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Cucciniello L, Blondeaux E, Bighin C, Gasparro S, Russo S, Dri A, Pugliese P, Fontana A, Naso G, Ferzi A, Riccardi F, Sini V, Boni L, Fabi A, Montemurro F, De Laurentiis M, Arpino G, Mastro LD, Gerratana L, Puglisi F. Abstract P1-11-04: Assessing the clinico-pathological characteristics of HER2 positive metastatic breast cancer patients experiencing radiologic complete response in a nationwide cohort. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p1-11-04] [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: 03/06/2023]
Abstract
Abstract
Background: Up to 6% of patients (pts) with HER2 positive (pos) metastatic breast cancer (MBC) experience a radiologic complete response (rCR) to a first line of therapy, but these results mostly derive from dated and/or limited cohorts. Aim of this study was to define the clinico-pathological characteristics of HER2 positive (pos) MBC pts experiencing a rCR. Methods: Pts were selected from the database of the GIM14 study (NCT02284581) and classified according to the best radiologic response obtained to the first line chemotherapy (CT) and upon time-to-treatment-failure (TTF). rCR was defined as complete response (CR) with a TTF > 3 months. The association across variables was tested through logistic regression and their prognostic impact in terms of overall survival (OS) was estimated using the Kaplan-Meier method and compared using the log-rank test. Results: Of the 3,423 pts included in the GIM14 study, 814 had HER2 pos MBC. After exclusion of pts treated with first line endocrine therapy and/or with TTF < 3 months, 656 pts were included in the present analysis, of which 96 (14.6%) experienced a rCR. Instead, the best response was a partial response for 295 pts (45.0%), stable disease for 221 pts (33.7%), and progression for 44 pts (6.7%). Most pts (59.8%) presented de novo MBC; 379 pts (57.8%) had visceral metastases (mets), 609 pts (92.8%) did not have central nervous system (CNS) involvement and 318 pts (48.5%) had only 1 site of distant mets. Also, 445 pts (67.9%) had hormone receptor (HR) pos disease, a HER2 3+ score at immunohistochemistry (IHC) was present in 59.8% of cases versus 40.2% with HER2 2+ at IHC and in situ hybridization (ISH) + disease. Taxanes were the main CT backbone (489 pts, 74.5%), 341 pts (52.0%) had received a Trastuzumab-Pertuzumab doublet. At multivariable analysis, higher odds of experiencing a rCR were reported for presence of non-visceral mets (OR 1.87, 95%CI 1.10-3.17), low number of metastatic sites (OR 2.42, 95%CI 0.80-7.33 for 1 site only) and HER2 3+ score at IHC (OR 1.80, 95%CI 1.09-2.98). Disease-free interval (DFI) was associated to rCR at univariable but not at multivariable analysis. HR status, CT backbone and type of anti-HER2 regimen were not associated with rCR neither at univariable nor at multivariable analysis. Median follow-up was 76.2 months. Amongst pts with TTF>12 months, those with rCR had a significantly higher OS compared to those not experiencing a rCR (median OS 133 and 90 months, respectively; p=0.0191). OS rates in pts with TTF ≥ 12 months were 97.8% at 2-year follow-up and 59.4% at 5-year follow-up. Instead, in pts with TTF ≥ 60 months, OS rates were 76.7% at 10-year follow-up. Amongst the 96 pts experiencing a CR, 38 had a rCR with TTF between 12 and 60 months, while 22 pts had a rCR with a TTF ≥ 60 months. The remaining pts had a CR with a TTF < 12 months. Pts with HR negative (neg) disease were found to be more likely to experience a rCR with a with TTF between 12 and 60 months, whilst pts with HR pos disease had a higher probability to experience a rCR with a TTF ≥ 60 months (p=0.0074). Pts with HER2 3+ score at IHC had a higher probability to achieve a rCR with a TTF ≥ 12 months compared to pts with HER2 2+ score at IHC and ISH + (p=0.0216). Age at diagnosis, menopausal status, DFI, number and site of mets, CT backbone and anti-HER2 therapy did not influence the duration of the rCR obtained. Conclusions: This study characterized a real-world cohort of HER2 positive MBC patients experiencing radiologic complete response to a first line treatment. Based on these results a clinical trial focused on liquid biopsy-based minimal residual disease is being designed. Novel anti-HER2 agents are gaining momentum as ever increasingly effective treatments and future de-escalation strategies after complete response will represent a growing need.
Citation Format: Linda Cucciniello, Eva Blondeaux, Claudia Bighin, Simona Gasparro, Stefania Russo, Arianna Dri, Palma Pugliese, Andrea Fontana, Giuseppe Naso, Antonella Ferzi, Ferdinando Riccardi, Valentina Sini, Luca Boni, Alessandra Fabi, Filippo Montemurro, Michelino De Laurentiis, Grazia Arpino, Lucia Del Mastro, Lorenzo Gerratana, Fabio Puglisi. Assessing the clinico-pathological characteristics of HER2 positive metastatic breast cancer patients experiencing radiologic complete response in a nationwide cohort [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-11-04.
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Affiliation(s)
- Linda Cucciniello
- 1Unit of Medical Oncology and Cancer Prevention, Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano
| | | | | | | | - Stefania Russo
- 5Department of Medical Oncology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC) Udine, Italy
| | - Arianna Dri
- 6Santa Maria della Misericordia University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine
| | | | | | | | | | | | - Valentina Sini
- 12Centro Oncologico S. Spirito-Nuovo Regina Margherita, ASL Roma 1, Rome
| | - Luca Boni
- 13IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Alessandra Fabi
- 14Precision Medicine in Breast Cancer, Fondazione Policlinico Universitario A. Gemelli, IRCCS Rome, Rome,, Italy
| | | | | | | | | | - Lorenzo Gerratana
- 19Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano
| | - Fabio Puglisi
- 20Department of Medicine (DAME), University of Udine, Udine, Italy and Department of Medical Oncology - CRO Aviano, National Cancer Institute, IRCCS, Friuli-Venezia Giulia, Italy
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Naso G, Gkazi S, Georgiadis C, Jayarajan V, Jacków J, Fleck R, Allison L, Ogunbiyi O, McGrath J, Ilic D, Di W, Petrova A, Qasim W. Cytosine deaminase base editing to restore COL7A1 in dystrophic epidermolysis bullosa human:murine skin model. JID Innovations 2023; 3:100191. [DOI: 10.1016/j.xjidi.2023.100191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 12/26/2022] [Accepted: 01/06/2023] [Indexed: 02/22/2023] Open
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Cucciniello L, Blondeaux E, Bighin C, Gasparro M, Russo S, Dri A, Pugliese P, Fontana A, Naso G, Ferzi A, Riccardi F, Sini V, Fabi A, Montemurro F, De Laurentiis M, Arpino G, Del Mastro L, Gerratana L, Puglisi F. 270P Defining clinico-pathological characteristics of HER2 positive metastatic breast cancer (MBC) patients experiencing radiologic complete response (rCR) in a nationwide real-world cohort. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1854] [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: 11/01/2022] Open
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Abstract
Most patients with early HR+ and HER2- breast cancer receive a hormone therapy; the clinical question still open is how to identify patients who can really benefit from adjuvant chemotherapy. The accurate identification of these patients is essential to avoid an over-treatment, increasing the risk of an unnecessary toxicity; on the contrary, the omission of chemotherapy can deprive high risk patients of a potential life-saving treatment (under-treatment). Several multigene assays (MGAs), assessing the risk of relapse according to the biological characteristics of the tumor, have been developed. To date, the 21-gene assay (Oncotype DX Breast Recurrence Score®) is the only test developed and validated to be actionable, i.e., able to predict the benefit of adjuvant chemotherapy. The different available tests can be classified according to their clinical utility based on their prognostic and predictive value. A prognostic test gives information about the outcome of the disease, regardless of the administered therapy. When the aim of the test is to drive the treatment decisions, the predictive component, and therefore the ability to accurately identify which patients could benefit from chemotherapy, is essential. This review summarizes the clinical evidences of the Oncotype DX® test supporting its clinical utility.
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Affiliation(s)
- Francesco Cognetti
- Department of Clinical and Molecular Medicine, University La Sapienza, Rome, Italy
| | - Giuseppe Naso
- Department of Clinical and Molecular Medicine, University La Sapienza, Rome, Italy
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Tekkela S, Sheriff A, Naso G, Petrova A, Lu L, Mellerio J, McGrath J, Jackow J. 165 Allelic specific COL7A1 correction in dominant dystrophic epidermolysis bullosa fibroblasts. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.08.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Raimondi L, Di Benedetto L, Naso G, Raimondi FM, Di Rocco A, Giaconi L, Lazzeroni R, Spinelli GP. Resistance to CDK4/6 inhibitors (CDK4/6i): The clinical usefulness of liquid biopsy in metastatic breast cancer (mBC). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.1053] [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
Retraction The abstract by Raimondi et al entitled, “Resistance to CDK4/6 inhibitors (CDK4/6i): The clinical usefulness of liquid biopsy in metastatic breast cancer (mBC),” published in Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021) 1053-1053, was retracted by the Journal of Clinical Oncology. ( JCO). An Expression of Concern was previously issued by JCO on June 16, 2021. Subsequent to publication of the abstract, questions about the data were brought to JCO’s attention. The data were provided by author Giuseppe Naso, who has since died. As the source of the data and methods of data collection cannot be verified, the abstract is being retracted. A copy of this Retraction Notice was sent to the last known email addresses for the authors. Authors Lucrezia Raimondi, Laura Giaconi, and Gian Paolo Spinelli agreed to the retraction. Authors Rachele Lazzeroni, Laura Di Benedetto, Filippo Maria Raimondi, and Arianna Di Rocco did not respond to our queries. Author Giuseppe Naso is deceased. This abstract was retracted on November 9, 2021. 1053 Expression of Concern The abstract by Raimondi et al entitled, “Resistance to CDK4/6 inhibitors (CDK4/6i): The clinical usefulness of liquid biopsy in metastatic breast cancer (mBC),” published in Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021) 1053-1053, is under further review. Questions have been raised regarding the integrity of the methods, results, and analysis of the reported abstract. Until the authors and their institutions can fully provide additional information, readers should interpret the findings presented with caution. An update will be provided when our investigation is complete. Background: Palbociclib (P) in combination with fulvestrant (F) or letrozole (L), is used globally to treat metastatic breast cancer but despite therapeutic improvements most patients acquire resistance to CDK4/6i. KRAS tumor mutations (mutKRAS) have been associated with worse PFS in several tumor types but have not been analysed extensively in breast cancer. To understand the molecular mechanisms of resistance to CDK4/6i and their clinical behavior, using liquid biopsy, we evaluated the opportunity to reveal the onset of resistance to CDK4/6i detecting mutKRAS ctDNA. Methods: We studied the KRAS mutation status of 211 patients with mBC treated with CDK4/6i plus L or F as first-line metastatic therapy. Using Bio-Rad QX200 droplet digital polymerase chain reaction (ddPCR) system we determined KRAS ctDNA levels in plasma. Using logistic and Cox regression, a predictive model for objective response (OR), progression-free survival (PFS) and overall survival (OS) was constructed. The PFS and the OS were estimated by the Kaplan–Meier method and compared with use of the log-rank test. Results: In 38% (81 patients, 24 in treatment with L and 57 in treatment with F) we observed mutKRAS ctDNA before starting CDK4/6i: the detection of mutKRAS significantly correlated with the onset of resistance to CDK4/6i within 6months from the evidence of KRAS mutation and worse PFS ( p<0.001). OR was seen in 84 of 130 KRAS wild-type (WT) patients versus 0 of 81 in KRAS mutants. At 24-month follow up, median PFS was significantly better in KRAS WT versus mutants (3.1 [range: 1-6months,95%CI 0.9-3.6] versus NA months; p<0.001). Correlating the results of liquid biopsy both to tumoral burden and patients clinical features, we observed a higher mutKRAS circulating copies-number in those patients with two or more metastatic sites( p<0.001). Conclusions: Despite the study’s limitations, our data suggest mutKRAS ctDNA status leads to CDK4/6i resistance acquisition within 6 months from the detection and provide critical information for the prediction of therapeutic responses in mBC. Monitoring KRAS status with liquid biopsy, we could predict who will take advantage from CDK4/6i, decreasing wastes of resources ensuring the best patients’ quality of life.
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Affiliation(s)
- Lucrezia Raimondi
- U.O.C. Territorial Oncology of Aprilia, Sapienza University of Rome, Aprilia, Italy
| | | | - Giuseppe Naso
- Division of Medical Oncology, Policlinico Umberto I, Roma, Italy
| | | | - Arianna Di Rocco
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Laura Giaconi
- Clinical and Molecular Medicine Department, Sapienza University of Rome, Rome, Italy
| | - Rachele Lazzeroni
- Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Rome, Italy
| | - Gian Paolo Spinelli
- U.O.C. Territorial Oncology of Aprilia, AUSL Latina, Sapienza University of Rome, Aprilia, Italy, Aprilia, Italy
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Raimondi L, Naso G, Lazzeroni R, Di Benedetto L, Raimondi FM, Di Rocco A, Giaconi L, Rossi L, Spinelli GP. Usefulness of assessment of circulating tumor DNA(ctDNA) of cerebrospinal fluid(CSF) samples for early detection of brain metastasis (BrM) in patients with triple-negative breast cancer (TNBC). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Retraction The abstract by Raimondi et al entitled, “Usefulness of assessment of circulating tumor DNA(ctDNA) of cerebrospinal fluid(CSF) samples for early detection of brain metastasis (BrM) in patients with triple-negative breast cancer (TNBC),” published in Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021) 507-507, was retracted by the Journal of Clinical of Oncology (JCO). An Expression of Concern was previously issued by JCO on June 16, 2021. Subsequent to publication of the abstract, questions about the data were brought to JCO’s attention. The data were provided by author Giuseppe Naso, who has since died. As the source of the data and methods of data collection cannot be verified, the abstract is being retracted. A copy of this Retraction Notice was sent to the last known email addresses for the authors. Authors Lucrezia Raimondi, Laura Giaconi, and Gian Paolo Spinelli agreed to the retraction. Authors Rachele Lazzeroni, Laura Di Benedetto, Filippo Maria Raimondi, Arianna Di Rocco, and Luigi Rossi did not respond to our queries. Author Giuseppe Naso is deceased. This abstract was retracted on November 9, 2021. 507 Expression of Concern The abstract by Raimondi et al entitled, “Usefulness of assessment of circulating tumor DNA(ctDNA) of cerebrospinal fluid(CSF) samples for early detection of brain metastasis (BrM) in patients with triple-negative breast cancer (TNBC),” published in Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021) 507-507, is under further review. Questions have been raised regarding the integrity of the methods, results, and analysis of the reported abstract. Until the authors and their institutions can fully provide additional information, readers should interpret the findings presented with caution. An update will be provided when our investigation is complete. Background: Despite improvements in treatments, patients diagnosed with TNBC still have poor prognosis for a higher tendency of developing BrM. Identifying patients at high risk of BrM, enabling to predict who will take advantage from appropriate additional treatment, remains a critical problem. ctDNA represents a valuable tool associated with the outcome and the aggressiveness of breast cancer but no prognostic and predictive biomarker has been identified to predict the development of BrM in TNBC. We studied the usefulness of assessment of CSF-ctDNA for early identification of the risk of BrM in TNBC. Methods: Between January 2016 and December 2020, 323 newly diagnosed non-metastatic TNBC patients who underwent neoadjuvant therapy+surgery(NACT) with complete response(CR)were prospectively enrolled. After surgery, samples of CSF measuring ctDNA were obtained from all patients: CSF-ctDNA was extracted with the QIAamp Circulating Nucleic Acid Kit (Qiagen, Valencia, CA, USA) and ctDNA levels were measured. Survival curves were estimated using the Kaplan-Meier method and compared with the Log-rank test. Multivariate Cox regression was used to identify the risk of mortality at three years. Results: After NACT, CSF-ctDNA was detectable in 126/323 (39%) patients, 101/126 (80%) were diagnosed at III stage. 124 of 126 (98.4%) ctDNA+ patients subsequently developed BrM. In contrast, only 2 (2/197, 1%) ctDNA- patients subsequently developed BrM and the 195 other patients remain in a CR (p < 0.001, Fisher's exact test). CSF-ctDNA did associate with PFS and OS: undetectable ctDNA was associated with superior PFS (HR 0.3; p = 0.002) and OS (HR 0.2; p < 0.01), indicating survival is largely determined by the onset of BrM. With a median follow-up of 3 years, median PFS of ctDNA+ vs ctDNA- patients was 13 months vs not reach, p = 0.004 (by Log-rank test). Median OS for ctDNA+ vs ctDNA- patients was 16 months after NACT vs not reach, p = 0.0016 (by Log-rank test). At multivariate analysis detectable CSF-ctDNA emerged as the best predictor of the develop of BrM and 24-month mortality (HR:3.62; p < 0.0001). Age, stage, Ki67% and response to chemotherapy were not significantly associated with the prognosis. Conclusions: After NACT, detectable CSF-ctDNA significantly associates with PFS and OS, identifying early at-risk patients to develop BrM in TNBC.
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Affiliation(s)
- Lucrezia Raimondi
- U.O.C. Territorial Oncology of Aprilia, Sapienza University of Rome, Aprilia, Italy
| | - Giuseppe Naso
- Division of Medical Oncology, Policlinico Umberto I, Roma, Italy
| | - Rachele Lazzeroni
- Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Rome, Italy
| | | | | | - Arianna Di Rocco
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Laura Giaconi
- Clinical and Molecular Medicine Department, Sapienza University of Rome, Rome, Italy
| | - Luigi Rossi
- O.C. Territorial Oncology of Aprilia, AUSL Latina, Sapienza University of Rome, Aprilia, Italy
| | - Gian Paolo Spinelli
- U.O.C. Territorial Oncology of Aprilia, AUSL Latina, Sapienza University of Rome, Aprilia, Italy, Aprilia, Italy
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Cognetti F, Masetti R, Fabi A, Bianchi G, Santini D, Rognone A, Catania G, Angelucci D, Naso G, Giuliano M, Vassalli L, Vici P, Scognamiglio G, Generali D, Zambelli A, Colleoni M, Tinterri C, Scanzi F, Vigna L, Scavina P, Gamucci T, Marrazzo E, Scinto AF, Berardi R, Fabbri MA, Pinotti G, Franco D, Terribile DA, Tonini G, Cianniello D, Barni S. PONDx: real-life utilization and decision impact of the 21-gene assay on clinical practice in Italy. NPJ Breast Cancer 2021; 7:47. [PMID: 33953182 PMCID: PMC8099872 DOI: 10.1038/s41523-021-00246-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 11/12/2020] [Indexed: 12/19/2022] Open
Abstract
Clinicopathological prognostic features have limited value to identify with precision newly diagnosed patients with hormone receptor (HR)-positive, HER2-negative breast cancer (BC), who would benefit from chemotherapy (CT) in addition to adjuvant hormonal therapy (HT). The 21-gene Oncotype DX Breast Recurrence Score® (RS) assay has been demonstrated to predict CT benefit, hence supporting personalized decisions on adjuvant CT. The multicenter, prospective, observational study PONDx investigated the real-life use of RS® results in Italy and its impact on treatment decisions. Physicians' treatment recommendations (HT ± CT) were documented before and after availability of RS results, and changes in recommendations were determined. In the HR+ HER2- early BC population studied (N = 1738), physicians recommended CT + HT in 49% of patients pre-RS. RS-guided treatment decisions resulted in 36% reduction of CT recommendations. PONDx confirms that RS results provide clinically relevant information for CT recommendation in early-stage BC, resulting in a reduction of more than a third of CT use.
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Affiliation(s)
- Francesco Cognetti
- Università La Sapienza di Roma, Dipartimento Medicina Clinica e Molecolare, Rome, Italy.
| | | | | | - Giulia Bianchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | | | | | | | | | - Mario Giuliano
- Azienda Ospedaliera Universitaria Federico II, Napoli, Italy
| | | | - Patrizia Vici
- IRCCS Regina Elena National Cancer Institute, Roma, Italy
| | | | | | | | | | | | | | | | - Paola Scavina
- Azienda Ospedaliera San Giovanni - Addolorata, Roma, Italy
| | | | | | | | - Rossana Berardi
- Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona, Torrette, Italy
| | | | | | | | | | | | | | - Sandro Barni
- ASST BG Ovest Ospedale Treviglio, Treviglio, BG, Italy
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Cognetti F, Biganzoli L, De Placido S, del Mastro L, Masetti R, Naso G, Pruneri G, Santini D, Tondini CA, Tinterri C, Tonini G, Barni S. Multigene tests for breast cancer: the physician's perspective. Oncotarget 2021; 12:936-947. [PMID: 33953847 PMCID: PMC8092339 DOI: 10.18632/oncotarget.27948] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 04/01/2021] [Indexed: 11/29/2022] Open
Abstract
Breast cancer is the most common tumour in women and the first cause of death for cancer in the female population. Preserving the quality of life has therefore become an important objective in the management of the disease. The benefits of adjuvant chemotherapy in patients with HR+ HER2- early breast cancer should always be balanced against its potential short and long-term adverse effects, and identifying the appropriate patients for whom chemotherapy can offer the highest clinical benefit is critical. Besides clinical and pathological factors, today four multigene tests able to guide the choice of the adjuvant therapy early breast cancer are available in Italy: Oncotype DX®, EndoPredict®, MammaPrint® e Prosigna®. This review evaluates the main characteristics of these diagnostic tests, the studies on clinical utility, their economic impact and their inclusion in international and national guidelines. The Oncotype DX Breast Recurrence Score® test is the only multigene test validated, with level IA evidence, to guide the adjuvant therapy decisions: hormone therapy alone for most patients with RS results 0-25, and chemotherapy for patients with RS results 26-100. Clinical data demonstrate that the Oncotype DX test is able to significantly impact therapeutic decisions, reducing chemotherapy use up to 49% and supporting the use of chemotherapy (up to 12%) in potentially under-treated patients. Based on the level of clinical evidence and established clinical utility, several multigene tests have been included in the main international guidelines, with recommendations ranging from "strong" to "moderate".
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Affiliation(s)
- Francesco Cognetti
- Scuola di specializzazione di Oncologia, La Sapienza University, Rome, Italy
| | - Laura Biganzoli
- Sandro Pitigliani Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - Sabino De Placido
- Università Degli Studi di Napoli Federico II Dipartimento di Medicina clinica e Chirurgia Professore di Oncologia Medica, Napoli, Italy
| | - Lucia del Mastro
- Oncology, IRCCS AOU San Martino - IST Istituto Nazionale per la Ricerca del Cancro, Genova, Italy
| | | | - Giuseppe Naso
- Department of Radiology, Pathology and Oncology, La Sapienza University, Rome, Italy
| | - Giancarlo Pruneri
- Department of Pathology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Donatella Santini
- Department of Pathology, IRCCS Azienda Ospedaliera Universitaria di Bologna, Policlinico di Sant’Orsola, Bologna, Italy
| | | | | | - Giuseppe Tonini
- Medical Oncology, School University Campus Bio-Medico, Rome, Italy
| | - Sandro Barni
- Emeritus, Department of Oncology, ASST Bergamo Ovest, Treviglio, Bergamo, Italy
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Marazzi F, Barone R, Masiello V, Magri V, Mulè A, Santoro A, Cacciatori F, Boldrini L, Franceschini G, Moschella F, Naso G, Tomao S, Gambacorta MA, Mantini G, Masetti R, Smaniotto D, Valentini V. Oncotype DX Predictive Nomogram for Recurrence Score Output: The Novel System ADAPTED01 Based on Quantitative Immunochemistry Analysis. Clin Breast Cancer 2020; 20:e600-e611. [PMID: 32565110 DOI: 10.1016/j.clbc.2020.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 04/21/2020] [Accepted: 04/23/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE Oncotype DX (ODX) predicts breast cancer recurrence risk, guiding the choice of adjuvant treatment. In many countries, access to the test is not always available. We used correlation between phenotypical tumor characteristics, quantitative classical immunohistochemistry (IHC), and recurrence score (RS) assessed by ODX to develop a decision supporting system for clinical use. PATIENTS AND METHODS Breast cancer patients who underwent ODX testing between 2014 and 2018 were retrospectively included in the study. The data selected for analysis were age, menopausal status, and pathologic and IHC features. IHC was performed with standardized quantitative methods. The data set was split into two subsets: 70% for the training set and 30% for the internal validation set. Statistically significant features were included in logistic models to predict RS ≤ 25 or ≤ 20. Another set was used for external validation to test reproducibility of prediction models. RESULTS The internal set included 407 patients. Mean (range) age was 53.7 (31-80) years, and 222 patients (54.55%) were > 50 years old. ODX results showed 67 patients (16.6%) had RS between 0 and 10, 272 patients between 11 and 25 (66.8%), and 68 patients > 26 (16.6%). Logistic regression analysis showed that RS score (for threshold ≤ 25) was significantly associated with estrogen receptor (P = .004), progesterone receptor (P < .0001), and Ki-67 (P < .0001). Generalized linear regression resulted in a model that had an area under the receiver operating characteristic curve (AUC) of 92.2 (sensitivity 84.2%, specificity 80.1%) and that was well calibrated. The external validation set (183 patients) analysis confirmed the model performance, with an AUC of 82.3 and a positive predictive value of 91%. A nomogram was generated for further prospective evaluation to predict RS ≤ 25. CONCLUSION RS was related to quantitative IHC in patients with RS ≤ 25, with a good performance of the statistical model in both internal and external validation. A nomogram for enhancing clinical approach in a cost-effective manner was developed. Prospective studies must test this application in clinical practice.
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Affiliation(s)
- Fabio Marazzi
- UOC di Radioterapia Oncologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Rome, Italy
| | | | - Valeria Masiello
- UOC di Radioterapia Oncologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Rome, Italy.
| | - Valentina Magri
- Breast Unit, Division of Medical Oncology, Department of Radiological Oncological and Pathological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Antonino Mulè
- UOC di Anatomia Patologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Rome, Italy
| | - Angela Santoro
- UOC di Anatomia Patologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Rome, Italy
| | - Federica Cacciatori
- UOC di Anatomia Patologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Rome, Italy
| | - Luca Boldrini
- UOC di Radioterapia Oncologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Rome, Italy
| | - Gianluca Franceschini
- UOC di Chirurgia Senologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Rome, Italy; Università Cattolica del Sacro Cuore, Istituto di Radiologia, Rome, Italy
| | - Francesca Moschella
- UOC di Chirurgia Senologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Rome, Italy
| | - Giuseppe Naso
- Breast Unit, Division of Medical Oncology, Department of Radiological Oncological and Pathological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Silverio Tomao
- Breast Unit, Division of Medical Oncology, Department of Radiological Oncological and Pathological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Maria Antonietta Gambacorta
- UOC di Radioterapia Oncologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Rome, Italy; Università Cattolica del Sacro Cuore, Istituto di Radiologia, Rome, Italy
| | - Giovanna Mantini
- UOC di Radioterapia Oncologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Rome, Italy; Università Cattolica del Sacro Cuore, Istituto di Radiologia, Rome, Italy
| | - Riccardo Masetti
- UOC di Chirurgia Senologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Rome, Italy; Università Cattolica del Sacro Cuore, Istituto di Radiologia, Rome, Italy
| | - Daniela Smaniotto
- UOC di Radioterapia Oncologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Rome, Italy; Università Cattolica del Sacro Cuore, Istituto di Radiologia, Rome, Italy
| | - Vincenzo Valentini
- UOC di Radioterapia Oncologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Rome, Italy; Università Cattolica del Sacro Cuore, Istituto di Radiologia, Rome, Italy
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11
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Orlandi A, Iattoni E, Pizzuti L, Fabbri A, Botticelli A, Dio CD, Palazzo A, Garufi G, Indellicati G, Alesini D, Carbognin L, Paris I, Vaccaro A, Moscetti L, Cassano A, Vici P, Magri V, Naso G, Giannarelli D, Marchetti P, Bria E, Tortora G. Abstract P1-19-43: Palbociclib-fulvestrant (PALBO-FUL) and everolimus -exemestane (EVE-EXE) for second line hormonal treatment (HT) of metastatic breast cancer (MBC) with lobular histology: A propensity score matched analysis. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p1-19-43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Recently, CDK4/6i proved to improve the efficacy of HT of pts affected by luminal MBC. However, the best sequence of HT is still unclear and it is still uncertain if pts with lobular histology derive the same benefit of ductal when receiving second line CDK4/6i. Particularly in lobular MBC, the dysregulation of the AKTpathway with the overexpression of cyclin E potentially represents an important mechanism of acquired resistance to HT, finally providing an intrinsic resistance to subsequent CDK4/6i. Thus, a multicentric retrospective study was conducted to determine the efficacy of PALBO-FUL versus EVE-EXE as second line HT of MBC with Lobular histology.Methods: Pts affected by Lobular MBC receiving PALBO-FUL or EVE-EXE for second line HT from 2013 to 2018 in 6 Italian centers were considered eligible. The primary endpoint was progression free survival (PFS). A propensity score (PS) adjustment for baseline characteristics was further accomplished for survival analysis. Results: Seventy-four of 376 screened pts were diagnosed for Lobular MBC; 46pts received PALBO-FUL, whereas 28 were treated with EVE-EXE, without imbalance in clinical characteristics. PFS resulted to be significantly longer for pts receiving EVE-EXE in comparison with PALBO-FUL (6.1 vs. 4.5 months, HR 0.58, 95% CI 0.35-0.96; p=0.025). Previous chemotherapy exposure resulted to be significantly associated with PFS at the multivariate analysis (HR 0.41, 95% CI 0.24-0.72, p=0.002). At the PS analysis, adjusted for previous chemotherapy exposure and synchronous/metachronous metastatic status, PFS was confirmed to be significantly longer for pts receiving EVE-EXE in comparison with PALBO-FUL (6.0 vs. 4.6 months, p=0.04)Conclusion: This retrospective real-world analysis generates the hypothesis of a potential benefit of EVE-EXE in comparison with PALBO-FUL for second line HT of MBC with Lobular histology. Nevertheless, the small pts’ sample calls for a larger and adequately sized prospective validation. However, these data allow to speculate on the best hormonal therapeutic sequence in MLBC. Indeed, in this setting a late exposure to CDK4/6i might not allow to exploit its efficacy, while once hormonal resistance is acquired the inhibition of AKT/m-TOR pathway may represent the best option.
Citation Format: Armando Orlandi, Elena Iattoni, Laura Pizzuti, Agnese Fabbri, Andrea Botticelli, Carmela Di Dio, Antonella Palazzo, Giovanna Garufi, Giulia Indellicati, Daniele Alesini, Luisa Carbognin, Ida Paris, Angela Vaccaro, Luca Moscetti, Alessandra Cassano, Patrizia Vici, Valentina Magri, Giuseppe Naso, Diana Giannarelli, Paolo Marchetti, Emilio Bria, Giampaolo Tortora. Palbociclib-fulvestrant (PALBO-FUL) and everolimus -exemestane (EVE-EXE) for second line hormonal treatment (HT) of metastatic breast cancer (MBC) with lobular histology: A propensity score matched analysis [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-19-43.
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Affiliation(s)
- Armando Orlandi
- 1Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Elena Iattoni
- 1Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | | | | | | | - Carmela Di Dio
- 1Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | | | - Giovanna Garufi
- 1Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | | | | | - Luisa Carbognin
- 1Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Ida Paris
- 1Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | | | | | | | | | | | | | | | | | - Emilio Bria
- 1Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
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12
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Frassoldati A, Biganzoli L, Bordonaro R, Cinieri S, Conte P, Laurentis MD, Mastro LD, Gori S, Lauria R, Marchetti P, Michelotti A, Montemurro F, Naso G, Pronzato P, Puglisi F, Tondini CA. Endocrine therapy for hormone receptor-positive, HER2-negative metastatic breast cancer: extending endocrine sensitivity. Future Oncol 2019; 16:129-145. [PMID: 31849236 DOI: 10.2217/fon-2018-0942] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Targeted agents have significantly prolonged survival and improved response rates in first- and second-line settings of hormone receptor-positive/HER2-negative metastatic breast cancer. Optimal sequencing of the available options may prolong endocrine sensitivity, slow disease progression and delay the need for chemotherapy. However, the optimal treatment sequence remains unclear and therapeutic decisions are complex. We review the latest recommendations and supporting evidence for endocrine therapy in women with hormone receptor-positive/HER2-negative metastatic breast cancer and discuss strategies for the optimal sequential therapy in scenarios of response to endocrine therapy. Although more data are needed to define the best sequence of endocrine treatments, more personalized sequential strategies, which take into account response to previous treatments as well as disease symptoms and safety issues, will be increasingly feasible.
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Affiliation(s)
- Antonio Frassoldati
- Department of Oncology, Azienda Ospedaliero Universitaria di Ferrara-Arcispedale Sant'Anna, Ferrara, Italy
| | - Laura Biganzoli
- Breast Centre, Department of Oncology, AUSL Toscana Centro-Prato, Italy
| | - Roberto Bordonaro
- Department of Oncology, Medical Oncology Unit, ARNAS Garibaldi, Catania, Italy
| | - Saverio Cinieri
- Depertment of Oncology, Medical Oncology & Breast Unit, "Antonio Perrino" Hospital, Brindisi, Italy
| | - Pierfranco Conte
- University of Padua & Istituto Oncologico Veneto, Department of Oncology, Medical Oncology 2, IRCCS, Padua, Italy
| | - Michelino De Laurentis
- Department of Breast and Thoracic Oncology, National Cancer Institute Fondazione "G.Pascale", Naples, Italy
| | - Lucia Del Mastro
- Department of Oncology & Hematology, Medical Oncology 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Stefania Gori
- Department of Oncology, IRCCS Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy
| | - Rossella Lauria
- Department of Clinical Medicine & Surgery, University of Naples "Federico II", Naples, Italy
| | - Paolo Marchetti
- Medical Oncology Unit, Sant'Andrea Hospital of Rome & IDI-IRCCS, Rome, Italy
| | | | - Filippo Montemurro
- Direzione Day Hospital Oncologico Multidisciplinare, Istituto di Candiolo, FPO-IRCCS, Candiolo, Italy
| | - Giuseppe Naso
- Oncology B Unit, Sapienza University of Rome, Rome, Italy
| | - Paolo Pronzato
- Department of Oncology & Hematology, Medical Oncology 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Fabio Puglisi
- Department of Medicine, University of Udine, Italy; Department of Medical Oncology, IRCCS, CRO Aviano, National Cancer Institute, Aviano (PN), Italy
| | - Carlo Alberto Tondini
- Department of Medical Oncology, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
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13
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Conte B, Fabi A, Poggio F, Blondeaux E, Dellepiane C, D’alonzo A, Buono G, Arpino G, Magri V, Naso G, Presti D, Mura S, Fontana A, Cognetti F, Molinelli C, Pastorino S, Bighin C, Miglietta L, Boccardo F, Lambertini M, Del Mastro L. T-DM1 EFFICACY AND ACTIVITY IN HER2-POSITIVE METASTATIC BREAST CANCER PATIENTS PROGRESSING AFTER FRONTLINE TAXANE PLUS PERTUZUMAB AND TRASTUZUMAB: AN ITALIAN MULTICENTER OBSERVATIONAL STUDY OF THE GRUPPO ITALIANO MAMMELLA (GIM) STUDY GROUP. Breast 2019. [DOI: 10.1016/s0960-9776(19)30674-5] [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] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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14
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Marazzi F, Masiello V, Barone R, Magri V, Mulé A, Santoro A, Cacciatori F, Boldrini L, Franceschini G, Moschella F, Naso G, Tomao S, Mantini G, Masetti R, Smaniotto D, Valentini V. OncotypeDX® predictive nomogram for recurrence score output: A machine learning system based on quantitative immunochemistry analysis - ADAPTED01. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz240.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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15
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Botticelli A, Cerbelli B, Pisano A, Naso G, Monti M, Ascierto PA, Costarelli L, Magri V, Mauri M, Pignataro MG, Campagna D, Pernazza A, Nuti M, Fortunato L, Della Rocca C, D'Amati G, Marchetti P. Abstract P5-12-08: Not presented. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p5-12-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
This abstract was not presented at the conference.
Citation Format: Botticelli A, Cerbelli B, Pisano A, Naso G, Monti M, Ascierto PA, Costarelli L, Magri V, Mauri M, Pignataro MG, Campagna D, Pernazza A, Nuti M, Fortunato L, Della Rocca C, D'Amati G, Marchetti P. Not presented [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-12-08.
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Affiliation(s)
- A Botticelli
- Sapienza , University of Rome, Rome, Italy; San Giovanni Addolorata, Hospital, Rome, Italy; Istituto Nazionale Tumori -IRCCS- 'Fondazione G. Pascale', Naples, Italy
| | - B Cerbelli
- Sapienza , University of Rome, Rome, Italy; San Giovanni Addolorata, Hospital, Rome, Italy; Istituto Nazionale Tumori -IRCCS- 'Fondazione G. Pascale', Naples, Italy
| | - A Pisano
- Sapienza , University of Rome, Rome, Italy; San Giovanni Addolorata, Hospital, Rome, Italy; Istituto Nazionale Tumori -IRCCS- 'Fondazione G. Pascale', Naples, Italy
| | - G Naso
- Sapienza , University of Rome, Rome, Italy; San Giovanni Addolorata, Hospital, Rome, Italy; Istituto Nazionale Tumori -IRCCS- 'Fondazione G. Pascale', Naples, Italy
| | - M Monti
- Sapienza , University of Rome, Rome, Italy; San Giovanni Addolorata, Hospital, Rome, Italy; Istituto Nazionale Tumori -IRCCS- 'Fondazione G. Pascale', Naples, Italy
| | - PA Ascierto
- Sapienza , University of Rome, Rome, Italy; San Giovanni Addolorata, Hospital, Rome, Italy; Istituto Nazionale Tumori -IRCCS- 'Fondazione G. Pascale', Naples, Italy
| | - L Costarelli
- Sapienza , University of Rome, Rome, Italy; San Giovanni Addolorata, Hospital, Rome, Italy; Istituto Nazionale Tumori -IRCCS- 'Fondazione G. Pascale', Naples, Italy
| | - V Magri
- Sapienza , University of Rome, Rome, Italy; San Giovanni Addolorata, Hospital, Rome, Italy; Istituto Nazionale Tumori -IRCCS- 'Fondazione G. Pascale', Naples, Italy
| | - M Mauri
- Sapienza , University of Rome, Rome, Italy; San Giovanni Addolorata, Hospital, Rome, Italy; Istituto Nazionale Tumori -IRCCS- 'Fondazione G. Pascale', Naples, Italy
| | - MG Pignataro
- Sapienza , University of Rome, Rome, Italy; San Giovanni Addolorata, Hospital, Rome, Italy; Istituto Nazionale Tumori -IRCCS- 'Fondazione G. Pascale', Naples, Italy
| | - D Campagna
- Sapienza , University of Rome, Rome, Italy; San Giovanni Addolorata, Hospital, Rome, Italy; Istituto Nazionale Tumori -IRCCS- 'Fondazione G. Pascale', Naples, Italy
| | - A Pernazza
- Sapienza , University of Rome, Rome, Italy; San Giovanni Addolorata, Hospital, Rome, Italy; Istituto Nazionale Tumori -IRCCS- 'Fondazione G. Pascale', Naples, Italy
| | - M Nuti
- Sapienza , University of Rome, Rome, Italy; San Giovanni Addolorata, Hospital, Rome, Italy; Istituto Nazionale Tumori -IRCCS- 'Fondazione G. Pascale', Naples, Italy
| | - L Fortunato
- Sapienza , University of Rome, Rome, Italy; San Giovanni Addolorata, Hospital, Rome, Italy; Istituto Nazionale Tumori -IRCCS- 'Fondazione G. Pascale', Naples, Italy
| | - C Della Rocca
- Sapienza , University of Rome, Rome, Italy; San Giovanni Addolorata, Hospital, Rome, Italy; Istituto Nazionale Tumori -IRCCS- 'Fondazione G. Pascale', Naples, Italy
| | - G D'Amati
- Sapienza , University of Rome, Rome, Italy; San Giovanni Addolorata, Hospital, Rome, Italy; Istituto Nazionale Tumori -IRCCS- 'Fondazione G. Pascale', Naples, Italy
| | - P Marchetti
- Sapienza , University of Rome, Rome, Italy; San Giovanni Addolorata, Hospital, Rome, Italy; Istituto Nazionale Tumori -IRCCS- 'Fondazione G. Pascale', Naples, Italy
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16
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Framarino-Dei-Malatesta M, Chiarito A, Bianciardi F, Fiorelli M, Ligato A, Naso G, Pecorella I. Metastases to extraocular muscles from breast cancer: case report and up-to-date review of the literature. BMC Cancer 2019; 19:36. [PMID: 30621656 PMCID: PMC6325788 DOI: 10.1186/s12885-018-5253-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 12/26/2018] [Indexed: 01/27/2023] Open
Abstract
Background Unilateral or bilateral metastases to extraocular muscles are very rare in breast cancer. Case presentation We describe a case of inferior rectus extraocular muscle involved by ductal luminal B/Her-2 neu negative breast cancer, observed in a cohort of 580 patients. Our patient had received chemotherapy and hormonal therapy (tamoxifen for 3 years and letrozole in the following 3 years) for her primary cancer and developed an orbital metastasis while she was under aromatase inhibitor-based therapy. Diagnosis was confirmed by MRI and biopsy. Orbital radiotherapy, combined with fulvestrant, resulted in shrinking of the secondary mass. A third line hormonal therapy using palbociclib was then started. Twelve-months later, MRI showed no residual tumor mass. Currently, the patient is alive and in good general conditions after 20 months. Conclusions Literature review yielded 57 patients with extraocular muscle metastases from breast cancer, mostly due to the invasive lobular subtype of carcinoma. In addition to the present case, only 4 other extraocular muscles metastases from invasive ductal carcinoma has been reported, pointing out to the rarity of ductal type spread to the orbit in the natural history of breast cancer. Surgery may be used as a single treatment, despite no improvement of symptoms. Radiotherapy alone or combined with chemotherapy, or with chemotherapy plus hormonal therapy are available options. Results are, however, missing or poor. The present case is the first one with complete and stable response after 20 months to radiotherapy, antiestrogen drug fulvestrant and selective inhibitor of CDK4 /CDK6 palbociclib. In this subset of patients, with unusual metastatic sites and frequent multi-organ metastatic impairment, a multidisciplinary approach is indicated in order to achieve the best therapeutic management and long-term surveillance.
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Affiliation(s)
- Marialuisa Framarino-Dei-Malatesta
- Department of Gynecological, Obstetrical, and Urological Sciences, University Sapienza of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy. .,, Rome, Italy.
| | - Annalisa Chiarito
- Department of Gynecological, Obstetrical, and Urological Sciences, University Sapienza of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Federico Bianciardi
- Radiotherapy - UPMC San Pietro Fatebenefratelli, Via Cassia 600, 00189, Rome, Italy
| | - Marco Fiorelli
- Department of Neurosciences, University Sapienza of Rome, Policlinico Umberto I, Viale dell'Universita' 30, 00185, Rome, Italy
| | - Azzurra Ligato
- Department of Gynecological, Obstetrical, and Urological Sciences, University Sapienza of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Giuseppe Naso
- Department of Radiological, Oncological and Anatomical Pathology Sciences, University Sapienza of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Irene Pecorella
- Department of Radiological, Oncological and Anatomical Pathology Sciences, University Sapienza of Rome, Viale Regina Elena 324 -, 00161, Rome, Italy
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17
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Conte B, Fabi A, Poggio F, Blondeaux E, Dellepiane C, D'Alonzo A, Staiano A, Buono G, Arpino G, Magri V, Naso G, Presti D, Mura S, Fontana A, Cognetti F, Molinelli C, Pastorino S, Bighin C, Lambertini M, Del Mastro L. Effectiveness of trastuzumab emtansine (TDM1) in patients with HER2-positive advanced breast cancer (ABC) progressing after taxane plus pertuzumab plus trastuzumab. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy272.316] [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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18
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Barni S, Curtit E, Cognetti F, Bourgeois D, Masetti R, Zilberman S, Naso G, Gligorov J. Real-life utilization of genomic testing for invasive breast cancer patients in Italy and France reduces chemotherapy recommendations. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy270.189] [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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19
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Iacovelli R, DE Tursi M, Mosillo C, Ciardi A, Carella C, Natoli C, Naso G, Cortesi E. Relationship and Predictive Role of the Dual Expression of FGFR and IL-8 in Metastatic Renal Cell Carcinoma Treated with Targeted Agents. Anticancer Res 2018; 38:3105-3110. [PMID: 29715147 DOI: 10.21873/anticanres.12569] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 03/20/2018] [Accepted: 03/21/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM The expression of IL-8 and FGFR has been related to prognosis and pathological features in renal cell carcinoma. We investigated the relationship between IL-8 and FGFR and the outcome in metastatic renal cell carcinoma (mRCC) patients. MATERIALS AND METHODS Clinical data and histological samples of patients affected by mRCC and treated with targeted agents were reviewed. The expression of proteins was assessed using immunohistochemistry. RESULTS FGFR1, FGFR2, and IL-8 were found to be expressed in 16%, 30%, and 50% of cases, respectively. Significant correlations were found between selected proteins. A lack of expression of FGFR2 and IL8 was found to be correlated with increased progression-free survival (PFS). The survival rate at 24 months was 44%, 38%, and 79% of those expressing both, one, or none of the evaluated proteins, respectively (p=0.047). CONCLUSION This analysis found a relationship between the expression of IL-8 and FGFR2 in mRCC patients treated with targeted agents.
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Affiliation(s)
- Roberto Iacovelli
- Department of Medicine, Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Michele DE Tursi
- Department of Oral and Medical Sciences, Oncology Unit, G. D'Annunzio University, Chieti, Italy
| | - Claudia Mosillo
- Department of Radiology, Oncology and Human Pathology, Oncology Unit, Sapienza University of Rome, Rome, Italy
| | - Antonio Ciardi
- Department of Radiology, Oncology and Human Pathology, Human Pathology Unit, Sapienza University of Rome, Rome, Italy
| | - Consiglia Carella
- Department of Oral and Medical Sciences, Oncology Unit, G. D'Annunzio University, Chieti, Italy
| | - Clara Natoli
- Department of Oral and Medical Sciences, Oncology Unit, G. D'Annunzio University, Chieti, Italy
| | - Giuseppe Naso
- Department of Radiology, Oncology and Human Pathology, Oncology Unit, Sapienza University of Rome, Rome, Italy
| | - Enrico Cortesi
- Department of Radiology, Oncology and Human Pathology, Oncology Unit, Sapienza University of Rome, Rome, Italy
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Cortesi E, Palleschi M, Magri V, Naso G. The promise of liquid biopsy in cancer: a clinical perspective. Chin J Cancer Res 2015; 27:488-90. [PMID: 26543335 DOI: 10.3978/j.issn.1000-9604.2015.10.01] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The clinical utility of liquid biopsy in cancer treatment will increase as circulating tumor cells (CTCs) analysis move from the enumeration to the real-time measurement of tumor characteristics. Intratumor heterogeneity is becoming increasingly recognized as a major drawback to the shift to personalized medicine. Spatial and temporal heterogeneity might be reflected by the serial assessment of CTCs. Indeed, the developing technologies for CTCs analysis now allow digital genomic and next-generation sequencing approaches, able to differentiate molecular subtypes of the disease and to monitor genetic variation over time. The liquid biopsy of cancer might offer a real-time assessment of tumor biology, providing the opportunity to serially evaluate patients most likely to benefit from targeted drugs based on a dynamic characterization of the disease at the molecular level. Although hurdles remain before liquid biopsy is seen in routine clinical practice, the information derived from CTCs may facilitate the real-time identification of actionable mutations in cancer leading the way toward personalized medicine.
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Affiliation(s)
- Enrico Cortesi
- Medical Oncology Unit, Department of Radiological Oncological and Pathological Sciences, Sapienza, University of Rome, Italy
| | - Michela Palleschi
- Medical Oncology Unit, Department of Radiological Oncological and Pathological Sciences, Sapienza, University of Rome, Italy
| | - Valentina Magri
- Medical Oncology Unit, Department of Radiological Oncological and Pathological Sciences, Sapienza, University of Rome, Italy
| | - Giuseppe Naso
- Medical Oncology Unit, Department of Radiological Oncological and Pathological Sciences, Sapienza, University of Rome, Italy
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Naso G, Cortesi E. Crossing-over to imatinib 800 mg in a patient with GIST, after progression with standard
dosage: a case report. CMI 2015. [DOI: 10.7175/cmi.v5i1s.1103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
A 69-years-old patient underwent radical surgery to remove a lesion of small bowel with histological diagnosis of malignant primary stromal cancer of the gastro-intestinal wall (GIST). After a disease-free survival of 25 months instrumental evidence of loco-regional recurrence was detected with subsequent resection of the ileum: histology confirmed recurrent high risk GIST. After 34 months, TC scan showed peritoneal and hepatic progression of disease. Treatment with imatinib was started with standard dose of 400 mg/day, obtaining partial response on peritoneum and liver radiological complete response, after 5 months of therapy. Patient continued treatment with the same dose for 20 months. When radiological progression was detected we decided to increase imatinib to 800 mg/day based on the results of two principal phase III studies. Radiological partial response was reached after three months of therapy. Actually patient is still in treatment with imatinib showing stable disease with good tolerance.
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Alesini D, Mosillo C, Naso G, Cortesi E, Iacovelli R. Clinical experience with everolimus in the second-line treatment of advanced renal cell carcinoma. Ther Adv Urol 2015; 7:286-94. [PMID: 26425143 PMCID: PMC4549702 DOI: 10.1177/1756287215591764] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Everolimus is an oral inhibitor of mammalian target of rapamycin (mTOR-I) and is currently approved for the treatment of metastatic renal cell carcinoma (mRCC) after failure of first-line vascular endothelial growth factor receptor tyrosine kinase inhibitor (TKI). In this narrative review, we aim to report the available evidence about the use of everolimus as second-line therapy for mRCC. A literature search was performed using PubMed/MEDLINE and abstracts from major conferences on clinical oncology as sources. We report data from prospective as well as retrospective and real world data studies and we analyze the safety and efficacy profile of everolimus as second-line therapy for mRCC. Although different drugs are currently available for the second-line treatment of mRCC, everolimus represents a feasible and safe option in this setting, especially for patients who have experienced high-grade toxicity or are still carrying TKI-related toxicities from first-line treatment.
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Affiliation(s)
- Daniele Alesini
- Department of Radiology, Oncology and Human Pathology, Sapienza University of Rome, Rome, Italy
| | - Claudia Mosillo
- Department of Radiology, Oncology and Human Pathology, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Naso
- Department of Radiology, Oncology and Human Pathology, Sapienza University of Rome, Rome, Italy
| | - Enrico Cortesi
- Department of Radiology, Oncology and Human Pathology, Sapienza University of Rome, Rome, Italy
| | - Roberto Iacovelli
- Division of Medical Oncology, Genitourinary Unit, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy
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Mosillo C, Iacovelli R, De Tursi M, Ciardi A, Carella C, Natoli C, Naso G, Corstesi E. Relationship and predictive role of the dual expression of FGFR and IL8 in metastatic renal cell carcinoma (mRCC). Ann Oncol 2015. [DOI: 10.1093/annonc/mdv341.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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24
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Raimondi C, Gradilone A, Naso G, Cortesi E, Gazzaniga P. Clinical utility of circulating tumor cell counting through CellSearch(®): the dilemma of a concept suspended in Limbo. Onco Targets Ther 2014; 7:619-25. [PMID: 24790460 PMCID: PMC4000244 DOI: 10.2147/ott.s46200] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
To date, 10 years after the first demonstration of circulating tumor cells (CTCs), prognostic significance in metastatic breast cancer using the US Food and Drug Administration–cleared system CellSearch®, the potential utility of CTCs in early clinical development of drugs, their role as a surrogate marker of response to therapy, and their molecular analysis for patient stratification for targeted therapies are still major unsolved questions. Great expectations are pinned on the ongoing interventional trials aimed to demonstrate that CTCs might be of value for guiding treatment of patients and predicting cancer progression. To fill the gap between theory and practice with regard to the clinical utility of CTCs, a bridge is needed, taking into account innovative design for clinical trials, a revised definition of traditional CTCs, next-generation CTC technology, the potential clinical application of CTC analysis in non-validated settings of disease, and finally, expanding the number of patients enrolled in the studies. In this regard, the results of the first European pooled analysis definitely validated the independent prognostic value of CTC counting in metastatic breast cancer patients.
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Affiliation(s)
- Cristina Raimondi
- Dipartimento Medicina Molecolare, Sapienza Università di Roma, Rome, Italy
| | - Angela Gradilone
- Dipartimento Medicina Molecolare, Sapienza Università di Roma, Rome, Italy
| | - Giuseppe Naso
- Dipartimento di Scienze Radiologiche, Oncologiche e Anatomopatologiche, Sapienza Università di Roma, Rome, Italy
| | - Enrico Cortesi
- Dipartimento di Scienze Radiologiche, Oncologiche e Anatomopatologiche, Sapienza Università di Roma, Rome, Italy
| | - Paola Gazzaniga
- Dipartimento Medicina Molecolare, Sapienza Università di Roma, Rome, Italy
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Iacovelli R, Alesini D, Palazzo A, Trenta P, Santoni M, De Marchis L, Cascinu S, Naso G, Cortesi E. Targeted therapies and complete responses in first line treatment of metastatic renal cell carcinoma. A meta-analysis of published trials. Cancer Treat Rev 2013; 40:271-5. [PMID: 24070900 DOI: 10.1016/j.ctrv.2013.09.003] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 08/30/2013] [Accepted: 09/03/2013] [Indexed: 11/30/2022]
Abstract
Antiangiogenic agents (AAs) have reported grater efficacy compared to interferon. Despite these advances, radiological complete response to therapy is rare. We meta-analyzed the incidence of complete response in patients treated with AAs and in controls in main randomized clinical trials for first-line therapy in metastatic renal cell carcinoma. PubMed was reviewed for phase II-III randomized clinical trials with AAs vs. non-AAs in patients with good or intermediate prognosis. We calculated the relative risk of events in patients assigned to AAs compared to control. Five RCTs were found; four were phase III and one was phase II. A total of 2747 patients was valuable for final analysis and randomized to receive AAs or control. Patients in the control-group had interferon (85%) or placebo (15%); patients in the AAs-group received bevacizumab (48%), sunitinib (26%), pazopanib (20%) or sorafenib (6%). The incidence of complete response in patients treated with AAs was 2.0% (95% CI, 1.2-2.8) compared to 1.4% (95% CI, 0.7-2.1) in the control arm. Comparing the different type of AAs, the incidence of complete response was 2.5% (95% CI, 1.2-3.8) in the bevacizumab group and 1.6% (95% CI, 0.1-2.5) in the TKIs group. The relative risk to have a complete response was 1.52 (95% CI, 0.85-2.73; p=0.16) in patients treated with AAs compared to controls; this was found higher in patients treated with TKIs compared to bevacizumab. The complete response is a rare event in metastatic kidney tumor, even if AAs reported greater efficacy in terms of progression-free survival and of overall response rate, they did not increase the curative rate of metastatic disease. Probably, some biologic factors other than angiogenesis may influence the complete response in this disease.
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Affiliation(s)
- Roberto Iacovelli
- "Sapienza" University of Rome, Department of Radiology, Oncology and Human Pathology, Viale Regina Elena 324, 00161 Rome, Italy.
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26
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Nelli F, Naso G, De Pasquale Ceratti A, Saltarelli R, Dauria G, Lugini A, Ferraldeschi R, Picone V, Moscetti L, Cortesi E. Weekly Vinorelbine and Docetaxel as Second-Line Chemotherapy for Pretreated Non-Small Cell Lung Cancer Patients: a Phase I-II Trial. J Chemother 2013; 16:392-9. [PMID: 15332716 DOI: 10.1179/joc.2004.16.4.392] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [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: 10/31/2022]
Abstract
Docetaxel was proven to be effective as second-line therapy for patients with advanced NSCLC after failure of platinum-based front-line chemotherapy. We designed this phase I/II study to define the Maximum Tolerated Dose of weekly docetaxel combined with weekly vinorelbine, and subsequently evaluate tolerability and activity of this schedule in NSCLC patients who were progressive after treatment with either cisplatin and gemcitabine or carboplatin and paclitaxel regimens. To be eligible for the study, patients were required to have a WHO performance status < or =2, failure after at least two cycles of first platinum-based chemotherapy, and no prior treatment with docetaxel and vinorelbine. A total of 27 patients were enrolled in this phase I/II study. A weekly docetaxel dose of 25 mg/m2 was recommended in combination with fixed vinorelbine dose of 20 mg/m2, and 24 patients were treated at this dose level. Severe neutropenia (62%) and febrile neutropenia (29%) were the most frequent toxicities, with 83% of patients requiring dose modification or delay. In the phase II study, 5 (21%) patients obtained a partial response, 8 (33%) patients had stable disease, whereas 10 (42%) patients progressed. After a median follow-up of 18.7 months, median survival was 8 months, with 30% surviving at 1 year. Regardless of the use of weekly docetaxel schedule, this regimen was highly myelosuppressive, and did not seem to improve response rate and survival compared to single-agent docetaxel. No further developments of this schedule are warranted.
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Affiliation(s)
- F Nelli
- Department of Experimental Medicine and Pathology, Medical Oncology, University of Rome La Sapienza, Rome, Italy
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27
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Iacovelli R, Palazzo A, Mezi S, Morano F, Naso G, Cortesi E. Incidence and risk of pulmonary toxicity in patients treated with mTOR inhibitors for malignancy. A meta-analysis of published trials. Acta Oncol 2012; 51:873-9. [PMID: 22909392 DOI: 10.3109/0284186x.2012.705019] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND mTOR inhibitors are currently used in the treatment of solid malignancies. Since their approval, several cases of pulmonary toxicity (PT) have been described. This analysis aims to report the incidence and the risk of PT in published randomized controlled trials. MATERIAL AND METHODS PubMed and Scopus were reviewed for phase II-III randomized controlled trials with temsirolimus and everolimus. The characteristic of each study and incidence of all- and high-grades PT were collected. RESULTS A total of 2233 patients were available for meta-analysis: 989 had breast cancer, 833 had neuroendocrine tumor and 411 had metastatic renal cell carcinoma. In patients taking mTOR inhibitors, the incidence of all- and high-grades PT was 10.4% and 2.4%, respectively. Compared to controls, the relative risk for all- and high-grades PT was 31- and 8.8-folds, respectively. No significant heterogeneity was observed between the studies. Not any relationship was found between the incidence of lung metastases, treatment exposure and the incidence of PT. CONCLUSIONS The high grade PT is a rare event and 10% of patients may experience mild grade toxicity with a worsening of quality of life and interruption of therapy in some cases. We recommend monitoring of PT in patients treated with mTOR inhibitors.
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Affiliation(s)
- Roberto Iacovelli
- Dipartimento di Scienze Radiologiche, Oncologiche e Anatomo-Patologiche, Sapienza Università di Roma, Rome, Italy.
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Gradilone A, Raimondi C, Nicolazzo C, Petracca A, Gandini O, Vincenzi B, Naso G, Aglianò AM, Cortesi E, Gazzaniga P. Circulating tumour cells lacking cytokeratin in breast cancer: the importance of being mesenchymal. J Cell Mol Med 2011; 15:1066-70. [PMID: 21352474 PMCID: PMC3822619 DOI: 10.1111/j.1582-4934.2011.01285.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Circulating tumour cells (CTCs) are independent predictor of prognosis in metastatic breast cancer. Nevertheless, in one third of patients, circulating tumour cells are undetected by conventional methods. Aim of the study was to assess the prognostic value of circulating tumour cells expressing mesenchymal markers in metastatic breast cancer patients. We isolated CTC from blood of 55 metastatic breast cancer patients. CTC were characterized for cytokeratins and markers of epithelial mesenchymal transition. The gain of mesenchymal markers in CTC was correlated to prognosis of patients in a follow-up of 24 months. The presence of mesenchymal markers on CTC more accurately predicted worse prognosis than the expression of cytokeratins alone. Because of the frequent loss of epithelial antigens by CTC, assays targeting epithelial antigens may miss the most invasive cell population. Thus, there is an urgent need to improve detection methods to identify CTC which undergone epithelial mesenchymal transition program.
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Affiliation(s)
- Angela Gradilone
- Department of Molecular Medicine, Sapienza University, Viale Regina Elena, Rome, Italy
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29
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Gazzaniga P, Naso G, Raimondi C, Gradilone A, Palazzo A, Gandini O, Petracca A, Nicolazzo C, Cortesi E, Frati L. Circulating tumor cells count and characterization in a male breast cancer patient. Cancer Biol Ther 2011; 12:379-82. [PMID: 21725206 DOI: 10.4161/cbt.12.5.16304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
A 64-y-old man presented to Medical Oncology Department a metastatic invasive ductal breast carcinoma, positive for estrogen (ER) and progesterone receptors (PR) and Her2/neu negative. The patient was treated with different lines of therapy, with rapid radiological progression of disease. After four courses of a third-line chemotherapy, a radiological stable disease was maintained. The patient was followed by serial blood drawings for the characterization and count of circulating tumor cells (CTC). This is the first report concerning the predictive and prognostic value of CTC in a male breast cancer patient.
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Affiliation(s)
- Paola Gazzaniga
- Department of Molecular Medicine,apienza University of Rome, Rome, Italy.
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30
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Felici A, Naso G, Di Segni S, Vici P, Antenucci A, Angelini F, Pizzuti L, Mandoj C, D'Auria G, Fabi A, Tata A, Cognetti F, Papaldo P. Fulvestrant administered in two different schedules: Pharmacokinetics, biological markers, and activity. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e11026] [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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31
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Gazzaniga P, Gradilone A, Petracca A, Nicolazzo C, Raimondi C, Iacovelli R, Naso G, Cortesi E. Molecular markers in circulating tumour cells from metastatic colorectal cancer patients. J Cell Mol Med 2011; 14:2073-7. [PMID: 20597995 PMCID: PMC3822998 DOI: 10.1111/j.1582-4934.2010.01117.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [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: 12/13/2022] Open
Abstract
The prognosis of metastatic cancer patients is still largely affected by treatment failure, mainly due to drug resistance. The hypothesis that chemotherapy might miss circulating tumour cells (CTCs) and particularly a subpopulation of more aggressive, stem-like CTCs, characterized by multidrug resistance, has been recently raised. We investigated the prognostic value of drug resistance and stemness markers in CTCs from metastatic colorectal cancer patients treated with oxaliplatin (L-OHP) and 5-fluoruracil (5-FU) based regimens. Forty patients with metastatic colorectal cancer were enrolled. CTCs were isolated from peripheral blood and analysed for the expression of aldheyde dehydrogenase 1 (ALDH1), CD44, CD133 (used as markers of stemness), multidrug resistance related protein 5 (MRP5 used as marker of resistance to 5-FU and L-OHP) and survivin (used as a marker of apoptosis resistance). CTCs were found in 27/40 (67%) patients. No correlation was found between the expression of either CD44 and CD133 in CTCs and the outcome of patients, while a statistically significant shorter progression-free survival was found in patients with CTCs positive for the expression of ALDH1, survivin and MRP5. These results support the idea that isolating survivin and MRP5+ CTCs may help in the selection of metastatic colorectal cancer patients resistant to standard 5-FU and L-OHP based chemotherapy, for which alternative regimens may be appropriate.
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Affiliation(s)
- Paola Gazzaniga
- Department of Experimental Medicine, Sapienza University of Rome, Italy.
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32
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Raimondi C, Gradilone A, Naso G, Vincenzi B, Petracca A, Nicolazzo C, Palazzo A, Saltarelli R, Spremberg F, Cortesi E, Gazzaniga P. Epithelial-mesenchymal transition and stemness features in circulating tumor cells from breast cancer patients. Breast Cancer Res Treat 2011; 130:449-55. [PMID: 21298334 DOI: 10.1007/s10549-011-1373-x] [Citation(s) in RCA: 193] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Accepted: 01/23/2011] [Indexed: 02/06/2023]
Abstract
Currently used methods to detect and enumerate circulating tumor cells (CTCs) rely on the expression of the epithelial cell adhesion molecule (EpCAM) and cytokeratins. This selection may exclude cells that have undergone intrinsic modifications of their phenotype, as epithelial-mesenchymal transition (EMT). Aim of the study was to investigate the expression of EMT and stemness markers in CTCs from breast cancer patients in all stages of disease. 92 female breast cancer patients were enrolled. CTCs were isolated by CELLection Dynabeads coated with the monoclonal antibody toward EpCam. Samples found positive for CTCs presence (CD45-/CK+) were evaluated for the expression of ER alpha, HER2, ALDH1, vimentin, and fibronectin. Samples negative for CTCs presence (CD45-/CK-) were also evaluated for the expression of vimentin and fibronectin, used as markers of EMT. CTCs were found in 66% of patients. The distribution of CTCs presence according to stage and grade of disease was found statistically significant. The expression of ALDH1 on CTCs was found to correlate to stage of disease and to the expression of vimentin and fibronectin. In 34% of patients, we detected cells with negative CK/CD45 expression but positive expression of vimentin and fibronectin. There is an urgent need for optimizing CTCs detection methods through the inclusion of EMT markers. The detection of cells in mesenchymal transition, retaining EMT and stemness features, may contribute to discover additional therapeutic targets useful to eradicate micrometastatic disease in breast cancer.
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Affiliation(s)
- Cristina Raimondi
- Division of Medical Oncology, Sapienza University of Rome, Rome, Italy
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33
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Passaro A, Pellegrino A, Palazzo A, Iacovelli R, Conte D, Truscelli K, Alesini D, Modica D, Naso G, Cortesi E. 89PD LONG-TERM SURVIVAL IN UNSELECTED PATIENTS TREATED WITH A PERSONALIZED SCHEDULE WITH ERLOTINIB. Lung Cancer 2011. [DOI: 10.1016/s0169-5002(11)70226-4] [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: 10/18/2022]
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Gradilone A, Naso G, Raimondi C, Cortesi E, Gandini O, Vincenzi B, Saltarelli R, Chiapparino E, Spremberg F, Cristofanilli M, Frati L, Aglianò A, Gazzaniga P. Circulating tumor cells (CTCs) in metastatic breast cancer (MBC): prognosis, drug resistance and phenotypic characterization. Ann Oncol 2011; 22:86-92. [DOI: 10.1093/annonc/mdq323] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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35
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Raimondi C, Naso G, Gradilone A, Gianni W, Cortesi E, Gazzaniga P. Circulating tumor cells in cancer therapy: are we off target? Curr Cancer Drug Targets 2010; 10:509-18. [PMID: 20384574 DOI: 10.2174/156800910791517163] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Accepted: 04/10/2010] [Indexed: 11/22/2022]
Abstract
What clinical oncologists learned about metastatic process, is that it is the main cause of cancer-related deaths. What scientists learned about metastatic disease, is that it is due to a highly selective process, which involves a minority of tumor cells that are able to survive within the bloodstream, and to initiate a new growth in distant sites. These cells "in transit" are known as circulating tumor cells (CTCs). Although their nature is not fully understood, what is widely accepted, is that they are drug resistant, and that their presence may represent the main reason for treatment failure. Despite this body of evidence, the pharmacological approach against cancer, with both chemotherapic and biological drugs, is still targeted on the primary tumor, raising the question as to whether we are missing the target. Targeting circulating tumor cells, may represent a new promising approach to indivisualize anticancer therapy.
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Affiliation(s)
- C Raimondi
- Division of Medical Oncology, Sapienza University of Rome, Rome, Italy.
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36
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Madaio RA, Spalletta G, Cravello L, Ceci M, Repetto L, Naso G. Overcoming endocrine resistance in breast cancer. Curr Cancer Drug Targets 2010; 10:519-28. [PMID: 20384578 DOI: 10.2174/156800910791517226] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Accepted: 04/10/2010] [Indexed: 11/22/2022]
Abstract
Approximately 70% of breast cancers express the estrogen receptor (ER) and endocrine therapy is the most important component of systemic therapy for hormone-responsive breast cancer. Unfortunately, endocrine-resistant ER-positive disease represents up to one-quarter of all breast cancers and a number of different mechanisms have been implicated in endocrine resistance, either intrinsic, occurring de novo at the initial exposure to endocrine therapies or acquired, occurring after an initial response to therapy. In the present work a number of molecular mechanisms accounting for intrinsic and acquired resistance to hormonal therapies have been reviewed and the most promising strategies to overcome endocrine resistance have been highlighted.
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Affiliation(s)
- R A Madaio
- Division of Medical Oncology, Ospedale Israelitico, Rome, Italy
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37
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Gradilone A, Petracca A, Nicolazzo C, Gianni W, Cortesi E, Naso G, Vincenzi B, Cristini C, De Berardinis E, Di Silverio F, Aglianò AM, Gazzaniga P. Prognostic significance of survivin-expressing circulating tumour cells in T1G3 bladder cancer. BJU Int 2010; 106:710-5. [DOI: 10.1111/j.1464-410x.2009.09130.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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38
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Gazzaniga P, Naso G, Gradilone A, Cortesi E, Gandini O, Gianni W, Fabbri MA, Vincenzi B, di Silverio F, Frati L, Aglianò AM, Cristofanilli M. Chemosensitivity profile assay of circulating cancer cells: prognostic and predictive value in epithelial tumors. Int J Cancer 2010; 126:2437-47. [PMID: 19821489 DOI: 10.1002/ijc.24953] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The prognostic value associated with the detection of circulating tumor cells (CTCs) in metastatic breast cancer by the CellSearch technology raise additional issues regarding the biological value of this information. We postulated that a drug-resistance profile of CTCs may predict response to chemotherapy in cancer patients and therefore could be used for patient selection. One hundred 5 patients with diagnosis of carcinoma were enrolled in a prospective trial. CTCs were isolated from peripheral blood, and positive samples were evaluated for the expression of a panel of genes involved in anticancer drugs resistance. The drug-resistance profile was correlated with disease-free survival (DFS; patients in adjuvant setting) and time to progression (TTP; metastatic patients) in a 24-months follow-up. Objective response correlation was a secondary end point. Fifty-one percent of patients were found positive for CTCs while all blood samples from healthy donors were negative. The drug-resistance profile correlates with DFS and TTP (p < 0.001 in both). Sensitivity of the test: able to predict treatment response in 98% of patients. Specificity of the test: 100%; no sample from healthy subject was positive for the presence of CTCs. Positive and negative predictive values were found to be 96.5 and 100%, respectively. We identified a drug-resistance profile of CTCs, which is predictive of response to chemotherapy, independent of tumor type and stage of disease. This approach may represent a first step toward the individualization of chemotherapy in cancer patients.
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Affiliation(s)
- Paola Gazzaniga
- Dipartimento Medicina Sperimentale, Sapienza Università di Roma, Viale Regina Elena 324, Roma, Italy.
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39
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Gazzaniga P, Gradilone A, de Berardinis E, Sciarra A, Cristini C, Naso G, di Silverio F, Frati L, Aglianò AM. A chemosensitivity test to individualize intravesical treatment for non-muscle-invasive bladder cancer. BJU Int 2009; 104:184-8. [PMID: 19154503 DOI: 10.1111/j.1464-410x.2008.08342.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe the design of a new chemosensitivity assay based on the expression of genes involved in the resistance to standard intravesical regimens, to allow individualization of therapy for high-risk non-muscle-invasive bladder cancer. PATIENTS AND METHODS To date, 35 patients with high-risk non-muscle-invasive bladder cancer have been enrolled, all candidates for transurethral resection of the bladder (TURB) followed by intravesical treatment. The intravesical regimen was chosen according to the risk profile of each patient. All patients were evaluated by cystoscopy 3 and 6 months after TURB. According to the molecular characterization of each tumour, our team of molecular oncologists determined for each patient a molecular profile of chemosensitivity to BCG, mitomycin c, anthracyclines and gemcitabine. This profile was then correlated to the response to intravesical therapy 6 months after TURB. RESULTS This chemosensitivity test was able to predict response to treatment in 96% of patients. The assay is easy to perform, inexpensive and quick. CONCLUSION Our results, although preliminary, are encouraging for the future of an individualized therapeutic approach, with the aim to provide a higher treatment success rate while sparing patients unnecessary toxicity from drugs that are not suited for their tumours.
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Affiliation(s)
- Paola Gazzaniga
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy.
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Gazzaniga P, Gradilone A, Naso G, Cortesi E, Gianni W, Frati L, Aglianò AM. Chemoresistance profile of circulating tumor cells: toward a clinical benefit? Int J Cancer 2008; 123:1730-2. [PMID: 18646187 DOI: 10.1002/ijc.23699] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Papaldo P, Ferretti G, Di Cosimo S, Giannarelli D, Marolla P, Lopez M, Cortesi E, Antimi M, Terzoli E, Carlini P, Vici P, Botti C, Di Lauro L, Naso G, Nisticò C, Mottolese M, Di Filippo F, Ruggeri EM, Ceribelli A, Cognetti F. Does Granulocyte Colony-Stimulating Factor Worsen Anemia in Early Breast Cancer Patients Treated With Epirubicin and Cyclophosphamide? J Clin Oncol 2006; 24:3048-55. [PMID: 16769988 DOI: 10.1200/jco.2005.02.9488] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [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: 11/20/2022] Open
Abstract
Purpose We report on the effects of granulocyte colony-stimulating factor (G-CSF) on hemoglobin (Hb) value in early breast cancer patients receiving high-dose epirubicin and cyclophosphamide (EC) adjuvant treatment. Methods Five hundred and six stage I or stage II female breast cancer patients were treated with E 120 mg/m2 and C 600 mg/m2 with or without G-CSF and randomly assigned to receive in a factorial 2 × 2 design: EC; EC + lonidamine; EC + G-CSF; EC + lonidamine + G-CSF. Five consecutive G-CSF schedules tested 100 randomly assigned patients each: (1) 480 μg subcutaneously on days 8 to 14; (2) 480 μg on days 8, 10, 12, 14; (3) 300 μg on days 8 to 14; (4) 300 μg on days 8, 10, 12, and 14; and (5) 300 μg on days 8 and 12. The mean Hb level of 246 patients receiving EC plus G-CSF was compared with that of 240 patients receiving EC alone. The data presented are derived from an exploratory hypothesis-generating analysis. Results The EC dose intensity did not statistically differ between the G-CSF and the control arm. From the third cycle onward, the mean Hb value resulted significantly lower in G-CSF arm compared with control at each time point of each cycle (P < .0001). No statistically significant difference in the mean Hb level was observed between schedule 5 and control. Of interest, from the second course onward, the mean Hb level tended to be lower in patients receiving seven or four G-CSF injections compared with those patients who received only two injections. Conclusion Our data suggest that a G-CSF dose-related effect may play a role in worsening anemia in patients receiving adjuvant EC.
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Affiliation(s)
- Paola Papaldo
- Department of Medical Oncology, Regina Elena Cancer Institute, Italy
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Aglianó AM, Santangelo C, Silvestri I, Gazzaniga P, Giuliani L, Naso G, Frati L, Castiglia R. On chromosomal instability: what is the karyotype of your 32D CI3 cell line. Blood 2000; 95:3636-7. [PMID: 10877550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
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Butler RWH, Corrado S, Mazzoli S, De Donatis M, Di Bucci D, Naso G, Scrocca D, Nicolai C, Zucconi V. Time and space variability of «thin-skinned» and «thick-skinned» thrust tectonics in the Apennines (Italy). Rend Fis Acc Lincei 2000. [DOI: 10.1007/bf02904594] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Gradini R, Realacci M, Ginepri A, Naso G, Santangelo C, Cela O, Sale P, Berardi A, Petrangeli E, Gallucci M, Di Silverio F, Russo MA. Nitric oxide synthases in normal and benign hyperplastic human prostate: immunohistochemistry and molecular biology. J Pathol 1999; 189:224-9. [PMID: 10547579 DOI: 10.1002/(sici)1096-9896(199910)189:2<224::aid-path422>3.0.co;2-k] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The expression of nitric oxide synthase (NOS) isoforms has been investigated in normal (three subjects) and benign hyperplastic prostate (ten patients) by immunohistochemistry and reverse transcriptase-polymerase chain reaction (RT-PCR). The inducible NOS (iNOS or NOS-2) is not detected in normal prostate, while it is expressed in the prostate of all benign prostatic hyperplasia (BPH) patients, even in the absence of prostatitis or systemic signs of an inflammatory condition. This suggests that sex hormones may be involved in iNOS induction and that there may be a role for NO in the pathogenesis of BPH. Constitutive NOSs (nNOS and eNOS) are expressed in both normal and hyperplastic prostate and are co-expressed in epithelial cells. eNOS, however, is present mainly in the basal layer cells; nNOS seems abundantly expressed in the more superficial cells of the affected prostate. This indicates that the switching between the two constitutive isoforms may be part of the usual process of cell differentiation from the basal to the secretory layer of the epithelium.
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Affiliation(s)
- R Gradini
- Department of Experimental Medicine and Pathology, University La Sapienza, Rome, Italy
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Pescarmona E, Pignoloni P, Santangelo C, Naso G, Realacci M, Cela O, Lavinia AM, Martelli M, Russo MA, Baroni CD. Expression of p53 and retinoblastoma gene in high-grade nodal peripheral T-cell lymphomas: immunohistochemical and molecular findings suggesting different pathogenetic pathways and possible clinical implications. J Pathol 1999; 188:400-6. [PMID: 10440751 DOI: 10.1002/(sici)1096-9896(199908)188:4<400::aid-path379>3.0.co;2-#] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The expression of p53 and the retinoblastoma gene has been investigated by immunohistochemical and molecular analysis in 45 cases of nodal peripheral T-cell lymphoma with high-grade histology. Most cases (73.3 per cent) were primary nodal lymphomas without any extra-nodal site involvement. Most of them (75.6 per cent) were histologically classified as pleomorphic, small, medium, and large cell type. Immunohistochemistry detected p53 in nine cases (20 per cent). In each of these cases, the polymerase chain reaction (PCR)/heteroduplex analysis did not show the presence of mutations, this finding being consistent with an alteration of the p53 functional pathway, in the presence of a wild-type protein. The retinoblastoma gene product was detected by immunohistochemistry in 35 cases (77.8 per cent) and not detected in ten cases (22.2 per cent). In the latter cases, the reverse transcription (RT)-PCR analysis showed the presence of a specific retinoblastoma gene transcript in six cases and was negative in the remaining four cases. The immunohistochemical and molecular findings seem to be consistent with abnormalities of retinoblastoma gene expression at either the transcriptional or the post-transcriptional level. Since all nine p53-positive cases by immunohistochemical analysis were also retinoblastoma gene product-positive, and all ten retinoblastoma gene product-negative cases were also p53-negative, two different and mutually exclusive pathways of possible pathogenetic significance may be suggested, the former involving abnormalities of the functional pathway of p53 in the absence of mutations and the latter abnormalities of retinoblastoma gene expression at the transcriptional and/or post-transcriptional level. Finally, the clinico-pathological correlations showed that p53 immunohistochemical expression is significantly associated with a poorer response to intensive chemotherapy.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Biomarkers, Tumor/metabolism
- Cell Division
- Female
- Gene Expression
- Genes, Retinoblastoma
- Genes, p53
- Humans
- Lymphoma, T-Cell, Peripheral/drug therapy
- Lymphoma, T-Cell, Peripheral/genetics
- Lymphoma, T-Cell, Peripheral/metabolism
- Male
- Middle Aged
- Neoplasm Proteins/metabolism
- Retinoblastoma Protein/metabolism
- Reverse Transcriptase Polymerase Chain Reaction
- Treatment Outcome
- Tumor Suppressor Protein p53/metabolism
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Affiliation(s)
- E Pescarmona
- II Cattedra di Anatomia ed Istologia Patologica, Dipartimento di Medicina Sperimentale e Patologia, Policlinico Umberto I, Rome, Italy.
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Agliano A, Naso G, Silvestri I, Gradilone A, Vercillo R, Napolitano M, Gazzaniga P, Gandini O, Realacci M, Santangelo C, Saccani G, Manzari V, Frati L. Involvement of bcl-2 and bax gene expression in apoptosis and differentiation of the non-tumorigenic murine hematopoietic cell line, 32DC13(G). Int J Oncol 1997; 11:1271-7. [PMID: 21528334 DOI: 10.3892/ijo.11.6.1271] [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: 11/05/2022] Open
Abstract
32DCl3(G) is an interleukin-3 (IL-3) dependent, non-tumorigenic murine hematopoietic cell line which undergoes terminal differentiation into granulocytes when exposed to granulocyte-colony stimulating factor (G-CSF). This line therefore offers a convenient system to study the expression of genes involved in apoptosis and differentiation. In our experiments we have acquired evidence that during the differentiation pathway, likewise in apoptosis induced by IL-3 deprivation, detectable levels of bax mRNA appear, while bcl-2 expression decreases. These events are under the control of the p53 tumor-suppressor gene. In these cells, an overexpression of exogenous wild-type p53 leads to a decrease in bcl-2 mRNA and to the appearance of box mRNA, which instead is absent in the parental cells growing in IL-3 conditioned medium. Furthermore, results from experiments on p53 transfected cells demonstrate that excess wild-type p53 activity, on its own, fails to elicit apoptosis as long as IL-3 is present and does not induce differentiation if G-CSF is not added to the culture medium. We conclude that in apoptosis and differentiation of 32DCl3(G) the alterate ratio of bcl-2 and box gene expression, modulated by p53, is an early event dependent on IL-3 withdrawal and that the appearance of bax and the decrease of bcl-2 expression are necessary, but not sufficient for the acquisition of a completely mature granulocytic phenotype.
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Affiliation(s)
- A Agliano
- UNIV ROMA TOR VERGATA, DIPARTIMENTO MED SPERIMENTALE & SCI BIOCHIM, I-00173 ROME, ITALY. IST MEDITERRANEO NEUROSCI, POZZILLI, ITALY
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Calugi A, Eleuteri P, Cavallo D, Naso G, Albonici L, Lombardi MP, Manzari V, Romanini C, DeVita R. Detection of cellular heterogeneity by DNA ploidy, 17 chromosome, and p53 gene in primary carcinoma and metastasis in a case of ovarian cancer. Int J Gynecol Pathol 1996; 15:77-81. [PMID: 8852451 DOI: 10.1097/00004347-199601000-00013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
An unusual case of a patient with ovarian carcinoma carrying the p53 point mutation in both metastases (omentum and lymph node), but not in the primary tumor, is described. The presence of a p53 single mutation (G:A) at the second base of codon 248 was examined by polymerase chain reaction-amplification refractory mutation system (PCR-ARMS) analysis. This case was examined also by fluorescent in situ hybrization (FISH) analysis and flow cytometry (FCM) to obtain further information at the single cell level and to detect heterogeneity within a population of cells. FCM analysis evidenced the same multiple aneuploid cell subpopulations in primary and in metastatic samples showing the presence of a cellular heterogeneity. FISH analysis showed a disomic condition for the 17 chromosome in the primary and in one metastasis, while in the other metastasis a monosomic together with a disomic subpopulation was revealed. Our results confirm the independent clonal evolution of the metastasis. The late mutation event observed only in metastatic specimens suggests the hypothesis that in the primary tumor the wild-type gene either does not perform its control role for unknown genetic structural events or the p53 gene in this case does not play a critical role in carcinogenesis.
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Affiliation(s)
- A Calugi
- Obstetric and Gynaecologic Clinic, Tor Vergata University, Rome, Italy
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Gazzaniga P, Gallucci M, Gradilone A, Gandini O, Vincenzoni A, Gianni W, Naso G, Frati L, Agliano AM. Detection of BCL-2 RNA in low grade tumours of the urinary bladder. Eur J Cancer 1995; 31A:2119-20. [PMID: 8562180 DOI: 10.1016/0959-8049(95)00404-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Aglianò AM, Gradilone A, Gazzaniga P, Napolitano M, Vercillo R, Albonici L, Naso G, Manzari V, Frati L, Vecchione A. High frequency of human papillomavirus detection in urinary bladder cancer. Urol Int 1994; 53:125-9. [PMID: 7645137 DOI: 10.1159/000282652] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We investigated the presence of human papillomaviruses (HPVs) types 16 and 18 DNA in formalin-fixed, paraffin-embedded tissues from the urinary bladder (46 transitional carcinomas and 10 non-neoplastic normal urinary samples) to find a possible role for HPV types in urinary tract cancerogenesis. The analysis was performed using polymerase chain reaction followed by filter hybridization with oligonucleotide-specific probes. The HPV16 and/or HPV18 genomes were detected in 23 of 46 (50%) bladder carcinomas and in none of 10 (0%) non-neoplastic urinary samples. These results suggest that HPV16 and 18 may carry a risk for the development of malignancy in the urinary tract as it occurs in the anogenital regions.
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Affiliation(s)
- A M Aglianò
- Department of Experimental Medicine, University of Rome La Sapienza, Italy
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Pontieri G, Lenti L, Naso G, Lombardi D, Misasi LR, Mardente S. Oncogenesis and immunosubversion. Pharmacotherapy 1993. [DOI: 10.1016/0753-3322(93)90233-b] [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: 11/26/2022]
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