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Ottaiano A, Santorsola M, Diana A, Belli A, Lentini Graziano ML, Orefice J, Patrone R, Di Mauro A, Scognamiglio G, Tatangelo F, De Bellis M, Piccirillo M, Fiore F, Stilo S, Tarotto L, Correra M, Di Lorenzo S, Capuozzo M, Avallone A, Silvestro L, Bianco A, Granata V, Federico P, Montesarchio V, Daniele B, Izzo F, Nasti G. Treatments, prognostic factors, and genetic heterogeneity in advanced cholangiocarcinoma: A multicenter real-world study. Cancer Med 2024; 13:e6892. [PMID: 38457226 PMCID: PMC10923031 DOI: 10.1002/cam4.6892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/14/2023] [Accepted: 12/16/2023] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND AND AIMS Cholangiocarcinoma (CCA), a rare and aggressive hepatobiliary malignancy, presents significant clinical management challenges. Despite rising incidence and evolving treatment options, prognosis remains poor, motivating the exploration of real-world data for enhanced understanding and patient care. METHODS This multicenter study analyzed data from 120 metastatic CCA patients at three institutions from 2016 to 2023. Kaplan-Meier curves assessed overall survival (OS), while univariate and multivariate analyses evaluated links between clinical variables (age, gender, tumor site, metastatic burden, ECOG performance status, response to first-line chemotherapy) and OS. Genetic profiling was conducted selectively. RESULTS Enrolled patients had a median age of 68.5 years, with intrahepatic tumors predominant in 79 cases (65.8%). Among 85 patients treated with first-line chemotherapy, cisplatin and gemcitabine (41.1%) was the most common regimen. Notably, one-third received no systemic treatment. After a median 14-month follow-up, 81 CCA-related deaths occurred, with a median survival of 13.1 months. Two clinical variables independently predicted survival: response to first-line chemotherapy (disease control vs. no disease control; HR: 0.27; 95% CI: 0.14-0.50; p < 0.0001) and metastatic involvement (>1 site vs. 1 site; HR: 1.99; 95% CI: 1.04-3.80; p = 0.0366). The three most common genetic alterations involved the ARID1A, tp53, and CDKN2A genes. CONCLUSIONS Advanced CCA displays aggressive clinical behavior, emphasizing the need for treatments beyond chemotherapy. Genetic diversity supports potential personalized therapies. Collaborative research and deeper CCA biology understanding are crucial to enhance patient outcomes in this challenging malignancy.
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Affiliation(s)
| | | | - Anna Diana
- Medical Oncology UnitOspedale del MareNapoliItaly
| | - Andrea Belli
- Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”NapoliItaly
| | | | | | - Renato Patrone
- Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”NapoliItaly
| | | | | | | | - Mario De Bellis
- Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”NapoliItaly
| | - Mauro Piccirillo
- Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”NapoliItaly
| | - Francesco Fiore
- Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”NapoliItaly
| | - Salvatore Stilo
- Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”NapoliItaly
| | - Luca Tarotto
- Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”NapoliItaly
| | - Marco Correra
- Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”NapoliItaly
| | | | | | - Antonio Avallone
- Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”NapoliItaly
| | | | - Antonella Bianco
- Medical Oncology UnitAORN Ospedali dei Colli‐Monaldi‐Cotugno‐CTONapoliItaly
| | - Vincenza Granata
- Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”NapoliItaly
| | | | | | | | - Francesco Izzo
- Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”NapoliItaly
| | - Guglielmo Nasti
- Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”NapoliItaly
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2
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Di Girolamo E, Belli A, Ottaiano A, Granata V, Borzillo V, Tarotto L, Tatangelo F, Palaia R, Civiletti C, Piccirillo M, D’Angelo V, Fiore F, Marone P, Nasti G, Izzo F, de Bellis M. Impact of endobiliary radiofrequency ablation on survival of patients with unresectable cholangiocarcinoma: a narrative review. Front Oncol 2023; 13:1077794. [PMID: 37324013 PMCID: PMC10266199 DOI: 10.3389/fonc.2023.1077794] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 05/05/2023] [Indexed: 06/17/2023] Open
Abstract
Cholangiocarcinoma (CCA) is a rare cancer originating from the biliary epithelium and accounts for about 3% of all gastrointestinal malignancies. Unfortunately, the majority of patients are not eligible for surgical resection at the time of diagnosis, because of the locally advanced stage or metastatic disease. The overall survival time of unresectable CCA is generally less than 1 year, despite current chemotherapy regimens. Biliary drainage is often required as a palliative treatment for patients with unresectable CCA. Recurrent jaundice and cholangitis tend to occur because of reobstruction of the biliary stents. This not only jeopardizes the efficacy of chemotherapy, but also causes significant morbidity and mortality. Effective control of tumor growth is crucial for prolonging stent patency and consequently patient survival. Recently, endobiliary radiofrequency ablation (ERFA) has been experimented as a treatment modality to reduce tumor mass, and delay tumor growth, extending stent patency. Ablation is accomplished by means of high-frequency alternating current which is released from the active electrode of an endobiliary probe placed in a biliary stricture. It has been shown that tumor necrosis releases intracellular particles which are highly immunogenic and activate antigen-presenting cells, enhancing local immunity directed against the tumor. This immunogenic response could potentially enhance tumor suppression and be responsible for improved survival of patients with unresectable CCA who undergo ERFA. Several studies have demonstrated that ERFA is associated with an increased median survival of approximately 6 months in patients with unresectable CCA. Furthermore, recent data support the hypothesis that ERFA could ameliorate the efficacy of chemotherapy administered to patients with unresectable CCA, without increasing the risk of complications. This narrative review discusses the results of the studies published in recent years and focuses on the impact that ERFA could have on overall survival of patients with unresectable cholangiocarcinoma.
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Affiliation(s)
- Elena Di Girolamo
- Division of Gastroenterology and Gastrointestinal Endoscopy. Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Naples, Italy
| | - Andrea Belli
- Division of Hepatobiliary Surgery. Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Naples, Italy
| | - Alessandro Ottaiano
- Unit for Innovative Therapies of Abdominal Metastastes. Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Naples, Italy
| | - Vincenza Granata
- Division of Radiology. Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Naples, Italy
| | - Valentina Borzillo
- Division of Radiotherapy. Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Naples, Italy
| | - Luca Tarotto
- Division of Interventional Radiology. Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Naples, Italy
| | - Fabiana Tatangelo
- Division of Anatomic Pathology and Cytopathology. Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Naples, Italy
| | - Raffaele Palaia
- Gastropancreatic Surgical Unit. Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Naples, Italy
| | - Corrado Civiletti
- Division of Gastroenterology and Gastrointestinal Endoscopy. Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Naples, Italy
| | - Mauro Piccirillo
- Division of Hepatobiliary Surgery. Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Naples, Italy
| | - Valentina D’Angelo
- Division of Gastroenterology and Gastrointestinal Endoscopy. Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Naples, Italy
| | - Francesco Fiore
- Division of Interventional Radiology. Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Naples, Italy
| | - Pietro Marone
- Division of Gastroenterology and Gastrointestinal Endoscopy. Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Naples, Italy
| | - Guglielmo Nasti
- Unit for Innovative Therapies of Abdominal Metastastes. Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Naples, Italy
| | - Francesco Izzo
- Division of Hepatobiliary Surgery. Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Naples, Italy
| | - Mario de Bellis
- Division of Gastroenterology and Gastrointestinal Endoscopy. Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Naples, Italy
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3
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Pierantozzi E, Raucci L, Buonocore S, Rubino EM, Ding Q, Laurino A, Fiore F, Soldaini M, Chen J, Rossi D, Vangheluwe P, Chen H, Sorrentino V. Skeletal muscle overexpression of sAnk1.5 in transgenic mice does not predispose to type 2 diabetes. Sci Rep 2023; 13:8195. [PMID: 37210436 PMCID: PMC10199891 DOI: 10.1038/s41598-023-35393-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 05/17/2023] [Indexed: 05/22/2023] Open
Abstract
Genome-wide association studies (GWAS) and cis-expression quantitative trait locus (cis-eQTL) analyses indicated an association of the rs508419 single nucleotide polymorphism (SNP) with type 2 diabetes (T2D). rs508419 is localized in the muscle-specific internal promoter (P2) of the ANK1 gene, which drives the expression of the sAnk1.5 isoform. Functional studies showed that the rs508419 C/C variant results in increased transcriptional activity of the P2 promoter, leading to higher levels of sAnk1.5 mRNA and protein in skeletal muscle biopsies of individuals carrying the C/C genotype. To investigate whether sAnk1.5 overexpression in skeletal muscle might predispose to T2D development, we generated transgenic mice (TgsAnk1.5/+) in which the sAnk1.5 coding sequence was selectively overexpressed in skeletal muscle tissue. TgsAnk1.5/+ mice expressed up to 50% as much sAnk1.5 protein as wild-type (WT) muscles, mirroring the difference reported between individuals with the C/C or T/T genotype at rs508419. However, fasting glucose levels, glucose tolerance, insulin levels and insulin response in TgsAnk1.5/+ mice did not differ from those of age-matched WT mice monitored over a 12-month period. Even when fed a high-fat diet, TgsAnk1.5/+ mice only presented increased caloric intake, but glucose disposal, insulin tolerance and weight gain were comparable to those of WT mice fed a similar diet. Altogether, these data indicate that sAnk1.5 overexpression in skeletal muscle does not predispose mice to T2D susceptibility.
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Affiliation(s)
- E Pierantozzi
- Department of Molecular and Developmental Medicine, University of Siena, 53100, Siena, Italy
| | - L Raucci
- Department of Molecular and Developmental Medicine, University of Siena, 53100, Siena, Italy
| | - S Buonocore
- Department of Molecular and Developmental Medicine, University of Siena, 53100, Siena, Italy
| | - E M Rubino
- Department of Molecular and Developmental Medicine, University of Siena, 53100, Siena, Italy
| | - Q Ding
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, 210008, Jiangsu, China
| | - A Laurino
- Department of Molecular and Developmental Medicine, University of Siena, 53100, Siena, Italy
| | - F Fiore
- Department of Molecular and Developmental Medicine, University of Siena, 53100, Siena, Italy
| | - M Soldaini
- Department of Molecular and Developmental Medicine, University of Siena, 53100, Siena, Italy
| | - J Chen
- Laboratory of Cellular Transport Systems, Department of Cellular and Molecular Medicine, Katholieke Universiteit Leuven (KU Leuven), 3000, Leuven, Belgium
| | - D Rossi
- Department of Molecular and Developmental Medicine, University of Siena, 53100, Siena, Italy
- Interdepartmental Program of Molecular Diagnosis and Pathogenetic Mechanisms of Rare Genetic Diseases, Azienda Ospedaliera Universitaria Senese, 53100, Siena, Italy
| | - P Vangheluwe
- Laboratory of Cellular Transport Systems, Department of Cellular and Molecular Medicine, Katholieke Universiteit Leuven (KU Leuven), 3000, Leuven, Belgium
| | - H Chen
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, 210008, Jiangsu, China
- Programme in Cardiovascular and Metabolic Disorders, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - V Sorrentino
- Department of Molecular and Developmental Medicine, University of Siena, 53100, Siena, Italy.
- Interdepartmental Program of Molecular Diagnosis and Pathogenetic Mechanisms of Rare Genetic Diseases, Azienda Ospedaliera Universitaria Senese, 53100, Siena, Italy.
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4
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Ottaiano A, Santorsola M, Circelli L, Trotta AM, Izzo F, Perri F, Cascella M, Sabbatino F, Granata V, Correra M, Tarotto L, Stilo S, Fiore F, Martucci N, Rocca AL, Picone C, Muto P, Borzillo V, Belli A, Patrone R, Mercadante E, Tatangelo F, Ferrara G, Di Mauro A, Scognamiglio G, Berretta M, Capuozzo M, Lombardi A, Galon J, Gualillo O, Pace U, Delrio P, Savarese G, Scala S, Nasti G, Caraglia M. Oligo-Metastatic Cancers: Putative Biomarkers, Emerging Challenges and New Perspectives. Cancers (Basel) 2023; 15:cancers15061827. [PMID: 36980713 PMCID: PMC10047282 DOI: 10.3390/cancers15061827] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/13/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
Some cancer patients display a less aggressive form of metastatic disease, characterized by a low tumor burden and involving a smaller number of sites, which is referred to as "oligometastatic disease" (OMD). This review discusses new biomarkers, as well as methodological challenges and perspectives characterizing OMD. Recent studies have revealed that specific microRNA profiles, chromosome patterns, driver gene mutations (ERBB2, PBRM1, SETD2, KRAS, PIK3CA, SMAD4), polymorphisms (TCF7L2), and levels of immune cell infiltration into metastases, depending on the tumor type, are associated with an oligometastatic behavior. This suggests that OMD could be a distinct disease with specific biological and molecular characteristics. Therefore, the heterogeneity of initial tumor burden and inclusion of OMD patients in clinical trials pose a crucial methodological question that requires responses in the near future. Additionally, a solid understanding of the molecular and biological features of OMD will be necessary to support and complete the clinical staging systems, enabling a better distinction of metastatic behavior and tailored treatments.
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Affiliation(s)
- Alessandro Ottaiano
- Istituto Nazionale Tumori di Napoli, IRCCS "G. Pascale", Via Mariano Semmola, 80131 Naples, Italy
| | - Mariachiara Santorsola
- Istituto Nazionale Tumori di Napoli, IRCCS "G. Pascale", Via Mariano Semmola, 80131 Naples, Italy
| | - Luisa Circelli
- AMES, Centro Polidiagnostico Strumentale SRL, Via Padre Carmine Fico 24, 80013 Casalnuovo Di Napoli, Italy
| | - Anna Maria Trotta
- Istituto Nazionale Tumori di Napoli, IRCCS "G. Pascale", Via Mariano Semmola, 80131 Naples, Italy
| | - Francesco Izzo
- Istituto Nazionale Tumori di Napoli, IRCCS "G. Pascale", Via Mariano Semmola, 80131 Naples, Italy
| | - Francesco Perri
- Istituto Nazionale Tumori di Napoli, IRCCS "G. Pascale", Via Mariano Semmola, 80131 Naples, Italy
| | - Marco Cascella
- Istituto Nazionale Tumori di Napoli, IRCCS "G. Pascale", Via Mariano Semmola, 80131 Naples, Italy
| | - Francesco Sabbatino
- Oncology Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Vincenza Granata
- Istituto Nazionale Tumori di Napoli, IRCCS "G. Pascale", Via Mariano Semmola, 80131 Naples, Italy
| | - Marco Correra
- Istituto Nazionale Tumori di Napoli, IRCCS "G. Pascale", Via Mariano Semmola, 80131 Naples, Italy
| | - Luca Tarotto
- Istituto Nazionale Tumori di Napoli, IRCCS "G. Pascale", Via Mariano Semmola, 80131 Naples, Italy
| | - Salvatore Stilo
- Istituto Nazionale Tumori di Napoli, IRCCS "G. Pascale", Via Mariano Semmola, 80131 Naples, Italy
| | - Francesco Fiore
- Istituto Nazionale Tumori di Napoli, IRCCS "G. Pascale", Via Mariano Semmola, 80131 Naples, Italy
| | - Nicola Martucci
- Istituto Nazionale Tumori di Napoli, IRCCS "G. Pascale", Via Mariano Semmola, 80131 Naples, Italy
| | - Antonello La Rocca
- Istituto Nazionale Tumori di Napoli, IRCCS "G. Pascale", Via Mariano Semmola, 80131 Naples, Italy
| | - Carmine Picone
- Istituto Nazionale Tumori di Napoli, IRCCS "G. Pascale", Via Mariano Semmola, 80131 Naples, Italy
| | - Paolo Muto
- Istituto Nazionale Tumori di Napoli, IRCCS "G. Pascale", Via Mariano Semmola, 80131 Naples, Italy
| | - Valentina Borzillo
- Istituto Nazionale Tumori di Napoli, IRCCS "G. Pascale", Via Mariano Semmola, 80131 Naples, Italy
| | - Andrea Belli
- Istituto Nazionale Tumori di Napoli, IRCCS "G. Pascale", Via Mariano Semmola, 80131 Naples, Italy
| | - Renato Patrone
- Istituto Nazionale Tumori di Napoli, IRCCS "G. Pascale", Via Mariano Semmola, 80131 Naples, Italy
| | - Edoardo Mercadante
- Istituto Nazionale Tumori di Napoli, IRCCS "G. Pascale", Via Mariano Semmola, 80131 Naples, Italy
| | - Fabiana Tatangelo
- Istituto Nazionale Tumori di Napoli, IRCCS "G. Pascale", Via Mariano Semmola, 80131 Naples, Italy
| | - Gerardo Ferrara
- Istituto Nazionale Tumori di Napoli, IRCCS "G. Pascale", Via Mariano Semmola, 80131 Naples, Italy
| | - Annabella Di Mauro
- Istituto Nazionale Tumori di Napoli, IRCCS "G. Pascale", Via Mariano Semmola, 80131 Naples, Italy
| | - Giosué Scognamiglio
- Istituto Nazionale Tumori di Napoli, IRCCS "G. Pascale", Via Mariano Semmola, 80131 Naples, Italy
| | - Massimiliano Berretta
- Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria, 98125 Messina, Italy
| | | | - Angela Lombardi
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Via Luigi De Crecchio 7, 80138 Naples, Italy
| | - Jérôme Galon
- INSERM, Laboratory of Integrative Cancer Immunology, 75006 Paris, France
- Equipe Labellisée Ligue Contre le Cancer, 75006 Paris, France
- Centre de Recherche des Cordeliers, Sorbonne Université, Université de Paris, 75006 Paris, France
| | - Oreste Gualillo
- SERGAS (Servizo Galego de Saude) and NEIRID Lab (Neuroendocrine Interactions in Rheumatology and Inflammatory Diseases), Research Laboratory 9, IDIS (Instituto de Investigación Sanitaria de Santiago), Santiago University Clinical Hospital, 15706 Santiago de Compostela, Spain
| | - Ugo Pace
- Istituto Nazionale Tumori di Napoli, IRCCS "G. Pascale", Via Mariano Semmola, 80131 Naples, Italy
| | - Paolo Delrio
- Istituto Nazionale Tumori di Napoli, IRCCS "G. Pascale", Via Mariano Semmola, 80131 Naples, Italy
| | - Giovanni Savarese
- AMES, Centro Polidiagnostico Strumentale SRL, Via Padre Carmine Fico 24, 80013 Casalnuovo Di Napoli, Italy
| | - Stefania Scala
- Istituto Nazionale Tumori di Napoli, IRCCS "G. Pascale", Via Mariano Semmola, 80131 Naples, Italy
| | - Guglielmo Nasti
- Istituto Nazionale Tumori di Napoli, IRCCS "G. Pascale", Via Mariano Semmola, 80131 Naples, Italy
| | - Michele Caraglia
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Via Luigi De Crecchio 7, 80138 Naples, Italy
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Passarelli A, Ventriglia J, Pisano C, Cecere SC, Napoli MD, Rossetti S, Tambaro R, Tarotto L, Fiore F, Farolfi A, Bartoletti M, Pignata S. The way to precision medicine in gynecologic cancers: The first case report of an exceptional response to alpelisib in a PIK3CA-mutated endometrial cancer. Front Oncol 2023; 12:1088962. [PMID: 36713525 PMCID: PMC9880853 DOI: 10.3389/fonc.2022.1088962] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 12/12/2022] [Indexed: 01/15/2023] Open
Abstract
Endometrial cancer (EC) is the most common gynecologic cancer in Europe and its prevalence is increasing. EC includes a biological and clinical heterogeneous group of tumors, usually classified as type I (endometrioid) or type II (non-endometrioid) based on the histopathological characteristics. In 2013, a new molecular classification was proposed by The Cancer Genome Atlas (TCGA) based on the comprehensive molecular profiling of EC. Several molecular somatic alterations have been described in development and progression of EC. Using these molecular features, EC was reclassified into four subgroups: POLE ultra-mutated, MSI hypermutated, copy-number low, and copy-number high that correlate with the prognosis. To this regard, it is widely reported that EC has more frequent mutations in the phosphatidylinositol 3-kinase (PI3K) pathway signaling than any other tumor. PIK3CA is the main significant mutated gene after PTEN alterations. Overall, over 90% of endometrioid tumors have activating PI3K molecular alterations that suggests its critical role in the EC pathogenesis. Thus, the dysregulation of PI3K pathway represents an attractive target in EC treatment. Herein, we report a radiological and clinically meaningful response to a selective PIK3 inhibitor in a patient with extensively pre-treated advanced endometrioid EC harboring a somatic activating PIK3CA hotspot mutation. These evidences provide the rational for translational strategies of the PI3K inhibition and could support the clinical usefulness of PIK3CA genotyping in advanced EC. To our knowledge, this is the first clinical case of PIK3CA-mutated EC successfully treated with alpelisib.
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Affiliation(s)
- Anna Passarelli
- Department of Urology and Gynecology, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione G. Pascale, Naples, Italy,*Correspondence: Anna Passarelli, ,
| | - Jole Ventriglia
- Department of Urology and Gynecology, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione G. Pascale, Naples, Italy
| | - Carmela Pisano
- Department of Urology and Gynecology, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione G. Pascale, Naples, Italy
| | - Sabrina Chiara Cecere
- Department of Urology and Gynecology, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione G. Pascale, Naples, Italy
| | - Marilena Di Napoli
- Department of Urology and Gynecology, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione G. Pascale, Naples, Italy
| | - Sabrina Rossetti
- Department of Urology and Gynecology, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione G. Pascale, Naples, Italy
| | - Rosa Tambaro
- Department of Urology and Gynecology, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione G. Pascale, Naples, Italy
| | - Luca Tarotto
- Interventional Radiology Unit, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione G. Pascale, Naples, Italy
| | - Francesco Fiore
- Interventional Radiology Unit, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione G. Pascale, Naples, Italy
| | - Alberto Farolfi
- Department of Medical Oncology, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Emilia-Romagna, Italy
| | - Michele Bartoletti
- Unit of Medical Oncology and Cancer Prevention, Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), Aviano, Italy
| | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione G. Pascale, Naples, Italy
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6
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Mallardo D, Simeone E, Vanella V, Vitale MG, Palla M, Scarpato L, Paone M, De Cristofaro T, Borzillo V, Cortellini A, Sparano F, Pignata S, Fiore F, Caracò C, Maiolino P, Petrillo A, Cavalcanti E, Lastoria S, Muto P, Budillon A, Warren S, Ascierto PA. Concomitant medication of cetirizine in advanced melanoma could enhance anti-PD-1 efficacy by promoting M1 macrophages polarization. J Transl Med 2022; 20:436. [PMID: 36180872 PMCID: PMC9523893 DOI: 10.1186/s12967-022-03643-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 09/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The clinical observation showed a potential additive effect of anti-PD-1 agents and cetirizine in patients with advanced melanoma. METHODS Clinical outcomes of concomitant cetirizine/anti-PD-1 treatment of patients with stage IIIb-IV melanoma were retrospectively collected, and a transcriptomic analysis was performed on blood samples obtained at baseline and after 3 months of treatment. RESULTS Patients treated with cetirizine concomitantly with an anti-PD-1 agent had significantly longer progression-free survival (PFS; mean PFS: 28 vs 15 months, HR 0.46, 95% CI: 0.28-0.76; p = 0.0023) and OS (mean OS was 36 vs 23 months, HR 0.48, 95% CI: 0.29-0.78; p = 0.0032) in comparison with those not receiving cetirizine. The concomitant treatment was significantly associated with ORR and DCR (p < 0.05). The expression of FCGR1A/CD64, a specific marker of macrophages, was increased after the treatment in comparison with baseline in blood samples from patients receiving cetirizine, but not in those receiving only the anti-PD1, and positively correlated with the expression of genes linked to the interferon pathway such as CCL8 (rho = 0.32; p = 0.0111), IFIT1 (rho = 0.29; p = 0.0229), IFIT3 (rho = 0.57; p < 0.0001), IFI27 (rho = 0.42; p = 0.008), MX1 (rho = 0.26; p = 0.0383) and RSAD2 (rho = 0.43; p = 0.0005). CONCLUSIONS This retrospective study suggests that M1 macrophage polarization may be induced by cetirizine through the interferon-gamma pathway. This effect may synergize with the immunotherapy of advanced melanoma with anti-PD-1 agents.
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Affiliation(s)
- Domenico Mallardo
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori - IRCCS - Fondazione "G. Pascale", Naples, Italy
| | - Ester Simeone
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori - IRCCS - Fondazione "G. Pascale", Naples, Italy
| | - Vito Vanella
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori - IRCCS - Fondazione "G. Pascale", Naples, Italy
| | - Maria Grazia Vitale
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori - IRCCS - Fondazione "G. Pascale", Naples, Italy
| | - Marco Palla
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori - IRCCS - Fondazione "G. Pascale", Naples, Italy
| | - Luigi Scarpato
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori - IRCCS - Fondazione "G. Pascale", Naples, Italy
| | - Miriam Paone
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori - IRCCS - Fondazione "G. Pascale", Naples, Italy
| | - Teresa De Cristofaro
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori - IRCCS - Fondazione "G. Pascale", Naples, Italy
| | - Valentina Borzillo
- Radiation Oncology Unit, Istituto Nazionale Tumori - IRCCS -Fondazione "G. Pascale", Naples, Italy
| | - Alessio Cortellini
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, London, W120HS, UK
| | - Francesca Sparano
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori - IRCCS - Fondazione "G. Pascale", Naples, Italy
| | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori - IRCCS -Fondazione "G. Pascale", Naples, Italy
| | - Francesco Fiore
- Interventional Radiology Unit, Istituto Nazionale Tumori - IRCCS -Fondazione "G. Pascale", Naples, Italy
| | - Corrado Caracò
- Division of Surgery of Melanoma and Skin Cancer, Istituto Nazionale Tumori - IRCCS - Fondazione "G. Pascale", Naples, Italy
| | - Piera Maiolino
- Hospital Pharmacy, Istituto Nazionale Tumori - IRCCS - Fondazione "G. Pascale", Naples, Italy
| | - Antonella Petrillo
- Radiology Division, Istituto Nazionale Tumori - IRCCS - Fondazione "G. Pascale", Naples, Italy
| | - Ernesta Cavalcanti
- Division of Laboratory Medicine, Istituto Nazionale Tumori - IRCCS -Fondazione "G. Pascale", Naples, Italy
| | - Secondo Lastoria
- Nuclear Medicine Unit, Istituto Nazionale Tumori - IRCCS - Fondazione "G. Pascale", Naples, Italy
| | - Paolo Muto
- Radiation Oncology Unit, Istituto Nazionale Tumori - IRCCS -Fondazione "G. Pascale", Naples, Italy
| | - Alfredo Budillon
- Experimental Pharmacology Unit, Istituto Nazionale Tumori - IRCCS - Fondazione "G. Pascale", Naples, Italy
| | | | - Paolo Antonio Ascierto
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori - IRCCS - Fondazione "G. Pascale", Naples, Italy.
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7
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Passarelli A, Pisano C, Cecere SC, Di Napoli M, Rossetti S, Tambaro R, Ventriglia J, Gherardi F, Iannacone E, Venanzio SS, Fiore F, Bartoletti M, Scognamiglio G, Califano D, Pignata S. Targeting immunometabolism mediated by the IDO1 Pathway: A new mechanism of immune resistance in endometrial cancer. Front Immunol 2022; 13:953115. [PMID: 36119020 PMCID: PMC9479093 DOI: 10.3389/fimmu.2022.953115] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/12/2022] [Indexed: 11/13/2022] Open
Abstract
Immunotherapy is acquiring a primary role in treating endometrial cancer (EC) with a relevant benefit for many patients. Regardless, patients progressing during immunotherapy or those who are resistant represent an unmet need. The mechanisms of immune resistance and escape need to be better investigated. Here, we review the major mechanisms of immune escape activated by the indolamine 2,3-dioxygenase 1 (IDO1) pathway in EC and focus on potential therapeutic strategies based on IDO1 signaling pathway control. IDO1 catalyzes the first rate-limiting step of the so-called “kynurenine (Kyn) pathway”, which converts the essential amino acid l-tryptophan into the immunosuppressive metabolite l-kynurenine. Functionally, IDO1 has played a pivotal role in cancer immune escape by catalyzing the initial step of the Kyn pathway. The overexpression of IDO1 is also associated with poor prognosis in EC. These findings can lead to advantages in immunotherapy-based approaches as a rationale for overcoming the immune escape. Indeed, besides immune checkpoints, other mechanisms, including the IDO enzymes, contribute to the EC progression due to the immunosuppression induced by the tumor milieu. On the other hand, the IDO1 enzyme has recently emerged as both a promising therapeutic target and an unfavorable prognostic biomarker. This evidence provides the basis for translational strategies of immune combination, whereas IDO1 expression would serve as a potential prognostic biomarker in metastatic EC.
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Affiliation(s)
- Anna Passarelli
- Department of Urology and Gynecology, Istituto Nazionale Tumori Istituto di Ricovero e Cura a Carattere Scientifico Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione G. Pascale, Naples, Italy
- *Correspondence: Anna Passarelli,
| | - Carmela Pisano
- Department of Urology and Gynecology, Istituto Nazionale Tumori Istituto di Ricovero e Cura a Carattere Scientifico Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione G. Pascale, Naples, Italy
| | - Sabrina Chiara Cecere
- Department of Urology and Gynecology, Istituto Nazionale Tumori Istituto di Ricovero e Cura a Carattere Scientifico Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione G. Pascale, Naples, Italy
| | - Marilena Di Napoli
- Department of Urology and Gynecology, Istituto Nazionale Tumori Istituto di Ricovero e Cura a Carattere Scientifico Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione G. Pascale, Naples, Italy
| | - Sabrina Rossetti
- Department of Urology and Gynecology, Istituto Nazionale Tumori Istituto di Ricovero e Cura a Carattere Scientifico Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione G. Pascale, Naples, Italy
| | - Rosa Tambaro
- Department of Urology and Gynecology, Istituto Nazionale Tumori Istituto di Ricovero e Cura a Carattere Scientifico Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione G. Pascale, Naples, Italy
| | - Jole Ventriglia
- Department of Urology and Gynecology, Istituto Nazionale Tumori Istituto di Ricovero e Cura a Carattere Scientifico Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione G. Pascale, Naples, Italy
| | - Federica Gherardi
- Radiation Oncology Unit, Istituto Nazionale Tumori Istituto di Ricovero e Cura a Carattere Scientifico Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione G. Pascale, Naples, Italy
| | - Eva Iannacone
- Radiation Oncology Unit, Istituto Nazionale Tumori Istituto di Ricovero e Cura a Carattere Scientifico Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione G. Pascale, Naples, Italy
| | | | - Francesco Fiore
- Interventional Radiology Unit, Istituto Nazionale Tumori Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione G. Pascale, Naples, Italy
| | - Michele Bartoletti
- Medical Oncology and Cancer Prevention Unit, Department of Medical Oncology, Oncology Referral Center, Aviano, Italy
| | - Giosuè Scognamiglio
- Surgical Pathology Unit, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy
| | - Daniela Califano
- Functional Genomic Unit, Istituto Nazionale Tumori Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione G. Pascale, Naples, Italy
| | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori Istituto di Ricovero e Cura a Carattere Scientifico Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione G. Pascale, Naples, Italy
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8
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Fiore F, Iengo M, Lepre D, Fiorentino M, Chiappetti R, Greco T, Flocco V, Cante T, Puzone B, Rengo G, De Vita A, Piccolo A, Tocchetti G, Abete P, Cacciatore F. Effects of repeated administration of Levosimendan in advanced heart failure in the elderly patient. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0801] [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: 11/12/2022] Open
Abstract
Abstract
Introduction
Advanced heart failure (AHF) is characterized by repeated episodes of hemodynamic instability, frequent hospitalizations with progressive reduction in quality of life. The aim of the study was to verify in a small group of patients, no longer susceptible to heart transplantation (HT) and left ventricular assistance (LVAD), the effectiveness of monthly treatment with Levosimendan for a period of at least 6 months on quality of life and hospitalization.
Materials and methods
29 elderly patients (≥65 years) with AHF, excluded from the waiting list for HT or no longer eligible for inclusion on the waiting list were enrolled. 12 patients practiced at least 1 infusion of Levosimendan and were considered as cases, while 17 patients with maximized treatment were used as controls. All patients underwent a multidimensional evaluation in which Fraity was assessed according to Fried criteria, cognitive function with Mini-Mental State Examination (MMSE), depressive symptoms with Geriatric Depression Scale (GDS).
Results
The 29 patients were followed up monthly and the 12 patients of Levosimendan group practiced an average of 4.6±2.7 infusions in absence of adverse events. The mean age was 73.3±6.2, 87.5% males, with a NYHA class of 3.4±0.4, an ejection fraction of 26.6±4.9 and NT-pro-BNP value of 7016.8±4876.1. Renal function was impaired with eGFR (ml / min) = 36.8±20.1. These patients had been hospitalized 1.8±0.7 times in the previous year. The data are not statistically different compared to the control group although a greater severity of the clinical condition of the case group is evident. The 6 minute walking test (6MWT) was 201.4±118.1 meters. The mean values of Frailty was 4.6±0.5, the GDS 6.4±4.2 and the MMSE 23.8±4.3. Only the MMSE was lower in the case group than in the controls (26.9±1.9, p=0.022). The results in terms of pre-post treatment difference identify an improvement of 35.3±136.3 meters at 6MWT in patients treated with Levosimendan compared to −72.2±94.2 meters in controls (p=0.030), Frailty is reduced by 1.4±1.6 points compared to 0.1±1.1 in controls (p=0.030), the GDS decreases by 0.9±1.5 in cases and increases by 2±2.1 in the control group (p=0.020), the MMSE score increases by 2.12±4.1 in treated patients, while it is reduced by 2.75±2.3 in the control group; p=0.003. The eGFR is reduced in both groups although more in the controls (−1.87±5.8 vs −10.8±11.1; p=0.043). There are no significant differences in mortality while there was less hospitalization during the follow-up period 0.9±0.6 vs 2.4±1.5; p=0.016). Multiple regression analysis shows that hospitalizations reduction is correlated with the recovery of frailty. This association is independent by age and disease severity.
Conclusion
Levosimendan improves physical and cognitive function, at the same time a minor decrease in renal function is observed, with a reduction of unscheduled visits to the hospital.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- F Fiore
- Federico II University of Naples, Naples, Italy
| | - M Iengo
- Federico II University of Naples, Naples, Italy
| | - D Lepre
- Federico II University of Naples, Naples, Italy
| | | | | | - T Greco
- Federico II University of Naples, Naples, Italy
| | - V Flocco
- Federico II University of Naples, Naples, Italy
| | - T Cante
- Federico II University of Naples, Naples, Italy
| | - B Puzone
- Federico II University of Naples, Naples, Italy
| | - G Rengo
- Federico II University of Naples, Naples, Italy
| | - A De Vita
- Federico II University of Naples, Naples, Italy
| | - A Piccolo
- Federico II University of Naples, Naples, Italy
| | - G Tocchetti
- Federico II University of Naples, Naples, Italy
| | - P Abete
- Federico II University of Naples, Naples, Italy
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9
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Cuomo A, Paudice F, D'Angelo G, Perrotta G, Carannante A, Attanasio U, Iengo M, Fiore F, Tocchetti CG, Mercurio V, Pirozzi F. New-Onset Cancer in the HF Population: Epidemiology, Pathophysiology, and Clinical Management. Curr Heart Fail Rep 2021; 18:191-199. [PMID: 34181210 PMCID: PMC8342372 DOI: 10.1007/s11897-021-00517-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/19/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW Oncological treatments are known to induce cardiac toxicity, but the impact of new-onset cancer in patients with pre-existing HF remains unknown. This review focuses on the epidemiology, pathophysiological mechanisms, and clinical implications of HF patients who develop malignancies. RECENT FINDINGS Novel findings suggest that HF and cancer, beside common risk factors, are deeply linked by shared pathophysiological mechanisms. In particular, HF itself may enhance carcinogenesis by producing pro-inflammatory cytokines, and it has been suggested that neurohormonal activation, commonly associated with the failing heart, might play a pivotal role in promoting neoplastic transformation. The risk of malignancies seems to be higher in HF patients compared to the general population, probably due to shared risk factors and common pathophysiological pathways. Additionally, management of these patients represents a challenge for clinicians, considering that the co-existence of these diseases significantly worsens patients' prognosis and negatively affects therapeutic options for both diseases.
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Affiliation(s)
- Alessandra Cuomo
- Department of Translational Medical Sciences, Federico II University, Naples, Italy.
| | - Francesca Paudice
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Giovanni D'Angelo
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Giovanni Perrotta
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Antonio Carannante
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Umberto Attanasio
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Martina Iengo
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Francesco Fiore
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Carlo Gabriele Tocchetti
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
- Interdepartmental Center of Clinical and Translational Sciences (CIRCET), Federico II University, Naples, Italy
- Interdepartmental Hypertension Research Center (CIRIAPA), Federico II University, Naples, Italy
| | - Valentina Mercurio
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Flora Pirozzi
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
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10
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Somma F, Stoia V, D’Angelo R, Fiore F. Imaging-guided radiofrequency ablation of osteoid osteoma in typical and atypical sites: Long term follow up. PLoS One 2021; 16:e0248589. [PMID: 33735214 PMCID: PMC7971862 DOI: 10.1371/journal.pone.0248589] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 03/01/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose To assess efficacy and safety of imaging-guided radiofrequency ablation (RFA) of Osteoid Osteoma (OO) in both typical and atypical sites. Methods and materials Between January 2014 and March 2019, 102 consecutive percutaneous RFA were performed and retrospectively reviewed. The procedures were performed using a RFA bipolar ablation system (Covidien, exposed tip of 0.7-1cm), under Computed Tomography (CT) guidance or using a navigation system (Masmec) under CT and Cone Beam CT (CBCT) guidance. Patients were followed up over 24 months. Clinical success and recurrences were considered on the base of established criteria. In patients with clinical failure and/or imaging evidence of relapse, retreatment was considered. Results Administered power per-procedure was ≤8 W (mean temperature, 90°C). The pre-procedure average value of visual analog scale (VAS) was 8.33+/-0.91. Primary and secondary success rate 96.08% (98/102) and100% (102/102), respectively. No major complication was described. Technical success was proved in every patient by CT scan acquisition after needle positioning. Relapse and tumour location were significantly correlated (p-value = 0.0165). The mean dose-length product was 751.55 mGycm2. Advanced bone healing was noted in 68 lesions after 1y-follow up and in 86 lesions after 2y-follow up. Conclusion Imaging-guided percutaneous RFA is a highly effective technique for OO, both in typical and atypical sites. CT or CBCT guidance, navigation systems and operator experience grant the technical success, which is the most crucial parameter affecting outcome.
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Affiliation(s)
- Francesco Somma
- Radiologia Interventistica, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, Napoli (IT), Naples, Italy
- * E-mail:
| | - Vincenzo Stoia
- Radiologia Interventistica, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, Napoli (IT), Naples, Italy
| | - Roberto D’Angelo
- Radiologia Interventistica, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, Napoli (IT), Naples, Italy
| | - Francesco Fiore
- Radiologia Interventistica, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, Napoli (IT), Naples, Italy
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11
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Buonaguro FM, Botti G, Ascierto PA, Pignata S, Ionna F, Delrio P, Petrillo A, Cavalcanti E, Di Bonito M, Perdonà S, De Laurentiis M, Fiore F, Palaia R, Izzo F, D'Auria S, Rossi V, Menegozzo S, Piccirillo M, Celentano E, Cuomo A, Normanno N, Tornesello ML, Saviano R, Barberio D, Buonaguro L, Giannoni G, Muto P, Miscio L, Bianchi AAM. The clinical and translational research activities at the INT - IRCCS "Fondazione Pascale" cancer center (Naples, Italy) during the COVID-19 pandemic. Infect Agent Cancer 2020; 15:69. [PMID: 33292365 PMCID: PMC7681193 DOI: 10.1186/s13027-020-00330-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/01/2020] [Indexed: 01/19/2023] Open
Abstract
COVID-19 pandemic following the outbreak in China and Western Europe, where it finally lost the momentum, is now devastating North and South America. It has not been identified the reason and the molecular mechanisms of the two different patterns of the pulmonary host responses to the virus from a minimal disease in young subjects to a severe distress syndrome (ARDS) in older subjects, particularly those with previous chronic diseases (including diabetes) and cancer. The Management of the Istituto Nazionale Tumori - IRCCS "Fondazione Pascale" in Naples (INT-Pascale), along with all Health professionals decided not to interrupt the treatment of those hospitalized and to continue, even if after a careful triage in order not to allow SARS-CoV-2 positive subjects to access, to take care of cancer patients with serious conditions. Although very few (n = 3) patients developed a symptomatic COVID-19 and required the transfer to a COVID-19 area of the Institute, no patients died during the hospitalization and completed their oncology treatment. Besides monitoring of the patients, all employees of the Institute (physicians, nurses, researchers, lawyers, accountants, gatekeepers, guardians, janitors) have been tested for a possible exposure. Personnel identified as positive, has been promptly subjected to home quarantine and subdued to health surveillance. One severe case of respiratory distress has been reported in a positive employees and one death of a family member. Further steps to home monitoring of COVID-19 clinical course have been taken with the development of remote Wi-Fi connected digital devices for the detection of early signs of respiratory distress, including heart rate and oxygen saturation.In conclusion cancer care has been performed and continued safely also during COVID-19 pandemic and further remote home strategies are in progress to ensure the appropriate monitoring of cancer patients.
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Affiliation(s)
| | - Gerardo Botti
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | | | - Sandro Pignata
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Franco Ionna
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Paolo Delrio
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | | | | | | | - Sisto Perdonà
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | | | - Francesco Fiore
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Raffaele Palaia
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Francesco Izzo
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Stefania D'Auria
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Virginia Rossi
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Simona Menegozzo
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Mauro Piccirillo
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Egidio Celentano
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Arturo Cuomo
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Nicola Normanno
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | | | - Rocco Saviano
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Daniela Barberio
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Luigi Buonaguro
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | | | - Paolo Muto
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Leonardo Miscio
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
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12
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Nappi A, Zanaletti N, Silvestro L, Cassata A, Stefano AD, Casaretti R, Romano C, Calabrese F, Lzzo F, Fiore F, M. Piccirillo, Avallone A. P-269 Lenvatinib in hepatocellular carcinoma: QoL surveys and radiological imaging markers predicting clinical outcome in patients with hepatocellular carcinoma treated with lenvatinib as first-line treatment (SULENVA-HCC). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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13
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Fiore F, Stoia V, Somma F. Surgical recurrence of solitary fibrous tumor of the pleura treated with microwave (MW) thermoablation: A case report. Thorac Cancer 2019; 11:443-446. [PMID: 31876364 PMCID: PMC6997023 DOI: 10.1111/1759-7714.13263] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 11/06/2019] [Accepted: 11/08/2019] [Indexed: 12/22/2022] Open
Abstract
Solitary fibrous tumor (SFT) of the pleura is a rare neoplasm which is challenging for clinicians to treat and radiologists to diagnose. Herein, we report a case of recurrence of SFT of the pleura in a 77-year-old patient which was diagnosed and surgically treated on the first occasion in 2005. The patient had a recurrence in 2016 which was treated and then six months later, he again experienced chest pain and a further local recurrence was found. Taking into consideration the age and comorbidities of the patient, CT-guided percutaneous microwave-thermal ablation was preferrable to surgery and a safe and highly effective local ablative technique with few side-effects.
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Affiliation(s)
- Francesco Fiore
- Interventional Radiology Unit, National Cancer Institute "IRCCS Fondazione Pascale", Napoli, Italy
| | - Vincenzo Stoia
- Interventional Radiology Unit, National Cancer Institute "IRCCS Fondazione Pascale", Napoli, Italy
| | - Francesco Somma
- Interventional Radiology Unit, National Cancer Institute "IRCCS Fondazione Pascale", Napoli, Italy
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Pugliese M, Amatiello A, Correra M, Stoia V, Cerciello V, Roca V, Loffredo F, Fiore F, La Verde G. Evaluation of the current status of the eye lens radiation exposure in an Interventional Radiology department. Med Lav 2018; 109:471-477. [PMID: 30556537 PMCID: PMC7682182 DOI: 10.23749/mdl.v110i6.7286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 09/24/2018] [Indexed: 11/17/2022]
Abstract
Background: Following recent epidemiological studies, which showed tissue reactions from ionizing radiation at significantly lower doses, the 2013/59 EURATOM Directive of 5th December 2013 lowered the limit on the equivalent dose to the eye lens from 150 mSv to 20 mSv per year. Therefore, as a precautionary measure, it is considered appropriate to perform a timely dose monitoring by using specific dosimeters. Objectives: Analysis of the current state of the eye lens exposures during interventional procedures. The survey aimed at assessing the degree of information available to the exposed workers as regards lowering the dose limit in Interventional Radiology departments of some hospitals in Campania (Southern Italy). Methods: The equivalent dose was assessed, over a period of 90 days, using specific Hp dosimeters(3), placed sideways with regard to prescription eye glasses. The level of awareness of the new dose limit among operators was assessed using a questionnaire. Results: The values of the equivalent dose to the lens of the eye for the I and II Operators were found to be <150 mSv/year but for the I Operator a value of 54 mSv/year was obtained, ie higher than 20 mSv/year, that is the new limit of the equivalent dose according to 2013/59 EURATOM. The initial results of the questionnaire from 52 exposed workers, of which 46 (88%) were from exposure category A and 6 (12%) from category B, showed a low level of information (19%). Conclusions: The results highlight not only the importance of using specific devices for individual protection but also the importance of the level of training and information the exposed medical staff are given concerning the new regulations.
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Sangro B, Maini CL, Ettorre GM, Cianni R, Golfieri R, Gasparini D, Ezziddin S, Paprottka PM, Fiore F, Van Buskirk M, Bilbao JI, Salvatori R, Giampalma E, Geatti O, Wilhelm K, Hoffmann RT, Izzo F, Iñarrairaegui M, Urigo C, Cappelli A, Vit A, Ahmadzadehfar H, Jakobs TF, Sciuto R, Pizzi G, Lastoria S. Radioembolisation in patients with hepatocellular carcinoma that have previously received liver-directed therapies. Eur J Nucl Med Mol Imaging 2018. [PMID: 29516130 PMCID: PMC6097757 DOI: 10.1007/s00259-018-3968-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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] [Indexed: 02/06/2023]
Abstract
Purpose Radioembolisation is part of the multimodal treatment of hepatocellular carcinoma (HCC) at specialist liver centres. This study analysed the impact of prior treatment on tolerability and survival following radioembolisation. Methods This was a retrospective analysis of 325 consecutive patients with a confirmed diagnosis of HCC, who received radioembolisation with yttrium-90 resin microspheres at eight European centres between September 2003 and December 2009. The decision to treat was based on the clinical judgement of multidisciplinary teams. Patients were followed from the date of radioembolisation to last contact or death and the nature and severity of all adverse events (AEs) recorded from medical records. Results Most radioembolisation candidates were Child-Pugh class A (82.5%) with multinodular HCC (75.9%) invading both lobes (53.1%); 56.3% were advanced stage. Radioembolisation was used first-line in 57.5% of patients and second-line in 34.2%. Common prior procedures were transarterial (chemo)embolisation therapies (27.1%), surgical resection/transplantation (17.2%) and ablation (8.6%). There was no difference in AE incidence and severity between prior treatment subgroups. Median (95% confidence interval [CI]) survival following radioembolisation was similar between procedure-naive and prior treatment groups for Barcelona Clinic Liver Cancer (BCLC) stage A: 22.1 months (15.1–45.9) versus 30.9 months (19.6–46.8); p = 0.243); stage B: 18.4 months (11.2–19.4) versus 22.8 months (10.9–34.2); p = 0.815; and stage C: 8.8 months (7.1–10.8) versus 10.8 months (7.7–12.6); p = 0.976. Conclusions Radioembolisation is a valuable treatment option for patients who relapse following surgical, ablative or vascular procedures and remain suitable candidates for this treatment.
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Affiliation(s)
- Bruno Sangro
- Liver Unit, Clinica Universidad de Navarra, and Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBEREHD), Avda. Pio XII, 36, 31008, Pamplona, Spain.
| | | | | | - Roberto Cianni
- Interventional Radiology, Ospedale S.M.Goretti, Latina, Italy
| | - Rita Golfieri
- Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Daniele Gasparini
- Diagnostic and Interventional Radiology, Azienda Ospedaliera S. M. della Misericordia, Udine, Italy
| | - Samer Ezziddin
- Nuclear Medicine, Universitätsklinik Bonn, Bonn, Germany
| | - Philipp M Paprottka
- Interventional Radiology, LMU Klinikum der Universität München, Munich, Germany
| | - Francesco Fiore
- Onco Interventional Radiology, Istituto Tumori Pascale, Naples, Italy
| | | | | | | | | | - Onelio Geatti
- Nuclear Medicine, Azienda Ospedaliera S. M. della Misericordia, Udine, Italy
| | - Kai Wilhelm
- Department of Radiology, University of Bonn, Bonn, Germany
| | | | - Francesco Izzo
- Hepatobiliary Surgery, Istituto Tumori Pascale, Naples, Italy
| | - Mercedes Iñarrairaegui
- Liver Unit, Clinica Universidad de Navarra, and Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBEREHD), Avda. Pio XII, 36, 31008, Pamplona, Spain
| | - Carlo Urigo
- Interventional Radiology, Ospedale S.M.Goretti, Latina, Italy
| | | | - Alessandro Vit
- Interventional Radiology, IFO Regina Elena National Cancer Institute, Rome, Italy
| | | | - Tobias Franz Jakobs
- Interventional Radiology, LMU Klinikum der Universität München, Munich, Germany
| | - Rosa Sciuto
- Nuclear Medicine, IFO Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppe Pizzi
- Interventional Radiology, IFO Regina Elena National Cancer Institute, Rome, Italy
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Sechi S, Di Cerbo A, Canello S, Guidetti G, Chiavolelli F, Fiore F, Cocco R. Effects in dogs with behavioural disorders of a commercial nutraceutical diet on stress and neuroendocrine parameters. Vet Rec 2016; 180:18. [PMID: 27885066 PMCID: PMC5284471 DOI: 10.1136/vr.103865] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [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: 10/29/2016] [Indexed: 02/07/2023]
Abstract
The well-being of dogs can be affected by changes in human lifestyle, eating habits and increased stressors that lead to behavioural disorders including fear, hyperactivity and anxiety, followed by negative affective moods and poor welfare. This randomised, controlled clinical evaluation involved 69 dogs, 38 males and 31 females, of different breeds, with behavioural disorders related to anxiety and chronic stress. They were fed a control diet or a nutraceutical diet (ND group) for 45 days. Neuroendocrine (serotonin, dopamine, β-endorphins, noradrenaline and cortisol) and stress (derivatives of reactive oxygen metabolites (dROMs) and biological antioxidant potential (BAP)) parameters related to behavioural disorders were evaluated at the beginning and end of the study period. Results showed a significant increase in serotonin, dopamine and β-endorphins plasma concentrations (*P<0.05, *P<0.05 and **P<0.01, respectively) and a significant decrease in noradrenaline and cortisol plasma concentrations in the ND group (*P<0.05). dROMs significantly decreased in the ND group (*P<0.05) while BAP was not affected. This study demonstrated for the first time that a specific diet significantly and positively affected neuroendocrine parameters and dROMs. These results open significant perspectives concerning the use of diet and nutraceuticals in the treatment of behavioural disorders.
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Affiliation(s)
- S Sechi
- Department of Veterinary Medicine, Pathology and Veterinary Clinic Section, University of Sassari, Via Vienna 2, 07100 Sassari, Italy
| | - A Di Cerbo
- Department of Biomedical Sciences, School of Specialization in Clinical Biochemistry, "G. d'Annunzio" University, Via dei Vestini 31, 66100 Chieti, Italy
| | - S Canello
- Research and Development Department, Forza10 USA Corp., 10142 Canopy Tree Ct. 32836 Orlando, Florida, USA
| | - G Guidetti
- Research and Development Department, Forza10 USA Corp., 10142 Canopy Tree Ct. 32836 Orlando, Florida, USA
| | - F Chiavolelli
- Department of Diagnostic Medicine, Clinical and Public Health, University of Modena and Reggio Emilia, Via Campi 213/A, 41125 Modena, Italy
| | - F Fiore
- Department of Veterinary Medicine, Pathology and Veterinary Clinic Section, University of Sassari, Via Vienna 2, 07100 Sassari, Italy
| | - R Cocco
- Department of Veterinary Medicine, Pathology and Veterinary Clinic Section, University of Sassari, Via Vienna 2, 07100 Sassari, Italy
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Fiore F, Gargiulo L, Cardone C, Laterza M, Fasano M, De Vita F, Ciardiello F. Evaluation of burnout syndrome and personalized intervention in the medical oncology unit of the Second University of Naples (SUN). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw386.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Fiore F, Gargiulo L, Cardone C, Laterza M, Fasano M, De Vita F, Ciardiello F. Evaluation of burnout syndrome and personalized intervention in the medical oncology unit of second university of naples (sun). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw342.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Rocco G, Morabito A, Leone A, Muto P, Fiore F, Budillon A. Management of non-small cell lung cancer in the era of personalized medicine. Int J Biochem Cell Biol 2016; 78:173-179. [DOI: 10.1016/j.biocel.2016.07.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 07/11/2016] [Accepted: 07/13/2016] [Indexed: 01/20/2023]
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20
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Carfi A, Vetrano D, Brandi V, Fiore F, Mascia D, Di Tella S, Bernabei R, Onder G. P-057: Association between left ventricular diastolic function and cognitive performance in adults with Down syndrome. Eur Geriatr Med 2015. [DOI: 10.1016/s1878-7649(15)30160-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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21
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Somma F, D’Angelo R, Serra N, Gatta G, Grassi R, Fiore F. Use of Ethanol in the Trans-Arterial Lipiodol Embolization (TAELE) of Intermediated-Stage HCC: Is This Safer than Conventional Trans-Arterial Chemo-Embolization (c-TACE)? PLoS One 2015; 10:e0129573. [PMID: 26110810 PMCID: PMC4481347 DOI: 10.1371/journal.pone.0129573] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 05/11/2015] [Indexed: 12/23/2022] Open
Abstract
Purpose To evaluate safety and efficacy of Trans-Arterial Ethanol-Lipiodol Embolization (TAELE) compared with conventional Trans-Arterial Chemo-Embolization (cTACE) in the treatment of small intermediate-HCC (BCLC-Stage B). Materials and Methods A random sample of 87 patients (37.93% male; 62.07% female; age range, 36–86 years) with documented small intermediate-HCC and treated with TAELE (mixture 1:1 of Ethanol and Lipiodol) or cTACE (mixture of 50mg-Epirubicin and 5cc-Lipiodol) were retrospectively studied in an institutional review board approved protocol. The two procedures were compared with χ2-test, χ2-test with Yates correction, McNemar’s exact test, ANOVA test and log-rank test. Results TAELE and cTACE therapies were performed in 45 and 42 patients, respectively. Thirty days after the procedure, a Multi-Detector Computed Tomography (MDCT) showed no significant difference in the number of patients with partial and complete response between the two groups (p-value = 0.958), according to mRECIST. Contrary, significant differences were found in tumor-devascularization, lesion-reduction and post-embolization syndrome occurrence (p-value = 0.0004, p-value = 0.0003 and p-value = 0.009, respectively). Similar survival was observed during 36-month follow-up (p-value = 0.884). Conclusion Compared to cTACE, TAELE showed a better toxicity profile with similar 36-month survival and similar one-month anti-tumor effects, which makes it better tolerated by patients, especially in case of more than one treatment.
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Affiliation(s)
- Francesco Somma
- Department of Medicine and Surgery “Magrassi and Lanzara”, Section of Radiology, Second University of Naples (SUN), Napoli, Italy
- * E-mail:
| | - Roberto D’Angelo
- Department of Interventional Radiology, National Cancer Institute of Naples “Fondazione Pascale”, Napoli, Italy
| | - Nicola Serra
- Department of Medicine and Surgery “Magrassi and Lanzara”, Section of Radiology, Second University of Naples (SUN), Napoli, Italy
| | - Gianluca Gatta
- Department of Medicine and Surgery “Magrassi and Lanzara”, Section of Radiology, Second University of Naples (SUN), Napoli, Italy
| | - Roberto Grassi
- Department of Medicine and Surgery “Magrassi and Lanzara”, Section of Radiology, Second University of Naples (SUN), Napoli, Italy
| | - Francesco Fiore
- Department of Interventional Radiology, National Cancer Institute of Naples “Fondazione Pascale”, Napoli, Italy
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Martelli A, Buli P, Cortecchia V, Spatafora S, Fiore F, Tiozzi E. Urease inhibition in the treatment of infected renal stones: propionohydroxamic acid. Contrib Nephrol 2015; 58:196-200. [PMID: 3691126 DOI: 10.1159/000414517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- A Martelli
- Department of Urology, University of Bologna, Italy
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Britton KE, al-Nahhas AM, Nimmon CC, Carroll MJ, Fiore F, Solanki K, Bomanji J. The measurement of intrarenal plasma flow distribution in essential hypertension. The effect of angiotensin-converting enzyme inhibition. Contrib Nephrol 2015; 79:186-9. [PMID: 2146083 DOI: 10.1159/000418175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- K E Britton
- Department of Nuclear Medicine, St. Bartholomew's Hospital, West Smithfield, London, UK
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Mikus E, Grattoni C, Fiore F, Conte M, Coppola R, Chierchia S, Bosi S, Jori MC, Castriota F, Del Giglio M. Hybrid coronary artery revascularization: initial experience of a single centre. Eur Heart J Suppl 2015. [DOI: 10.1093/eurheartj/suv015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Carfi’ A, Antocicco M, Brandi V, Cipriani C, Fiore F, Mascia D, Vetrano D, Onder G. O1.12: Down syndrome in adulthood: a disease for geriatricians. Eur Geriatr Med 2014. [DOI: 10.1016/s1878-7649(14)70095-6] [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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Fiore F, Del Prete M, Franco R, Marotta V, Ramundo V, Marciello F, Di Sarno A, Carratù AC, de Luca di Roseto C, Colao A, Faggiano A. Transarterial embolization (TAE) is equally effective and slightly safer than transarterial chemoembolization (TACE) to manage liver metastases in neuroendocrine tumors. Endocrine 2014; 47:177-82. [PMID: 24385266 DOI: 10.1007/s12020-013-0130-9] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 11/21/2013] [Indexed: 12/24/2022]
Abstract
Liver metastases from neuroendocrine tumor (NET) can be treated by transarterial embolization (TAE) or transarterial chemoembolization (TACE). The goal of TAE and TACE is to reduce blood flow to the tumor resulting in tumor ischemia and necrosis. In this retrospective study, the effectiveness and safety of TAE-TACE in the treatment of liver metastases in patients with NET was compared. Thirty patients with a histologically confirmed gastro-entero-pancreatic NET with liver metastases were retrospectively investigated. Seventeen patients underwent TAE, while 13 patients underwent TACE. Tumor response, degree of devascularization in treated lesions, and progression free survival (PFS) were evaluated in the whole population and then separately in TAE and TACE subgroups. In all patients treated with TAE and TACE, there was a significant size reduction of lesions as compared to baseline. Per lesion reduction was 2.2 ± 1.4 versus 3.3 ± 1.5 cm for TAE (p < 0.001) and 2.2 ± 1.5 versus 3.4 ± 1.7 cm for TACE (p < 0.001). In the whole population, the median PFS for all patients was 36 months (16.2-55.7 CI), without significant difference between TAE and TACE. In no patient did adverse events grade 3 and 4 as well as TAE/TACE-related death occurred, while the post-embolization syndrome occurred in 41 % of patients treated with TAE and 61 % of those treated with TACE. TAE and TACE are both effective in NET patients with liver metastases. TAE should be preferred to TACE in light of its similar anti-tumor effects and slightly better toxicity profile.
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Affiliation(s)
- Francesco Fiore
- Interventional Radiology, National Cancer Institute, Fondazione "G. Pascale", Naples, Italy,
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Romano M, D’Antò M, Bifulco P, Fiore F, Cesarelli M. Robustness to noise of arterial blood flow estimation methods in CT perfusion. BMC Res Notes 2014; 7:540. [PMID: 25130498 PMCID: PMC4152598 DOI: 10.1186/1756-0500-7-540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 08/01/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Perfusion CT is a technology which allows functional evaluation of tissue vascularity. Due to this potential, it is finding increasing utility in oncology. Although since its introduction continuous advances have interested CT technique, some issues have to be still defined, concerning both clinical and technical aspects. In this study, we dealt with the comparison of two widely employed mathematical models (dual input one compartment model - DOCM - and maximum slope - SM -) analyzing their robustness to the noise. METHODS We carried out a computer simulation process to quantify effect of noise on the evaluation of an important perfusion parameter (Arterial Blood Flow - BFa) in liver tumours. A total of 4500 liver TAC, corresponding to 3 fixed BFa values, were simulated using different arterial and portal TAC (computed from 5 real CT images) at 10 values of signal to noise ratio (SNR). BFa values were calculated by applying four different algorithms, specifically developed, to these noisy simulated curves. Three algorithms were developed to implement SM (one semiautomatic, one automatic and one automatic with filtering) and the last for the DOCM method. RESULTS In all the simulations, DOCM provided the best results, i.e., those with the lowest percentage error compared to the reference value of BFa. Concerning SM, the results are variable. Results obtained with the automatic algorithm with filtering are close to the reference value, but only if SNR is higher than 50. Vice versa, results obtained by means of the semiautomatic algorithm gave, in all simulations, the lowest results with the lowest standard deviation of the percentage error. CONCLUSIONS Since the use of DOCM is limited by the necessity that portal vein is visible in CT scans, significant restriction for patients' follow-up, we concluded that SM can be reliably employed. However, a proper software has to be used and an estimation of SNR would be carried out.
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Affiliation(s)
- Maria Romano
- />DIETI, University of Naples, “Federico II”, Naples, Italy
- />Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, Rome, Italy
| | - Michela D’Antò
- />DIETI, University of Naples, “Federico II”, Naples, Italy
- />National Cancer Institute “Pascale Foundation”, Naples, Italy
| | - Paolo Bifulco
- />DIETI, University of Naples, “Federico II”, Naples, Italy
- />Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, Rome, Italy
| | - Francesco Fiore
- />National Cancer Institute “Pascale Foundation”, Naples, Italy
| | - Mario Cesarelli
- />DIETI, University of Naples, “Federico II”, Naples, Italy
- />Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, Rome, Italy
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Del Prete M, Fiore F, Modica R, Marotta V, Marciello F, Ramundo V, Di Sarno A, Carratù A, di Roseto CDL, Tafuto S, Tatangelo F, Baldelli R, Colao A, Faggiano A. Hepatic arterial embolization in patients with neuroendocrine tumors. J Exp Clin Cancer Res 2014; 33:43. [PMID: 24887262 PMCID: PMC4038067 DOI: 10.1186/1756-9966-33-43] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 05/05/2014] [Indexed: 12/23/2022]
Abstract
Liver metastases occur in 46-93% of patients with neuroendocrine neoplasms (NENs). Presence and extension of liver metastases are considered important prognostic factors, as they may significantly impair the patient's quality of life, because of either tumor bulk or hormonal hypersecretion. Therapies for NEN liver metastases include surgical resection, liver transplantation, chemotherapy and biotherapy. Surgery is the gold standard for curative therapy, but in most of NEN patients with liver metastases, when surgery can not be applied, minimally invasive therapeutic approaches are adopted. They include trans-arterial embolization (TAE), trans-arterial chemoembolization (TACE), radiofrequency thermal ablation and new emerging techniques.TAE is based on selective infusion of particles in the branch of the hepatic artery supplying the tumor lesions. The goal of TAE is to occlude tumor blood vessels resulting in ischemia and necrosis. Many reports have shown that TAE can reduce tumor size and hormone output, resulting in palliation of symptoms without the use of cytotoxic drugs, resulting in better tolerability. This review will focus on TAE performance and safety in NEN patients with liver metastases.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Antongiulio Faggiano
- Divisione di Endocrinologia, Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Naples, Italy.
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Golfieri R, Bilbao JI, Carpanese L, Cianni R, Gasparini D, Ezziddin S, Paprottka PM, Fiore F, Cappelli A, Rodriguez M, Ettorre GM, Saltarelli A, Geatti O, Ahmadzadehfar H, Haug AR, Izzo F, Giampalma E, Sangro B, Pizzi G, Notarianni E, Vit A, Wilhelm K, Jakobs TF, Lastoria S. Comparison of the survival and tolerability of radioembolization in elderly vs. younger patients with unresectable hepatocellular carcinoma. J Hepatol 2013; 59:753-61. [PMID: 23707371 DOI: 10.1016/j.jhep.2013.05.025] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 04/19/2013] [Accepted: 05/10/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND & AIMS The European Network on Radioembolization with Yttrium-90 resin microspheres study group (ENRY) conducted a retrospective study to evaluate the outcomes among elderly (≥ 70 years) and younger patients (<70 years) with unresectable hepatocellular carcinoma (HCC) who received radioembolization at 8 European centers. METHODS Patients with confirmed diagnosis of unresectable HCC who either progressed following resection or locoregional treatment and/or who were considered poor candidates for chemoembolization were evaluated by a multidisciplinary team for radioembolization with (90)Y-resin microspheres (SIR-Spheres; Sirtex Medical). The survival outcome and all adverse events were compared between the two age groups. RESULTS Between 2003 and 2009, 128 elderly and 197 younger patients received radioembolization. Patients in both groups had similar demographic characteristics. Many elderly and younger patients alike had multinodular, BCLC stage C disease, invading both lobes (p = 0.648). Elderly patients had a lower tumor burden, a smaller median target liver volume (p = 0.016) and appeared more likely to receive segmental treatment (p = 0.054). Radioembolization was equally well tolerated in both cohorts and common procedure-related adverse events were predominantly grade 1-2 and of short duration. No significant differences in survival between the groups were found (p = 0.942) with similar median survival in patients with early, intermediate or advanced BCLC stage disease. CONCLUSIONS Radioembolization appears to be as well-tolerated and effective for the elderly as it is for younger patients with unresectable HCC. Age alone should not be a discriminating factor for the management of HCC patients.
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Affiliation(s)
- Rita Golfieri
- Azienda Ospedaliero-Universitaria, Policlinico S. Orsola-Malpighi, Bologna, Italy.
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Cardone E, Apice G, Rega D, Montesarchio L, Scala D, Granata C, Vallone P, Fiore F, Mori S, Delrio P. Salvage vacuum therapy after failed reconstruction of abdominal wall for extensive resection in recurrent uterine sarcoma. Eur J Surg Oncol 2013. [DOI: 10.1016/j.ejso.2013.07.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Izzo F, Vogl TJ, Gadaleta-Caldarola G, Middleton MR, Valle JW, Hammerstingl R, Gadaleta CD, Martignoni M, Petroccione A, Mariani M, Davite C, Fiore F. Phase II trial of nemorubicin hydrochloride (N) in combination with cisplatin (cDDP) administered by intra-hepatic artery (IHA) in patients (pts) with hepatocellular carcinoma (HCC): Final results. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e15061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15061 Background: N is a novel DNA-intercalator, mainly metabolized in liver by CYP3A4 enzyme and showing synergic antitumor activity with cDDP. The objective of this study was to evaluate the efficacy and toxicity of N administered by IHA in combination with cDDP to unresectable HCC pts. Methods: The study was in two HCC pt populations: advanced risk (ARP) (CLIP 2, bilirubin ≤ 2.5 mg/dL, portal vein thrombosis [PVT] admitted) and intermediate risk (IRP) (CLIP 0-1, bilirubin ≤ 1.5 x ULN, no PVT). Treatment was repeated every 4-6 wks for a maximum of 6 courses, if acceptable toxicity and no disease progression occurred. A single-arm, Simon’s Minimax two-stage design was adopted to evaluate the primary endpoint of tumour response (WHO criteria, critical numbers of responses to reject H0were ≥ 6/29 evaluable pts and ≥ 11/33 evaluable pts in ARP and IRP, respectively). Results: Thirty-seven ARP pts (27 evaluable) and 42 IRP pts (33 evaluable) were enrolled. The median number of cycles was 3 in both ARP (range 1-13; dose 400 mcg/m2 nemorubicin and 60 mg/m2 cDDP) and in IRP (range 1-6; dose 600 mcg/m2 nemorubicin and 60 mg/m2 cDDP). The trial was successful in ARP with 8 successes/27 evaluable pts (RR 30%): 7 partial responses (PR), 1 downstaging and 8 minor responses (MR)/ disease stabilization (SD) > 3 months. The IRP did not meet the efficacy criteria:2 CR, 5 PR and 13 MR/SD > 3 months (7 responses/33 evaluable pts; RR 21%). Overall, the main Grade 3-4 hematological and biochemical toxicities in ARP/IRP were thrombocytopenia (28/58%), neutropenia (26/60%), aspartate aminotransferase (25/31%), alanine aminotransferase (14/23%) and bilirubin increase (17/21%). The most frequent adverse events (any Grade ≥ 20%) were fatigue (38%), nausea (35/29%), and vomiting (24/26%). Conclusions: The trial was successful in ARP but not in IRP; IHA infusion of N with cDDP showed promising activity in both IRP and ARP with a well tolerated regimen. These encouraging results warrant further investigation in HCC, specially in multinodular type. Clinical trial information: 2005-000731-26.
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Affiliation(s)
| | - Thomas J. Vogl
- Hospital of the Johann Wolfgang Goethe University, Frankfurt am Main, Germany
| | | | | | - Juan W. Valle
- University of Manchester, Manchester Academic Health Science Centre; Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Renate Hammerstingl
- Hospital of the Johann Wolfgang Goethe University, Frankfurt am Main, Germany
| | | | - Marcella Martignoni
- CLInical Organization for Strategies & Solutions (CLIOSS), NMS Group, Nerviano, Italy
| | - Anna Petroccione
- CLInical Organization for Strategies & Solutions (CLIOSS), NMS Group, Nerviano, Italy
| | - Mariangela Mariani
- CLInical Organization for Strategies & Solutions (CLIOSS), NMS Group, Nerviano, Italy
| | - Cristina Davite
- CLInical Organization for Strategies & Solutions (CLIOSS), NMS Group, Nerviano, Italy
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Melucci E, Cosimelli M, Carpanese L, Pizzi G, Izzo F, Fiore F, Golfieri R, Giampalma E, Sperduti I, Ercolani C, Sciuto R, Mancini R, Garufi C, Diodoro MG, Mottolese M. Decrease of survivin, p53 and Bcl-2 expression in chemorefractory colorectal liver metastases may be predictive of radiosensivity radiosensivity after radioembolization with yttrium-90 resin microspheres. J Exp Clin Cancer Res 2013; 32:13. [PMID: 23497522 PMCID: PMC3602019 DOI: 10.1186/1756-9966-32-13] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 02/27/2013] [Indexed: 12/24/2022]
Abstract
In a prospective multicenter phase II trial of radioembolization with yttrium-90 (90Y-RE) in chemorefractory liver-dominant metastatic colorectal cancer (mCRC), we showed that median survival was 12.6 months (95% CI 7.0–18.3) with 48% of 50 patients achieving disease control. In this extension retrospective study, we analyzed whether a panel of biomarkers, known to be associated to an adverse clinical outcome, underwent variations in CRC liver metastases pre and post 90Y-RE. Of the 50 patients included in the study, 29 pre-90Y-RE therapy and 15 post-90Y-RE had liver biopsy specimens available. In these series we investigated survivin, p53, Bcl-2 and Ki-67 expression pre- and post-90Y-RE by immuhistochemistry (IHC). Our findings evidenced a decrease of survivin (77% vs 33%), p53 (93% vs 73%), Bcl-2 (37% vs 26%) expression as well as of Ki-67 proliferation index (62.5% vs 40%) on liver biopsies collected post-90Y-RE as compared to pre-90Y-RE. In the subset of 13 matched liver metastases we further confirmed the reduction of survivin (92.3% vs 53.8%; p = 0.06), p53 (100% vs 69.2%; p = 0.05) and Bcl-2 (69.2% vs 53.8%; p = 0.05) expression post-90Y-RE. This biomarker modulation was accompanied by morphological changes as steatohepatitis, hepatocyte necrosis, collagen deposition, proliferating and/or bile duct ectasia, focal sinusoidal dilatation and fibrosis. Although our analysis was conducted in a very limited number cases, these changes appear strictly related to the response to 90Y-RE therapy and may deserve further investigation on a larger series of patients.
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Affiliation(s)
- Elisa Melucci
- Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy
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de Bellis M, Palaia R, Sandomenico C, Di Girolamo E, Cascella M, Fiore F. Is Preoperative Endoscopic Biliary Drainage Indicated for Jaundiced Patients with Resectable Pancreatic Cancer? Curr Drug Targets 2012; 13:753-63. [PMID: 22458521 DOI: 10.2174/138945012800564167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Revised: 03/05/2012] [Accepted: 03/27/2012] [Indexed: 11/22/2022]
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Carpanese L, Pizzi G, Sangro B, Cianni R, Golfieri R, Gasparini D, Fiore F, Sciuto R, Jakobs T, Bilbao J, Ettorre G. Abstract No. 200: Evaluation of safety, tolerability and overall survival following whole-liver, lobar or segmental radioembolization in unresectable hepatocellular carcinoma (HCC). J Vasc Interv Radiol 2012. [DOI: 10.1016/j.jvir.2011.12.248] [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: 11/16/2022] Open
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Sangro B, Carpanese L, Cianni R, Golfieri R, Gasparini D, Ezziddin S, Paprottka PM, Fiore F, Van Buskirk M, Bilbao JI, Ettorre GM, Salvatori R, Giampalma E, Geatti O, Wilhelm K, Hoffmann RT, Izzo F, Iñarrairaegui M, Maini CL, Urigo C, Cappelli A, Vit A, Ahmadzadehfar H, Jakobs TF, Lastoria S. Survival after yttrium-90 resin microsphere radioembolization of hepatocellular carcinoma across Barcelona clinic liver cancer stages: a European evaluation. Hepatology 2011; 54:868-78. [PMID: 21618574 DOI: 10.1002/hep.24451] [Citation(s) in RCA: 476] [Impact Index Per Article: 36.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Accepted: 05/12/2011] [Indexed: 12/07/2022]
Abstract
UNLABELLED A multicenter analysis was conducted to evaluate the main prognostic factors driving survival after radioembolization using yttrium-90-labeled resin microspheres in patients with hepatocellular carcinoma at eight European centers. In total, 325 patients received a median activity of 1.6 GBq between September 2003 and December 2009, predominantly as whole-liver (45.2%) or right-lobe (38.5%) infusions. Typically, patients were Child-Pugh class A (82.5%), had underlying cirrhosis (78.5%), and had good Eastern Cooperative Oncology Group (ECOG) performance status (ECOG 0-1; 87.7%), but many had multinodular disease (75.9%) invading both lobes (53.1%) and/or portal vein occlusion (13.5% branch; 9.8% main). Over half had advanced Barcelona Clinic Liver Cancer (BCLC) staging (BCLC C, 56.3%) and one-quarter had intermediate staging (BCLC B, 26.8%). The median overall survival was 12.8 months (95% confidence interval, 10.9-15.7), which varied significantly by disease stage (BCLC A, 24.4 months [95% CI, 18.6-38.1 months]; BCLC B, 16.9 months [95% CI, 12.8-22.8 months]; BCLC C, 10.0 months [95% CI, 7.7-10.9 months]). Consistent with this finding , survival varied significantly by ECOG status, hepatic function (Child-Pugh class, ascites, and baseline total bilirubin), tumor burden (number of nodules, alpha-fetoprotein), and presence of extrahepatic disease. When considered within the framework of BCLC staging, variables reflecting tumor burden and liver function provided additional prognostic information. The most significant independent prognostic factors for survival upon multivariate analysis were ECOG status, tumor burden (nodules >5), international normalized ratio >1.2, and extrahepatic disease. Common adverse events were: fatigue, nausea/vomiting, and abdominal pain. Grade 3 or higher increases in bilirubin were reported in 5.8% of patients. All-cause mortality was 0.6% and 6.8% at 30 and 90 days, respectively. CONCLUSION This analysis provides robust evidence of the survival achieved with radioembolization, including those with advanced disease and few treatment options.
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Affiliation(s)
- Bruno Sangro
- Liver Unit, Clinica Universidad de Navarra and Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBEREHD), Pamplona, Spain.
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Cosimelli M, Golfieri R, Cagol PP, Carpanese L, Sciuto R, Maini CL, Mancini R, Sperduti I, Pizzi G, Diodoro MG, Perrone M, Giampalma E, Angelelli B, Fiore F, Lastoria S, Bacchetti S, Gasperini D, Geatti O, Izzo F. Multi-centre phase II clinical trial of yttrium-90 resin microspheres alone in unresectable, chemotherapy refractory colorectal liver metastases. Br J Cancer 2010; 103:324-31. [PMID: 20628388 PMCID: PMC2920024 DOI: 10.1038/sj.bjc.6605770] [Citation(s) in RCA: 190] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND This multi-centre phase II clinical trial is the first prospective evaluation of radioembolisation of patients with colorectal liver metastases (mCRC) who failed previous oxaliplatin- and irinotecan-based systemic chemotherapy regimens. METHODS Eligible patients had adequate hepatic, haemopoietic and renal function, and an absence of major hepatic vascular anomalies and hepato-pulmonary shunting. Gastroduodenal and right gastric arteries were embolised before hepatic arterial administration of yttrium-90 resin microspheres (median activity, 1.7 GBq; range, 0.9-2.2). RESULTS Of 50 eligible patients, 38 (76%) had received > or =4 lines of chemotherapy. Most presented with synchronous disease (72%), >4 hepatic metastases (58%), 25-50% replacement of total liver volume (60%) and bilateral spread (70%). Early and intermediate (>48 h) WHO G1-2 adverse events (mostly fever and pain) were observed in 16 and 22% of patients respectively. Two died due to renal failure at 40 days or liver failure at 60 days respectively. By intention-to-treat analysis using Response Evaluation Criteria in Solid Tumours, 1 patient (2%) had a complete response, 11 (22%) partial response, 12 (24%) stable disease, 22 (44%) progressive disease; 4 (8%) were non-evaluable. Median overall survival was 12.6 months (95% CI, 7.0-18.3); 2-year survival was 19.6%. CONCLUSION Radioembolisation produced meaningful response and disease stabilisation in patients with advanced, unresectable and chemorefractory mCRC.
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Affiliation(s)
- M Cosimelli
- Regina Elena National Cancer Institute, Via Elio Chianesi, 53, 00144 Rome, Italy.
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Sangro B, Carpanese L, Cianni R, Golfieri R, Gasparini D, Ezzidin S, Hoffman R, Fiore F. European multicenter evaluation of survival for patients with hepatocellular carcinoma (HCC) treated by radioembolization with 90y-labeled resin microspheres. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.4027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Fiore F, Patti K, Viviani S, Rossi A, Di Raimondo F, Cantonetti M, Feldman T, Biggi A, Barrington S, Gallamini A. Effect of early chemotherapy intensification with BEACOPP in high-risk, interim-PET positive, advanced-stage Hodgkin lymphoma on overall treatment outcome of ABVD. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Gallamini A, Biggi A, Chauvie S, Bianchi A, Conti S, Fiore F, Sorasio R, Vose J, Thomas DL, Juweid ME. Does a negative post-therapy PET obviate the need for any further follow-up imaging in patients with nonbulky early-stage Hodgkin's lymphoma (HL)? J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8058] [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: 11/20/2022] Open
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Fonsi M, Fiore F, Jones P, Kinzel O, Laufer R, Rowley M, Monteagudo E. Metabolism-related liabilities of a potent histone deacetylase (HDAC) inhibitor and relevance of the route of administration on its metabolic fate. Xenobiotica 2010; 39:722-37. [PMID: 19569735 DOI: 10.1080/00498250903082279] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Compound A [1-methyl-N-{(1S)-1-[5-(2-naphthyl)-1H-imidazol-2-yl]-7-oxooctyl}piperidine-4-carboxamide is a potent class I histone deacetylase (HDAC) inhibitor that demonstrated good antiproliferative activity against human tumour cell lines of different origin. This compound showed high in vivo clearance in rats (160 ml min(-1) kg(-1)) due to metabolism. The main metabolite detected in urine after intravenous dosing was characterized as a dihydrohydroxy S-mercapturic acid conjugate. Following oral dosing, however, the mercapturic acid derivative was no longer the main metabolite but the major metabolites were mono- and di-glucuronide conjugates of oxidized species having a mass shift of +34 m/z with respect to the parent. Comparison of plasma concentration after intra-arterial infusion and intravenous infusion and incubation with microsomes from different tissues (liver, kidney, small intestine and lung) in the presence of beta-nicotinamide adenine dinucleotide phosphate (NADPH) indicated that the compound was highly cleared by the lung. Oxidation of the naphthalene moiety was demonstrated to be the cause of the high in vivo clearance of compound A and the potential for bioactivation of this group was flagged.
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Affiliation(s)
- M Fonsi
- Department of DMPK, IRBM, Merck Research Laboratories, Rome, Italy.
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Russo A, Pirone S, Passione N, D’Amato F, Pirarella F, Fiore F. P03-369 - Compliance to treatment with quetiapine vs quetiapine XR of 24 patients with diagnosis of first episode of psychosis in SPDC. Eur Psychiatry 2010. [DOI: 10.1016/s0924-9338(10)70975-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Salvaterra R, Valle MD, Campana S, Chincarini G, Covino S, D’Avanzo P, Fernández-Soto A, Guidorzi C, Mannucci F, Margutti R, Thöne CC, Antonelli LA, Barthelmy SD, De Pasquale M, D’Elia V, Fiore F, Fugazza D, Hunt LK, Maiorano E, Marinoni S, Marshall FE, Molinari E, Nousek J, Pian E, Racusin JL, Stella L, Amati L, Andreuzzi G, Cusumano G, Fenimore EE, Ferrero P, Giommi P, Guetta D, Holland ST, Hurley K, Israel GL, Mao J, Markwardt CB, Masetti N, Pagani C, Palazzi E, Palmer DM, Piranomonte S, Tagliaferri G, Testa V. GRB 090423 at a redshift of z ≈ 8.1. Nature 2009; 461:1258-60. [PMID: 19865166 DOI: 10.1038/nature08445] [Citation(s) in RCA: 358] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Accepted: 08/19/2009] [Indexed: 11/09/2022]
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Izzo F, Catino AM, Vogl TJ, Middleton M, Valle JW, Fiore F, Gadaleta CD, Pirotta RM, Martignoni M, Laffranchi B. Phase II trial of nemorubicin hydrocloride (nemorubicin) in combination with cisplatin (cDDP) in patients (pts) with hepatocellular carcinoma (HCC): First step results. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.4593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4593 Background: Nemorubicin is a novel DNA-intercalator, mainly metabolized in liver by CYP3A4 enzyme and showing synergic antitumor activity with cDDP. The objective of this study was to evaluate the efficacy and adverse effects of nemorubicin administered by intra-hepatic artery in combination with cDDP to unresectable HCC pts. Methods: The study was in two HCC pt populations: intermediate risk (IRP) (CLIP 0–1, bilirubin < 1.5 x upper normal limit, no portal vein thrombosis [PVT]) and advanced risk (ARP) (CLIP 2, bilirubin < 2.5 mg/dL, PVT admitted). Treatment was repeated every 4–6 weeks for a maximum of six courses, if no toxicity and disease progression occurred. A single-arm, Simon's minimax two-stage design was adopted to evaluate the primary endpoint of tumour response (WHO criteria). In the first step >5/18 responses (IRP) and >2/10 responses (ARP) are needed to proceed with the second step. Results: Twenty-three IRP pts (13 evaluable) and 13 ARP pts (10 evaluable) were enrolled. The median number of treatments was 3 (range 1–6) in IRP (dose 600 mcg/m2 nemorubicin and 60 mg/m2 cDDP) and 4 (range 1–4) in ARP (dose 400 mcg/m2 nemorubicin and 60 mg/m2 cDDP). In IRP, so far 1 pt (8%) achieved complete response, 3 pts (23%) had partial response (PR), 5 pts (38%) had minor response (MR)/disease stabilization (SD) >3 months. In ARP, 2 pts (20%) had PR, satisfying the first step efficacy criteria. Also, 2 ARP pts (20%) had MR/SD. Overall, the main grade 3 and 4 hematological toxicities were thrombocytopenia (47%), leukopenia (42%), anemia (12%) and neutropenia (6%). Grade 3 and 4 biochemical alterations were aspartate aminotranferase (29%) alanine transferase (24%) and bilirubin increase (12%). The most frequent adverse events were fatigue (35%), vomiting (29%), diarrhoea (24%) and nausea (18%). Conclusions: Hepatic arterial infusion of nemorubicin with cisplatin showed promising activity in the first step of the study and it was a well tolerated regimen. These encouraging results warrant further development in HCC pts. No significant financial relationships to disclose.
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Affiliation(s)
- F. Izzo
- NCI Fondaz. G. Pascale, Napoli, Italy; I.R.C.C.S. Ospedale Oncologico, Bari, Italy; Hospital of the Johann Wolfgang Goethe University, Frankfurt am Main, Germany; University of Oxford, Churchill Hospital, Oxford, United Kingdom; Christie Hospital NHS Foundation Trust, Manchester, United Kingdom; Nerviano Medical Sciences, Nerviano, Italy
| | - A. M. Catino
- NCI Fondaz. G. Pascale, Napoli, Italy; I.R.C.C.S. Ospedale Oncologico, Bari, Italy; Hospital of the Johann Wolfgang Goethe University, Frankfurt am Main, Germany; University of Oxford, Churchill Hospital, Oxford, United Kingdom; Christie Hospital NHS Foundation Trust, Manchester, United Kingdom; Nerviano Medical Sciences, Nerviano, Italy
| | - T. J. Vogl
- NCI Fondaz. G. Pascale, Napoli, Italy; I.R.C.C.S. Ospedale Oncologico, Bari, Italy; Hospital of the Johann Wolfgang Goethe University, Frankfurt am Main, Germany; University of Oxford, Churchill Hospital, Oxford, United Kingdom; Christie Hospital NHS Foundation Trust, Manchester, United Kingdom; Nerviano Medical Sciences, Nerviano, Italy
| | - M. Middleton
- NCI Fondaz. G. Pascale, Napoli, Italy; I.R.C.C.S. Ospedale Oncologico, Bari, Italy; Hospital of the Johann Wolfgang Goethe University, Frankfurt am Main, Germany; University of Oxford, Churchill Hospital, Oxford, United Kingdom; Christie Hospital NHS Foundation Trust, Manchester, United Kingdom; Nerviano Medical Sciences, Nerviano, Italy
| | - J. W. Valle
- NCI Fondaz. G. Pascale, Napoli, Italy; I.R.C.C.S. Ospedale Oncologico, Bari, Italy; Hospital of the Johann Wolfgang Goethe University, Frankfurt am Main, Germany; University of Oxford, Churchill Hospital, Oxford, United Kingdom; Christie Hospital NHS Foundation Trust, Manchester, United Kingdom; Nerviano Medical Sciences, Nerviano, Italy
| | - F. Fiore
- NCI Fondaz. G. Pascale, Napoli, Italy; I.R.C.C.S. Ospedale Oncologico, Bari, Italy; Hospital of the Johann Wolfgang Goethe University, Frankfurt am Main, Germany; University of Oxford, Churchill Hospital, Oxford, United Kingdom; Christie Hospital NHS Foundation Trust, Manchester, United Kingdom; Nerviano Medical Sciences, Nerviano, Italy
| | - C. D. Gadaleta
- NCI Fondaz. G. Pascale, Napoli, Italy; I.R.C.C.S. Ospedale Oncologico, Bari, Italy; Hospital of the Johann Wolfgang Goethe University, Frankfurt am Main, Germany; University of Oxford, Churchill Hospital, Oxford, United Kingdom; Christie Hospital NHS Foundation Trust, Manchester, United Kingdom; Nerviano Medical Sciences, Nerviano, Italy
| | - R. M. Pirotta
- NCI Fondaz. G. Pascale, Napoli, Italy; I.R.C.C.S. Ospedale Oncologico, Bari, Italy; Hospital of the Johann Wolfgang Goethe University, Frankfurt am Main, Germany; University of Oxford, Churchill Hospital, Oxford, United Kingdom; Christie Hospital NHS Foundation Trust, Manchester, United Kingdom; Nerviano Medical Sciences, Nerviano, Italy
| | - M. Martignoni
- NCI Fondaz. G. Pascale, Napoli, Italy; I.R.C.C.S. Ospedale Oncologico, Bari, Italy; Hospital of the Johann Wolfgang Goethe University, Frankfurt am Main, Germany; University of Oxford, Churchill Hospital, Oxford, United Kingdom; Christie Hospital NHS Foundation Trust, Manchester, United Kingdom; Nerviano Medical Sciences, Nerviano, Italy
| | - B. Laffranchi
- NCI Fondaz. G. Pascale, Napoli, Italy; I.R.C.C.S. Ospedale Oncologico, Bari, Italy; Hospital of the Johann Wolfgang Goethe University, Frankfurt am Main, Germany; University of Oxford, Churchill Hospital, Oxford, United Kingdom; Christie Hospital NHS Foundation Trust, Manchester, United Kingdom; Nerviano Medical Sciences, Nerviano, Italy
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Vannelli A, Battaglia L, Poiasina E, Corsi C, Del Conte C, Fiore F, Valera V. A tension-free technique for the repair of large incisional hernias during abdominal surgery: results and long-term outcome. S AFR J SURG 2008; 46:112-115. [PMID: 19051954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- A Vannelli
- Foundation IRCCS - Istituto Nazionale dei Tumori, Division of General Surgery B, Milan, Italy
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Monteagudo E, Pesci S, Taliani M, Fiore F, Petrocchi A, Nizi E, Rowley M, Laufer R, Summa V. Studies of metabolism and disposition of potent human immunodeficiency virus (HIV) integrase inhibitors using19F-NMR spectroscopy. Xenobiotica 2008; 37:1000-12. [PMID: 17896326 DOI: 10.1080/00498250701652323] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
(19)F-nuclear magnetic resonance (NMR) has been extensively used in a drug-discovery programme to support the selection of candidates for further development. Data on an early lead compound, N-(4-fluorobenzyl)-5-hydroxy-1-methyl-2-(4-methylmorpholin-3-yl)-6-oxo-1,6-dihydropyrimidine-4-carboxamide (compound A (+)), and MK-0518 (N-(4-fluorobenzyl)-5-hydroxy-1-methyl-2-(1-methyl-1-{[(5-methyl-1,3,4-oxadiazol-2-yl)carbonyl]amino}ethyl)-6-oxo-1,6-dihydropyrimidine-4-carboxamide), a potent inhibitor of this series currently in phase III clinical trials, are described. The metabolic fate and excretion balance of compound A (+) and MK-0518 were investigated in rats and dogs following intravenous and oral dosing using a combination of (19)F-NMR-monitored enzyme hydrolysis and solid-phase extraction chromatography and NMR spectroscopy (SPEC-NMR). Dosing with the (3)H-labelled compound A (+) enabled the comparison of standard radiochemical analysis with (19)F-NMR spectroscopy to obtain quantitative metabolism and excretion data. Both compounds were eliminated mainly by metabolism. The major metabolite identified in rat urine and bile and in dog urine was the 5-O-glucuronide.
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Affiliation(s)
- E Monteagudo
- Department of Pharmacology, Istituto di Ricerche di Biologia Molecolare (IRBM) P. Angeletti, Merck Research Laboratories, Pomezia, Rome, Italy.
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Giuliano C, Fiore F, Di Marco A, Padron Velazquez J, Bishop A, Bonelli F, Gonzalez-Paz O, Marcucci I, Harper S, Narjes F, Pacini B, Monteagudo E, Migliaccio G, Rowley M, Laufer R. Preclinical pharmacokinetics and metabolism of a potent non-nucleoside inhibitor of the hepatitis C virus NS5B polymerase. Xenobiotica 2008; 35:1035-54. [PMID: 16393860 DOI: 10.1080/00498250500356548] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The disposition of compound A, a potent inhibitor of the hepatitis C virus (HCV) NS5B polymerase, was characterized in animals in support of its selection for further development. Compound A exhibited marked species differences in pharmacokinetics. Plasma clearance was 44 ml min-1 kg-1 in rats, 9 ml min-1 kg-1 in dogs and 16 ml min-1 kg-1 in rhesus monkeys. Oral bioavailability was low in rats (10%) but significantly higher in dogs (52%) and monkeys (26%). Compound A was eliminated primarily by metabolism in rats, with biliary excretion accounting for 30% of its clearance. Metabolism was mainly mediated by cyclohexyl hydroxylation, with N-deethylation and acyl glucuronide formation constituting minor metabolic pathways. Qualitatively, the same metabolites were identified using in vitro systems from all species studied, including humans. The low oral bioavailability of compound A in rats was mostly due to poor intestinal absorption. This conclusion was borne out by the findings that hepatic extraction in the rat was only 30%, intraperitoneal bioavailability was good, and compound A was poorly absorbed from the rat isolated intestinal loop, with no detectable intestinal metabolism. Compound A was not an inhibitor of major human cytochrome P450 enzymes, indicating minimal potential for clinical drug-drug interactions. The metabolic clearance of compound A in rat, dog and monkey hepatocytes correlated with the systemic clearance observed in these species. Since compound A was very stable in human hepatocytes, the results suggest that it will be a low clearance drug in humans.
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Affiliation(s)
- C Giuliano
- Department of Pharmacology, Istituto di Ricerche di Biologia Molecolare (IRBM) P. Angeletti, Merck Research Laboratories Rome, Pomezia, Italy
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Racusin JL, Karpov SV, Sokolowski M, Granot J, Wu XF, Pal’shin V, Covino S, van der Horst AJ, Oates SR, Schady P, Smith RJ, Cummings J, Starling RLC, Piotrowski LW, Zhang B, Evans PA, Holland ST, Malek K, Page MT, Vetere L, Margutti R, Guidorzi C, Kamble AP, Curran PA, Beardmore A, Kouveliotou C, Mankiewicz L, Melandri A, O’Brien PT, Page KL, Piran T, Tanvir NR, Wrochna G, Aptekar RL, Barthelmy S, Bartolini C, Beskin GM, Bondar S, Bremer M, Campana S, Castro-Tirado A, Cucchiara A, Cwiok M, D’Avanzo P, D’Elia V, Valle MD, de Ugarte Postigo A, Dominik W, Falcone A, Fiore F, Fox DB, Frederiks DD, Fruchter AS, Fugazza D, Garrett MA, Gehrels N, Golenetskii S, Gomboc A, Gorosabel J, Greco G, Guarnieri A, Immler S, Jelinek M, Kasprowicz G, La Parola V, Levan AJ, Mangano V, Mazets EP, Molinari E, Moretti A, Nawrocki K, Oleynik PP, Osborne JP, Pagani C, Pandey SB, Paragi Z, Perri M, Piccioni A, Ramirez-Ruiz E, Roming PWA, Steele IA, Strom RG, Testa V, Tosti G, Ulanov MV, Wiersema K, Wijers RAMJ, Winters JM, Zarnecki AF, Zerbi F, Mészáros P, Chincarini G, Burrows DN. Broadband observations of the naked-eye γ-ray burst GRB 080319B. Nature 2008; 455:183-8. [DOI: 10.1038/nature07270] [Citation(s) in RCA: 376] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2008] [Accepted: 07/11/2008] [Indexed: 11/09/2022]
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Fiore F, Gadaleta CD, Granetto C, Middleton M, Sorio R, Labianca R, Valota O, Pirotta RN, Battaglia R, Izzo F. Nemorubicin hydrochloride (nemorubicin) in combination with cisplatin (cDDP): Phase I in patients (pts) with hepatocellular carcinoma (HCC). J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.2572] [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: 11/20/2022] Open
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Facchini G, Caraglia M, Santini D, Nasti G, Ottaiano A, Striano S, Maiolino P, Ruberto M, Fiore F, Tonini G, Budillon A, Iaffaioli RV, Zeppetella GL. The clinical response on bone metastasis from breast and lung cancer during treatment with zoledronic acid is inversely correlated to skeletal related events (SRE). J Exp Clin Cancer Res 2007; 26:307-312. [PMID: 17987788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Current management of bone metastases involves a multimodal approach. Aminobisphosphonates (BPs) are a valid weapon in the treatment of skeletal localization of tumour disease. Patients with bone metastases from breast and lung cancer were enrolled in order to evaluate the impact of the addition of bisphosphonates therapy to standard treatments in terms of (i) pain control, (ii) quality of life (QoL) and (iii) toxicity and to evaluate (iv) any relations between clinical activity and the occurrence of SREs. A total of 60 patients were included in the study. Median age was 76 years (range 40-83). The majority of patients were treated with chemotherapy or hormonal therapy. All patients received zoledronic acid (ZOL) (4 mg) every 3-4 weeks for at least 3 cycles. No significant improvement in Performance Status of patients after 12 cycles of ZOL (p = 0.1672) was recorded. A statistically significant early and long-lasting amelioration of both pain, narcotic scores and QoL was found. Twenty-one patients (48%) experienced at least one SRE during the study. The most common SRE was radiation to bone (30% of patients). An inverse correlation between bone tumour response and SREs was also found (p = 0.019). ZOL addition induces a clinical benefit and improves QoL of patients with bone metastases. Moreover, the occurrence of bone clinical response is related to a reduced risk of SREs.
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Affiliation(s)
- G Facchini
- Medical Oncology Division B, National Cancer Institute, Naples, Italy
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Curti A, Aluigi M, Pandolfi S, Ferri E, Isidori A, Salvestrini V, Durelli I, Horenstein AL, Fiore F, Massaia M, Piccioli M, Pileri SA, Zavatto E, D'Addio A, Baccarani M, Lemoli RM. Acute myeloid leukemia cells constitutively express the immunoregulatory enzyme indoleamine 2,3-dioxygenase. Leukemia 2006; 21:353-5. [PMID: 17170728 DOI: 10.1038/sj.leu.2404485] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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