University Hospital Careggi, Firenze 50134, Italy
| | | | - Andrea Bonetti
- Department of Oncology, Mater Salutis Hospital, Legnago 37045, Italy
| | - Alessandro Follador
- Department of Oncology, University Hospital Santa Maria Della Misericordia, Udine 33100, Italy
| | - Fabrizio Artioli
- Oncology & Palliative Care Units, Civil Hospital Carpi, USL, Carpi 41012, Italy
| | - Carlo Genova
- Academic Oncology Unit, IRCCS Ospedale Policlinico San Martino, Genoa 16132, Italy
- Department of Internal Medicine & Medical Specialties (DiMI), Università degli Studi di Genova, Genoa 16132, Italy
| | - Fausto Barbieri
- Division of Medical Oncology, Azienda Ospedaliero-Universitaria Policlinico, Modena 41125, Italy
| | - Antonio Frassoldati
- Department of Oncology, Azienda Ospedaliero Universitaria di Ferrara-Arcispedale Sant'Anna, Ferrara 44124, Italy
| | | | - Ida Colantonio
- Medical Oncology Unit, Hospital of Cuneo, Cuneo 12100, Italy
| | - Giulia Pasello
- Department of Surgery, Oncology & Gastroenterology, University of Padova, Padova 35122, Italy
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova 35122, Italy
| | - Corrado Ficorella
- Department of Biotechnological & Applied Clinical Sciences, St Salvatore Hospital, University of L'Aquila, L'Aquila 67100, Italy
| | - Saverio Cinieri
- Department of Oncology, Medical Oncology & Breast Unit, Antonio Perrino Hospital, Brindisi 72100, Italy
| | - Marcello Tiseo
- Department of Medicine & Surgery, University of Parma & Medical Oncology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma 43126, Italy
| | - Francesco Gelsomino
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna 40138, Italy
| | - Michele Tognetto
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna 40138, Italy
| | - Karim Rihawi
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna 40138, Italy
| | - Andrea Ardizzoni
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna 40138, Italy
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7
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Guaitoli G, Bertolini F, Bettelli S, Manfredini S, Maur M, Trudu L, Aramini B, Masciale V, Grisendi G, Dominici M, Barbieri F. Deepening the Knowledge of ROS1 Rearrangements in Non-Small Cell Lung Cancer: Diagnosis, Treatment, Resistance and Concomitant Alterations. Int J Mol Sci 2021; 22:12867. [PMID: 34884672 PMCID: PMC8657497 DOI: 10.3390/ijms222312867] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/12/2021] [Accepted: 11/23/2021] [Indexed: 12/26/2022] Open
Abstract
ROS proto-oncogene 1 (ROS1) rearrangements are reported in about 1-2% of non-squamous non-small-cell lung cancer (NSCLC). After efficacy of crizotinib was demonstrated, identification of ROS1 translocations in advanced disease became fundamental to give patients the chance of specific and effective treatment. Different methods are available for detection of rearrangements, and probably the real prevalence of ROS1 rearrangements is higher than that reported in literature, as our capacity to detect gene rearrangements is improving. In particular, with next generation sequencing (NGS) techniques, we are currently able to assess multiple genes simultaneously with increasing sensitivity. This is leading to overcome the "single oncogenic driver" paradigm, and in the very near future, the co-existence of multiple drivers will probably emerge more frequently and represent a therapeutic issue. Since recently, crizotinib has been the only available therapy, but today, many other tyrosine kinase inhibitors (TKI) are emerging and seem promising both in first and subsequent lines of treatment. Indeed, novel inhibitors are also able to overcome resistance mutations to crizotinib, hypothesizing a possible sequential strategy also in ROS1-rearranged disease. In this review, we will focus on ROS1 rearrangements, dealing with diagnostic aspects, new therapeutic options, resistance issues and the coexistence of ROS1 translocations with other molecular alterations.
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Affiliation(s)
- Giorgia Guaitoli
- Ph.D. Program Clinical and Experimental Medicine (CEM), Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy
- Oncology and Hematology, Modena University Hospital, University of Modena and Reggio Emilia, 41125 Modena, Italy; (L.T.); (M.D.)
| | - Federica Bertolini
- Oncology and Hematology, Modena University Hospital, 41125 Modena, Italy; (F.B.); (M.M.); (F.B.)
| | - Stefania Bettelli
- Molecular Pathology, Modena University Hospital, 41125 Modena, Italy; (S.B.); (S.M.)
| | - Samantha Manfredini
- Molecular Pathology, Modena University Hospital, 41125 Modena, Italy; (S.B.); (S.M.)
| | - Michela Maur
- Oncology and Hematology, Modena University Hospital, 41125 Modena, Italy; (F.B.); (M.M.); (F.B.)
| | - Lucia Trudu
- Oncology and Hematology, Modena University Hospital, University of Modena and Reggio Emilia, 41125 Modena, Italy; (L.T.); (M.D.)
| | - Beatrice Aramini
- Thoracic Surgery Unit, Department of Diagnostic and Specialty Medicine—DIMES of the Alma Mater Studiorum, University of Bologna, G.B. Morgagni—L. Pierantoni Hospital, 47121 Forlì, Italy;
| | - Valentina Masciale
- Laboratory of Cellular Therapy, Program of Cell Therapy and Immuno-Oncology, Division of Oncology, University-Hospital of Modena and Reggio Emilia, Department of Medical and Surgical Sciences for Children & Adults, 41125 Modena, Italy; (V.M.); (G.G.)
| | - Giulia Grisendi
- Laboratory of Cellular Therapy, Program of Cell Therapy and Immuno-Oncology, Division of Oncology, University-Hospital of Modena and Reggio Emilia, Department of Medical and Surgical Sciences for Children & Adults, 41125 Modena, Italy; (V.M.); (G.G.)
| | - Massimo Dominici
- Oncology and Hematology, Modena University Hospital, University of Modena and Reggio Emilia, 41125 Modena, Italy; (L.T.); (M.D.)
- Laboratory of Cellular Therapy, Program of Cell Therapy and Immuno-Oncology, Division of Oncology, University-Hospital of Modena and Reggio Emilia, Department of Medical and Surgical Sciences for Children & Adults, 41125 Modena, Italy; (V.M.); (G.G.)
| | - Fausto Barbieri
- Molecular Pathology, Modena University Hospital, 41125 Modena, Italy; (S.B.); (S.M.)
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8
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Baldessari C, Pecchi A, Marcheselli R, Guaitoli G, Bonacini R, Valoriani F, Torricelli P, Reverberi L, Menozzi R, Pugliese G, Vitale MG, Sabbatini R, Bertolini F, Barbieri F, Dominici M. Body composition and inflammation impact in non-small-cell lung cancer patients treated by first-line immunotherapy. Immunotherapy 2021; 13:1501-1519. [PMID: 34670403 DOI: 10.2217/imt-2021-0038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Immunotherapy changed the landscape of non-small-cell lung cancer (NSCLC). Efforts were made to implement its action. This study aims to describe body composition, nutritional and inflammatory status in NSCLC patients treated by first-line immunotherapy, their correlation, variation and impact. Patients and methods: We retrospectively analyzed 44 consecutive patients who received pembrolizumab treatment. Results: During the therapy, inflammation and visceral fat increased, whereas muscle and subcutaneous fat decreased. Parameters related to inflammation had an interesting prognostic impact. High numbers of white blood cells remained significantly correlated with a high risk of death in multivariate model. Conclusion: For the best treatment choice, a combination of clinical and biological factors will be most likely be necessary. Prospective and larger studies with a multidimensional approach are needed.
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Affiliation(s)
- Cinzia Baldessari
- Department of Oncology & Hematology, Azienda Ospedaliero-Universitaria of Modena, Modena, 41124, Italy
| | - Annarita Pecchi
- Department of Radiology, University of Modena & Reggio Emilia, Azienda Ospedaliero-Universitaria of Modena, Modena, 41124, Italy
| | - Raffaella Marcheselli
- Department of Diagnostic, Clinical & Public Health Medicine, University of Modena & Reggio Emilia, Modena, Modena, 41124, Italy
| | - Giorgia Guaitoli
- Department of Oncology & Hematology, Azienda Ospedaliero-Universitaria of Modena, Modena, 41124, Italy
| | - Riccardo Bonacini
- Department of Radiology, University of Modena & Reggio Emilia, Azienda Ospedaliero-Universitaria of Modena, Modena, 41124, Italy
| | - Filippo Valoriani
- Unit of Metabolic Disorder & Clinical Nutrition, Department of Specialist Medicines, Azienda Ospedaliero-Universitaria of Modena, Modena, 41124, Italy
| | - Pietro Torricelli
- Department of Radiology, University of Modena & Reggio Emilia, Azienda Ospedaliero-Universitaria of Modena, Modena, 41124, Italy
| | - Linda Reverberi
- Unit of Metabolic Disorder & Clinical Nutrition, Department of Specialist Medicines, Azienda Ospedaliero-Universitaria of Modena, Modena, 41124, Italy
| | - Renata Menozzi
- Unit of Metabolic Disorder & Clinical Nutrition, Department of Specialist Medicines, Azienda Ospedaliero-Universitaria of Modena, Modena, 41124, Italy
| | - Giuseppe Pugliese
- Department of Oncology & Hematology, Azienda Ospedaliero-Universitaria of Modena, Modena, 41124, Italy
| | - Maria Giuseppa Vitale
- Department of Oncology & Hematology, Azienda Ospedaliero-Universitaria of Modena, Modena, 41124, Italy
| | - Roberto Sabbatini
- Department of Oncology & Hematology, Azienda Ospedaliero-Universitaria of Modena, Modena, 41124, Italy
| | - Federica Bertolini
- Department of Oncology & Hematology, Azienda Ospedaliero-Universitaria of Modena, Modena, 41124, Italy
| | - Fausto Barbieri
- Department of Oncology & Hematology, Azienda Ospedaliero-Universitaria of Modena, Modena, 41124, Italy
| | - Massimo Dominici
- Department of Oncology & Hematology, Azienda Ospedaliero-Universitaria of Modena, Modena, 41124, Italy
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Barbieri F, Bleckwenn S, Stoessl L, Plank F, Beyer C, Gollmann-Tepekoeylue C, Holfeld J, Senoner T, Bonaros N, Schachner T, Dichtl W, Feuchtner G. Bicuspid aortic valve is associated with less coronary artery calcium and coronary artery disease burden by computed tomography. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0173] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Bicuspid aortic valve (BAV) is associated with genetic defects (NOTCH 1, GATA 5 mutations) and aortopathy. Differences in flow pattern and a genetic predisposition could also affect coronary arteries.
Purpose
To assess the coronary artery calcium score (CACS) and coronary artery disease (CAD) burden by coronary computed tomography angiography (CTA) in patients with BAV stenosis, as compared to those with tricuspid aortic valve (TAV) stenosis.
Methods
47 patients with congenital BAV (68.9 years±12.9, 38.3% females) who underwent cardiovascular CTA for TAVR planning were matched with 47 TAV patients for age, gender, smoking, arterial hypertension, dyslipidemia, diabetes, body-mass-index and chronic kidney disease. The coronary artery calcium score (CACS) (Agatston Units=AU) and coronary stenosis severity by CTA (CADRAD:<25% minimal,<50%milde,50–70%moderate,>70/%severe) were quantified.
Results
The coronary artery calcium score (CACS) was lower in BAV (237.4 vs. 1013.3AU; p<0.001), and coronary stenosis severity was less (CAD-RAD:p<0.001) as compared to patients with TAV.
More patients with BAV had CACS zero (27.7% vs. 0%, p<0.001). The majority (68.1%) of patients with BAV had no or non-obstructive CAD but only 25.5% of tricuspid (p<0.001).
Obstructive CAD (>50% stenosis) by CTA was more frequently observed in TAV patients (68.1%; p<0.001). There were no differences in statin use and NOAC, and other co-morbidities such as AF and COPD.
Conclusion
Patients with BAV have markedly less coronary artery calcium load and yielded less severe coronary stenosis. CTA succeeds to rule out obstructive CAD in the majority of patients with BAV, with adherent implications for TAVR planning.
Funding Acknowledgement
Type of funding sources: None. 72 YOM with BAV, zero CACS and no CADCACS was lower in BAV
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Affiliation(s)
- F Barbieri
- Innsbruck Medical University, Innsbruck, Austria
| | - S Bleckwenn
- Innsbruck Medical University, Innsbruck, Austria
| | - L Stoessl
- Innsbruck Medical University, Innsbruck, Austria
| | - F Plank
- Innsbruck Medical University, Innsbruck, Austria
| | - C Beyer
- Innsbruck Medical University, Innsbruck, Austria
| | | | - J Holfeld
- Innsbruck Medical University, Innsbruck, Austria
| | - T Senoner
- Innsbruck Medical University, Innsbruck, Austria
| | - N Bonaros
- Innsbruck Medical University, Innsbruck, Austria
| | - T Schachner
- Innsbruck Medical University, Innsbruck, Austria
| | - W Dichtl
- Innsbruck Medical University, Innsbruck, Austria
| | - G Feuchtner
- Innsbruck Medical University, Innsbruck, Austria
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10
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Zweiker D, Sieghartsleitner R, Toth G, Stix G, Vock P, Schratter A, Fiedler L, Aichinger J, Steinwender C, Binder R, Barbieri F, Ablasser K, Verheyen N, Zirlik A, Scherr D. Low haemoglobin is associated with increased risk of complications in left atrial appendage closure patients. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0581] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Left atrial appendage closure is associated with a relevant procedural complication rate. Baseline risk factors, such as pre-procedural lab results, may identify patients that develop acute complications.
Methods
We performed a retrospective analysis of the impact of baseline characteristics and preprocedural lab results on the acute procedural outcome in patients undergoing left atrial appendage closure from the Austrian Left Atrial Appendage Closure Registry between 2010 and 2019. The endpoint for procedural complications was defined as death, stroke, major bleeding, necessity for intensive care, other complications requiring invasive interventions or failure to implant the device. We also evaluated a modified endpoint with the exclusion of bleeding events. Logistic regression was performed using stepwise approach (backward method with p_out = 0.1) and forced inclusion of age, left-ventricular function and kidney function.
Results
A total of 320 consecutive patients from 9 centres with a median age of 75 years (36.6% female) were included. Seventy-eight percent had a history of bleeding and 35% had a history of stroke. Median CHA2DS2-VASc score was 5 (interquartile range, 3–5) and median HAS-BLED score was 3 (2–4). Procedural complications occurred in 15.3% of cases. Low haemoglobin and low activated partial thromboplastin time were associated with an increased complication rate. Other significant baseline factors were liver disease, absence of intracranial haemorrhage and severe aortic stenosis. In multivariate analysis, low haemoglobin remained a significant predictor, even after adjustment for age, left-ventricular function and kidney function (Table). In the modified procedural complication endpoint excluding major bleeding events (14.1%), low haemoglobin remained a significant predictor (haemoglobin 11.9±2.0 vs. 12.8±2.0 g/dL in patients with vs. without modified endpoint, p=0.013). A baseline haemoglobin lower than 12 g/dL was present in 39.4% and it increased relative risk of procedural complications by 89% (21.4 vs. 11.3% in patients with reduced vs. normal haemoglobin), and risk of complications without bleeding by 92% (19.8 vs. 10.3%).
Conclusion
Low baseline haemoglobin is independently associated with a higher complication rate after left appendage closure compared to patients with normal haemoglobin levels, even in a modified endpoint excluding bleeding and requirement for transfusion.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Boston Scientific - unrestricted grant Table 1
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Affiliation(s)
- D Zweiker
- Medical University of Graz, Division of Cardiology, Graz, Austria
| | | | - G Toth
- Medical University of Graz, Division of Cardiology, Graz, Austria
| | - G Stix
- Medical University of Vienna, Division of Cardiology, Vienna, Austria
| | - P Vock
- University Hospital St. Polten, Department of Internal Medicine 3, St. Polten, Austria
| | - A Schratter
- Floridsdorf Clinic, Department of Cardiology, Vienna, Austria
| | - L Fiedler
- LK Wiener Neustadt Abteilung fuer Kardiologie und Nephrologie, Wiener Neustadt, Austria
| | - J Aichinger
- Ordensklinikum Linz Elisabethinen, Department of Internal Medicine 2, Linz, Austria
| | - C Steinwender
- Kepler University Hospital, Division of Cardiology, Linz, Austria
| | - R.K Binder
- Klinikum Wels-Grieskirchen, Department of Internal Medicine 2, Wels, Austria
| | - F Barbieri
- Medical University of Innsbruck, Department of Internal Medicine 3, Innsbruck, Austria
| | - K Ablasser
- Medical University of Graz, Division of Cardiology, Graz, Austria
| | - N Verheyen
- Medical University of Graz, Division of Cardiology, Graz, Austria
| | - A Zirlik
- Medical University of Graz, Division of Cardiology, Graz, Austria
| | - D Scherr
- Medical University of Graz, Division of Cardiology, Graz, Austria
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11
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Plank F, Beyer C, Langer C, Senoner T, Bleckwenn S, Widmann G, Barbieri F, Friedrich G, Dichtl W, Feuchtner G. The atherosclerosis profile by coronary CTA compared to the coronary artery calcium score (CACS) in a young symptomatic high-risk population between 19 and 49 years. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0189] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Whether the coronary artery calcium score (CACS) or coronary CTA should be used in young high-risk adults for screening of coronary artery disease (CAD), is an open debate and data sparse.
Aims
To evaluate the coronary atherosclerosis profile by coronary computed tomography angiography (CTA) in a young symptomatic high-risk population (age, 19–49 years) in comparison with the coronary artery calcium score (CACS).
Methods and results
1137 symptomatic high-risk patients between 19–49 years (mean 42.4y; 33.2%females) with suspected CAD who underwent CTA and CACS were assigned into 6 age groups (19–30; 31–35; 36–40; 41–45; 46–47; 48–49y).CTA-analysis included stenosis severity (CADRADS) and high-risk-plaque (“HRP”) criteria.
Atherosclerosis was more often detected by CTA than by CACS (45% vs. 27%; p<0.001), >50% stenosis in 13.6% and HRP in 17.7%. Prevalence of atherosclerosis was low and not different between CACS and CTA in the youngest (19–30y:5.2% and 6.4%; 30–35y:10.6% and 16%). Above >35 years, atherosclerosis detection by CTA increased (p=0.004, OR: 2.8, 95% CI: 1.45–5.89); and was higher by CTA as compared to CACS (34.9% vs 16.7%; p<0.001).
CTA outperformed CACS among all higher age groups >35 years, with an increasing gap towards a superior performance of CTA along with age: Above 35 years, stenosis severity (CADRADS) (p=0.002) and >50% stenosis increased from 2.6% to 12.5% (p<0.001).
The rate of HRP increased linearly with age from 6.4% to 26.5%.The distribution of HRP into CACS0 and CACS>0.1AU was similar among all age groups (CACS 0:45.1% had HRP), with an increasing proportion of HRP in CACS>0.1AU with age. 24.9% of CACS 0 patients had CAD by CTA, 4.4% >50% stenosis and 11.5% HRP.
Conclusion
Above 35 years of age, CTA outperforms CACS with an increasing power. Between 19 and 35 years, CACS 0 does not reliably rule out CAD and high-risk-plaque; hence for “noRISK100%safety”, CTA is superior.(#eachlifematters)
Funding Acknowledgement
Type of funding sources: None. 30 YOM diabetic, CACS 0 and HRP by CTAAtherosclerosis vs age: CACS vs CTA
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Affiliation(s)
- F Plank
- Innsbruck Medical University, Innsbruck, Austria
| | - C Beyer
- Innsbruck Medical University, Innsbruck, Austria
| | - C Langer
- Innsbruck Medical University, Innsbruck, Austria
| | - T Senoner
- Innsbruck Medical University, Innsbruck, Austria
| | - S Bleckwenn
- Innsbruck Medical University, Innsbruck, Austria
| | - G Widmann
- Innsbruck Medical University, Innsbruck, Austria
| | - F Barbieri
- Innsbruck Medical University, Innsbruck, Austria
| | - G Friedrich
- Innsbruck Medical University, Innsbruck, Austria
| | - W Dichtl
- Innsbruck Medical University, Innsbruck, Austria
| | - G Feuchtner
- Innsbruck Medical University, Innsbruck, Austria
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12
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Gelsomino F, Tiseo M, Barbieri F, Riccardi F, Cavanna L, Frassoldati A, Delmonte A, Longo L, Dazzi C, Cinieri S, Colantonio I, Sperandi F, Lamberti G, Brocchi S, Tofani L, Boni L, Ardizzoni A. Correction to: Phase 2 study of NAB-paclitaxel in SensiTivE and refractory relapsed small cell lung cancer (SCLC) (NABSTER TRIAL). Br J Cancer 2021; 125:306. [PMID: 34012035 PMCID: PMC8292309 DOI: 10.1038/s41416-021-01439-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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13
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Buti S, Bersanelli M, Perrone F, Bracarda S, Di Maio M, Giusti R, Nigro O, Cortinovis DL, Aerts JGJV, Guaitoli G, Barbieri F, Ferrara MG, Bria E, Grossi F, Bareggi C, Berardi R, Torniai M, Cantini L, Sforza V, Genova C, Chiari R, Rocco D, Della Gravara L, Gori S, De Tursi M, Di Marino P, Mansueto G, Zoratto F, Filetti M, Citarella F, Russano M, Mazzoni F, Garassino MC, De Toma A, Signorelli D, Gelibter A, Siringo M, Follador A, Bisonni R, Tuzi A, Minuti G, Landi L, Ricciardi S, Migliorino MR, Tabbò F, Olmetto E, Metro G, Adamo V, Russo A, Spinelli GP, Banna GL, Addeo A, Friedlaender A, Cannita K, Porzio G, Ficorella C, Carmisciano L, Pinato DJ, Mazzaschi G, Tiseo M, Cortellini A. Predictive ability of a drug-based score in patients with advanced non-small-cell lung cancer receiving first-line immunotherapy. Eur J Cancer 2021; 150:224-231. [PMID: 33934059 DOI: 10.1016/j.ejca.2021.03.041] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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: 03/04/2021] [Revised: 03/16/2021] [Accepted: 03/18/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND We previously demonstrated the cumulative poor prognostic role of concomitant medications on the clinical outcome of patients with advanced cancer treated with immune checkpoint inhibitors, creating and validating a drug-based prognostic score to be calculated before immunotherapy initiation in patients with advanced solid tumours. This 'drug score' was calculated assigning score 1 for each between proton-pump inhibitor and antibiotic administration until a month before cancer therapy initiation and score 2 in case of corticosteroid intake. The good risk group included patients with score 0, intermediate risk with score 1-2 and poor risk with score 3-4. METHODS Aiming at validating the prognostic and putative predictive ability depending on the anticancer therapy, we performed the present comparative analysis in two cohorts of advanced non-small-cell lung cancer (NSCLC), respectively, receiving first-line pembrolizumab or chemotherapy through a random case-control matching and through a pooled multivariable analysis including the interaction between the computed score and the therapeutic modality (pembrolizumab vs chemotherapy). RESULTS Nine hundred fifty and 595 patients were included in the pembrolizumab and chemotherapy cohorts, respectively. After the case-control random matching, 589 patients from the pembrolizumab cohort and 589 from the chemotherapy cohort were paired, with no statistically significant differences between the characteristics of the matched subjects. Among the pembrolizumab-treated group, good, intermediate and poor risk evaluable patients achieved an objective response rate (ORR) of 50.0%, 37.7% and 23.4%, respectively, (p < 0.0001), whereas among the chemotherapy-treated group, patients achieved an ORR of 37.0%, 40.0% and 32.4%, respectively (p = 0.4346). The median progression-free survival (PFS) of good, intermediate and poor risk groups was 13.9 months, 6.3 months and 2.8 months, respectively, within the pembrolizumab cohort (p < 0.0001), and 6.2 months, 6.2 months and 4.3 months, respectively, within the chemotherapy cohort (p = 0.0280). Among the pembrolizumab-treated patients, the median overall survival (OS) for good, intermediate and poor risk patients was 31.4 months, 14.5 months and 5.8 months, respectively, (p < 0.0001), whereas among the chemotherapy-treated patients, it was 18.3 months, 16.8 months and 10.6 months, respectively (p = 0.0003). A similar trend was reported considering the two entire populations. At the pooled analysis, the interaction term between the score and the therapeutic modality was statistically significant with respect to ORR (p = 0.0052), PFS (p = 0.0003) and OS (p < 0.0001), confirming the significantly different effect of the score within the two cohorts. CONCLUSION Our 'drug score' showed a predictive ability with respect to ORR in the immunotherapy cohort only, suggesting it might be a useful tool for identifying patients unlikely to benefit from first-line single-agent pembrolizumab. In addition, the prognostic stratification in terms of PFS and OS was significantly more pronounced among the pembrolizumab-treated patients.
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Affiliation(s)
- Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | | | - Fabiana Perrone
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Sergio Bracarda
- Struttura Complessa di Oncologia Medica e Traslazionale, Azienda Ospedaliera Santa Maria di Terni, Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin and Medical Oncology, AO Ordine Mauriziano, Turin, Italy
| | | | - Olga Nigro
- Medical Oncology, ASST-Sette Laghi, Varese, Italy
| | | | - Joachim G J V Aerts
- Department of Pulmonary Diseases, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Giorgia Guaitoli
- Dipartimeto di Oncologia Ed Ematologia, AOU Policlinico Modena, Modena, Italy
| | - Fausto Barbieri
- Dipartimeto di Oncologia Ed Ematologia, AOU Policlinico Modena, Modena, Italy
| | - Miriam G Ferrara
- Comprehensive Cancer Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy; Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Lazio, Italy
| | - Emilio Bria
- Comprehensive Cancer Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy; Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Lazio, Italy
| | - Francesco Grossi
- Division of Medical Oncology, University of Insubria, Varese, Italy
| | - Claudia Bareggi
- Medical Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Rossana Berardi
- Oncology Clinic, Università Politecnica Delle Marche, Ospedali Riuniti Di Ancona, Ancona, Italy
| | - Mariangela Torniai
- Oncology Clinic, Università Politecnica Delle Marche, Ospedali Riuniti Di Ancona, Ancona, Italy
| | - Luca Cantini
- Department of Pulmonary Diseases, Erasmus Medical Center, Rotterdam, the Netherlands; Oncology Clinic, Università Politecnica Delle Marche, Ospedali Riuniti Di Ancona, Ancona, Italy
| | - Vincenzo Sforza
- Thoracic Medical Oncology, Istituto Nazionale Tumori "Fondazione G Pascale", IRCCS, Napoli, Italy
| | - Carlo Genova
- Lung Cancer Unit IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Rita Chiari
- Medical Oncology, Ospedali Riuniti Padova Sud "Madre Teresa Di Calcutta", Monselice, Italy
| | - Danilo Rocco
- Pneumo-Oncology Unit, Monaldi Hospital, Naples, Italy
| | | | - Stefania Gori
- Oncology Unit, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, VR, Italy
| | - Michele De Tursi
- Dipartimento di Terapie Innovative in Medicina e Odontoiatria, Università G. D'Annunzio, Chieti-Pescara, Chieti, Italy
| | | | | | | | | | | | - Marco Russano
- Medical Oncology, Campus Bio-Medico University, Rome, Italy
| | - Francesca Mazzoni
- Department of Oncology, Careggi University Hospital, Florence, Italy
| | - Marina C Garassino
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Alessandro De Toma
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Diego Signorelli
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy; Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alain Gelibter
- Medical Oncology (B), Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Marco Siringo
- Medical Oncology (B), Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Alessandro Follador
- Department of Oncology, University Hospital Santa Maria Della Misericordia, Udine, Italy
| | | | | | - Gabriele Minuti
- Department of Oncology and Hematology, AUSL Romagna, Ravenna, Italy
| | - Lorenza Landi
- Department of Oncology and Hematology, AUSL Romagna, Ravenna, Italy
| | - Serena Ricciardi
- Pneumo-Oncology Unit, St. Camillo-Forlanini Hospital, Rome, Italy
| | | | - Fabrizio Tabbò
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, (TO), Italy
| | - Emanuela Olmetto
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, (TO), Italy
| | - Giulio Metro
- Department of Medical Oncology, Santa Maria Della Misericordia Hospital, Azienda Ospedaliera di Perugia, Perugia, Italy
| | - Vincenzo Adamo
- Medical Oncology, A.O. Papardo & Department of Human Pathology, University of Messina, Italy
| | - Alessandro Russo
- Medical Oncology, A.O. Papardo & Department of Human Pathology, University of Messina, Italy
| | - Gian P Spinelli
- UOC Territorial Oncology of Aprilia, AUSL Latina, University of Rome Sapienza, Aprilia, Italy
| | | | - Alfredo Addeo
- Oncology Department, University Hospital of Geneva, Geneva, Switzerland
| | - Alex Friedlaender
- Oncology Department, University Hospital of Geneva, Geneva, Switzerland
| | - Katia Cannita
- Medical Oncology, St. Salvatore Hospital, L'Aquila, Italy
| | | | - Corrado Ficorella
- Medical Oncology, St. Salvatore Hospital, L'Aquila, Italy; Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - David J Pinato
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK; Department of Translational Medicine, Università del Piemonte Orientale "A. Avogadro", Novara, Italy
| | - Giulia Mazzaschi
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Marcello Tiseo
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy; Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Alessio Cortellini
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy; Division of Cancer, Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK.
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14
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Cortellini A, Di Maio M, Nigro O, Leonetti A, Cortinovis DL, Aerts JG, Guaitoli G, Barbieri F, Giusti R, Ferrara MG, Bria E, D'Argento E, Grossi F, Rijavec E, Guida A, Berardi R, Torniai M, Sforza V, Genova C, Mazzoni F, Garassino MC, De Toma A, Signorelli D, Gelibter A, Siringo M, Marchetti P, Macerelli M, Rastelli F, Chiari R, Rocco D, Della Gravara L, Inno A, Michele DT, Grassadonia A, Di Marino P, Mansueto G, Zoratto F, Filetti M, Santini D, Citarella F, Russano M, Cantini L, Tuzi A, Bordi P, Minuti G, Landi L, Ricciardi S, Migliorino MR, Passiglia F, Bironzo P, Metro G, Adamo V, Russo A, Spinelli GP, Banna GL, Friedlaender A, Addeo A, Cannita K, Ficorella C, Porzio G, Pinato DJ. Differential influence of antibiotic therapy and other medications on oncological outcomes of patients with non-small cell lung cancer treated with first-line pembrolizumab versus cytotoxic chemotherapy. J Immunother Cancer 2021; 9:e002421. [PMID: 33827906 PMCID: PMC8031700 DOI: 10.1136/jitc-2021-002421] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Some concomitant medications including antibiotics (ATB) have been reproducibly associated with worse survival following immune checkpoint inhibitors (ICIs) in unselected patients with non-small cell lung cancer (NSCLC) (according to programmed death-ligand 1 (PD-L1) expression and treatment line). Whether such relationship is causative or associative is matter of debate. METHODS We present the outcomes analysis according to concomitant baseline medications (prior to ICI initiation) with putative immune-modulatory effects in a large cohort of patients with metastatic NSCLC with a PD-L1 expression ≥50%, receiving first-line pembrolizumab monotherapy. We also evaluated a control cohort of patients with metastatic NSCLC treated with first-line chemotherapy. The interaction between key medications and therapeutic modality (pembrolizumab vs chemotherapy) was validated in pooled multivariable analyses. RESULTS 950 and 595 patients were included in the pembrolizumab and chemotherapy cohorts, respectively. Corticosteroid and proton pump inhibitor (PPI) therapy but not ATB therapy was associated with poorer performance status at baseline in both the cohorts. No association with clinical outcomes was found according to baseline statin, aspirin, β-blocker and metformin within the pembrolizumab cohort. On the multivariable analysis, ATB emerged as a strong predictor of worse overall survival (OS) (HR=1.42 (95% CI 1.13 to 1.79); p=0.0024), and progression free survival (PFS) (HR=1.29 (95% CI 1.04 to 1.59); p=0.0192) in the pembrolizumab but not in the chemotherapy cohort. Corticosteroids were associated with shorter PFS (HR=1.69 (95% CI 1.42 to 2.03); p<0.0001), and OS (HR=1.93 (95% CI 1.59 to 2.35); p<0.0001) following pembrolizumab, and shorter PFS (HR=1.30 (95% CI 1.08 to 1.56), p=0.0046) and OS (HR=1.58 (95% CI 1.29 to 1.94), p<0.0001), following chemotherapy. PPIs were associated with worse OS (HR=1.49 (95% CI 1.26 to 1.77); p<0.0001) with pembrolizumab and shorter OS (HR=1.12 (95% CI 1.02 to 1.24), p=0.0139), with chemotherapy. At the pooled analysis, there was a statistically significant interaction with treatment (pembrolizumab vs chemotherapy) for corticosteroids (p=0.0020) and PPIs (p=0.0460) with respect to OS, for corticosteroids (p<0.0001), ATB (p=0.0290), and PPIs (p=0.0487) with respect to PFS, and only corticosteroids (p=0.0033) with respect to objective response rate. CONCLUSION In this study, we validate the significant negative impact of ATB on pembrolizumab monotherapy but not chemotherapy outcomes in NSCLC, producing further evidence about their underlying immune-modulatory effect. Even though the magnitude of the impact of corticosteroids and PPIs is significantly different across the cohorts, their effects might be driven by adverse disease features.
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Affiliation(s)
- Alessio Cortellini
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Biotechnology and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
| | - Massimo Di Maio
- Department of Oncology and Medical Oncology, University of Turin and AO Ordine Mauriziano, Turin, Italy
| | - Olga Nigro
- Medical Oncology, ASST dei Sette Laghi, Varese, Italy
| | | | | | - Joachim Gjv Aerts
- Department of Pulmonary Disease, Erasmus Medical Center, Rotterdam, Netherlands
| | - Giorgia Guaitoli
- Dipartimento di Oncologia ed Ematologia, AOU Policlinico di Modena, Modena, Italy
| | - Fausto Barbieri
- Dipartimento di Oncologia ed Ematologia, AOU Policlinico di Modena, Modena, Italy
| | - Raffaele Giusti
- Medical Oncology Unit, Sant'Andrea Hospital of Rome, Roma, Italy
| | - Miriam G Ferrara
- Comprehensive Cancer Center, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Roma, Italy
- Department of Translational Medicine and Surgery, Universitá Cattolica del Sacro Cuore, Roma, Italy
| | - Emilio Bria
- Comprehensive Cancer Center, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Roma, Italy
- Department of Translational Medicine and Surgery, Universitá Cattolica del Sacro Cuore, Roma, Italy
| | - Ettore D'Argento
- Comprehensive Cancer Center, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Roma, Italy
| | - Francesco Grossi
- Division of Medical Oncology, University of Insubria, Varese, Italy
| | - Erika Rijavec
- Medical Oncology, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Annalisa Guida
- Struttura Complessa di Oncologia Medica e Traslazionale, Azienda Ospedaliera Santa Maria di Terni, Terni, Italy
| | - Rossana Berardi
- Oncology Clinic, Università Politecnica delle Marche, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Mariangela Torniai
- Oncology Clinic, Università Politecnica delle Marche, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Vincenzo Sforza
- Thoracic Medical Oncology, National Cancer Institute IRCCS Pascale Foundation, Napoli, Italy
| | - Carlo Genova
- Lung Cancer Unit, IRCCS Ospedal Policlinico San Martino, Genova, Italy
| | - Francesca Mazzoni
- Department of Medical Oncology, Careggi University Hospital, Firenze, Toscana, Italy
| | | | - Alessandro De Toma
- Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Diego Signorelli
- Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alain Gelibter
- Medical Oncology Unit B, Policlinico Umberto I, Sapienza University of Rome, Roma, Italy
| | - Marco Siringo
- Medical Oncology Unit B, Policlinico Umberto I, Sapienza University of Rome, Roma, Italy
| | - Paolo Marchetti
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Roma, Italy
| | - Marianna Macerelli
- Medical Oncology, University Hospital Santa Maria della Misericordia, Udine, Italy
| | | | - Rita Chiari
- Medical Oncology, Ospedali riuniti Padova Sud "Madre Teresa Di Calcutta", Monselice, Padova, Italy
| | - Danilo Rocco
- Pneumo-Oncology Unit, Ospedali dei Colli Monaldi Cotugno CTO, Napoli, Italy
| | | | - Alessandro Inno
- Oncology Unit, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Italy
| | - De Tursi Michele
- Dipartimento di Terapie Innovative in Medicina ed Odontoiatria, Universitá G. D'Annunzio, Chieti-Pescara, Italy
| | - Antonino Grassadonia
- Dipartimento di Terapie Innovative in Medicina ed Odontoiatria, Universitá G. D'Annunzio, Chieti-Pescara, Italy
| | | | - Giovanni Mansueto
- Medical Oncology, Azienda Sanitaria Locale Frosinone, Frosinone, Italy
| | | | - Marco Filetti
- Medical Oncology Unit, Sant'Andrea Hospital of Rome, Roma, Italy
| | | | | | - Marco Russano
- Medical Oncology, Campus Bio-Medico University, Roma, Italy
| | - Luca Cantini
- Department of Pulmonary Disease, Erasmus Medical Center, Rotterdam, Netherlands
- Oncology Clinic, Università Politecnica delle Marche, Ospedali Riuniti di Ancona, Ancona, Italy
| | | | - Paola Bordi
- Medical Oncology, University Hospital of Parma, Parma, Italy
| | - Gabriele Minuti
- Department of Oncology and Hematology, AUSL della Romagna, Ravenna, Italy
| | - Lorenza Landi
- Department of Oncology and Hematology, AUSL della Romagna, Ravenna, Italy
| | - Serena Ricciardi
- Pneumo-Oncology Unit, San Camillo Forlanini Hospital, Roma, Italy
| | | | - Francesco Passiglia
- Department of Oncology, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Paolo Bironzo
- Department of Oncology, San Luigi Hospital, Orbassano, Italy
| | - Giulio Metro
- Department of Medical Oncology, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Vincenzo Adamo
- Medical Oncology and Department of Human Pathology, Azienda Ospedaliera Papardo and Università degli Studi di Messina, Messina, Italy
| | - Alessandro Russo
- Medical Oncology and Department of Human Pathology, Azienda Ospedaliera Papardo and Università degli Studi di Messina, Messina, Italy
| | - Gian Paolo Spinelli
- UOC Territorial Oncology of Aprilia, AUSL Latina, Sapienza University of Rome, Aprilia, Italy
| | - Giuseppe L Banna
- Medical Oncology, Portsmouth University Hospitals NHS Trust, Portsmouth, UK
| | - Alex Friedlaender
- Oncology Department, University Hospital of Geneva, Geneve, Switzerland
| | - Alfredo Addeo
- Oncology Department, University Hospital of Geneva, Geneve, Switzerland
| | - Katia Cannita
- Medical Oncology, San Salvatore Hospital, L'Aquila, Italy
| | - Corrado Ficorella
- Department of Biotechnology and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
- Medical Oncology, San Salvatore Hospital, L'Aquila, Italy
| | | | - David J Pinato
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Translational Medicine, Universitá del Piemonte Orientale "A. Avogadro", Novara, Italy
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15
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Banna GL, Cortellini A, Cortinovis DL, Tiseo M, Aerts JGJV, Barbieri F, Giusti R, Bria E, Grossi F, Pizzutilo P, Berardi R, Morabito A, Genova C, Mazzoni F, Di Noia V, Signorelli D, Gelibter A, Macerelli M, Rastelli F, Chiari R, Rocco D, Gori S, De Tursi M, Di Marino P, Mansueto G, Zoratto F, Filetti M, Montrone M, Citarella F, Marco R, Cantini L, Nigro O, D'Argento E, Buti S, Minuti G, Landi L, Guaitoli G, Lo Russo G, De Toma A, Donisi C, Friedlaender A, De Giglio A, Metro G, Porzio G, Ficorella C, Addeo A. The lung immuno-oncology prognostic score (LIPS-3): a prognostic classification of patients receiving first-line pembrolizumab for PD-L1 ≥ 50% advanced non-small-cell lung cancer. ESMO Open 2021; 6:100078. [PMID: 33735802 PMCID: PMC7988288 DOI: 10.1016/j.esmoop.2021.100078] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 01/26/2021] [Accepted: 02/02/2021] [Indexed: 12/30/2022] Open
Abstract
Background To stratify the prognosis of patients with programmed cell death-ligand 1 (PD-L1) ≥ 50% advanced non-small-cell lung cancer (aNSCLC) treated with first-line immunotherapy. Methods Baseline clinical prognostic factors, the neutrophil-to-lymphocyte ratio (NLR), PD-L1 tumour cell expression level, lactate dehydrogenase (LDH) and their combination were investigated by a retrospective analysis of 784 patients divided between statistically powered training (n = 201) and validation (n = 583) cohorts. Cut-offs were explored by receiver operating characteristic (ROC) curves and a risk model built with validated independent factors by multivariate analysis. Results NLR < 4 was a significant prognostic factor in both cohorts (P < 0.001). It represented 53% of patients in the validation cohort, with 1-year overall survival (OS) of 76.6% versus 44.8% with NLR > 4, in the validation series. The addition of PD-L1 ≥ 80% (21% of patients) or LDH < 252 U/l (25%) to NLR < 4 did not result in better 1-year OS (of 72.6% and 74.1%, respectively, in the validation cohort). Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 2 [P < 0.001, hazard ratio (HR) 2.04], pretreatment steroids (P < 0.001, HR 1.67) and NLR < 4 (P < 0.001, HR 2.29) resulted in independent prognostic factors. A risk model with these three factors, namely, the lung immuno-oncology prognostic score (LIPS)-3, accurately stratified three OS risk-validated categories of patients: favourable (0 risk factors, 40%, 1-year OS of 78.2% in the whole series), intermediate (1 or 2 risk factors, 54%, 1-year OS 53.8%) and poor (>2 risk factors, 5%, 1-year OS 10.7%) prognosis. Conclusions We advocate the use of LIPS-3 as an easy-to-assess and inexpensive adjuvant prognostic tool for patients with PD-L1 ≥ 50% aNSCLC. Immunotherapy/chemoimmunotherapy combinations are currently not superior to immunotherapy alone for high PD-L1 aNSCLC. NLR with a cut-off of 4 was validated as an independent prognostic factor for immunotherapy in high PD-L1 aNSCLC. The addition of either PD-L1 ≥ 80% or LDH < 252 U/l to NLR < 4 did not result in better prognostic stratification. The LIPS-3 is a validated 3-class prognostic classification based on the NLR, ECOG PS and pretreatment steroids. The LIPS-3 is a routinely assessable adjuvant prognostic tool for high PD-L1 aNSCLC patients.
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Affiliation(s)
- G L Banna
- Oncology Department, Portsmouth University Hospitals NHS Trust, Portsmouth, UK
| | - A Cortellini
- Department of Surgery and Cancer, Imperial College London, London, UK; Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
| | | | - M Tiseo
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy; Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - J G J V Aerts
- Department of Pulmonary Diseases, Erasmus Medical Center, Rotterdam, the Netherlands
| | - F Barbieri
- Department of Oncology and Hematology, Modena University Hospital, Modena, Italy
| | - R Giusti
- Medical Oncology, St. Andrea Hospital, Rome, Italy
| | - E Bria
- Comprehensive Cancer Center, Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Rome, Italy; Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - F Grossi
- Medical Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - P Pizzutilo
- Thoracic Oncology Unit, Clinical Cancer Center IRCCS Istituto Temorid 'Giovanni Paolo II', Bari, Italy
| | - R Berardi
- Oncology Clinic, Università Politecnica Delle Marche, Ospedali Riuniti Di Ancona, Ancona, Italy
| | - A Morabito
- Thoracic Medical Oncology, Istituto Nazionale Tumori 'Fondazione G Pascale', IRCCS, Napoli, Italy
| | - C Genova
- Lung Cancer Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - F Mazzoni
- Department of Oncology, Careggi University Hospital, Florence, Italy
| | - V Di Noia
- Medical Oncology, University Hospital of Foggia, Foggia, Italy
| | - D Signorelli
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - A Gelibter
- Medical Oncology (B), Policlinico Umberto I, 'Sapienza' University of Rome, Rome, Italy
| | - M Macerelli
- Department of Oncology, University Hospital Santa Maria Della Misericordia, Udine, Italy
| | - F Rastelli
- Medical Oncology, Fermo Area Vasta 4, Fermo, Italy
| | - R Chiari
- Medical Oncology, Ospedali Riuniti Padova Sud 'Madre Teresa Di Calcutta', Monselice, Italy
| | - D Rocco
- Pneumo-Oncology Unit, Monaldi Hospital, Naples, Italy
| | - S Gori
- Oncology Unit, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella VR, Italy
| | - M De Tursi
- Department of Medical, Oral & Biotechnological Sciences University G. D'Annunzio, Chieti-Pescara, Chieti, Italy
| | - P Di Marino
- Clinical Oncology Unit, S.S. Annunziata Hospital, Chieti, Italy
| | - G Mansueto
- Medical Oncology, F. Spaziani Hospital, Frosinone, Italy
| | - F Zoratto
- Medical Oncology, Santa Maria Goretti Hospital, Latina, Italy
| | - M Filetti
- Medical Oncology, St. Andrea Hospital, Rome, Italy
| | - M Montrone
- Thoracic Oncology Unit, Clinical Cancer Center IRCCS Istituto Temorid 'Giovanni Paolo II', Bari, Italy
| | - F Citarella
- Medical Oncology, Campus Bio-Medico University, Rome, Italy
| | - R Marco
- Medical Oncology, Campus Bio-Medico University, Rome, Italy
| | - L Cantini
- Department of Pulmonary Diseases, Erasmus Medical Center, Rotterdam, the Netherlands; Oncology Clinic, Università Politecnica Delle Marche, Ospedali Riuniti Di Ancona, Ancona, Italy
| | - O Nigro
- Medical Oncology, ASST-Sette Laghi, Varese, Italy
| | - E D'Argento
- Comprehensive Cancer Center, Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Rome, Italy
| | - S Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - G Minuti
- Department of Oncology and Hematology, AUSL Romagna, Ravenna, Italy
| | - L Landi
- Department of Oncology and Hematology, AUSL Romagna, Ravenna, Italy
| | - G Guaitoli
- Department of Oncology and Hematology, Modena University Hospital, Modena, Italy
| | - G Lo Russo
- Medical Oncology (B), Policlinico Umberto I, 'Sapienza' University of Rome, Rome, Italy
| | - A De Toma
- Medical Oncology (B), Policlinico Umberto I, 'Sapienza' University of Rome, Rome, Italy
| | - C Donisi
- Medical Oncology Unit, University Hospital and University of Cagliari, Cagliari, Italy
| | - A Friedlaender
- Oncology Department, University Hospital of Geneva, Geneva, Switzerland
| | - A De Giglio
- Division of Medical Oncology, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - G Metro
- Department of Medical Oncology, Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia, Perugia, Italy
| | - G Porzio
- Medical Oncology, St. Salvatore Hospital, L'Aquila, Italy
| | - C Ficorella
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy; Medical Oncology, St. Salvatore Hospital, L'Aquila, Italy
| | - A Addeo
- Oncology Department, University Hospital of Geneva, Geneva, Switzerland
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16
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Baldessari C, Guaitoli G, Valoriani F, Bonacini R, Marcheselli R, Reverberi L, Pecchi A, Menozzi R, Torricelli P, Bertolini F, Barbieri F, Dominici M. Impact of body composition, nutritional and inflammatory status on outcome of non-small cell lung cancer patients treated with immunotherapy. Clin Nutr ESPEN 2021; 43:64-75. [PMID: 34024567 DOI: 10.1016/j.clnesp.2021.02.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 02/21/2021] [Accepted: 02/22/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND AIMS Body composition and balance of nutritional and inflammatory status are important for the immune system. Alterations of these aspects may impact on response, outcome and toxicities of immunotherapy. In this review we try to clarify some definitions and tools used for the assessment of the different aspects of nutritional disorders, body composition and inflammatory status with a focus on lung cancer. METHODS We primary investigate the definitions of malnutrition, cachexia, sarcopenia and overweight. Secondary, tools used to measure body composition, nutritional and inflammatory status, mainly in lung cancer are reviewed. RESULTS All these features, in the time of precision medicine may improve assessment and selection of patients, incorporating also early palliative care in standard therapy. CONCLUSIONS A multimodal approach based on nutrition assessment and physical exercise should be evaluated to improve aspects of the immune response against cancer and to propose the best treatment to every patient.
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Affiliation(s)
- Cinzia Baldessari
- Department of Oncology and Hematology, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria of Modena, Italy.
| | - Giorgia Guaitoli
- Department of Oncology and Hematology, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria of Modena, Italy
| | - Filippo Valoriani
- Unit of Metabolic Disorder and Clinical Nutrition, Department of Specialist Medicines, Azienda Ospedaliero Universitaria of Modena, Italy
| | - Riccardo Bonacini
- Department of Radiology, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria of Modena, Italy
| | - Raffaella Marcheselli
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Linda Reverberi
- Unit of Metabolic Disorder and Clinical Nutrition, Department of Specialist Medicines, Azienda Ospedaliero Universitaria of Modena, Italy
| | - Annarita Pecchi
- Department of Radiology, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria of Modena, Italy
| | - Renata Menozzi
- Unit of Metabolic Disorder and Clinical Nutrition, Department of Specialist Medicines, Azienda Ospedaliero Universitaria of Modena, Italy
| | - Pietro Torricelli
- Department of Radiology, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria of Modena, Italy
| | - Federica Bertolini
- Department of Oncology and Hematology, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria of Modena, Italy
| | - Fausto Barbieri
- Department of Oncology and Hematology, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria of Modena, Italy
| | - Massimo Dominici
- Department of Oncology and Hematology, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria of Modena, Italy
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17
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Schnabl D, Schanner LL, Barbieri F, Laimer J, Bruckmoser E, Steiner R, Grunert I. Is dental general anaesthesia in children an outdated concept? A retrospective analysis. Eur J Paediatr Dent 2020; 21:283-286. [PMID: 33337903 DOI: 10.23804/ejpd.2020.21.04.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIM The aim of this retrospective study was to determine the prevalence of caries and treatment needs in the collective of patients ?16 years of age, who underwent scheduled dental general anaesthesia (DGA) at the University Clinic of Innsbruck from January 2015 to June 2019, with respect to demographic factors. MATERIALS AND METHODS A retrospective analysis of children's diagnoses, demographics, and dental treatment under general anaesthesia in Innsbruck, Austria, from 2015 to 2019 was performed. Anonymised demographic data (age; gender; the presence or absence of general disease or disablement; parents' first language (German- (GS) or non-German-speaking (non-GS), reflecting ethnicity; and the number of teeth restored and extracted under DGA were collected from patients' files. Data was analysed by means of descriptive and comparative statistics. RESULTS The main group consisted of 545 subjects at a median age of 5.3 (IQR 4.4-6.6) years, who had exclusively primary teeth and or first molars that received restorations or were extracted. Of the subjects, 84.4% were classified with uncooperativeness due to dental anxiety and 15.6% with systemic diseases or intellectual and or physical disablement. In this group, 47.9% were GS and 52.1% were non-GS or had GS or non- GS parents. In the total sample, 5 (IQR 3-7) primary teeth were restored and 4 (IQR 4-7) extracted. Subgroup analysis revealed statistically significant differences in the number of extracted primary teeth between children with and without systemic diseases or disablement - 3 (IQR 1-5) versus 4 (IQR 2-7) - and between children of GS and non-GS parents - 4 (IQR 2-6) versus 5 (IQR 3-7.8). Zero (IQR 0-0) first molars were filled and extracted. CONCLUSION Within the study collective of children in poor oral health, the offspring of non-GS families were overrepresented (compared to their prevalence in the total population) and displayed a higher prevalence of deep caries than those of GS parents. By intensifying and special gearing of prophylactic measures to the non-GS population and promoting the parents' insight into the importance of oral hygiene and regular dental attendance, the demand for scheduled DGA might be greatly reduced. In the small share of children who suffer from severe diseases or disablement and are thus unable to cooperate with home care or dental treatment, DGA will remain the treatment of choice.
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Affiliation(s)
- D Schnabl
- Department of Operative and Prosthetic Dentistry, Medical University of Innsbruck, Innsbruck, Austria
| | - L L Schanner
- Department of Operative and Prosthetic Dentistry, Medical University of Innsbruck, Innsbruck, Austria
| | - F Barbieri
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - J Laimer
- Department of Operative and Prosthetic Dentistry, Medical University of Innsbruck, Innsbruck, Austria
| | - E Bruckmoser
- Private Practice for Oral and Maxillofacial Surgery, Salzburg, Austria
| | - R Steiner
- Department of Operative and Prosthetic Dentistry, Medical University of Innsbruck, Innsbruck, Austria
| | - I Grunert
- Department of Operative and Prosthetic Dentistry, Medical University of Innsbruck, Innsbruck, Austria
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18
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Guaitoli G, Barbieri F, Barbolini M, Molinaro E, Emidio KD, Borghi V, Dominici M, Bertolini F. Pembrolizumab rechallenge in squamous non-small-cell lung cancer and HIV-positivity: a case report. Immunotherapy 2020; 13:277-281. [PMID: 33249929 DOI: 10.2217/imt-2020-0180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Immune checkpoint inhibitors (ICIs) changed management of non-small-cell lung cancer, but resistance usually develops. Today, at ICIs failure, chemotherapy is the treatment of choice, but the chance of immunotherapy rechallenge is appealing. Another challenging issue is whether it is safe to treat HIV-positive patients with ICIs: safety and efficacy of immunotherapy have been marginally considered in this subgroup. We report the case of a non-small-cell lung cancer patient treated by PD-1 inhibitors rechallenge despite his HIV-positivity, achieving good partial response with significant clinical benefit and without toxicities. Our experience underlines that HIV-positive patients can be treated similarly to HIV-negative individuals. HIV-positivity should be considered similar to other comorbidities, and not as a sufficient reason to preclude them the best available treatments.
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Affiliation(s)
- Giorgia Guaitoli
- Department of Oncology & Hematology, Modena University Hospital, University of Modena & Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy
| | - Fausto Barbieri
- Department of Oncology & Hematology, Modena University Hospital, Via del Pozzo 71, 41124 Modena, Italy
| | - Monica Barbolini
- Department of Oncology & Hematology, Modena University Hospital, Via del Pozzo 71, 41124 Modena, Italy
| | - Eleonora Molinaro
- Department of Oncology & Hematology, Modena University Hospital, University of Modena & Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy
| | - Katia Di Emidio
- Department of Oncology & Hematology, Modena University Hospital, Via del Pozzo 71, 41124 Modena, Italy
| | - Vanni Borghi
- Clinic of Infectious Diseases, Modena University Hospital, University of Modena & Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy
| | - Massimo Dominici
- Department of Oncology & Hematology, Modena University Hospital, University of Modena & Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy
| | - Federica Bertolini
- Department of Oncology & Hematology, Modena University Hospital, Via del Pozzo 71, 41124 Modena, Italy
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19
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Bersanelli M, Giannarelli D, De Giorgi U, Pignata S, Di Maio M, Verzoni E, Clemente A, Guadalupi V, Signorelli D, Tiseo M, Giusti R, Filetti M, Di Napoli M, Calvetti L, Cappetta A, Ermacora P, Zara D, Barbieri F, Baldessari C, Scotti V, Mazzoni F, Veccia A, Guglielmini PF, Maruzzo M, Rossi E, Grossi F, Casadei C, Cortellini A, Verderame F, Montesarchio V, Rizzo M, Mencoboni M, Zustovich F, Fratino L, Cinieri S, Negrini G, Banzi M, Sorarù M, Zucali PA, Lacidogna G, Russo A, Battelli N, Fornarini G, Mucciarini C, Bracarda S, Bonetti A, Pezzuolo D, Longo L, Sartori D, Iannopollo M, Cavanna L, Meriggi F, Tassinari D, Corbo C, Gernone A, Prati V, Carnio S, Giordano P, Dicorato AM, Verusio C, Atzori F, Carrozza F, Gori S, Castro A, Pilotto S, Vaccaro V, Garzoli E, Di Costanzo F, Maiello E, Labianca R, Pinto C, Tognetto M, Buti S. Symptomatic COVID-19 in advanced-cancer patients treated with immune-checkpoint inhibitors: prospective analysis from a multicentre observational trial by FICOG. Ther Adv Med Oncol 2020; 12:1758835920968463. [PMID: 33224275 PMCID: PMC7649863 DOI: 10.1177/1758835920968463] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/02/2020] [Indexed: 12/30/2022] Open
Abstract
Background This prospective, multicentre, observational INVIDIa-2 study is investigating the clinical efficacy of influenza vaccination in advanced-cancer patients receiving immune-checkpoint inhibitors (ICIs), enrolled in 82 Italian centres, from October 2019 to January 2020. The primary endpoint was the incidence of influenza-like illness (ILI) until 30 April 2020. All the ILI episodes, laboratory tests, complications, hospitalizations and pneumonitis were recorded. Therefore, the study prospectively recorded all the COVID-19 ILI events. Patients and methods Patients were included in this non-prespecified COVID-19 analysis, if alive on 31 January 2020, when the Italian government declared the national emergency. The prevalence of confirmed COVID-19 cases was detected as ILI episode with laboratory confirmation of SARS-CoV-2. Cases with clinical-radiological diagnosis of COVID-19 (COVID-like ILIs), were also reported. Results Out of 1257 enrolled patients, 955 matched the inclusion criteria for this unplanned analysis. From 31 January to 30 April 2020, 66 patients had ILI: 9 of 955 cases were confirmed COVID-19 ILIs, with prevalence of 0.9% [95% confidence interval (CI): 0.3-2.4], a hospitalization rate of 100% and a mortality rate of 77.8%. Including 5 COVID-like ILIs, the overall COVID-19 prevalence was 1.5% (95% CI: 0.5-3.1), with 100% hospitalization and 64% mortality. The presence of elderly, males and comorbidities was significantly higher among patients vaccinated against influenza versus unvaccinated (p = 0.009, p < 0.0001, p < 0.0001). Overall COVID-19 prevalence was 1.2% for vaccinated (six of 482 cases, all confirmed) and 1.7% for unvaccinated (8 of 473, 3 confirmed COVID-19 and 5 COVID-like), p = 0.52. The difference remained non-significant, considering confirmed COVID-19 only (p = 0.33). Conclusion COVID-19 has a meaningful clinical impact on the cancer-patient population receiving ICIs, with high prevalence, hospitalization and an alarming mortality rate among symptomatic cases. Influenza vaccination does not protect from SARS-CoV-2 infection.
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Affiliation(s)
- Melissa Bersanelli
- Medicine and Surgery Department, University of Parma, and Medical Oncology Unit, University Hospital of Parma, Via Gramsci 14, Parma 43126, Italy
| | - Diana Giannarelli
- Biostatistical Unit, Regina Elena National Cancer Institute, IRCCS, Rome, Lazio, Italy
| | - Ugo De Giorgi
- Istituto Scientifico Romagnolo per lo Studio e la Cura de Tumori (IRST) IRCCS, Meldola, Italy
| | - Sandro Pignata
- Dipartimento Corp-S Assistenziale dei Percorsi Oncologici Uro-Genitale, SSD Oncologia Clinica Sperimentale Uro-Andrologica, Istituto Nazionale Tumori 'Fondazione G. Pascale', IRCCS, Napoli, Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin and Medical Oncology, AO Ordine Mauriziano, Turin, Italy
| | - Elena Verzoni
- SS Oncologia Genitourinaria, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Alberto Clemente
- Biostatistics and Clinical Research Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Valentina Guadalupi
- SS Oncologia Genitourinaria, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Diego Signorelli
- Thoracic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori of Milan, Milano, Italy
| | - Marcello Tiseo
- Medicine and Surgery Department, University of Parma, Parma, Italy
| | - Raffaele Giusti
- Medical Oncology Unit, Azienda Ospedaliero-Universitaria Sant'Andrea, Roma, Italy
| | - Marco Filetti
- Medical Oncology Unit, Azienda Ospedaliero-Universitaria Sant'Andrea - Sapienza Facoltà di Medicina e Psicologia, Roma, Italy
| | - Marilena Di Napoli
- Dipartimento Corp-S Assistenziale dei Percorsi Oncologici Uro-Genitale, SSD Oncologia Clinica Sperimentale Uro-Andrologica, Istituto Nazionale Tumori 'Fondazione G. Pascale', IRCCS, Napoli, Italy
| | - Lorenzo Calvetti
- Department of Oncology, San Bortolo General Hospital, Unità Locale Socio-Sanitaria (ULSS) 8 Berica-East District, Vicenza, Italy
| | - Alessandro Cappetta
- Department of Oncology, San Bortolo General Hospital, Unità Locale Socio-Sanitaria (ULSS) 8 Berica-East District, Vicenza, Italy
| | - Paola Ermacora
- Dipartimento di Oncologia, Presidio Ospedaliero Universitario Santa Maria della Misericordia, Azienda sanitaria universitaria integrata Friuli Centrale, Udine, Italy
| | - Diego Zara
- Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Fausto Barbieri
- Medical Oncology Unit, University Hospital of Modena, Modena, Italy
| | | | - Vieri Scotti
- Oncology Department, Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | | | | | | | - Marco Maruzzo
- Oncologia Medica 1, Istituto Oncologico Veneto IOV-IRCCS, Padova
| | - Ernesto Rossi
- Medical Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Francesco Grossi
- Department of Medical Oncology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Chiara Casadei
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Alessio Cortellini
- Department of Biotechnological and Applied Clinical Sciences, St. Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | | | - Vincenzo Montesarchio
- UOC Oncologia, Ospedale Monaldi, Azienda Ospedaliera Specialistica dei Colli, Napoli, Italy
| | - Mimma Rizzo
- Oncologia Traslazionale, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | | | - Fable Zustovich
- UOC Oncologia di Belluno, Dipartimento di Oncologia Clinica, AULSS 1 Dolomiti, Ospedale S. Martino, Belluno, Italy
| | - Lucia Fratino
- Dipartimento di Oncologia Medica, Centro di Riferimento Oncologico di Aviano, Pordenone, Italy
| | - Saverio Cinieri
- Medical Oncology Division and Breast Unit, Senatore Antonio Perrino Hospital, ASL Brindisi, Brindisi, Italy
| | - Giorgia Negrini
- Oncologia Medica, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Maria Banzi
- Medical Oncology Unit, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Mariella Sorarù
- Medical Oncology, Camposampiero Hospital, USSL15 Alta Padovana, Padova, Italy
| | - Paolo Andrea Zucali
- Department of Oncology, Humanitas Clinical and Research Centre, IRCCS, Rozzano, Milan, Italy, and Humanitas University, Department of Biomedical Sciences, Milan, Italy
| | | | - Antonio Russo
- Dipartimento di Discipline Chirurgiche, Oncologiche e Stomatologiche, Università degli Studi di Palermo, Palermo, Italy
| | - Nicola Battelli
- UOC Oncologia, Ospedale Generale Provinciale di Macerata, ASUR Marche Area Vasta 3, Macerata, Italy
| | - Giuseppe Fornarini
- Medical Oncology Unit 1, IRCCS Policlinico San Martino Hospital, Genova, Italy
| | | | - Sergio Bracarda
- Struttura Complessa di Oncologia Medica e Traslazionale, Azienda Ospedaliera Santa Maria di Terni, Italy
| | - Andrea Bonetti
- Department of Oncology, Mater Salutis Hospital, Legnago, Verona
| | - Debora Pezzuolo
- Medicina oncologica, Ospedale di Guastalla e Correggio, Area Nord, Reggio Emilia, Italy
| | - Lucia Longo
- Unità operativa di Oncologia, Ospedale di Sassuolo, Area Sud dell'Azienda USL di Modena, Sassuolo, Modena, Italy
| | - Donata Sartori
- Oncologia Dolo-Mirano, AULSS3 Serenissima, Mestre, Venezia, Italy
| | - Mauro Iannopollo
- Medical Oncology Unit, Dip. Oncology, St Jacopo Hospital, Azienda USL Toscana Centro, Pistoia, Italy
| | | | - Fausto Meriggi
- Oncologia Medica, Fondazione Poliambulanza, Istituto Ospedaliero, Brescia, Italy
| | | | - Claudia Corbo
- UO di Oncologia, Ospedale Sacro Cuore di Gesù, Fatebenefratelli, Benevento, Italy
| | - Angela Gernone
- UO Oncologia Medica Universitaria, Azienda Ospedaliera Policlinico di Bari, Bari, Italy
| | | | - Simona Carnio
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Italy
| | | | | | - Claudio Verusio
- Oncologia Medica, Presidio Ospedaliero di Saronno, Saronno, Italy
| | - Francesco Atzori
- Medical Oncology, Department of Medical Sciences 'M. Aresu', University Hospital and University of Cagliari, Cagliari, Italy
| | - Francesco Carrozza
- Unità Operativa di Oncologia di Faenza, AUSL Romagna, Faenza, Ravenna, Italy
| | - Stefania Gori
- Medical Oncology Unit, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Antonino Castro
- Struttura semplice dipartimentale di Oncologia, ASST Franciacorta, Chiari, Brescia, Italy
| | - Sara Pilotto
- Section of Oncology, Department of Medicine, University of Verona and Verona University Hospital Trust, Verona, Italy
| | - Vanja Vaccaro
- Oncology Unit 1, Regina Elena National Cancer Institute, IRCCS, Rome, Italy
| | | | | | - Evaristo Maiello
- Medical Oncology, Foundation IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | | | - Carmine Pinto
- Medical Oncology Unit, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | | | - Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
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20
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Barbieri F, Senoner T, Adukauskaite A, Lambert T, Zweiker D, Rainer P, Schmidt A, Feuchtner G, Steinwender C, Hoppe U, Hintringer F, Bauer A, Mueller S, Grimm M, Dichtl W. The prognostic value of preprocedural high-sensitivity troponin T in patients with severe aortic stenosis undergoing valve replacement: a gender analysis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1984] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Recent studies have demonstrated the predictive value of preprocedural cardiac biomarkers, such as N-terminal pro brain natriuretic peptide (NT-proBNP) and high-sensitivity troponin T (hsTnT), in patients with severe aortic valve stenosis undergoing valve replacement. Nonetheless, it remains still unclear whether hsTnT may be influenced by gender-specific differences.
Purpose
The aim of this subanalysis was to evaluate sex-related differences of preprocedural hsTnT in predicting postoperative long-term survival in a large cohort undergoing either surgical or transcatheter aortic valve replacement.
Methods
The TASS-2 group, a consortium of four university hospital centers, analysed 3595 consecutively enrolled patients admitted for valve implantation because of severe aortic stenosis between 2007 and 2017.
Results
The study cohort consisted of 1728 (48.1%) female and 1867 (51.9%) male patients. During a median follow-up of 2.9 years, cardiovascular mortality was found in 556 (15.5%) patients, amongst whom were 292 (16.9%) women and 264 (14.1%) men. All-cause mortality was detected in 919 (25.6%) patients dividing into 462 (26.7%) women and 457 (24.5%) men.
Preprocedural hsTnT was significantly higher (p<0.001) in male (19 ng/l, 11.8–34.0) than in female (16 ng/l, 10.0–30.0) patients. In contrary, NT-proBNP was lower (p=0.002) in male (1286 ng/l, 444.5–3225.5) than female (1407 ng/l, 604.5–3217.5) patients. For the univariate analysis of survival, hsTnT was categorized by using predefined subgroups (<5 ng/l; 5–13.99 ng/l; 14–50 ng/l; >50 ng/l). Cardiovascular and all-cause mortality were significantly increased with higher hsTnT plasma levels in women (p<0.001) as well as in men (<0.001).
In two separate multivariate cox regression models, one for either gender - adjusting for STS risk score, NT-proBNP plasma levels, degree of left ventricular systolic dysfunction, atrial fibrillation, age, renal function, chronic obstructive pneumonic disease, arterial hypertension, diabetes mellitus, concomitant significant coronary artery disease and type of procedure – pre-procedural hsTnT was a strong independent predictor for postoperative cardiovascular mortality with an hazard ratio [HR] of 3.34, 95% confidence interval [CI] 1.03–10.80, P=0.044 for mildly to moderately elevated hsTnT (14–50 ng/l) and an HR of 3.98, CI 1.19–13.30, P=0.025 for severely elevated hsTnT (>50 ng/l) in women, whereas an hazard ratio [HR] 4.09, 95% confidence interval [CI] 0.55–29.99, P=0.166 for mildly to moderately elevated hsTnT (14–50 ng/l) and an HR 7.48, CI 0.99–56.12, P=0.050 for severely elevated hsTnT (>50 ng/l) in men was yielded.
Conclusion
Long-term postoperative survival in patients with severe AS admitted for valve implantation was independently predicted by hsTnT, irrespective of gender.
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Tiroler Wissenschaftsförderung (Innsbruck, Austria)
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Affiliation(s)
- F Barbieri
- Innsbruck Medical University, Department of cardiology and angiology, Innsbruck, Austria
| | - T Senoner
- Innsbruck Medical University, Department of cardiology and angiology, Innsbruck, Austria
| | - A Adukauskaite
- Innsbruck Medical University, Department of cardiology and angiology, Innsbruck, Austria
| | - T Lambert
- Kepler University Hospital Linz, Department of cardiology, Linz, Austria
| | - D Zweiker
- Medical University of Graz, Department of Internal Medicine, Division of Cardiology, Graz, Austria
| | - P Rainer
- Medical University of Graz, Department of Internal Medicine, Division of Cardiology, Graz, Austria
| | - A Schmidt
- Medical University of Graz, Department of Internal Medicine, Division of Cardiology, Graz, Austria
| | - G Feuchtner
- Innsbruck Medical University, University Clinic of Radiology, Innsbruck, Austria
| | - C Steinwender
- Kepler University Hospital Linz, Department of cardiology, Linz, Austria
| | - U Hoppe
- Universitaetsklinikum Salzburg, University Clinic of Internal Medicine II, Salzburg, Austria
| | - F Hintringer
- Innsbruck Medical University, Department of cardiology and angiology, Innsbruck, Austria
| | - A Bauer
- Innsbruck Medical University, Department of cardiology and angiology, Innsbruck, Austria
| | - S Mueller
- Innsbruck Medical University, Department of cardiology and angiology, Innsbruck, Austria
| | - M Grimm
- Innsbruck Medical University, University Clinic of Heart Surgery, Innsbruck, Austria
| | - W Dichtl
- Innsbruck Medical University, Department of cardiology and angiology, Innsbruck, Austria
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21
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Cortellini A, Ricciuti B, Tiseo M, Bria E, Banna GL, Aerts JG, Barbieri F, Giusti R, Cortinovis DL, Migliorino MR, Catino A, Passiglia F, Torniai M, Morabito A, Genova C, Mazzoni F, Di Noia V, Signorelli D, Gelibter A, Occhipinti MA, Rastelli F, Chiari R, Rocco D, Inno A, De Tursi M, Di Marino P, Mansueto G, Zoratto F, Grossi F, Filetti M, Pizzutilo P, Russano M, Citarella F, Cantini L, Targato G, Nigro O, Ferrara MG, Buti S, Scodes S, Landi L, Guaitoli G, Della Gravara L, Tabbò F, Ricciardi S, De Toma A, Friedlaender A, Petrelli F, Addeo A, Porzio G, Ficorella C. Baseline BMI and BMI variation during first line pembrolizumab in NSCLC patients with a PD-L1 expression ≥ 50%: a multicenter study with external validation. J Immunother Cancer 2020; 8:jitc-2020-001403. [PMID: 33077515 PMCID: PMC7574933 DOI: 10.1136/jitc-2020-001403] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The association between obesity and outcomes in patients receiving programmed death-1/programmed death ligand-1 (PD-L1) checkpoint inhibitors has already been confirmed in pre-treated non-small cell lung cancer (NSCLC) patients, regardless of PD-L1 tumor expression. METHODS We present the outcomes analysis according to baseline body mass index (BMI) and BMI variation in a large cohort of metastatic NSCLC patients with a PD-L1 expression ≥50%, receiving first line pembrolizumab. We also evaluated a control cohort of metastatic NSCLC patients treated with first line platinum-based chemotherapy. Normal weight was set as control group. RESULTS 962 patients and 426 patients were included in the pembrolizumab and chemotherapy cohorts, respectively. Obese patients had a significantly higher objective response rate (ORR) (OR=1.61 (95% CI: 1.04-2.50)) in the pembrolizumab cohort, while overweight patients had a significantly lower ORR (OR=0.59 (95% CI: 0.37-0.92)) within the chemotherapy cohort. Obese patients had a significantly longer progression-free survival (PFS) (HR=0.61 (95% CI: 0.45-0.82)) in the pembrolizumab cohort. Conversely, they had a significantly shorter PFS in the chemotherapy cohort (HR=1.27 (95% CI: 1.01-1.60)). Obese patients had a significantly longer overall survival (OS) within the pembrolizumab cohort (HR=0.70 (95% CI: 0.49-0.99)), while no significant differences according to baseline BMI were found in the chemotherapy cohort. BMI variation significantly affected ORR, PFS and OS in both the pembrolizumab and the chemotherapy cohorts. CONCLUSIONS Baseline obesity is associated to significantly improved ORR, PFS and OS in metastatic NSCLC patients with a PD-L1 expression of ≥50%, receiving first line pembrolizumab, but not among patients treated with chemotherapy. BMI variation is also significantly related to clinical outcomes.
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Affiliation(s)
- Alessio Cortellini
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy .,Medical Oncology, St. Salvatore Hospital, L'Aquila, Italy
| | - Biagio Ricciuti
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA.,Medical Oncology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Marcello Tiseo
- Medical Oncology, University Hospital of Parma, Parma, Emilia-Romagna, Italy.,Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Emilio Bria
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Romae, Lazio, Italy.,Comprehensive Cancer Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Giuseppe L Banna
- Oncology Department, Queen Alexandra University Hospital, Portsmouth Hospitals NHS Trust, Portsmuth, UK
| | - Joachim Gjv Aerts
- Department of Pulmonary Diseases, Erasmus Medical Center, Rotterdam, Zuid-Holland, Netherlands
| | - Fausto Barbieri
- Department of Oncology and Hematology, University Hospital Modena, Modena, Emilia-Romagna, Italy
| | - Raffaele Giusti
- Medical Oncology Unit, Sant'Andrea Hospital, Roma, Lazio, Italy
| | - Diego L Cortinovis
- Medical Oncology, Azienda Ospedaliera San Gerardo, Monza, Lombardia, Italy
| | - Maria R Migliorino
- Pneumo-Oncology Unit, San Camillo Forlanini Hospital, Roma, Lazio, Italy
| | - Annamaria Catino
- Thoracic Oncology Unit, Clinical Cancer Center IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Puglia, Italy
| | - Francesco Passiglia
- Department of Oncology, University of Turin, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Mariangela Torniai
- Oncology Clinic, Università Politecnica delle Marche, Ospedali Riuniti di Ancona, Ancona, Marche, Italy
| | - Alessandro Morabito
- Thoracic Medical Oncology, Istituto Nazionale Tumori "Fondazione G Pascale" IRCCS, Napoli, Campania, Italy
| | - Carlo Genova
- Lung Cancer Unit, IRCCS Ospedale Policlinnico San Martino, Genova, Liguria, Italy
| | - Francesca Mazzoni
- Medical Oncology, University Hospital Careggi, Firenze, Toscana, Italy
| | - Vincenzo Di Noia
- Oncologia Medica e Terapia Biomolecolare, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Foggia, Foggia, Puglia, Italy
| | - Diego Signorelli
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Lombardia, Italy
| | - Alain Gelibter
- Medical Oncology Unit B, Policlinico Umberto I, Sapienza University of Rome, Roma, Lazio, Italy
| | | | | | - Rita Chiari
- Medical Oncology, Ospedali Riuniti Padova Sud "Madre Teresa di Calcutta", Monselice, Veneto, Italy
| | - Danilo Rocco
- Pneumo-Oncology Unit, Ospedali dei Colli Monaldi Cotugno CTO, Napoli, Campania, Italy
| | - Alessandro Inno
- Oncology Unit, IRCCS Ospedale Sacro Cuore don Calabria, Negrar, Veneto, Italy
| | - Michele De Tursi
- Department of Medical, Oral and Biotechnological Sciences, University G. D'Annunzio Chieti-Pescara, Chieti, CH, Italy
| | | | | | - Federica Zoratto
- Medical Oncology, Ospedale Santa Maria Goretti, Latina, Lazio, Italy
| | - Francesco Grossi
- Medical Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore di Milano Policlinico, Milano, Lombardia, Italy
| | - Marco Filetti
- Medical Oncology Unit, Sant'Andrea Hospital, Roma, Lazio, Italy
| | - Pamela Pizzutilo
- Thoracic Oncology Unit, Clinical Cancer Center IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Puglia, Italy
| | - Marco Russano
- Medical Oncology, Campus Bio-Medico University, Rome, Italy
| | | | - Luca Cantini
- Department of Pulmonary Diseases, Erasmus Medical Center, Rotterdam, Zuid-Holland, Netherlands.,Oncology Clinic, Università Politecnica delle Marche, Ospedali Riuniti di Ancona, Ancona, Marche, Italy
| | - Giada Targato
- Department of Oncology, University Hospital Santa Maria della Misericordia, Udine, Friuli-Venezia Giulia, Italy
| | - Olga Nigro
- Medical Oncology, ASST-Sette Laghi, Varese, Lombardia, Italy
| | - Miriam G Ferrara
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Romae, Lazio, Italy.,Comprehensive Cancer Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Sebastiano Buti
- Medical Oncology, University Hospital of Parma, Parma, Emilia-Romagna, Italy
| | - Simona Scodes
- Department of Oncology and Hematology, AUSL della Romagna, Ravenna, Emilia-Romagna, Italy
| | - Lorenza Landi
- Department of Oncology and Hematology, AUSL della Romagna, Ravenna, Emilia-Romagna, Italy
| | - Giorgia Guaitoli
- Department of Oncology and Hematology, University Hospital Modena, Modena, Emilia-Romagna, Italy
| | - Luigi Della Gravara
- Pneumo-Oncology Unit, Ospedali dei Colli Monaldi Cotugno CTO, Napoli, Campania, Italy
| | - Fabrizio Tabbò
- Department of Oncology, University of Turin, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Serena Ricciardi
- Pneumo-Oncology Unit, San Camillo Forlanini Hospital, Roma, Lazio, Italy
| | - Alessandro De Toma
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Lombardia, Italy
| | - Alex Friedlaender
- Oncology Department, University Hospital of Geneva, Geneve, Genève, Switzerland
| | - Fausto Petrelli
- Oncology Unit, ASST Bergamo Ovest, Treviglio, Lombardia, Italy
| | - Alfredo Addeo
- Oncology Department, University Hospital of Geneva, Geneve, Genève, Switzerland
| | | | - Corrado Ficorella
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.,Medical Oncology, St. Salvatore Hospital, L'Aquila, Italy
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22
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Marchioni A, Andrisani D, Tonelli R, Piro R, Andreani A, Cappiello GF, Meschiari E, Dominici M, Bavieri M, Barbieri F, Taddei S, Casalini E, Falco F, Gozzi F, Bruzzi G, Fantini R, Tabbì L, Castaniere I, Facciolongo N, Clini E. Integrated intErventional bronchoscopy in the treatment of locally adVanced non-small lung cancER with central Malignant airway Obstructions: a multicentric REtrospective study (EVERMORE). Lung Cancer 2020; 148:40-47. [PMID: 32795722 DOI: 10.1016/j.lungcan.2020.07.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/15/2020] [Accepted: 07/27/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Despite new therapeutic perspectives, the presence of central airways occlusion (CAO) in patients with locally advanced non-small cell lung cancer (NSCLC) is associated with poor survival. There is no clear evidence on the clinical impact of interventional bronchoscopy as a part of an integrated treatment to cure these patients. MATERIALS AND METHODS This retrospective cohort study was conducted in two teaching hospitals over a 10 years period (January 2010-January 2020) comparing patients with NSCLC at stage IIIB and CAO at disease onset treated with chemotherapy/radiotherapy (standard therapy-ST) with those receiving interventional bronchoscopy plus ST (integrated treatment-IT). Primary outcome was 1-year survival. The onset of respiratory events, symptoms-free interval, hospitalization, need for palliation, and overall mortality served as secondary outcomes. RESULTS A total of 100 patients were included, 60 in the IT and 40 in the ST group. Unadjusted Kaplan-Meier estimates showed greater effect of IT compared to ST on 1-year survival (HR = 2.1 95%CI[1.1-4.8], p = 0.003). IT showed a significantly higher survival gain over ST in those patients showing KRAS mutation (7.6 VS 0.8 months,<0.0001), a lumen occlusion >65% (6.6 VS 2.9 months,<0.001), and lacking the involvement of left bronchus (7 VS 2.3 months,<0.0001). Compared to ST, IT also showed a favorable difference in terms of new hospitalizations (p = 0.03), symptom-free interval (p = 0.02), and onset of atelectasis (p = 0.01). CONCLUSIONS In patients with NSCLC stage IIIB and CAO, additional interventional bronchoscopy might impact on 1-year survival. Genetic and anatomic phenotyping might allow identifying those patients who may gain life expectancy from the endoscopic intervention.
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Affiliation(s)
- Alessandro Marchioni
- University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, Modena, Italy.
| | - Dario Andrisani
- University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, Modena, Italy; Clinical and Experimental Medicine PhD Program, University of Modena Reggio Emilia, Modena, Italy.
| | - Roberto Tonelli
- University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, Modena, Italy; Clinical and Experimental Medicine PhD Program, University of Modena Reggio Emilia, Modena, Italy.
| | - Roberto Piro
- Respiratory Diseases Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy.
| | - Alessandro Andreani
- University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, Modena, Italy.
| | - Gaia Francesca Cappiello
- University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, Modena, Italy.
| | - Emmanuela Meschiari
- University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, Modena, Italy.
| | - Massimo Dominici
- University Hospital of Modena, Oncology Unit, University of Modena Reggio Emilia, Modena, Italy.
| | - Mario Bavieri
- University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, Modena, Italy.
| | - Fausto Barbieri
- University Hospital of Modena, Oncology Unit, University of Modena Reggio Emilia, Modena, Italy.
| | - Sofia Taddei
- Respiratory Diseases Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy.
| | - Eleonora Casalini
- Respiratory Diseases Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy.
| | - Francesco Falco
- Respiratory Diseases Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy.
| | - Filippo Gozzi
- University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, Modena, Italy.
| | - Giulia Bruzzi
- University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, Modena, Italy.
| | - Riccardo Fantini
- University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, Modena, Italy.
| | - Luca Tabbì
- University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, Modena, Italy.
| | - Ivana Castaniere
- University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, Modena, Italy; Clinical and Experimental Medicine PhD Program, University of Modena Reggio Emilia, Modena, Italy.
| | - Nicola Facciolongo
- Respiratory Diseases Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy.
| | - Enrico Clini
- University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, Modena, Italy.
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23
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Gelsomino F, Tiseo M, Barbieri F, Riccardi F, Cavanna L, Frassoldati A, Delmonte A, Longo L, Dazzi C, Cinieri S, Colantonio I, Sperandi F, Lamberti G, Brocchi S, Tofani L, Boni L, Ardizzoni A. Phase 2 study of NAB-paclitaxel in SensiTivE and refractory relapsed small cell lung cancer (SCLC) (NABSTER TRIAL). Br J Cancer 2020; 123:26-32. [PMID: 32346071 PMCID: PMC7341887 DOI: 10.1038/s41416-020-0845-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 03/14/2020] [Accepted: 04/01/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Despite sensitivity to first-line chemotherapy, most small-cell lung cancer (SCLC) patients relapse. In this setting, topotecan demonstrated modest activity with significant toxicity. Paclitaxel was also active. This study was designed to evaluate activity and safety of nab-paclitaxel in relapsed SCLC. METHODS In this multicentre prospective Phase 2 trial, patients with refractory or sensitive SCLC progressed to first-line platinum-based chemotherapy received nab-paclitaxel 100 mg/smq on days 1, 8, 15 every 4 weeks up to six cycles, progressive disease or intolerable toxicity. Primary endpoint was investigator-assessed objective tumour response. Secondary endpoints were toxicity, progression-free survival (PFS) and overall survival (OS). RESULTS Of the 68 patients treated, partial response was 8% in the refractory cohort and 14% in the sensitive cohort. Most common toxicities of any grade were fatigue (54%), anaemia (38%), neutropenia (29%), leukopenia (26%) and diarrhoea (21%). Median PFS was similar in both refractory (1.8 months) and sensitive cohorts (1.9 months), while median OS was longer in sensitive one (6.6 versus 3.6 months). CONCLUSIONS Although nab-paclitaxel has shown some modest anti-tumour activity in relapsed SCLC, associated with a favourable toxicity profile, the primary end-point of the study was not met. CLINICAL TRIAL REGISTRATION Clinical Trial registration number is ClinicalTrials.gov Identifier: NCT03219762.
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Affiliation(s)
| | - Marcello Tiseo
- Medical Oncology Unit, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy.
| | | | | | - Luigi Cavanna
- Medical Oncology Unit, AUSL of Piacenza, Piacenza, Italy
| | - Antonio Frassoldati
- Medical Oncology Unit, Azienda Ospedaliero-Universitaria of Ferrara, Ferrara, Italy
| | - Angelo Delmonte
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Lucia Longo
- Medical Oncology Unit, AUSL of Modena, Hospital of Carpi, Carpi, Italy
| | - Claudio Dazzi
- Medical Oncology Unit, AUSL of Romagna, Hospital of Ravenna, Ravenna, Italy
| | - Saverio Cinieri
- Medical Oncology Unit, Hospital of Brindisi, Brindisi, Italy
| | | | | | - Giuseppe Lamberti
- Medical Oncology Unit, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Stefano Brocchi
- Radiology Unit, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Lorenzo Tofani
- Clinical Trial Center, Istituto Toscano Tumori, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | - Luca Boni
- Clinical Trial Center, Istituto Toscano Tumori, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | - Andrea Ardizzoni
- Medical Oncology Unit, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
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24
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Grego L, Pignatto S, Alfier F, Arigliani M, Rizzetto F, Rassu N, Samassa F, Prosperi R, Barbieri F, Dall'Amico R, Cogo P, Lanzetta P. Optical coherence tomography (OCT) and OCT angiography allow early identification of sickle cell maculopathy in children and correlate it with systemic risk factors. Graefes Arch Clin Exp Ophthalmol 2020; 258:2551-2561. [PMID: 32518974 DOI: 10.1007/s00417-020-04764-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 05/13/2020] [Accepted: 05/20/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To determine the presence of sickle cell retinopathy and maculopathy and to identify associations between markers of hemolysis and systemic and ocular manifestations in children affected by sickle cell disease. METHODS Eighteen children with sickle cell disease, aged 5-16 years, underwent complete eye examination including best-corrected visual acuity, slit-lamp biomicroscopy, ophthalmoscopy after pharmacological mydriasis, spectral-domain optical coherence tomography (SD-OCT), and optical coherence tomography angiography (OCTA). Blood test results and clinical history information were collected for each child, including fetal hemoglobin (HbF), hemoglobin (Hb), hematocrit (Htc), mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), reticulocytes percentage (%ret), lactic dehydrogenase (LDH), total and direct bilirubin, glomerular filtration rate, number of painful crises, acute chest syndromes, and splenic sequestration. Therapeutic regimen and transfusion therapy were also evaluated. RESULTS Sixteen of 36 eyes (44.4%) had non-proliferative sickle cell retinopathy on ophthalmoscopic evaluation. No patients had proliferative sickle cell retinopathy. In 13 of 36 eyes (36.1%), SD-OCT and OCTA detected signs of sickle cell maculopathy. Nine eyes (25%) presented sickle cell retinopathy and maculopathy, 7 eyes (19.4%) sickle cell retinopathy alone, and 4 eyes (11.1%) sickle cell maculopathy alone. A statistically significant association was found between sickle cell retinopathy; lower levels of HbF, Hb, and Htc; and higher MCV and percentage of reticulocytes. Sickle cell maculopathy was associated with lower values of H and Htc and higher levels of reticulocytes and total bilirubin. CONCLUSIONS We identified early signs of sickle cell retinopathy and maculopathy in a pediatric population with SD-OCT and OCTA. These two retinal complications were more frequent in children with higher hemolytic rates.
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Affiliation(s)
- L Grego
- Department of Medicine- Ophthalmology, University of Udine, Udine, Italy
| | - S Pignatto
- Department of Medicine- Ophthalmology, University of Udine, Udine, Italy
| | - F Alfier
- Department of Medicine- Ophthalmology, University of Udine, Udine, Italy
| | - M Arigliani
- Department of Medicine- Paediatrics, University of Udine, Udine, Italy
| | - F Rizzetto
- Department of Ophthalmology, Hospital of Pordenone, Pordenone, Italy
| | - N Rassu
- Department of Medicine- Ophthalmology, University of Udine, Udine, Italy
| | - F Samassa
- Department of Medicine- Ophthalmology, University of Udine, Udine, Italy
| | - R Prosperi
- Department of Medicine- Ophthalmology, University of Udine, Udine, Italy
| | - F Barbieri
- Department of Paediatrics, Hospital of Pordenone, Pordenone, Italy
| | - R Dall'Amico
- Department of Paediatrics, Hospital of Pordenone, Pordenone, Italy
| | - P Cogo
- Department of Medicine- Paediatrics, University of Udine, Udine, Italy
| | - P Lanzetta
- Department of Medicine- Ophthalmology, University of Udine, Udine, Italy.
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25
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Barbieri F, Adukauskaite A, Heidbreder A, Brandauer E, Bergmann M, Senoner T, Rubatscher A, Schgoer W, Stuehlinger M, Pfeifer B, Bauer A, Hintringer F, Hoegl B, Dichtl W. P534Central sleep apnea in pacing-induced cardiomyopathy: prevalence, improvement by upgrading to cardiac resynchronisation therapy and impact on structural responder rates and long-term outcome. Europace 2020. [DOI: 10.1093/europace/euaa162.265] [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: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
ÖNB Jubiläumsfondsprojekt Nr. 15974, ISR grant by Boston Scientific, St. Paul, MN, USA
Background
Central sleep apnea (CSA) in pacing induced cardiomyopathy (PICM) is poorly studied. Specifically, it is unknown whether upgrading from right ventricular pacing (RVP) to cardiac resynchronisation therapy (CRT) improves CSA.
Methods
Fifty-three patients with impaired left ventricular ejection fraction, frequent right ventricular pacing due to high-grade atrioventricular block and heart failure symptoms despite optimal medical therapy underwent upgrading to CRT. Within one month after left ventricular lead implantation (but still not activated), sleep apnea was assessed in all participants by single-night polysomnography (PSG). Nineteen patients with moderate or severe CSA defined by an apnea hypopnea index (AHI) > 15 events per hour were re-scheduled for a follow up PSG 3-5 months after initiation of cardiac resynchronization therapy. Of this cohort, thirteen patients with stable mild heart failure agreed to be randomized to CRT versus RVP in a cross-over design.
Results
CSA (AHI > 5 events per hour) was diagnosed in 26 (49.1%), OSA in 16 (30.2%) patients suffering from PICM . Eleven (20.8%) patients did not have any form of sleep apnea. Moderate to severe CSA (AHI > 15 events per hour) was significantly improved (without specific CPAP therapy) by 102 (96-172) days of CRT: AHI decreased from 39.4 events per hour at baseline to 21.6 by CRT (p < 0.001). Furthermore, CRT led to a substantial decrease in left ventricular endsystolic volumes: baseline 141 ml (103-155), significant improvement under CRT (102 ml, 65-138; p < 0.001), whereas no effect with ongoing RV-pacing (147 ml, 130-161; p = 0.865). Preexistent CSA did not affect the structural response of CRT (56.5% in patients with CSA, 62.5% of patients with obstructive sleep apnea and 54.5% in patients without sleep apnea; p = 0.901) and had no impact on major adverse cardiac events (p = 0.412) and/or survival (p = 0.623) during long-term follow-up.
Conclusions
CSA is highly prevalent in patients with PICM and is significantly improved by upgrading to CRT. Preexistent CSA does not hamper structural improvement and long-term outcome after upgrading to CRT. Thus, CSA seems to occur as a consequence of PICM, rather than as a pathophysiological mediator.
Abstract Figure.
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Affiliation(s)
- F Barbieri
- Innsbruck Medical University, Department of cardiology and angiology, Innsbruck, Austria
| | - A Adukauskaite
- Innsbruck Medical University, Department of cardiology and angiology, Innsbruck, Austria
| | - A Heidbreder
- Muenster University Hospital, Department of Neurology, Division of Sleep Medicine and Neuromuscular Disorders, Muenster, Germany
| | - E Brandauer
- Innsbruck Medical University, Department of Neurology, Sleep Disorders Clinic, Innsbruck, Austria
| | - M Bergmann
- Innsbruck Medical University, Department of Neurology, Sleep Disorders Clinic, Innsbruck, Austria
| | - T Senoner
- Innsbruck Medical University, Department of cardiology and angiology, Innsbruck, Austria
| | - A Rubatscher
- Innsbruck Medical University, Department of cardiology and angiology, Innsbruck, Austria
| | - W Schgoer
- Innsbruck Medical University, Department of cardiology and angiology, Innsbruck, Austria
| | - M Stuehlinger
- Innsbruck Medical University, Department of cardiology and angiology, Innsbruck, Austria
| | - B Pfeifer
- University Teaching Hospital Hall in Tirol (UMIT), Institute of Electrical and Biomedical Engineering, Hall in Tyrol, Austria
| | - A Bauer
- Innsbruck Medical University, Department of cardiology and angiology, Innsbruck, Austria
| | - F Hintringer
- Innsbruck Medical University, Department of cardiology and angiology, Innsbruck, Austria
| | - B Hoegl
- Innsbruck Medical University, Department of Neurology, Sleep Disorders Clinic, Innsbruck, Austria
| | - W Dichtl
- Innsbruck Medical University, Department of cardiology and angiology, Innsbruck, Austria
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26
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Mariniello A, Ghisoni E, Righi L, Catino A, Chiari R, Del Conte A, Barbieri F, Cecere F, Gelibter A, Giajlevra M, Parra HS, Zichi C, DI Maio M, Valabrega G, Novello S. Women With Synchronous or Metachronous Lung and Ovarian Cancer: A Multi-Institutional Report. In Vivo 2020; 33:2021-2026. [PMID: 31662533 DOI: 10.21873/invivo.11699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 07/22/2019] [Accepted: 07/23/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND/AIM Double diagnosis of lung cancer (LC) and ovarian cancer (OC) is rare. Here, we describe patients with synchronous/metachronous LC and OC to identify common clinical and pathological patterns. PATIENTS AND METHODS Clinical, pathological and molecular data of patients diagnosed and treated at 30 European Institutions from 2008 to 2018 were retrieved and analysed. Whenever tissue was available, centralized pathology revision was performed. RESULTS A total of 19 cases were found; one was excluded at pathology revision. Most LCs were adenocarcinomas (15/18) and most OCs were high-grade serous (15/18) carcinomas. Of the 9 patients analysed, 7 carried oncogene-addicted LC (4 EGFR, 1 B-RAF and 2 ALK) and five out of 7 carried BRCA mutations. One patient with a germline-BRCA1 mutation received olaparib, resulting in a durable response of both malignancies. Median overall survival was 33 months. CONCLUSION In our series, most synchronous/metachronous LCs and OCs showed genetic alterations. Further analyses with wide NGS panel could shed light on the biological mechanisms driving their occurrence.
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Affiliation(s)
- Annapaola Mariniello
- Department of Oncology, University of Torino at San Luigi University Hospital, Orbassano, Italy
| | - Eleonora Ghisoni
- Department of Oncology, University of Torino, Turin, Italy.,Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | - Luisella Righi
- Department of Oncology, University of Torino at San Luigi University Hospital, Orbassano, Italy
| | - Annamaria Catino
- Thoracic Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Rita Chiari
- Department of Medical Oncology, University of Perugia at Santa Maria della Misericordia Hospital, Perugia, Italy
| | | | - Fausto Barbieri
- Department of Oncology and Hematology, University-Hospital of Modena and Reggio Emilia, Modena, Italy
| | - Fabiana Cecere
- Careggi University Hospital, Medical Oncology Unit, Department of Oncology, Florence, Italy
| | - Alain Gelibter
- Sapienza University of Rome at Policlinico Umberto I, Oncology Unit, Rome, Italy
| | - Matteo Giajlevra
- CHU Grenoble Alpes, Clinique Universitaire de Pneumologie, Pôle Thorax et Vaisseaux, Grenoble, France
| | | | - Clizia Zichi
- Department of Oncology, University of Torino at San Luigi University Hospital, Orbassano, Italy
| | - Massimo DI Maio
- Department of Oncology, University of Torino at Mauriziano Umberto I Hospital, Turin, Italy
| | - Giorgio Valabrega
- Department of Oncology, University of Torino, Turin, Italy .,Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | - Silvia Novello
- Department of Oncology, University of Torino at San Luigi University Hospital, Orbassano, Italy
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27
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Reale ML, Chiari R, Tiseo M, Vitiello F, Barbieri F, Cortinovis D, Ceresoli GL, Finocchiaro G, Romano GD, Piovano PL, Del Conte A, Borra G, Verderame F, Scotti V, Nonnis D, Galetta D, Sergi C, Migliorino MR, Tonini G, Cecere F, Berardi R, Pino MS, Martelli O, Gelibter A, Carta A, Vattemi E, Pagano M, Zullo A, Ferrari S, Rossi A, Novello S. Be-TeaM: An Italian real-world observational study on second-line therapy for EGFR-mutated NSCLC patients. Lung Cancer 2019; 140:71-79. [PMID: 31884129 DOI: 10.1016/j.lungcan.2019.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 09/16/2019] [Revised: 11/21/2019] [Accepted: 12/13/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Molecular diagnostics and care of non-small cell lung cancer (NSCLC) are continuously evolving. Few data document the current strategies to manage advanced NSCLC patients beyond progression in clinical practice. PATIENTS AND METHODS Be-TeaM is an Italian multi-center observational study conducted on consecutive EGFR-mutated stage IV NSCLC patients, progressed during/after a first-line EGFR-TKI. It consists of a retrospective phase, from first-line EGFR-TKI therapy start until study entry (i.e. beginning of the diagnostic process), and a prospective phase, until treatment choice or for 3 months if no therapy was prescribed. Primary objective was to describe the diagnostic and therapeutic approaches adopted after progression in a real-world setting. RESULTS Of 308 patients enrolled in 63 centers from July 2017 to June 2018, 289 were included in the analysis. In first line, 53.3 % received gefitinib, 32.5 % afatinib and 14.2 % erlotinib. The testing rate (i.e. rate of all patients undergone any biopsy -liquid and/or tissue- for the T790 M detection) was 90.7 %, with liquid biopsy being the most frequently executed. Of 262 biopsied patients, 64.5 % underwent only 1 liquid biopsy, 10.7 % only 1 tissue biopsy and 18.3 % >1 biopsy, both liquid and solid in 85.4 %. The T790M positivity rate was 45.3 %; of 166 patients undergone only a liquid biopsy and tested for the mutation, 39.8 % were T790M+ and 60.2 % T790M-/undetermined. By the observation end, 87.9 % patients had a post-progression treatment chosen, osimertinib being the most frequent among the T790M+. CONCLUSION Be-TeaM provides the first snapshot of current practices for the management of NSCLC patients beyond progression in Italy; in clinical practice, assessing the T790M status is not always feasible.
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Affiliation(s)
- Maria Lucia Reale
- Department of Oncology, University of Turin, AOU San Luigi Gonzaga, Regione Gonzole, 10, 10043, Orbassano, TO, Italy.
| | - Rita Chiari
- UOC Oncology, Ospedali Riuniti Padova Sud-AULSS6 Euganea, Via Albere, 30, Monselice, PD, Italy(1).
| | - Marcello Tiseo
- Department of Medicine and Surgery, University of Parma and Medical Oncology Unit, Azienda Ospedaliero-Universitaria, Viale Antonio Gramsci, 14, 43126, Parma, Italy.
| | - Fabiana Vitiello
- U.O.S.D. DH Pneumoncologico A.O. dei Colli - Monaldi, Via Leonardo Bianchi, 80131, Napoli, Italy.
| | - Fausto Barbieri
- Dipartimento Oncologia ed Ematologia, AOU Policlinico, Largo del Pozzo, 71, 41125, Modena, Italy.
| | - Diego Cortinovis
- UO Oncologia Medica, ASST Ospedale San Gerardo, Via G. B. Pergolesi, 33, 20900, Monza, MB, Italy.
| | - Giovanni Luca Ceresoli
- Unità di Oncologia Toracica e Urologica, Humanitas Gavazzeni, Via Mauro Gavazzeni, 21, 24125, Bergamo, Italy.
| | - Giovanna Finocchiaro
- U.O Oncologia Medica ed Ematologia, Humanitas Cancer Center, Istituto Clinico Humanitas-IRCCS, Via Alessandro Manzoni, 56, 20089, Rozzano, MI, Italy.
| | | | - Pier Luigi Piovano
- SC Oncologia, ASO SS Antonio e Biagio e C Arrigo, Via Venezia, 16, 15121, Alessandria, Italy.
| | - Alessandro Del Conte
- S.C. Oncologia Medica e dei Tumori Immunocorrelati (OMTI), Centro di Riferimento Oncologico (CRO) - IRCCS, Via Franco Gallini, 2, 33081, Aviano, PN, Italy.
| | - Gloria Borra
- Dipartimento Medico Specialistico ed Oncologico, AOU Maggiore della Carità, corso Mazzini 18, Novara, Italy.
| | - Francesco Verderame
- U.O Oncologia Medica, AO Riuniti Villa Sofia - Cervello, Via Trabucco 180, 90146, Palermo, Italy.
| | - Vieri Scotti
- Unità di Radioterapia Oncologica - Dipartimento di Oncologia, Azienda Ospedaliero-universitaria Careggi, Largo G. Alessandro Brambilla, 3, 50134, Florence, Italy.
| | - Daniela Nonnis
- Oncologia Medica, ASST Spedali Civili, Piazzale Spedali Civili, 1, 25123, Brescia, Italy.
| | - Domenico Galetta
- SSD Oncologia Medica Patologia Toracica IRCCS Oncologico Giovanni Paolo II, Viale Orazio Flacco, 65, 70124, Bari, Italy.
| | - Concetta Sergi
- U.O.C Oncologia Medica, AO di rilievo Nazionale, ARNAS Garibaldi-Nesima, Via Palermo, 636, Catania, Italy.
| | - Maria Rita Migliorino
- U.O.C Pneumologia Oncologica, AO S. Camillo Forlanini, Circonvallazione Gianicolense, 87, 00152, Roma, Italy.
| | - Giuseppe Tonini
- Dipartimento di Oncologia, Università Campus Bio-Medico, Via Alvaro del Portillo 200, 00128, Roma, Italy.
| | - Fabiana Cecere
- U.O. Oncologia Medica, Istituto Tumori Regina Elena, Via Elio Chianesi, 53, 00128, Roma, Italy.
| | - Rossana Berardi
- SOD Clinica Oncologica, AOU Ospedali Riuniti, Via Conca, 71, 60126, Ancona, Italy.
| | - Maria Simona Pino
- U.O. Oncologia Medica, Ospedale S. Maria Annunziata, Via Antella, 58, 50012, Ponte a Niccheri, Bagno a Ripoli, FI, Italy.
| | - Olga Martelli
- U.O Oncologia Medica, Azienda Ospedaliera S Giovanni-Addolorata, Via dell'Amba Aradam 8, 00184, Roma, Italy.
| | - Alain Gelibter
- U.O Oncologia Medica, Policlinico Umberto I, Via del Policlinico 155, Roma, Italy.
| | - Annamaria Carta
- U.O Oncologia Medica, Ospedale A. Businco, Via Edward Jenner, 1, 09121, Cagliari, Italy.
| | - Emanuela Vattemi
- U.O Oncologia Medica, Ospedale Regionale, Via Lorenz Böhler, 5, 39100, Bolzano, Italy.
| | - Maria Pagano
- Azienda Unità Sanitaria Locale-IRCCS, Via Giovanni Amendola, 2, 42122, Reggio Emilia, Italy.
| | | | - Silvia Ferrari
- AstraZeneca S.p.A., Via Ludovico il Moro, 6/C, 20080, Basiglio, MI, Italy.
| | - Antonio Rossi
- Oncology Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, Viale Cappuccini, 1, 71013, San Giovanni Rotondo, FG, Italy.
| | - Silvia Novello
- Department of Oncology, University of Turin, AOU San Luigi Gonzaga, Regione Gonzole, 10, 10043, Orbassano, TO, Italy.
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Rihawi K, Giannarelli D, Galetta D, Delmonte A, Giavarra M, Turci D, Garassino M, Tiseo M, Barbieri F, Panni S, Ardizzoni A. BRAF Mutant NSCLC and Immune Checkpoint Inhibitors: Results From a Real-World Experience. J Thorac Oncol 2019; 14:e57-e59. [PMID: 30782386 DOI: 10.1016/j.jtho.2018.11.036] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 11/15/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Karim Rihawi
- Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy; Department of Experimental, Diagnostic and Specialty Medicine, DIMES University Hospital of Bologna, Bologna, Italy.
| | - Diana Giannarelli
- Biostatistics Unit, Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | - Angelo Delmonte
- Istituto Scientifico Romagnolo per lo studio e la cura dei Tumori (IRST), Meldola, Italy
| | - Marco Giavarra
- Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | | | | | - Marcello Tiseo
- Azienda Ospedaliero, Universitaria di Parma, Parma, Italy
| | - Fausto Barbieri
- Azienda Ospedaliero, Universitaria Policlinico di Modena, Modena, Italy
| | - Stefano Panni
- Oncologia Istituti, Ospitalieri Cremona, Cremona, Italy
| | - Andrea Ardizzoni
- Azienda Ospedaliero, Universitaria Policlinico S. Orsola, Malpighi di Bologna, Bologna, Italy
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Barbieri F, Senoner T, Holfeld J, Semsroth S, Lambert T, Zweiker D, Theurl T, Rainer PP, Schmidt A, Feuchtner GM, Steinwender C, Hoppe U, Mueller S, Grimm M, Dichtl W. P4665High sensitivity troponin t and n-terminal pro brain natriuretic peptide plasma levels predict long-term postoperative survival in patients with severe aortic stenosis admitted for valve implantation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.1047] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
Optimal timing of valve implantation in patients with severe aortic stenosis (AS) is under debate, considering the subjective nature of symptom onset. We aimed to investigate the pre-procedural value of routinely available cardiac biomarkers in predicting postoperative long-term outcome in a large cohort undergoing either surgical or transcatheter aortic valve implantation.
Methods
The Tyrolean Aortic Stenosis Study-2 (TASS-2) group, a consortium of four university hospital centers in Austria, analysed pre-procedural high-sensitivity troponin T (hsTnT) and N-terminal pro brain natriuretic peptide (NT-proBNP) plasma levels in 3595 patients admitted for valve implantation because of severe aortic stenosis since 2007.
Results
Transcatheter aortic valve implantation was performed in 1517 (42.2%) of patients. During a median follow-up of 2.93 (1.91–4.92) years, 919 patients (25.6%) died, among them 556 (15.5%) due to cardiovascular causes. In multivariate cox regression analysis - adjusting for STS risk score (intermediate risk 4–8%, high risk >8%), degree of left ventricular systolic dysfunction (ejection fraction 30–50% and <30%), atrial fibrillation, sex, age, renal function, COPD, arterial hypertension, diabetes mellitus, concomitant significant coronary artery disease and type of procedure (surgical aortic valve replacement or transcatheter aortic valve implantation) - pre-procedural hsTnT as well as NT-proBNP plasma levels were strong independent predictors for postoperative survival: hazard ratio [HR] 1.82, 95% confidence interval [CI] 1.07–3.11, P=0.028 for mildly to moderately elevated hsTnT (14–50 ng/l); HR 2.80, CI 1.61–4.89, P<0.001 for severely elevated hsTnT (>50 ng/l); HR 1.38, CI 1.06–1.81, P=0.018 for mildly to moderately elevated NT-proBNP (defined by an increase of up to threefold of age- and sex-corrected normal range); HR 1.68, CI 1.29–2.18, P<0.001 for severely elevated NT-proBNP (defined by an increase of more than threefold of age- and sex-corrected normal range). For direct comparison of these two biomarkers a second cox regression model was conducted including only hsTnT and NT-proBNP revealing the strength of hsTnT as a predictive biomarker: HR 2.20, 95% CI 1.29–3.77, P=0.004 for minimally elevated hsTnT (5–13.99 ng/l); HR 4.05, CI 2.41–6.82, P<0.001 for mildly to moderately elevated hsTnT (14–50 ng/l); HR 8.63, CI 5.07–14.70, P<0.001 for severely elevated hsTnT (>50 ng/l); HR 1.47, CI 1.13–1.91, P=0.004 for mildly to moderately elevated NT-proBNP; HR 1.96, CI 1.54–2.51, P<0.001 for severely elevated NT-proBNP.
Conclusion
hsTNT and NT-proBNP strongly predict long-term postoperative survival in patients with severe AS admitted for valve implantation.
Acknowledgement/Funding
This work was supported by the Tiroler Wissenschaftsförderung: grant number TWF-2017-1-5, GZ: UNI-0404-2104
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Affiliation(s)
- F Barbieri
- Innsbruck Medical University, Department of cardiology and angiology, Innsbruck, Austria
| | - T Senoner
- Innsbruck Medical University, Department of cardiology and angiology, Innsbruck, Austria
| | - J Holfeld
- Innsbruck Medical University, Department of cardiac surgery, Innsbruck, Austria
| | - S Semsroth
- Innsbruck Medical University, Department of cardiac surgery, Innsbruck, Austria
| | - T Lambert
- General Hospital (AKH) of Linz, Department of cardiology, Linz, Austria
| | - D Zweiker
- Medical University of Graz, Department of cardiology, Graz, Austria
| | - T Theurl
- Paracelsus Private Medical University, University clinic of Internal Medicine II, Salzburg, Austria
| | - P P Rainer
- Medical University of Graz, Department of cardiology, Graz, Austria
| | - A Schmidt
- Medical University of Graz, Department of cardiology, Graz, Austria
| | - G M Feuchtner
- Innsbruck Medical University, Department of radiology, Innsbruck, Austria
| | - C Steinwender
- General Hospital (AKH) of Linz, Department of cardiology, Linz, Austria
| | - U Hoppe
- Paracelsus Private Medical University, University clinic of Internal Medicine II, Salzburg, Austria
| | - S Mueller
- Innsbruck Medical University, Department of cardiology and angiology, Innsbruck, Austria
| | - M Grimm
- Innsbruck Medical University, Department of cardiac surgery, Innsbruck, Austria
| | - W Dichtl
- Innsbruck Medical University, Department of cardiology and angiology, Innsbruck, Austria
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Senoner T, Barbieri F, Adukauskaite A, Sarcletti M, Plank F, Beyer C, Dichtl W, Feuchtner GM. P6156Coronary atherosclerosis characteristics in long-term antiretroviral therapy and HIV infection: insights from coronary CTA. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0762] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Purpose
To assess coronary artery disease (CAD) characteristics by coronary CT-angiography (CTA) in individuals with HIV-infection on long-term ART in a retrospective matched case-controlled cohort study.
Methods
69 HIV positive patients who underwent 128-slice dual source coronary CTA (mean age 54.9 years, 26.1% females) with mean 17.8±9.4 years of HIV-infection and a mean duration on ART of 13±7.3 years were propensity score matched with 69 HIV negative controls.
CTA was evaluated for: Stenosis severity (CAD-RADS), total plaque burden, mixed-non-calcified plaque burden (G-score), high-risk-plaque (HRP) features (Napkin-Ring-Sign, low-attenuation-plaque, spotty calcification, positive remodeling), perivascular fat attenuation index (FAI) and ectatic coronary segments.
Results
CAD-RADS was higher in HIV-positive participants as compared to controls (2.21±1.4 vs 1.69±1.5, p=0.031). A higher prevalence of CAD and G-score (p=0.043 and p=0.003) were found.
HRP prevalence (23 (34.3%) vs 8 (12.1%); p=0.002) and the number of HRP (36 vs 10, p<0.001) were higher in HIV-positive individuals. A positive perivascular FAI >-70 HU was present in 27.8% of HRP. Ectatic coronary arteries were found in 10 (14.5%) individuals with HIV-infection vs 0% in controls (p=0.003).
Conclusion(s)
HIV positive individuals on long-term ART display higher CAD burden and more HRP indicating vulnerable, potentially inflamed plaques.
CT- Angiography results HIV+ (N=67) HIV− (N=67) P-value CAD prevalence (any plaque), n (%) 56 (83.6) 46 (68.7) 0.043 SSS, mean ±SD 1.16±1.6 0.95±2.1 0.038 CAD RADS 0 11 22 1 11 7 2 10 21 <0.001 3 23 4 4 12 13 Total >50%, n (%) 35 (52.2) 17 (25.4) 0.001 CAD RADS, mean ±SD 2.21±1.4 1.69±1.5 0.031 SIS, mean ±SD 3.93±3.0 3.06±3.1 0.067 G-score, mean ±SD 10.04±8.5 5.76±5.9 0.003 Calcium score, mean ±SD 149.4±287.1 133.2±329.3 0.015 HRP, n (%) 23 (34.3) 8 (12.1) 0.002 HRP, n 36 10 <0.001 Non-calcifying plaque component, n (%) 44 (65.7) 34 (51.5) 0.097 Ectatic coronary segments, n (%) 10 (14.5) 0 (0) 0.003 CAD RADS: coronary artery disease reporting and data system; CCS: coronary calcium score; HRP: high-risk plaque; SIS: segment involvement score; SSS: stenosis severity score.
60 yo HIV-infected (31 yrs) male patient
These features strongly support the predominant inflammatory theory of cardiovascular events in HIV-infected individuals.
Acknowledgement/Funding
None
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Affiliation(s)
- T Senoner
- Innsbruck University Hospital, Cardiology, Innsbruck, Austria
| | - F Barbieri
- Innsbruck University Hospital, Cardiology, Innsbruck, Austria
| | - A Adukauskaite
- Innsbruck University Hospital, Cardiology, Innsbruck, Austria
| | - M Sarcletti
- Innsbruck University Hospital, Dermatology, Innsbruck, Austria
| | - F Plank
- Innsbruck University Hospital, Cardiology, Innsbruck, Austria
| | - C Beyer
- Innsbruck University Hospital, Radiology, Innsbruck, Austria
| | - W Dichtl
- Innsbruck University Hospital, Cardiology, Innsbruck, Austria
| | - G M Feuchtner
- Innsbruck University Hospital, Radiology, Innsbruck, Austria
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31
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Adukauskaite A, Barbieri F, Senoner T, Plank F, Knoflach M, Boehme C, Hintringer F, Mueller S, Dichtl W, Feuchtner G. P3383Left atrial appendage and left atrial morphology is associated with cryptogenic stroke. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0259] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Stroke causes a high burden of morbidity and mortality worldwide. Approximately 30% of stroke cases remain cryptogenic (CS), of which one third is due to occult atrial fibrillation (AF) with left atrial appendage (LAA) being the most frequent thrombus source.
Hence, aim of our study was to assess if LAA morphological parameters analysed by computed tomography angiography (CTA) are associated with CS.
Methods and materials
In 184 patients (Table 1), 82 CS patients and 102 controls (age median 62 (52,2–72), 40.2% females), matched for BMI, a CTA was performed, and LAA morphology evaluated retrospectively.
LAA morphology was classified into 5 types (Figure 1): Cactus, Cauliflower, Chicken-wing, Windsock and the new “Seahorse” with a distinctive tip angulation of ≤90° and 2 bends (Z-shape). Further measurements included: LAA tip angulation (≤90°, 91–110°, >110°), LAA lobe number, LAA ostium size (length) and angulation, left atrium wall thickness (LAWT).
Results
LAA and left atrium (LA) parameters associated with CS on multivariable analysis after adjusting for CHA2DS2-VASc score were: Chicken-wing type (OR 2.15; 95% CI: 1.01–4.56, p=0.046), a greater lobe number (OR 2.01; 95% CI: 1.52–2.64, p<0.001), a greater middle and mean LAWT (respectively, OR 2.13; 95% CI: 1.49–3.05, p<0.001, OR 2.64; 95% CI: 1.63–4.29, p<0.001), a larger (length, OR 1.08; 95% CI: 1.0–1.16, p=0.039) and a less bent LAA ostium (OR 1.02; 95% CI: 1.01–1.03, p=0.006). In contrast, a sharp-angled LAA tip (≤90°) was protective from CS (OR 0.43; 95% CI: 0.23–0.83, p=0.012) on multivariable analysis.
Table1. Clinical patient characteristics CS (n=82) Non-stroke (n=102) p value Females 21 (25.6%) 53 (52%) p<0.001 Age, y 66.5 (57–73) 57.5 (50–70) 0.001 BMI, kg/m2 25.6 (23.9–28.2) 26 (23.3–30.1) 0.320 CHA2DS2-VASc score 2 (1–3) 2 (1–3) 0.387 AF (paroxysmal/permanent) 0 4 0.071 Hypertension 68 (82.9%) 54 (56.3%) p<0.001 Diabetes mellitus, type 2 16 (19.8%) 11 (11.5%) 0.145 Values are given in median ± IQR. AF, atrial fibrillation; BMI, body mass index.
LAA and LA morphology in CTA.
Conclusion
In CS, a Chicken-wing LAA, a greater number of lobes and a thicker LA wall are independently associated with CS while a sharp LAA tip (≤90°) mostly seen in Seahorse type LAA is protective. Such “high-risk” LAA and LA morphology could help to select CS patients benefiting from extended rhythm-monitoring to detect an occult AF, however, further prospective studies are needed to confirm this hypothesis.
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Affiliation(s)
| | - F Barbieri
- Innsbruck University Hospital, Internal Medicine III, Innsbruck, Austria
| | - T Senoner
- Innsbruck University Hospital, Internal Medicine III, Innsbruck, Austria
| | - F Plank
- Innsbruck University Hospital, Internal Medicine III, Innsbruck, Austria
| | - M Knoflach
- Innsbruck University Hospital, Neurology, Innsbruck, Austria
| | - C Boehme
- Innsbruck University Hospital, Neurology, Innsbruck, Austria
| | - F Hintringer
- Innsbruck University Hospital, Internal Medicine III, Innsbruck, Austria
| | - S Mueller
- Innsbruck University Hospital, Internal Medicine III, Innsbruck, Austria
| | - W Dichtl
- Innsbruck University Hospital, Internal Medicine III, Innsbruck, Austria
| | - G Feuchtner
- Innsbruck University Hospital, Radiology, Innsbruck, Austria
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Losi L, Bertolini F, Guaitoli G, Fabbiani L, Banchelli F, Ambrosini-Spaltro A, Botticelli L, Scurani L, Baldessari C, Barbieri F, Cascinu S, Maiorana A. Role of evaluating tumor‑infiltrating lymphocytes, programmed death‑1 ligand 1 and mismatch repair proteins expression in malignant mesothelioma. Int J Oncol 2019; 55:1157-1164. [PMID: 31545419 DOI: 10.3892/ijo.2019.4883] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 07/26/2019] [Indexed: 11/06/2022] Open
Abstract
The tumor immune microenvironment (TME) and immune checkpoints have been reported to serve a role in the pathogenesis of malignant mesothelioma (MM) and treatment outcome. Additionally, mismatch Repair (MMR) deficiency appears to enhance the response to checkpoints blockade in several tumors. The aim of the present study was to analyze programmed death‑1 ligand 1 (PD‑L1) expression in MM and to characterize the TME. This could help to understand the immune response, and evaluate its prognostic and predictive values. We also investigated MMR protein expression. We retrospectively analyzed 55 mesotheliomas to determine PD‑L1, CD4+, CD8+, mutL homolog 1 (MLH1), mutS homolog 2 (MSH2), mutS homolog 6 (MSH6) and PMS1 homolog 2, mismatch repair system component (PMS2) expression. We used an immunoscore (1+, 2+ and 3+) to evaluate tumor‑infiltrating lymphocytes (TILs). TILs were observed in all but two samples (53/55); the majority had an immunoscore 1+ (30/53), while 2+/3+ was reported for 23/53 samples. A predominance of CD8+ was highlighted in 8 cases (15%). PD‑L1 expression of ≥1% on tumor cells was displayed in 40 cases; in 9 of these, ≥50% expression was reported. Of note, alterations in MMR staining was not observed. In addition, survival analysis revealed that epithelioid subtype was associated with better prognosis. We observed a trend towards poorer prognosis for ≥50% PD‑L1 expression on tumor cells, lower immunoscore (1+) and CD8+ TIL predominance. The present study highlighted the importance of exploring the TME and the standardization of PD‑L1 assessment guidelines to apply in the field of immunotherapy.
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Affiliation(s)
- Lorena Losi
- Department of Life Sciences, University of Modena and Reggio Emilia, I‑41124 Modena, Italy
| | - Federica Bertolini
- Division of Medical Oncology, Azienda Ospedaliero‑Universitaria Policlinico, I‑41124 Modena, Italy
| | - Giorgia Guaitoli
- Division of Medical Oncology, Azienda Ospedaliero‑Universitaria Policlinico, I‑41124 Modena, Italy
| | - Luca Fabbiani
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, I‑41124 Modena, Italy
| | - Federico Banchelli
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, I‑41124 Modena, Italy
| | | | - Laura Botticelli
- Unit of Pathology, Azienda Ospedaliero‑Universitaria Policlinico, I‑41124 Modena, Italy
| | - Letizia Scurani
- Department of Life Sciences, University of Modena and Reggio Emilia, I‑41124 Modena, Italy
| | - Cinzia Baldessari
- Division of Medical Oncology, Azienda Ospedaliero‑Universitaria Policlinico, I‑41124 Modena, Italy
| | - Fausto Barbieri
- Division of Medical Oncology, Azienda Ospedaliero‑Universitaria Policlinico, I‑41124 Modena, Italy
| | - Stefano Cascinu
- Division of Medical Oncology, Azienda Ospedaliero‑Universitaria Policlinico, I‑41124 Modena, Italy
| | - Antonino Maiorana
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, I‑41124 Modena, Italy
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Landi L, Chiari R, Tiseo M, D'Incà F, Dazzi C, Chella A, Delmonte A, Bonanno L, Giannarelli D, Cortinovis DL, de Marinis F, Borra G, Morabito A, Gridelli C, Galetta D, Barbieri F, Grossi F, Capelletto E, Minuti G, Mazzoni F, Verusio C, Bria E, Alì G, Bruno R, Proietti A, Fontanini G, Crinò L, Cappuzzo F. Crizotinib in MET-Deregulated or ROS1-Rearranged Pretreated Non–Small Cell Lung Cancer (METROS): A Phase II, Prospective, Multicenter, Two-Arms Trial. Clin Cancer Res 2019; 25:7312-7319. [DOI: 10.1158/1078-0432.ccr-19-0994] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/13/2019] [Accepted: 08/12/2019] [Indexed: 11/16/2022]
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Feuchtner GM, Barbieri F, Langer C, Beyer C, Friedrich G, Plank F. 38The secret of INOCA: High-risk plaque but not calcium density predicts ischemia, and their relationship with perivascular fat gradient. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez135.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - F Barbieri
- Innsbruck Medical University, Innsbruck, Austria
| | - C Langer
- Innsbruck Medical University, Innsbruck, Austria
| | - C Beyer
- Innsbruck Medical University, Innsbruck, Austria
| | - G Friedrich
- Innsbruck Medical University, Innsbruck, Austria
| | - F Plank
- Innsbruck Medical University, Innsbruck, Austria
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35
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Guaitoli G, Baldessari C, Bertolini F, Tomasello C, Cascinu S, Barbieri F. Are we ready to describe response or progression to immunotherapy in lung cancer? Crit Rev Oncol Hematol 2019; 138:112-119. [PMID: 31092366 DOI: 10.1016/j.critrevonc.2019.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 12/06/2018] [Accepted: 04/01/2019] [Indexed: 12/30/2022] Open
Abstract
Immune checkpoint inhibitors have changed history and management of different tumor types, including non-small cell lung cancer (NSCLC). Response patterns may be more heterogeneous than those seen with cytotoxic chemotherapy. Besides atypical response patterns, new types of outcome should be taken into account such as pseudo-progression (PP) and hyper-progressive disease (HPD). PP is described as initial tumor increase or appearance of new lesions followed by their shrinkage during immunotherapy treatment while HPD is a rapid and severe pattern of progression with a not yet univocal definition. Physiopathology and underlying mechanism of these phenomena are not completely understood and in absence of reliable clinical and biological markers of response to immunotherapy, radiological evaluation remains a key point in clinicians' decision-making process but further efforts would be useful to identify a unique system of evaluation.In this review we summarize the main radiological criteria available in the evaluation of response to checkpoint inhibitors and we describe peculiar response patterns such PP and HPD with a focus on lung cancer.
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Affiliation(s)
- Giorgia Guaitoli
- Department of Oncology and Hematology, Modena University Hospital, University of Modena and Reggio Emilia, via del Pozzo 71, 41124, Modena, Italy.
| | - Cinzia Baldessari
- Department of Oncology and Hematology, Modena University Hospital, University of Modena and Reggio Emilia, via del Pozzo 71, 41124, Modena, Italy.
| | - Federica Bertolini
- Department of Oncology and Hematology, Modena University Hospital, via del Pozzo 71, 41124, Modena, Italy.
| | - Chiara Tomasello
- Department of Oncology and Hematology, Modena University Hospital, via del Pozzo 71, 41124, Modena, Italy.
| | - Stefano Cascinu
- Department of Oncology and Hematology, Modena University Hospital, University of Modena and Reggio Emilia, via del Pozzo 71, 41124, Modena, Italy.
| | - Fausto Barbieri
- Department of Oncology and Hematology, Modena University Hospital, University of Modena and Reggio Emilia, via del Pozzo 71, 41124, Modena, Italy.
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36
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Salati M, Pifferi M, Baldessari C, Bertolini F, Tomasello C, Cascinu S, Barbieri F. Stevens-Johnson syndrome during nivolumab treatment of NSCLC. Ann Oncol 2019; 29:283-284. [PMID: 29045532 DOI: 10.1093/annonc/mdx640] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Affiliation(s)
- M Salati
- Department of Oncology, Università di Modena e Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - M Pifferi
- Unit of Oncology, Hospital of Sassuolo, Modena, Italy
| | - C Baldessari
- Department of Oncology, Università di Modena e Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - F Bertolini
- Department of Oncology, Università di Modena e Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - C Tomasello
- Department of Oncology, Università di Modena e Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - S Cascinu
- Department of Oncology, Università di Modena e Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - F Barbieri
- Department of Oncology, Università di Modena e Reggio Emilia, Policlinico di Modena, Modena, Italy
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37
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Oezpeker C, Barbieri F, Bonaros N, Grimm M, Hoefer D, Mueller L. Partial Upper Sternotomy versus full Sternotomy for Mitral Valve Surgery: A Propensity Score Matched Analysis. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678891] [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: 10/27/2022]
Affiliation(s)
- C.U. Oezpeker
- Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - F. Barbieri
- Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - N. Bonaros
- Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - M. Grimm
- Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - D. Hoefer
- Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - L. Mueller
- Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
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38
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Garassino MC, Crinò L, Catino A, Ardizzoni A, Cortesi E, Cappuzzo F, Bordi P, Calabrò L, Barbieri F, Santo A, Altavilla G, Ambrosio F, Mini E, Vasile E, Morgillo F, Scoppola A, Bengala C, Follador A, Tedde N, Giannarelli D, Lo Russo G, Vitiello F. Nivolumab in never-smokers with advanced squamous non-small cell lung cancer: Results from the Italian cohort of an expanded access program. Tumour Biol 2018; 40:1010428318815047. [DOI: 10.1177/1010428318815047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives: Never-smokers may be a distinct subgroup among patients with advanced non-small cell lung cancer, appearing to benefit less from immunotherapy than smokers. We report results from never-smokers enrolled in the Italian cohort of the nivolumab expanded access program in pre-treated patients with advanced squamous non-small cell lung cancer. Materials and methods: Nivolumab (3 mg/kg every 2 weeks for ≤24 months) was available on physician request. Efficacy data included objective tumor response, date of progression, and survival information. Safety was monitored. Results: Overall, 371 patients received at least one dose of nivolumab, including 31 never-smokers (8%). Objective response rate, disease-control rate, and median overall survival were 23%, 45%, and 12.1 months (95% confidence interval: 3.7–20.4), respectively, in never-smokers, and 18%, 47%, and 7.9 months (95% confidence interval: 6.2–9.6), respectively, in the overall expanded access program population. Any-grade and grade 3–4 treatment-related adverse events were reported in 12 (39%) and 3 (10%) never-smokers, respectively, and in 109 (29%) and 21 (6%) patients, respectively, in the overall expanded access program population. Grade 3–4 treatment-related adverse events in non-smokers were increased transaminases (n = 2; 6%) and diarrhea (n = 1; 3%). Treatment-related adverse events led to treatment discontinuation in 4 non-smokers (17%) and in 26 patients (9%) overall. Conclusion: Pre-treated never-smokers with advanced squamous non-small cell lung cancer in this Italian expanded access program demonstrated efficacy and safety that were consistent with those in the overall expanded access program population and clinical trials. These results suggest that a proportion of never-smoker patients with squamous non-small cell lung cancer may be responsive to immunotherapy. Other factors, such as the tumor mutational load and the status of programmed death-ligand 1, anaplastic lymphoma kinase, and epidermal growth factor receptor, might play a potential key role.
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Affiliation(s)
| | - Lucio Crinò
- Santa Maria della Misericordia Hospital, Perugia, Italy
| | | | | | | | | | | | | | | | - Antonio Santo
- Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | | | | | | | - Enrico Vasile
- Azienda Ospedaliera Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | | | | | | | | | - Natale Tedde
- Presidio ospedaliero ASL 2 di Olbia, Olbia, Italy
| | | | - Giuseppe Lo Russo
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
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Losi L, Bertolini F, Scurani L, Guaitoli G, Baldessari C, Ambrosini Spaltro A, Botticelli L, Maiorana A, Barbieri F, Cascinu S. Role of evaluating tumor infiltrating lymphocytes, programmed death-ligand 1 and mismatch-repair proteins expression in malignant mesothelioma. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy301.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Mariniello A, Ghisoni E, Righi L, Catino A, Chiari R, Del Conte A, Barbieri F, Cecere F, Gelibter A, Giaj Levra M, Soto Parra H, Zichi C, Valabrega G, Novello S. P2.09-21 Women with Synchronous or Metachronous Lung and Ovarian Cancers: A Multi-Institutional Report. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1318] [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: 11/17/2022]
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Gelsomino F, Tiseo M, Barbieri F, Riccardi F, Cavanna L, Frassoldati A, Delmonte A, Longo L, Dazzi C, Cinieri S, Colantonio I, Tognetto M, Baldari D, Tofani L, Ardizzoni A. Phase II study of NAB-paclitaxel in sensitive and refractory relapsed SCLC (NABSTER TRIAL). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy298.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Salati M, Baldessari C, Calabrese F, Rossi G, Pettorelli E, Grizzi G, Dominici M, Barbieri F. Nivolumab-Induced Impressive Response of Refractory Pulmonary Sarcomatoid Carcinoma with Brain Metastasis. Case Rep Oncol 2018; 11:615-621. [PMID: 30323751 PMCID: PMC6180262 DOI: 10.1159/000492666] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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: 07/31/2018] [Accepted: 08/03/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Pulmonary sarcomatoid carcinoma is a rare, poorly differentiated, and highly aggressive type of non-small cell lung cancer. High tumor mutational burden and PD-L1 overexpression make it an excellent candidate for immunotherapy. OBJECTIVES AND METHOD We presented the case of a patient who underwent left inferior lobectomy with concurrent right paravertebral muscular metastasectomy for an infiltrative neoplastic mass, whose final diagnosis was consistent with stage IV pulmonary sarcomatoid carcinoma. He received first- and second-line chemotherapy without any benefit. Since March 2016, he has been treated with the anti-PD1 agent nivolumab with a dramatic improvement of symptoms, disappearance of a brain lesion, and partial response on other metastatic sites. He tolerated the treatment well and is still responding after 22 months from the beginning. RESULTS AND CONCLUSIONS In very lethal non-small cell lung cancer subtypes such as the sarcomatoid variants, high tumor burden and deteriorated general conditions should not preclude, at least in some cases, the use of immunotherapy. Anti-PD1 may also have a reliable role in disease control in the brain. Lastly, the strong rationale behind sarcomatoid histology should further prompt trials exploring immunotherapeutic approaches in this subset of non-small cell lung cancer.
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Affiliation(s)
- Massimiliano Salati
- Department of Oncology, University of Modena and Reggio Emilia – Policlinico of Modena, Modena, Italy
| | - Cinzia Baldessari
- Department of Oncology, University of Modena and Reggio Emilia – Policlinico of Modena, Modena, Italy
| | - Fiorella Calabrese
- Department of Cardio-Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Giulio Rossi
- Pathology Unit, Azienda AUSL Romagna, Regional Hospital Ravenna, Ravenna, Italy
| | - Elisa Pettorelli
- Department of Oncology, University of Modena and Reggio Emilia – Policlinico of Modena, Modena, Italy
| | - Giulia Grizzi
- Department of Oncology, University of Modena and Reggio Emilia – Policlinico of Modena, Modena, Italy
| | - Massimo Dominici
- Department of Oncology, University of Modena and Reggio Emilia – Policlinico of Modena, Modena, Italy
| | - Fausto Barbieri
- Department of Oncology, University of Modena and Reggio Emilia – Policlinico of Modena, Modena, Italy
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Guaitoli G, Baldessari C, Tomasello C, Barbieri F, Cascinu S, Bertolini F, Cesinaro AM. Late Gastrointestinal Toxicity During Nivolumab Therapy in Non-Small Cell Lung Cancer: A Rare Case of Inflammatory Bowel Disease. J Thorac Oncol 2018; 13:e152-e153. [PMID: 30049380 DOI: 10.1016/j.jtho.2018.03.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 03/26/2018] [Accepted: 03/27/2018] [Indexed: 01/02/2023]
Affiliation(s)
- Giorgia Guaitoli
- Department of Oncology and Haematology, Modena University Hospital, Modena, Italy.
| | - Cinzia Baldessari
- Department of Oncology and Haematology, Modena University Hospital, Modena, Italy
| | - Chiara Tomasello
- Department of Oncology and Haematology, Modena University Hospital, Modena, Italy
| | - Fausto Barbieri
- Department of Oncology and Haematology, Modena University Hospital, Modena, Italy
| | - Stefano Cascinu
- Department of Oncology and Haematology, Modena University Hospital, Modena, Italy
| | - Federica Bertolini
- Department of Oncology and Haematology, Modena University Hospital, Modena, Italy
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Feuchtner GM, Langer CL, Barbieri F, Beyer C, Dichtl W, Friedrich GJ, Plank F. P3186The effect of omega-3 fatty acid supplementation on coronary atherosclerosis by quantitative coronary computed tomography angiography (CTA). Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3186] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - C L Langer
- Innsbruck Medical University, Innsbruck, Austria
| | - F Barbieri
- Innsbruck Medical University, Innsbruck, Austria
| | - C Beyer
- Innsbruck Medical University, Innsbruck, Austria
| | - W Dichtl
- Innsbruck Medical University, Innsbruck, Austria
| | | | - F Plank
- Innsbruck Medical University, Innsbruck, Austria
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Pelosi G, Papotti M, Righi L, Rossi G, Ferrero S, Bosari S, Calabrese F, Kern I, Maisonneuve P, Sonzogni A, Albini A, Harari S, Barbieri F, Capelletto E, Catino AM, Cavone D, De Palma A, Fusco N, Lunardi F, Maiorano E, Marzullo A, Novello S, Papanikolaou N, Pasello G, Pennella A, Pezzuto F, Punzi A, Prisciandaro E, Rea F, Rosso L, Scattone A, Serio G. Pathologic Grading of Malignant Pleural Mesothelioma: An Evidence-Based Proposal. J Thorac Oncol 2018; 13:1750-1761. [PMID: 30249391 DOI: 10.1016/j.jtho.2018.07.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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: 01/03/2018] [Revised: 06/23/2018] [Accepted: 07/02/2018] [Indexed: 01/15/2023]
Abstract
INTRODUCTION A pathologic grading system (PGS) for malignant pleural mesothelioma (MPM) is warranted to better identify different risk categories of patients, plan therapeutic options, and activate clinical trials. METHODS A series of 940 patients with MPM (328 in a training set and 612 in a validation set) that was diagnosed between October 1980 and June 2015 at the participant institutions was retrospectively assembled. A PGS was constructed by attributing to each histologic parameter, independent at multivariate analysis with excellent reproducibility (κ > 0.75), different scores based on the increase in corresponding hazard ratios. The relevant PGS score thus ranged from 0 to 8 points for individual patients with MPM. CONCLUSIONS The PGS was constructed by taking into consideration the histological subtyping of MPM (epithelioid/biphasic = 0 points; sarcomatoid = 2 points), necrosis (absent = 0 points versus present = 1 point), mitotic count per 1 mm2 (cutoffs as follows: 1-2 = 0 points, 3-5 = 1 point, 6-9 = 2 points, or ≥10 = 4 points), and Ki-67 labeling index based on 2000 cells (<30% = 0 points versus ≥30 = 1 point), all of which are independent factors in both patient sets after adjustment for stage and age at diagnosis. No heterogeneity was seen across the validation centers (p = 0.19). Epithelioid/biphasic MPM patterning and biopsy versus resection did not affect survival, whereas the PGS outperformed mitotic count and Ki-67 LI in both the training (area under the curve receiver operating characteristic = 0.76) and validation sets (area under the curve receiver operating characteristic = 0.73) (p < 0.01). Patient survival progressively deteriorated from a score of 0 (median times of 26.3 and 26.9 months) to a score 1 to 3 (median times of 12.8 and 14.4 months) and a score of 4 to 8 (median times of 3.7 and 7.7 months) in both sets of patients, with the hazard ratio for a 1-point increase in score being 1.46 (95% confidence interval: 1.36-1.56) in the training set and 1.28 (95% confidence interval: 1.22-1.34) in the validation set (after adjustment for age and [when available] tumor stage). The PGS was effective even in subgroup analysis (epithelioid, biphasic, and sarcomatoid tumors). DISCUSSION A simple and reproducible multiparametric PGS effectively predicted survival in patients with MPM.
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Affiliation(s)
- Giuseppe Pelosi
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy; Inter-Hospital Pathology Division, Science and Technology Park, Institute for Research and Treatment Multimedica - IRCCS, Milan, Italy.
| | - Mauro Papotti
- Department of Oncology, University of Turin, and Pathology Unit Molinette Hospital, City of Health and Science, Turin, Italy
| | - Luisella Righi
- Department of Oncology, University of Turin, and Pathology Unit San Luigi Hospital, Orbassano, Turin, Italy
| | - Giulio Rossi
- Division of Anatomic Pathology, Regional Hospital Umberto Parini, Aosta, Italy
| | - Stefano Ferrero
- Division of Anatomic Pathology, Foundation for Research and Treatment - IRCCS Ca' Granda Major Hospital Polyclinic, Milan, and, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Silvano Bosari
- Division of Anatomic Pathology, Foundation for Research and Treatment - IRCCS Ca' Granda Major Hospital Polyclinic, Milan, and Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Fiorella Calabrese
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Izidor Kern
- Department of Cytology and Pathology, University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia
| | - Patrick Maisonneuve
- Division of Epidemiology and Biostatistics, European Institute of Oncology - IRCCS, Milan, Italy
| | - Angelica Sonzogni
- Department of Pathology and Laboratory Medicine, Foundation for Research and Treatment- IRCCS National Cancer Institute, Milan, Italy
| | - Adriana Albini
- Laboratory of Vascular Biology and Angiogenesis, Science and Technology Park, Institute for Research and Treatment (IRCCS) MultiMedica, Milan, Italy, and Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Sergio Harari
- Department of Medical Sciences and Division of Pneumology, San Giuseppe Hospital, Institute for Research and Treatment - IRCCS MultiMedica, Milan, Italy
| | - Fausto Barbieri
- Oncology Unit, University Hospital Azienda Policlinico of Modena, Modena, Italy
| | - Enrica Capelletto
- Department of Oncology, University of Turin, Thoracic Oncology Unit San Luigi Hospital, Orbassano, Turin, Italy
| | - Anna Maria Catino
- Medical Thoracic Oncology, Cancer Institute "Giovanni Paolo II", Bari, Italy
| | - Domenica Cavone
- National Mesothelioma Registry-Apulia Region, Regional Operational Center Cor Apulia, Occupational Health Division Bernardino Ramazzini, Department of Interdisciplinary Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Angela De Palma
- Section of Thoracic Surgery, Department of Emergency and Organ Transplantation (DETO), University of Bari Aldo Moro, Bari, Italy
| | - Nicola Fusco
- Division of Anatomic Pathology, Foundation for Research and Treatment - IRCCS Ca' Granda Major Hospital Polyclinic, Milan, and, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Francesca Lunardi
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Eugenio Maiorano
- Section of Pathology, Department of Emergency and Organ Transplantation (DETO), University of Bari Aldo Moro, Bari, Italy
| | - Andrea Marzullo
- Section of Pathology, Department of Emergency and Organ Transplantation (DETO), University of Bari Aldo Moro, Bari, Italy
| | - Silvia Novello
- Department of Oncology, University of Turin, Thoracic Oncology Unit San Luigi Hospital, Orbassano, Turin, Italy
| | - Nikolaos Papanikolaou
- Inter-Hospital Pathology Division, Science and Technology Park, Institute for Research and Treatment Multimedica - IRCCS, Milan, Italy
| | - Giulia Pasello
- Medical Oncology 2, Department of Medical and Experimental Oncology, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Antonio Pennella
- Department of Surgery and Pathology, University of Foggia Medical School, Foggia, Italy
| | - Federica Pezzuto
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Alessandra Punzi
- Section of Pathology, Department of Emergency and Organ Transplantation (DETO), University of Bari Aldo Moro, Bari, Italy
| | - Elena Prisciandaro
- Section of Thoracic Surgery, Department of Emergency and Organ Transplantation (DETO), University of Bari Aldo Moro, Bari, Italy
| | - Federico Rea
- Thoracic Surgery Unit, Department of Cardiothoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Lorenzo Rosso
- Division of Thoracic Surgery, Foundation for Research and Treatment - IRCCS Ca' Granda Major Hospital Polyclinic, Milan and Department of Health Sciences, University of Milan, Milan, Italy
| | - Anna Scattone
- Section of Pathology, Cancer Institute "Giovanni Paolo II," Bari, Italy
| | - Gabriella Serio
- Section of Pathology, Department of Emergency and Organ Transplantation (DETO), University of Bari Aldo Moro, Bari, Italy
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Barbieri F, Dichtl W, Brandauer E, Heibreder A, Stefani A, Adukauskaite A, Schgoer W, Hintringer F, Hoegl B. P808Sleep apnea detection by a cardiac resynchronization device integrated thoracic impedance sensor - a validation study against the gold standard polysomnography. Europace 2018. [DOI: 10.1093/europace/euy015.412] [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: 11/13/2022] Open
Affiliation(s)
- F Barbieri
- Innsbruck Medical University, Department of cardiology and angiology, Innsbruck, Austria
| | - W Dichtl
- Innsbruck Medical University, Department of cardiology and angiology, Innsbruck, Austria
| | - E Brandauer
- Innsbruck Medical University, Department of neurology, Innsbruck, Austria
| | - A Heibreder
- Medical University Münster, Department of neurology, Münster, Germany
| | - A Stefani
- Innsbruck Medical University, Department of neurology, Innsbruck, Austria
| | - A Adukauskaite
- Innsbruck Medical University, Department of cardiology and angiology, Innsbruck, Austria
| | - W Schgoer
- Innsbruck Medical University, Department of cardiology and angiology, Innsbruck, Austria
| | - F Hintringer
- Innsbruck Medical University, Department of cardiology and angiology, Innsbruck, Austria
| | - B Hoegl
- Innsbruck Medical University, Department of neurology, Innsbruck, Austria
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Tomasello C, Baldessari C, Napolitano M, Orsi G, Grizzi G, Bertolini F, Barbieri F, Cascinu S. Resistance to EGFR inhibitors in non-small cell lung cancer: Clinical management and future perspectives. Crit Rev Oncol Hematol 2018; 123:149-161. [DOI: 10.1016/j.critrevonc.2018.01.013] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 11/09/2017] [Accepted: 01/31/2018] [Indexed: 12/18/2022] Open
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Pilotto S, Rossi A, Vavalà T, Follador A, Tiseo M, Galetta D, Morabito A, Di Maio M, Martelli O, Caffo O, Piovano PL, Cortinovis D, Zilembo N, Casartelli C, Banna GL, Ardizzoia A, Barzelloni ML, Bearz A, Genestreti G, Mucciarini C, Filipazzi V, Menis J, Rizzo E, Barbieri F, Rijavec E, Cecere F, Spitaleri G, Bria E, Novello S. Outcomes of First-Generation EGFR-TKIs Against Non-Small-Cell Lung Cancer Harboring Uncommon EGFR Mutations: A Post Hoc Analysis of the BE-POSITIVE Study. Clin Lung Cancer 2018. [DOI: 10.1016/j.cllc.2017.05.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Romano N, Fischetti A, Prono V, Migone S, Barbieri F, Pizzorni C, Garlaschi G, Cimmino MA. Plantar pain is not always fasciitis. Reumatismo 2017; 69:189-190. [PMID: 29320846 DOI: 10.4081/reumatismo.2017.989] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 07/18/2017] [Accepted: 07/28/2017] [Indexed: 11/22/2022] Open
Abstract
The case is described of a patient with chronic plantar pain, diagnosed as fasciitis, which was not improved by conventional treatment. Magnetic resonance imaging revealed flexor hallucis longus tenosynovitis, which improved after local glucocorticoid injection.
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Affiliation(s)
- N Romano
- Division of Radiology, Department of Internal Medicine, University of Genoa, Genoa.
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