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Caccese M, Desideri I, Villani V, Simonelli M, Buglione M, Chiesa S, Franceschi E, Gaviani P, Stasi I, Caserta C, Brugnara S, Lolli I, Bennicelli E, Bini P, Cuccu AS, Scoccianti S, Padovan M, Gori S, Bonetti A, Giordano P, Pellerino A, Gregucci F, Riva N, Cinieri S, Internò V, Santoni M, Pernice G, Dealis C, Stievano L, Paiar F, Magni G, De Salvo GL, Zagonel V, Lombardi G. REGOMA-OSS: a large, Italian, multicenter, prospective, observational study evaluating the efficacy and safety of regorafenib in patients with recurrent glioblastoma. ESMO Open 2024; 9:102943. [PMID: 38492275 PMCID: PMC10959650 DOI: 10.1016/j.esmoop.2024.102943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/02/2024] [Accepted: 02/16/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND In the randomized phase II REGOMA trial, regorafenib showed promising activity in patients with recurrent glioblastoma. We conducted a large, multicenter, prospective, observational study to confirm the REGOMA data in a real-world setting. PATIENTS AND METHODS The major inclusion criteria were histologically confirmed diagnosis of glioblastoma according to the World Health Organization (WHO) 2016 classification and relapse after radiotherapy with concurrent/adjuvant temozolomide treatment, good performance status [Eastern Cooperative Oncology Group performance status (ECOG PS 0-1)] and good liver function. Regorafenib was administered at the standard dose of 160 mg/day for 3 weeks on/1 week off. Brain magnetic resonance imaging was carried out within 14 days before starting regorafenib and every 8-12 weeks. The primary endpoint was overall survival (OS). The secondary endpoints were progression-free survival (PFS), objective response rate, disease control rate (DCR), safety and health-related quality of life. The Response Assessment in Neuro-Oncology (RANO) criteria were used for response evaluation and Common Terminology Criteria for Adverse Events (CTCAE) version 5 for assessment of adverse events (AEs). RESULTS From September 2020 to October 2022, 190 patients with recurrent glioblastoma were enrolled from 30 cancer centers in Italy: their median age was 58.5 years [interquartile range (IQR) 53-67 years], 68% were male and 85 (44.7%) were in optimal clinical condition (ECOG PS 0). The number of patients taking steroids at baseline was 113 (60%); the second surgery was carried out in 39 (20.5%). O6-methylguanine-DNA methyltransferase (MGMT) was methylated in 80 patients (50.3%) and 147 (92.4%) of the patients analyzed had isocitrate dehydrogenase (IDH) wild type. The median follow-up period was 20 months (IQR 15.6-25.5 months). The median OS was 7.9 months ([95% confidence interval (CI) 6.5-9.2 months] and the median PFS was 2.6 months (95% CI 2.3-2.9 months). Radiological response was partial response and stable disease in 13 (7.3%) and 26 (14.6%) patients, respectively, with a DCR of 21.9%. The median number of regorafenib cycles per patient was 3 (IQR 2.0-4.0). Grade 3-4 drug-related adverse events were reported in 22.6% of patients. A dose reduction due to AEs was required in 36% of patients. No deaths were considered as treatment-related AEs. CONCLUSIONS This large, real-world observational study showed similar OS with better tolerability of regorafenib in patients with relapsed glioblastoma compared with the REGOMA study.
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Affiliation(s)
- M Caccese
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua.
| | - I Desideri
- Department of Experimental and Clinical Biomedical Sciences, Radiation Oncology Unit, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence
| | - V Villani
- Neuro-Oncology Unit, IRCCS Regina Elena National Cancer Institute, Rome
| | - M Simonelli
- Department of Biomedical Sciences, Humanitas University, Milan; Humanitas Clinical and Research Center-IRCCS, Humanitas Cancer Center, Milan
| | - M Buglione
- Radiation Oncology Unit, ASST Spedali Civili of Brescia, Brescia
| | - S Chiesa
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, U.O.C. Radioterapia Oncologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome
| | - E Franceschi
- Nervous System Medical Oncology Department, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna
| | - P Gaviani
- Neuro-Oncological Unit, Istituto Neurologico Carlo Besta, Milan
| | - I Stasi
- Division of Medical Oncology, Civil Hospital, Livorno
| | - C Caserta
- Medical Oncology Department, Santa Maria Hospital, Terni
| | - S Brugnara
- Department of Medical Oncology, Santa Chiara Hospital, Trento
| | - I Lolli
- Oncology Unit of National Institute of Gastroenterology 'S. De Bellis', Research Hospital, Castellana Grotte, Bari
| | - E Bennicelli
- Ospedale Policlinico San Martino, Oncologia Medica 2, Genoa
| | - P Bini
- Neuroncology Unit, IRCCS 'C. Mondino Foundation', University of Pavia, Pavia
| | - A S Cuccu
- Medical Oncology, Sassari Hospital, Sassari
| | - S Scoccianti
- Radioterapia Oncologica, Ospedale Santa Maria Annunziata, Bagno a Ripoli, Florence
| | - M Padovan
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua
| | - S Gori
- Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella
| | - A Bonetti
- Department of Oncology, Mater Salutis Hospital, Legnago
| | - P Giordano
- Oncology Unit, Ospedale del Mare, Naples
| | - A Pellerino
- Division of Neuro-Oncology, Department of Neuroscience, City of Health and Science and University of Turin, Turin
| | - F Gregucci
- Department of Radiation Oncology, Miulli General Regional Hospital, Acquaviva delle Fonti
| | - N Riva
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) 'Dino Amadori', Meldola
| | - S Cinieri
- Oncology Unit, Ospedale Perrino, Brindisi
| | - V Internò
- Division of Oncology, Department of Biomedical Sciences and Human Oncology, University of Bari, Bari
| | - M Santoni
- Oncology Unit, Macerata Hospital, Macerata
| | - G Pernice
- Oncology Unit, Fondazione Istituto G. Giglio, Cefalù
| | - C Dealis
- Health Directorate, Azienda Sanitaria dell'Alto Adige, Bolzano
| | - L Stievano
- Department of Oncology, Ospedale Civile, Rovigo
| | - F Paiar
- Department of Radiation Oncology, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa
| | - G Magni
- Clinical Research Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - G L De Salvo
- Clinical Research Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - V Zagonel
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua
| | - G Lombardi
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua
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2
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Del Re M, Luculli GI, Petrini I, Sbrana A, Scotti V, Perez DDM, Livi L, Crucitta S, Iannopollo M, Mazzoni F, Ruglioni M, Tibaldi C, Olmetto E, Stasi I, Baldini E, Allegrini G, Antonuzzo L, Morelli F, Pierini A, Panzeri N, Fogli S, Chella A, Rolfo C, Danesi R. Clinical utility of Next Generation Sequencing of plasma cell-free DNA for the molecular profiling of patients with NSCLC at diagnosis and disease progression. Transl Oncol 2024; 41:101869. [PMID: 38290249 PMCID: PMC10859238 DOI: 10.1016/j.tranon.2023.101869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 11/17/2023] [Accepted: 12/15/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND The present study evaluates the utility of NGS analysis of circulating free DNA (cfDNA), which incorporates small amounts of tumor DNA (ctDNA), at diagnosis or at disease progression (PD) in NSCLC patients. METHODS Comprehensive genomic profiling on cfDNA by NGS were performed in NSCLC patients at diagnosis (if tissue was unavailable/insufficient) or at PD to investigate potential druggable molecular aberrations. Blood samples were collected as routinary diagnostic procedures, DNA was extracted, and the NextSeq 550 Illumina platform was used to run the Roche Avenio ctDNA Expanded Kit for molecular analyses. Gene variants were classified accordingly to the ESCAT score. RESULTS A total of 106 patients were included in this study; 44 % of cases were requested because of tissue unavailability at the diagnosis and 56 % were requested at the PD. At least one driver alteration was observed in 62 % of cases at diagnosis. Driver druggable variants classified as ESCAT level I were detected in 34 % of patients, including ALK-EML4, ROS1-CD74, EGFR, BRAF, KRAS p.G12C, PI3KCA. In the PD group, most patients were EGFR-positive, progressing to a first line-therapy. Sixty-three percent of patients had at least one driver alteration detected in blood and 17 % of patients had a known biological mechanism of resistance allowing further therapeutic decisions. CONCLUSIONS The present study confirms the potential of liquid biopsy to detect tumour molecular heterogeneity in NSCLC patients at the diagnosis and at PD, demonstrating that a significant number of druggable mutations and mechanisms of resistance can be detected by NGS analysis on ctDNA.
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Affiliation(s)
- Marzia Del Re
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy; Thoracic Oncology Center, Tisch Cancer Center, Mount Sinai Hospital System & Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Giovanna Irene Luculli
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Iacopo Petrini
- Unit of Pneumology, Department of Translational Research and New Technologies in Medicine, University Hospital of Pisa, Pisa, Italy
| | - Andrea Sbrana
- Unit of Pneumology, Department of Translational Research and New Technologies in Medicine, University Hospital of Pisa, Pisa, Italy
| | - Vieri Scotti
- Radiation Oncology Unit, Oncology Department, AOU Careggi Firenze, Firenze, Italy
| | - Diego de Miguel Perez
- Thoracic Oncology Center, Tisch Cancer Center, Mount Sinai Hospital System & Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Lorenzo Livi
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Stefania Crucitta
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Mauro Iannopollo
- Oncology Department, Oncology Unit, San Jacopo Hospital, Pistoia, Italy
| | | | - Martina Ruglioni
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Emanuela Olmetto
- Radiation Oncology Unit, Oncology Department, AOU Careggi Firenze, Firenze, Italy
| | - Irene Stasi
- Department of Oncology, Azienda USL Toscana Nord Ovest, Pisa, Italy
| | | | | | - Lorenzo Antonuzzo
- Medical Oncology, Careggi University Hospital, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Franco Morelli
- Medical Oncology Unit, Gemelli Hospital Molise, Campobasso, Italy
| | | | | | - Stefano Fogli
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Antonio Chella
- Unit of Pneumology, Department of Translational Research and New Technologies in Medicine, University Hospital of Pisa, Pisa, Italy
| | - Christian Rolfo
- Thoracic Oncology Center, Tisch Cancer Center, Mount Sinai Hospital System & Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Romano Danesi
- Department of Oncology and Hemato-Oncology, University of Milano, Via Festa del Perdono, 7, 20122 Milano, Italy.
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Coltelli L, Finale C, Musettini G, Fontana A, Barletta MT, Lucarini AR, Fabiani I, Scalese M, Bocci G, Masini LC, Soria G, Cupini S, Arrighi G, Barbara C, De Maio E, Salvadori B, Marini A, Pellino A, Stasi I, Emdin M, Giaconi S, Marcucci L, Allegrini G. Non-pegylated liposomal doxorubicin in older adjuvant early breast cancer patients: cardiac safety analysis and final results of the COLTONE study. Clin Exp Med 2023; 23:5113-5120. [PMID: 37634231 PMCID: PMC10725369 DOI: 10.1007/s10238-023-01144-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/12/2023] [Indexed: 08/29/2023]
Abstract
AIMS To explore the cardiac safety of adjuvant Non-Pegylated Liposomal Doxorubicin (NPL-DOX) plus Cyclophosphamide (CTX) followed by weekly Paclitaxel, in elderly women (≥ 65 years) with high-risk breast cancer. Previously, we described no symptomatic cardiac events within the first 12 months from starting treatment. We now reported the updated results after a median follow-up 76 months. METHODS The cardiac activity was evaluated with left ventricular ejection fraction (LVEF) echocardiograms assessments, before starting chemotherapy and every 6 months, until 30 months from baseline, then yearly for at least 5 years. RESULTS Forty-seven women were recruited by two Units of Medical Oncology (Ethics Committee authorization CESM-AOUP, 3203/2011; EudraCT identification number: 2010-024067-41, for Pisa and Pontedera Hospitals). An episode of grade 3 CHF (NCI-CTCAE, version 3.0) occurred after 18 months the beginning of chemotherapy. The echocardiograms assessments were performed comparing the LVEF values of each patient evaluated at fixed period of time, compared to baseline. We observed a slight changed in terms of mean values at 48, 60, 72 and 84 months. At these time points, a statistically significant reduction of - 3.2%, - 4.6%, - 6.4% and - 7.1%, respectively, was observed. However, LVEF remained above 50% without translation in any relevant clinical signs. No other cardiac significant episodes were reported. To this analysis, in 13 patients (28%) occurred disease relapse and, of them, 11 (23%) died due to metastatic disease. Eight patients died of cancer-unrelated causes. CONCLUSIONS The combination including NPL-DOX in elderly patients revealed low rate of cardiac toxic effects. Comparative trials are encouraged.
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Affiliation(s)
- Luigi Coltelli
- Division of Medical Oncology, Leghorn Hospital, Viale Alfieri 36, Leghorn, Italy.
- Department of Oncology, Azienda USL Toscana Nord Ovest, Pisa, Italy.
| | - Chiara Finale
- Division of Medical Oncology, Leghorn Hospital, Viale Alfieri 36, Leghorn, Italy
- Department of Oncology, Azienda USL Toscana Nord Ovest, Pisa, Italy
| | - Gianna Musettini
- Division of Medical Oncology, Leghorn Hospital, Viale Alfieri 36, Leghorn, Italy
- Department of Oncology, Azienda USL Toscana Nord Ovest, Pisa, Italy
| | - Andrea Fontana
- Division of Medical Oncology II, Azienda Ospedaliero-Universitaria Pisana, S. Chiara Hospital Via Roma, 67, Pisa, Italy
| | - Maria Teresa Barletta
- Division of Medical Oncology, Pontedera Hospital, Via Roma, 151, Pontedera, Italy
- Department of Oncology, Azienda USL Toscana Nord Ovest, Pisa, Italy
| | - Alessandra Renata Lucarini
- Department of Cardiology, Azienda Usl Toscana Nord Ovest, Pisa, Italy
- Department of Internal Medicine, Azienda USL Toscana Nord Ovest, Pisa, Italy
| | - Iacopo Fabiani
- Cardiology and Cardiovascular Medicine Division, Cardio-Thoracic Department, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Marco Scalese
- Institute of Clinical Physiology, Italian National Research Council - CNR, Pisa, Italy
| | - Guido Bocci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Luna Chiara Masini
- Division of Medical Oncology, Leghorn Hospital, Viale Alfieri 36, Leghorn, Italy
- Department of Oncology, Azienda USL Toscana Nord Ovest, Pisa, Italy
| | - Giulia Soria
- Division of Medical Oncology, Leghorn Hospital, Viale Alfieri 36, Leghorn, Italy
- Department of Oncology, Azienda USL Toscana Nord Ovest, Pisa, Italy
| | - Samanta Cupini
- Division of Medical Oncology, Leghorn Hospital, Viale Alfieri 36, Leghorn, Italy
- Department of Oncology, Azienda USL Toscana Nord Ovest, Pisa, Italy
| | - Giada Arrighi
- Division of Medical Oncology, Pontedera Hospital, Via Roma, 151, Pontedera, Italy
- Department of Oncology, Azienda USL Toscana Nord Ovest, Pisa, Italy
| | - Cecilia Barbara
- Division of Medical Oncology, Leghorn Hospital, Viale Alfieri 36, Leghorn, Italy
- Department of Oncology, Azienda USL Toscana Nord Ovest, Pisa, Italy
| | - Ermelinda De Maio
- Division of Medical Oncology, Leghorn Hospital, Viale Alfieri 36, Leghorn, Italy
- Department of Oncology, Azienda USL Toscana Nord Ovest, Pisa, Italy
| | - Barbara Salvadori
- Division of Medical Oncology II, Azienda Ospedaliero-Universitaria Pisana, S. Chiara Hospital Via Roma, 67, Pisa, Italy
| | - Andrea Marini
- Division of Medical Oncology, Leghorn Hospital, Viale Alfieri 36, Leghorn, Italy
- Department of Oncology, Azienda USL Toscana Nord Ovest, Pisa, Italy
| | - Antonio Pellino
- Division of Medical Oncology, Leghorn Hospital, Viale Alfieri 36, Leghorn, Italy
- Department of Oncology, Azienda USL Toscana Nord Ovest, Pisa, Italy
| | - Irene Stasi
- Division of Medical Oncology, Leghorn Hospital, Viale Alfieri 36, Leghorn, Italy
- Department of Oncology, Azienda USL Toscana Nord Ovest, Pisa, Italy
| | - Michele Emdin
- Cardiology and Cardiovascular Medicine Division, Cardio-Thoracic Department, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
- Health Science Interdisciplinary Research Center, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Stefano Giaconi
- Department of Cardiology, Azienda Usl Toscana Nord Ovest, Pisa, Italy
- Department of Internal Medicine, Azienda USL Toscana Nord Ovest, Pisa, Italy
| | - Lorenzo Marcucci
- Division of Medical Oncology, Pontedera Hospital, Via Roma, 151, Pontedera, Italy
- Department of Oncology, Azienda USL Toscana Nord Ovest, Pisa, Italy
| | - Giacomo Allegrini
- Division of Medical Oncology, Leghorn Hospital, Viale Alfieri 36, Leghorn, Italy
- Division of Medical Oncology, Pontedera Hospital, Via Roma, 151, Pontedera, Italy
- Department of Oncology, Azienda USL Toscana Nord Ovest, Pisa, Italy
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Ramella S, Morabito A, Silipigni S, Russo A, Capelletto E, Rossi S, Leonetti A, Montrone M, Facilissimo I, Romano G, Stasi I, Ceresoli G, Gridelli C, Lugini A, Pilotto S, Tagliaferri P, Bria E, Canova S, Rijavec E, Borghetti P, Brighenti M, Carta A, Ciuffreda L, Giusti R, Macerelli M, Verderame F, Zanelli F, Berardi R, Gregorc V, Sergi C, Vattemi E, Manglaviti S, Piovano P, Olmetto E, Borra G, Gori S, Aieta M, Bertolini A, Cecere F, Pasello G, Rocco D, Zulian M, Roncari B, Novello S. EP06.01-006 Multidisciplinary Team during the COVID-19 Pandemic: The BE-PACIFIC Italian Observational Study Analysis. J Thorac Oncol 2022. [PMCID: PMC9452007 DOI: 10.1016/j.jtho.2022.07.521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Camerini A, Caparello C, Pennucci MC, Rotellini M, Stasi I, Torrini A, Vasile E. La gestione del tumore al polmone non a piccole cellule (NSCLC) ALK positivo – l’esperienza dell’Azienda USL Toscana Nord-Ovest. Drugs Context 2021. [DOI: 10.7573/dic.2021-8-8] [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: 11/21/2022] Open
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Tibaldi C, Mazzoni F, Scotti V, Vasile E, Pozzessere D, Stasi I, Camerini A, Federici F, Meoni G, Caparello C, Turrini M, Rossi V, Ciccone LP, Pecora I, Fantechi B, Antonuzzo L, Giannarelli D, Baldini E. Pembrolizumab for First-Line Treatment of Advanced Non-Small-Cell Lung Cancer: Analysis of Prognostic Factors of Outcomes. Anticancer Agents Med Chem 2021; 22:1278-1285. [PMID: 34315390 DOI: 10.2174/1871520621666210727112212] [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: 11/16/2020] [Revised: 03/05/2021] [Accepted: 03/30/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND In advanced non-small-cell lung cancer, without activating mutations and with PD-L1≥50%, Pembrolizumab monotherapy is the therapeutic standard in Europe. OBJECTIVE to evaluate retrospectively the safety and the efficacy of this drug and to investigate potential prognostic factors in daily clinical practice. METHODS From September 2017 to September 2019, 205 consecutive patients from 14 Italian Medical Oncology Units were enrolled in the study. Gender, Age (> or <70 years), ECOG-PS (0-1 or 2), histology (squamous or non-squamous), presence of brain, bone and liver metastases at baseline, PD-L1 score (>90% or <90%), smoking status (never or former or current) were applied to the stratified log-rank. Cox's proportional hazards model was used for multivariate analysis. RESULTS At a median follow-up of 15.2 months, median progression-free and overall survival (mPFS and mOS) were 9.2 months (95% C.I., 4.8-13.5) and 15.9 months (95% C.I., not yet evaluable), respectively. Patients with Eastern Cooperative Oncology Group performance status (ECOG-PS) 2 had mPFS of 2.8 months (95% C.I., 2.1-3.4) and mOS of 3.9 months (95% C.I., 2.5-5.3). Patients with liver metastases at diagnosis had an mPFS of 3.2 months (95% C.I., 0.6-5.8) and an mOS of 6.0 months (95% C.I., 3.7-8.4). At multivariate analysis for OS gender, ECOG-PS 2, and presence of liver metastases were independent prognostic factors. CONCLUSION Patients with ECOG-PS 2 derived little benefit from the use of first-line pembrolizumab. In patients with liver metastases the association of pembrolizumab with platinum-based chemotherapy could be a better option than pembrolizumab alone.
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Affiliation(s)
| | | | - Vieri Scotti
- Department of Oncology, Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Enrico Vasile
- Department of Oncology, Azienda Ospedaliero-Universitaria, Pisa, Italy
| | | | - Irene Stasi
- Division of Medical Oncology, Civil Hospital, Livorno, Italy
| | - Andrea Camerini
- Department of Oncology, Versilia Hospital, Lido di Camaiore, Italy
| | | | - Giulia Meoni
- Department of Oncology, S.Giovanni di Dio Hospital, Firenze, Italy
| | | | - Marianna Turrini
- Department of Oncology, S. Maria alla Gruccia Hospital, Montevarchi, Italy
| | - Virginia Rossi
- Department of Oncology, Careggi University Hospital, Firenze, Italy
| | - Lucia Pia Ciccone
- Department of Oncology, Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Irene Pecora
- Department of Oncology, Azienda Ospedaliero-Universitaria, Pisa, Italy
| | | | | | - Diana Giannarelli
- Biostatistical Unit, Regina Elena National Cancer Institute, IRCCS, Rome, Italy
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Crucitta S, Restante G, Del Re M, Bertolini I, Bona E, Rofi E, Fontanelli L, Gianfilippo G, Fogli S, Stasi I, Ghilli M, Fontana A, Danesi R. Endothelial nitric oxide synthase c.-813C>T predicts for proteinuria in metastatic breast cancer patients treated with bevacizumab-based chemotherapy. Cancer Chemother Pharmacol 2019; 84:1219-1227. [PMID: 31529205 DOI: 10.1007/s00280-019-03933-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 08/21/2019] [Indexed: 02/03/2023]
Abstract
PURPOSE To investigate the association between single nucleotide polymorphisms (SNPs) in endothelial nitric oxide synthase (eNOS) and interleukin-8 (IL-8) genes and risk of developing bevacizumab-related adverse events in metastatic breast cancer (mBC) patients. PATIENTS AND METHODS mBC patients candidate to receive bevacizumab-based chemotherapy were enrolled in this pharmacogenetic study. eNOS c.-813C>T and c.894G>T, and IL-8 c.-251A>T were analyzed by real time PCR on genomic DNA extracted from peripheral blood. Univariate analysis was performed to test the association between each SNP and treatment-related toxicities. RESULTS Seventy-six mBC patients were enrolled in the present study. Patients carrying the homozygous variant eNOS c.-813TT genotype showed a statistically significant occurrence of any grade proteinuria when compared to CT or CC genotypes (p = 0.004). No significant association of proteinuria with IL-8 SNP or hypertension with selected eNOS and IL-8 SNPs was found. CONCLUSIONS These findings suggest an association between the eNOS c.-813C>T polymorphism and the development of proteinuria in mBC patients receiving a bevacizumab-based chemotherapy.
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Affiliation(s)
- Stefania Crucitta
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, 55, Via Roma, 56126, Pisa, Italy
| | - Giuliana Restante
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, 55, Via Roma, 56126, Pisa, Italy
| | - Marzia Del Re
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, 55, Via Roma, 56126, Pisa, Italy.
| | - Ilaria Bertolini
- Unit of Medical Oncology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Eleonora Bona
- Unit of Medical Oncology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Eleonora Rofi
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, 55, Via Roma, 56126, Pisa, Italy
| | - Lorenzo Fontanelli
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, 55, Via Roma, 56126, Pisa, Italy
| | - Giulia Gianfilippo
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, 55, Via Roma, 56126, Pisa, Italy
| | - Stefano Fogli
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, 55, Via Roma, 56126, Pisa, Italy
| | - Irene Stasi
- Unit of Medical Oncology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Matteo Ghilli
- Unit of Breast Surgery, Breast Cancer Centre, University Hospital of Pisa, Pisa, Italy
| | - Andrea Fontana
- Unit of Medical Oncology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Romano Danesi
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, 55, Via Roma, 56126, Pisa, Italy
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8
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Affiliation(s)
- Rosina Amoroso
- Unit of Neurosurgery, Livorno Civil Hospital, Livorno, Italy -
| | | | - Francesco Pieri
- Department of Neurosciences, University of Pisa, Pisa, Italy
| | - Vanna Zucchi
- Unit of Neurosurgery, Livorno Civil Hospital, Livorno, Italy
| | - Manrico Bosio
- Unit of Neurosurgery, Livorno Civil Hospital, Livorno, Italy
| | - Irene Stasi
- Unit of Neurosurgery, Livorno Civil Hospital, Livorno, Italy
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Stasi I, Farnesi A, Vasile E, Petrini I, Luccchesi M, Lupi C, Sensi E, Giannini R, Fornaro L, Caparello C, Pasquini G, Puppo G, Finale C, Barletta M, Chella A, Allegrini G, Falcone A, Fontanini G. A retrospective analysis of patients (pts) with non-small-cell lung cancer (NSCLC) with uncommon or complex epidermal growth factor receptor (EGFR) mutations treated with tyrosine kinase inhibitors (EGFR-TKIs): clinical features and outcome. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx426.006] [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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10
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Passaro A, Metro G, Tiseo M, Migliorino M, Santo A, Sperandi F, Maione P, Puppo G, Grossi F, Soto Parra H, Borra G, Roca E, Rocco D, Stasi I, Galetta D, Carta A, Milella M, Fasola G, Gebbia V, Ferrari S, De Marinis F. ASTRIS, a real world treatment study of osimertinib in patients (pts) with EGFR T790M positive non-small cell lung cancer (NSCLC): preliminary analysis of the Italian cohort. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx426.001] [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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Abstract
Bavituximab is a an unconjugated, chimeric immunoglobulin G1 (IgG1) monoclonal antibody directed against the phosphatidylserine (PS) expressed on tumor endothelium, with a specific mechanism of action. PS is an anionic membrane phospholipid, physiologically restricted to the internal membrane leaflet; various pathophysiologic processes cause the exposure of PS on the external membrane leaflet. Bavituximab, once bound, starts up host effector activities, such as antibody dependent cellular cytotoxicity, causing vessel destruction and enhancing antitumor immunity. Phase I clinical trials of bavituximab administered as monotherapy or in combination with other chemotherapeutic agents in adults with pretreated solid tumors have been accomplished, indicating that bavituximab can be safely dispensed weekly, with a recommended dose of 1 and 3 mg/kg. A Phase II randomized, placebo-controlled trial of bavituximab plus docetaxel, in the second-line therapy setting of locally advanced or metastatic non-small-cell lung cancer, has been conducted and recently presented, suggesting a clinical benefit of the combination, with an overall response rate of 17% and median overall survival of more than 11 months. A Phase III trial is currently ongoing. Bavituximab has been studied in combination with platinum-based doublets with promising results. In the present paper we summarize the preclinical development and clinical experience with bavituximab in non-small-cell lung cancer.
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Affiliation(s)
- Irene Stasi
- Medical Oncology Department, Istituto Toscano Tumori, Ospedale Civile, Livorno, Italy
| | - Federico Cappuzzo
- Medical Oncology Department, Istituto Toscano Tumori, Ospedale Civile, Livorno, Italy
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12
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Stasi I, Cappuzzo F. Second generation tyrosine kinase inhibitors for the treatment of metastatic non-small-cell lung cancer. Transl Respir Med 2014; 2:2. [PMID: 25505694 PMCID: PMC4215821 DOI: 10.1186/2213-0802-2-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 12/26/2013] [Indexed: 12/02/2022]
Abstract
Backgruond Since their first description, activating epidermal growth factor receptor (EGFR) mutations identify a distinct clinical entity of patients with non-small-cell lung cancer (NSCLC). Findings New targeted therapies for molecularly selected NSCLC are changing the natural history of the disease, with results superior to standard chemotherapy as demonstrated in large phase III studies with first generation EGFR tyrosine kinase inhibitors (TKIs) erlotinib and gefitinib. However, after an initial response, all patients inevitably progress and several mechanisms including a secondary mutation in exon 20 of the EGFR gene (T790M) or MET or HER2 amplifications are responsible for acquired resistance (AR). In clinical practice few options are available for patients with AR, and several new agents or strategies are currently under investigation, including second generation TKIs. Conclusions Aim of the present review is to present available data on new EGFR-TKIs and to discuss how these agents could overcome AR to erlotinib or gefitinib.
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Affiliation(s)
- Irene Stasi
- Medical Oncology Department, IstitutoToscanoTumori, OspedaleCivile, Livorno, Italy
| | - Federico Cappuzzo
- Medical Oncology Department, IstitutoToscanoTumori, OspedaleCivile, Livorno, Italy
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13
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Del Re M, Ferrarini I, Fontana A, Santoro M, Bona E, Del Re I, Stasi I, Bertolini I, Laurà F, Landucci E, Salvadori B, Falcone A, Danesi R. Abstract P5-17-06: The deficient eNOS c.894G>T genotype is not associated with increased severity of hypertension and proteinuria in breast cancer patients receiving bevacizumab. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p5-17-06] [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. Tumor angiogenesis is a complex process involving a wide array of effector molecules and stromal cells. In tumor tissue, vasculature is structurally and functionally abnormal, causing elevated interstitial pressure and irregular perfusion. The expression of vascular endothelial growth factor (VEGF), the most important angiogenic factor, is enhanced in many tumors. VEGF may induce nitric oxide (NO) production via up-regulation of the endothelial NO synthase (eNOS, NOS3) and the resultant overproduction of NO is associated with vasodilation and edema within tumors (Goel S et al. Physiol Rev 2011;91:1071). eNOS plays an important physiologic role in maintaining blood pressure homeostasis and vascular integrity by providing constitutive release of NO in endothelial cells. Functional variants of the eNOS gene, including the single-nucleotide polymorphism rs1799983 (c.894G>T, p. Asp298Glu) at codon 298, have been associated with reduced function of eNOS and higher incidence of hypertension (HT) (Niu W, Qi Y. PLoS One 2011;6:e24266).
Purpose. Since suppression of VEGF-eNOS axis by anti-angiogenic therapies is considered a causative factor of HT in patients, the purpose of this study was to examine whether the major eNOS non-synonymous variant c.894G>T may be associated with increased risk of developing hypertension (HT) and proteinuria (PU) in breast cancer patients treated with bevacizumab.
Patients and methods. Forty-one metastatic breast cancer patients given bevacizumab as per standard of care were enrolled. Main characteristics were: median age 49.5 years (range 29–73) at first diagnosis, 53 years (range 34–74) at metastatic disease; PS 0–1 in all patients; 4 subjects with hypertension and 1 patient with compensated cardiovascular disease at diagnosis. Twenty-six subjects had received neoadjuvant or adjuvant chemotherapy based on anthracycline and taxane; first-line chemotherapy for metastatic disease was paclitaxel plus bevacizumab for all patients; 14 subjects received hormone-therapy for metastatic disease (range 1–5 lines). Germline DNA was extracted from peripheral blood and used to screen patients for eNOS c.894G>T variant by automatic sequencing. The study was approved by the local Ethics Committee.
Results. Three patients (7.3%) were homozygous variant c.894TT, 12 (29.3%) homozygous wild-type c.894GG and the remaining 26 (63.4%) were heterozygous c.894GT. The c.894TT patients had no HT or PU at baseline and developed grade (G) 1, 2, 2 HT, respectively, and in one case PU during treatment. G1, 2 and 3 HT developed in 4, 5 and 2 c.894GG subjects, respectively, while PU was observed in 7/12 (58%) patients. The full range of HT grades and PU were observed in heterozygous subjects. Thirty-seven patients achieved one of the following: partial remission, minimal response or stable disease upon treatment with bevacizumab in combination with chemotherapy; 3 subjects had progressive disease and 1 was not evaluable.
Conclusions. The presence of the mutant T allele of c.894G>T is not associated with increased severity of HT and PU; therefore, bevacizumab can be administered at no increased risk in TT patients with respect to the wild-type GG population.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P5-17-06.
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Affiliation(s)
- M Del Re
- University Hospital, Pisa, Italy
| | | | | | | | - E Bona
- University Hospital, Pisa, Italy
| | - I Del Re
- University Hospital, Pisa, Italy
| | - I Stasi
- University Hospital, Pisa, Italy
| | | | - F Laurà
- University Hospital, Pisa, Italy
| | | | | | | | - R Danesi
- University Hospital, Pisa, Italy
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Fontana A, Allegrini G, al Zoubi M, Collecchi P, Mazzanti C, Stasi I, Lucchesi S, Bona E, Ferrarini I, Salvadori B, Arrighi G, Marcucci L, Filidei M, Orlandini C, Falcone A, Bevilacqua G, Zavaglia K. Impact of PIK3CA mutations and p95HER2 expression on the outcome of HER2-positive metastatic breast cancer patients treated with a trastuzumab-based therapy. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.629] [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
629 Background: Currently, no biomarkers of trastuzumab (T) clinical resistance have been validated. The aim of this pilot study was to evaluate the impact of PIK3CA mutations and p95HER2 (pHER2 truncated form) expression on the efficacy of a T based-therapy in a HER2-positive metastatic breast cancer (MBC) patients (pts). Methods: 107 HER2-positive MBC pts, treated in the last 10 years, were evaluated. Median age was 54 years (25-79); ECOG performance status was 0 in 56% of pts; all pts received several lines of treatment including T; biomarkers molecular analysis was performed in 70 tumor specimens. The IHC expression of p95HER2 was evaluated by a monoclonal antibody that specifically recognizes only the HER2 external domain; the HER2 integrity was defined by the presence of a homogeneous membrane staining (moderate or intense) in at least 30% of the cells, otherwise the HER2 was defined as p95HER2 positive. PIK3CA mutations in exons 9 and 20 were detected by automated sequencing. The molecular data were correlated to Time to progression (TTP) of the first line treatment including T and the Overall Survival (OS) by using the Kaplan-Meir method and the log-rank-test. Results: p95HER2 positive pts and PIK3CA mutations in exon 9 or 20 were detected in 42% and 22% of tumor specimens, respectively. p95HER2 positive tumors showed a shorter TTP and OS that did not reach statistical significance; PIK3CA mutations correlated with a worse TTP (median 7,6 vs 11,3 months) and OS (median 20,1 vs 41,0 months, p= 0,046). Conclusions: These preliminary results suggest a possible role of PIK3CA mutational status in predicting the outcome of MBC pts treated with T.
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Affiliation(s)
- Andrea Fontana
- Division of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | - Giacomo Allegrini
- U.O. Oncologia Medica, Azienda USL-5, Istituto Toscano Tumori, Pontedera, Italy
| | - Mazhar al Zoubi
- Division of Surgical, Molecular and Ultrastructural Pathology, University of Pisa and Pisa University Hospital, Pisa, Italy
| | - Paola Collecchi
- Division of Surgical, Molecular and Ultrastructural Pathology, University of Pisa and Pisa University Hospital, Pisa, Italy
| | - Chiara Mazzanti
- Division of Surgical, Molecular and Ultrastructural Pathology, University of Pisa and Pisa University Hospital, Pisa, Italy
| | - Irene Stasi
- Division of Medical Oncology, Pisa University Hospital, Pisa, Italy
| | | | - Eleonora Bona
- Division of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | - Ilaria Ferrarini
- Division of Medical Oncology, Pisa University Hospital, Pisa, Italy
| | | | - Giada Arrighi
- Division of Medical Oncology, USL 5 Pontedera, Pontedera, Italy
| | | | - Mario Filidei
- Division of Medical Oncology, USL 5 Pontedera, Pontedera, Italy
| | - Cinzia Orlandini
- Division of Medical Oncology, Pisa University Hospital, Pisa, Italy
| | - Alfredo Falcone
- U.O. Oncologia Medica 2, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | - Generoso Bevilacqua
- Division of Surgical, Molecular and Ultrastructural Pathology, University of Pisa and Pisa University Hospital, Pisa, Italy
| | - Katia Zavaglia
- Division of Surgical, Molecular and Ultrastructural Pathology, University of Pisa and Pisa University Hospital, Pisa, Italy
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15
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Loupakis F, Cremolini C, Fontanini G, Stasi I, Salvatore L, Falcone A. Beyond KRAS: perspectives on new potential markers of intrinsic and acquired resistance to epidermal growth factor receptor inhibitors in metastatic colorectal cancer. Ther Adv Med Oncol 2011; 1:167-81. [PMID: 21789120 DOI: 10.1177/1758834009348984] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The monoclonal antibodies cetuximab and panitumumab, directed against the epidermal growth factor receptor (EGFR), are licensed for the treatment of KRAS wild-type metastatic colorectal cancer (mCRC). Such 'molecular restriction' derived from post-hoc analyses of randomized trials and from other retrospective series all indicate how tumors bearing KRAS (v-Ki-ras2 Kirsten rat sarcoma viral oncogene homolog) mutations are resistant to EGFR inhibition. Even if highly sensitive for nonresponse, KRAS testing is not very specific. In fact, a limited but still considerable proportion of KRAS wild-type patients rapidly progress on treatment with an EGFR inhibitor. New potential molecular determinants of benefit from such treatment are under investigation and may further refine the selection of patients. Pharmacogenomic analyses and translational studies are also ongoing for exploring the field of acquired resistance to anti-EGFRs, since all patients eventually progress. New biological data are awaited for optimizing the use of molecular agents in colorectal cancer and for identifying promising targets that could allow to better understand and, potentially, overcome mechanisms of primary or secondary resistance to EGFR inhibitors.
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Affiliation(s)
- Fotios Loupakis
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana and Department of Oncology, Transplants and New Technologies in Medicine, University of Pisa, Italy
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Masi G, Vasile E, Loupakis F, Cupini S, Fornaro L, Baldi G, Salvatore L, Cremolini C, Stasi I, Brunetti I, Fabbri MA, Puglisi M, Trenta P, Granetto C, Chiara S, Fioretto L, Allegrini G, Crinò L, Andreuccetti M, Falcone A. Randomized trial of two induction chemotherapy regimens in metastatic colorectal cancer: an updated analysis. J Natl Cancer Inst 2010; 103:21-30. [PMID: 21123833 DOI: 10.1093/jnci/djq456] [Citation(s) in RCA: 137] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND In a randomized trial with a median follow-up of 18.4 months, 6 months of induction chemotherapy with a three-drug regimen comprising 5-fluorouracil (by continuous infusion)-leucovorin, irinotecan, and oxaliplatin (FOLFOXIRI) demonstrated statistically significant improvements in response rate, radical surgical resection of metastases, progression-free survival, and overall survival compared with 6 months of induction chemotherapy with fluorouracil-leucovorin and irinotecan (FOLFIRI). METHODS From November 14, 2001, to April 22, 2005, we enrolled 244 patients with metastatic colorectal cancer. To evaluate if the superiority of FOLFOXIRI is maintained in the long term, we updated the overall and progression-free survival data to include events that occurred up to February 12, 2009, with a median follow-up of 60.6 months. We performed a subgroup and a risk-stratified analysis to examine whether outcomes differed in specific patient subgroups, and we analyzed the results of treatment after progression. Survival curves were estimated by the Kaplan-Meier method. Multivariable Cox regression models were fit to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). All statistical tests were two-sided. RESULTS FOLFOXIRI demonstrated statistically significant improvements in median progression-free survival (9.8 vs 6.8 months, HR for progression = 0.59, 95% CI = 0.45 to 0.76, P < .001) and median overall survival (23.4 vs 16.7 months, HR for death = 0.74, 95% CI = 0.56 to 0.96, P = .026) with a 5-year survival rate of 15% (95% CI = 9% to 23%) vs 8% (95% CI = 4% to 14%). The improvements in progression-free survival and, to a lesser extent, in overall survival were evident even when the analysis excluded patients who received radical resection of metastases. With regard to the risk-stratified analysis, FOLFOXIRI results in longer progression-free survival and overall survival than FOLFIRI in all risk subgroups. CONCLUSIONS Six months of induction chemotherapy with FOLFOXIRI is associated with a clinically significant improvement in the long-term outcome compared with FOLFIRI with an absolute benefit in survival at 5 years of 7%.
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Affiliation(s)
- Gianluca Masi
- U.O. Oncologia Medica 2 Universitaria - Polo Oncologico, Azienda Ospedaliero-Universitaria Pisana, Via Roma, 67 - 56126 Pisa, Italy.
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17
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Fornaro L, Baldi GG, Masi G, Allegrini G, Loupakis F, Vasile E, Cupini S, Stasi I, Salvatore L, Cremolini C, Vincenzi B, Santini D, Tonini G, Graziano F, Ruzzo A, Canestrari E, Magnani M, Falcone A. Cetuximab plus irinotecan after irinotecan failure in elderly metastatic colorectal cancer patients: clinical outcome according to KRAS and BRAF mutational status. Crit Rev Oncol Hematol 2010; 78:243-51. [PMID: 20619672 DOI: 10.1016/j.critrevonc.2010.06.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Revised: 05/26/2010] [Accepted: 06/10/2010] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Scarce data are available about safety and efficacy of cetuximab in elderly metastatic colorectal cancer (mCRC) patients. PATIENTS AND METHODS We retrospectively analysed 54 irinotecan-refractory mCRC patients aged≥70 years treated with cetuximab plus irinotecan and evaluated clinical outcome according to KRAS and BRAF mutational status. RESULTS Median age was 73 years (70-82). Main grade 3-4 toxicities were skin rash (15%), diarrhea (19%) and neutropenia (13%). Irinotecan dose reduction was necessary in 39% of patients. Fifty-two (96%) patients were analysed for KRAS and BRAF status. The 29 KRAS wild-type patients achieved better RR (31% vs 4%; p=0.030) and median PFS (4.21 months vs 3.95 months; p=0.034; HR: 0.50, 95% CI: 0.27-0.95) when compared with KRAS mutated ones. RR (41% vs 3%; p=0.001) and mPFS (4.57 months vs 3.78 months, p=0.001; HR: 0.35, 95% CI: 0.19-0.66) were significantly higher among the 22 KRAS and BRAF wild-type patients compared to the 30 KRAS or BRAF mutated ones. CONCLUSION Cetuximab plus irinotecan has a favourable safety profile in elderly mCRC patients, but a reduced dose of irinotecan should be considered. Such a combination can be a useful option for elderly KRAS and BRAF wild-type patients.
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Affiliation(s)
- Lorenzo Fornaro
- U.O. Oncologia Medica 2 Universitaria, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
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Salvatore L, Loupakis F, Fontanini G, Cremolini C, Stasi I, Fabbri A, Ciarlo A, Granetto C, Basolo F, Falcone A. 6060 KRAS and BRAF mutational analyses in a phase II trial of first-line FOLFOXIRI plus bevacizumab (BV) in metastatic colorectal cancer (mCRC) patients (pts). EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71155-3] [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: 10/20/2022] Open
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Masi G, Vasile E, Loupakis F, Fornaro L, Salvatore L, Cupini S, Stasi I, Brunetti I, Andreuccetti M, Falcone A. 6082 Second-line treatments in patients with metastatic colorectal cancer progressed after first-line FOLFOXIRI. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71177-2] [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: 10/20/2022] Open
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20
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Loupakis F, Ruzzo A, Cremolini C, Vincenzi B, Salvatore L, Santini D, Masi G, Stasi I, Canestrari E, Rulli E, Floriani I, Bencardino K, Galluccio N, Catalano V, Tonini G, Magnani M, Fontanini G, Basolo F, Falcone A, Graziano F. KRAS codon 61, 146 and BRAF mutations predict resistance to cetuximab plus irinotecan in KRAS codon 12 and 13 wild-type metastatic colorectal cancer. Br J Cancer 2009; 101:715-21. [PMID: 19603018 PMCID: PMC2736831 DOI: 10.1038/sj.bjc.6605177] [Citation(s) in RCA: 434] [Impact Index Per Article: 28.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background: KRAS codons 12 and 13 mutations predict resistance to anti-EGFR monoclonal antibodies (moAbs) in metastatic colorectal cancer. Also, BRAF V600E mutation has been associated with resistance. Additional KRAS mutations are described in CRC. Methods: We investigated the role of KRAS codons 61 and 146 and BRAF V600E mutations in predicting resistance to cetuximab plus irinotecan in a cohort of KRAS codons 12 and 13 wild-type patients. Results: Among 87 KRAS codons 12 and 13 wild-type patients, KRAS codons 61 and 146 were mutated in 7 and 1 case, respectively. None of mutated patients responded vs 22 of 68 wild type (P=0.096). Eleven patients were not evaluable. KRAS mutations were associated with shorter progression-free survival (PFS, HR: 0.46, P=0.028). None of 13 BRAF-mutated patients responded vs 24 of 74 BRAF wild type (P=0.016). BRAF mutation was associated with a trend towards shorter PFS (HR: 0.59, P=0.073). In the subgroup of BRAF wild-type patients, KRAS codons 61/146 mutations determined a lower response rate (0 vs 37%, P=0.047) and worse PFS (HR: 0.45, P=0.023). Patients bearing KRAS or BRAF mutations had poorer response rate (0 vs 37%, P=0.0005) and PFS (HR: 0.51, P=0.006) compared with KRAS and BRAF wild-type patients. Conclusion: Assessing KRAS codons 61/146 and BRAF V600E mutations might help optimising the selection of the candidate patients to receive anti-EGFR moAbs.
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Affiliation(s)
- F Loupakis
- Unit of Medical Oncology 2, Azienda-Ospedaliero Universitaria Pisana, Istituto Toscano Tumori and Department of Oncology, Transplantes and New Technologies in Medicine, University of Pisa, Via Roma 67 - 56126 Pisa, Italy
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Loupakis F, Cremolini C, Perrone G, Stasi I, Salvatore L, Vincenzi B, Ruzzo A, Ronzoni M, Bencardino K, Falcone A. Amphiregulin (AR) expression in the prediction of benefit from cetuximab plus irinotecan in KRAS wild-type metastatic colorectal cancer (mCRC) patients. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.4021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4021 Background: AR is an endogenous ligand of Epidermal Growth Factor Receptor (EGFR), whose binding is prevented in the presence of cetuximab. Methods: We retrospectively assessed KRAS mutational status and AR expression at immunohistochemistry (IHC) in 86 irinotecan-refractory EGFR-positive mCRC patients treated with cetuximab plus irinotecan. AR-IHC was performed on tissue sections from paraffin-embedded primary tumors. Specimens were defined AR-low or AR-high according to a score (range 0–300) obtained multiplying intensity (0 to 3+) by percentage of stained cells (0–100%). According to the results of a ROC analysis, we identified a cut-off value of 18. The association between AR-IHC and treatment outcome in terms of response rate (RR), PFS, and OS was investigated in the subgroup of KRAS wild-type patients. Results: Eighty-six consecutive patients were included. M/F = 44/42, median age = 67 (41–78), median number of previous lines of chemotherapy = 2 (1–5). Among 51 (59%) KRAS wild-type patients, 12 PRs and 1 CR were observed, for an overall RR of 25% (13/51). AR-IHC was high, low or unconclusive in 27, 22 and 2 cases respectively. AR-low patients reported a significantly worse RR (2/22, 9%) compared with AR-high (10/27, 37%) (p = 0.024) and a trend toward shorter PFS (3.5 vs 5.3 months, HR 0.88 [95%CI: 0.46–1.60], p = 0.628) and OS (8.8 vs 15.1 months, HR 0.60 [95%CI: 0.30–1.10], p = 0.106). Conclusions: These results underline the potential role of endogenous ligands in influencing the activity of anti-EGFR monoclonal antibodies. Absent or low AR expression at IHC may be related to resistance to cetuximab plus irinotecan. Further data regarding the prognostic impact of AR expression are needed. No significant financial relationships to disclose.
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Affiliation(s)
- F. Loupakis
- Department of Oncology Azienda USL 6, Livorno, Italy; Surgical Pathology Campus Biomedico University, Roma, Italy; Medical Oncology Campus Biomedico University, Roma, Italy; Department of Biomolecular Sciences, University of Urbino, Urbino, Italy; Medical Oncology San Raffaele Scientific Institute, Milano, Italy; Department of Oncology, University of Pisa, Pisa, Italy
| | - C. Cremolini
- Department of Oncology Azienda USL 6, Livorno, Italy; Surgical Pathology Campus Biomedico University, Roma, Italy; Medical Oncology Campus Biomedico University, Roma, Italy; Department of Biomolecular Sciences, University of Urbino, Urbino, Italy; Medical Oncology San Raffaele Scientific Institute, Milano, Italy; Department of Oncology, University of Pisa, Pisa, Italy
| | - G. Perrone
- Department of Oncology Azienda USL 6, Livorno, Italy; Surgical Pathology Campus Biomedico University, Roma, Italy; Medical Oncology Campus Biomedico University, Roma, Italy; Department of Biomolecular Sciences, University of Urbino, Urbino, Italy; Medical Oncology San Raffaele Scientific Institute, Milano, Italy; Department of Oncology, University of Pisa, Pisa, Italy
| | - I. Stasi
- Department of Oncology Azienda USL 6, Livorno, Italy; Surgical Pathology Campus Biomedico University, Roma, Italy; Medical Oncology Campus Biomedico University, Roma, Italy; Department of Biomolecular Sciences, University of Urbino, Urbino, Italy; Medical Oncology San Raffaele Scientific Institute, Milano, Italy; Department of Oncology, University of Pisa, Pisa, Italy
| | - L. Salvatore
- Department of Oncology Azienda USL 6, Livorno, Italy; Surgical Pathology Campus Biomedico University, Roma, Italy; Medical Oncology Campus Biomedico University, Roma, Italy; Department of Biomolecular Sciences, University of Urbino, Urbino, Italy; Medical Oncology San Raffaele Scientific Institute, Milano, Italy; Department of Oncology, University of Pisa, Pisa, Italy
| | - B. Vincenzi
- Department of Oncology Azienda USL 6, Livorno, Italy; Surgical Pathology Campus Biomedico University, Roma, Italy; Medical Oncology Campus Biomedico University, Roma, Italy; Department of Biomolecular Sciences, University of Urbino, Urbino, Italy; Medical Oncology San Raffaele Scientific Institute, Milano, Italy; Department of Oncology, University of Pisa, Pisa, Italy
| | - A. Ruzzo
- Department of Oncology Azienda USL 6, Livorno, Italy; Surgical Pathology Campus Biomedico University, Roma, Italy; Medical Oncology Campus Biomedico University, Roma, Italy; Department of Biomolecular Sciences, University of Urbino, Urbino, Italy; Medical Oncology San Raffaele Scientific Institute, Milano, Italy; Department of Oncology, University of Pisa, Pisa, Italy
| | - M. Ronzoni
- Department of Oncology Azienda USL 6, Livorno, Italy; Surgical Pathology Campus Biomedico University, Roma, Italy; Medical Oncology Campus Biomedico University, Roma, Italy; Department of Biomolecular Sciences, University of Urbino, Urbino, Italy; Medical Oncology San Raffaele Scientific Institute, Milano, Italy; Department of Oncology, University of Pisa, Pisa, Italy
| | - K. Bencardino
- Department of Oncology Azienda USL 6, Livorno, Italy; Surgical Pathology Campus Biomedico University, Roma, Italy; Medical Oncology Campus Biomedico University, Roma, Italy; Department of Biomolecular Sciences, University of Urbino, Urbino, Italy; Medical Oncology San Raffaele Scientific Institute, Milano, Italy; Department of Oncology, University of Pisa, Pisa, Italy
| | - A. Falcone
- Department of Oncology Azienda USL 6, Livorno, Italy; Surgical Pathology Campus Biomedico University, Roma, Italy; Medical Oncology Campus Biomedico University, Roma, Italy; Department of Biomolecular Sciences, University of Urbino, Urbino, Italy; Medical Oncology San Raffaele Scientific Institute, Milano, Italy; Department of Oncology, University of Pisa, Pisa, Italy
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Loupakis F, Pollina L, Stasi I, Ruzzo A, Scartozzi M, Santini D, Masi G, Graziano F, Cremolini C, Rulli E, Canestrari E, Funel N, Schiavon G, Petrini I, Magnani M, Tonini G, Campani D, Floriani I, Cascinu S, Falcone A. PTEN expression and KRAS mutations on primary tumors and metastases in the prediction of benefit from cetuximab plus irinotecan for patients with metastatic colorectal cancer. J Clin Oncol 2009; 27:2622-9. [PMID: 19398573 DOI: 10.1200/jco.2008.20.2796] [Citation(s) in RCA: 348] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE PTEN, AKT, and KRAS are epidermal growth factor receptor (EGFR) downstream regulators. KRAS mutations confer resistance to cetuximab. This retrospective study investigated the role of PTEN loss, AKT phosphorylation, and KRAS mutations on the activity of cetuximab plus irinotecan in patients with metastatic colorectal cancer (mCRC). PATIENTS AND METHODS A cohort of patients with irinotecan-refractory mCRC who were treated with cetuximab plus irinotecan was tested for PTEN immunoreactivity (ie, immunohistochemistry; IHC), pAKT IHC, and KRAS mutations. Analyses were performed both on primary tumors and on related metastases, and the association among IHC, mutational results, and treatment outcomes was investigated. RESULTS One-hundred two patients were eligible. Ninety-six primary tumors, 59 metastases, and 53 paired samples were available. Forty-nine primary tumors (58% of assessable samples) had a preserved PTEN expression (PTEN-positive), whereas 35 (40% of assessable samples) were pAKT-positive. Levels of concordance between primary tumors and metastases were 60%, 68%, and 95% for PTEN, pAKT, and KRAS, respectively. PTEN status on primary tumors and pAKT status both on primary tumors and on metastases did not predict response or progression-free survival (PFS). On metastases, 12 (36%) of 33 patients with PTEN-positive tumors were responders compared with one (5%) of 22 who had PTEN-negative tumors (P = .007). The median PFS of patients with PTEN-positive metastases was 4.7 months compared with 3.3 months for those with PTEN-negative metastases (hazard ratio [HR], 0.49; P = .005). Patients with PTEN-positive metastases and KRAS wild type had longer PFS compared with other patients (5.5 months v 3.8 months; HR, 0.42; P = .001). CONCLUSION PTEN loss in metastases may be predictive of resistance to cetuximab plus irinotecan. The combination of PTEN IHC and KRAS mutational analyses could help to identify a subgroup of patients with mCRC who have higher chances of benefiting from EGFR inhibition.
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Affiliation(s)
- Fotios Loupakis
- Department of Oncology, Azienda USL 6, Istituto Toscano Tumori, Livorno, Italy.
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Stasi I, Loupakis F, Pollina L, Masi G, Funel N, Scartozzi M, Petrini I, Santini D, Cascinu S, Falcone A. Loss of PTEN expression in colorectal cancer (CRC) metastases (mets) but not in primary tumors predicts lack of activity of cetuximab plus irinotecan treatment. EJC Suppl 2008. [DOI: 10.1016/s1359-6349(08)71596-9] [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: 12/01/2022] Open
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Loupakis F, Pollina L, Stasi I, Masi G, Funel N, Scartozzi M, Petrini I, Santini D, Cascinu S, Falcone A. Evaluation of PTEN expression in colorectal cancer (CRC) metastases (mets) and in primary tumors as predictors of activity of cetuximab plus irinotecan treatment. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.4003] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [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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Vasile E, Giovannetti E, Tibaldi C, Mey V, Nannizzi S, Landi L, Stasi I, Danesi R, Del Tacca M, Falcone A. Analysis of single nucleotide polymorphisms (SNPs) of cytidine deaminase (CDA) and xeroderma pigmentosum group D (XPD) genes for the prediction of clinical response to gemcitabine and cisplatin in advanced non-small cell lung cancer (NSCLC) patients. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.7219] [Citation(s) in RCA: 3] [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: 11/20/2022] Open
Abstract
7219 Background: Detection of genomic differences predictive of drug response may allow to customize chemotherapy to the characteristics of individual patients. Gemcitabine alone or in combination with cisplatin are two of the most common regimens used in the treatment of advanced NSCLC. We investigated the correlation between selected SNPs of genes encoding enzymes involved in the activity of gemcitabine and cisplatin, including CDA, XPD and ERCC1, and the response to chemotherapy. Methods: Forty advanced NSCLC chemo-naïve patients were enrolled into the study; 16 patients, aged > 70 years, were treated with gemcitabine; 24 patients, aged < 70 years, were treated with cisplatin plus gemcitabine. SNPs CDA A79C, XPD A751C, XPD G312A and ERCC1 C118T were analyzed with the ABI PRISM 7900HT Sequence Detection System using TaqMan probe-based assay in DNA obtained from peripheral blood samples. Statistical analysis was performed using Pearson χ2 test, Kaplan-Meier curve and log rank test. Results: Up to now 31 patients, 11 treated with gemcitabine and 20 with cisplatin plus gemcitabine, are evaluable for response with RECIST criteria; correlation between response and genotype are showed in the table. Actuarial progression free survival (PFS) was longer in patients treated with gemcitabine ± cisplatin with CDA A79A genotype than in others (respectively 11.0 vs 2.5 months, p = 0.0092), while no correlation was found between the SNPs of XPD and ERCC1 and PFS in patients receiving cisplatin and gemcitabine. Conclusions: CDA A79A genotype resulted predictive of response and longer PFS in NSCLC patients treated with gemcitabine ± cisplatin. There was also a trend toward significant correlation between XPD A751A and better response in cisplatin-treated patients, while the SNPs in XPD 312 and ERCC1 118 were not associated with response to chemotherapy. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- E. Vasile
- Civil Hospital, Livorno, Italy; Division of Pharmacology and Chemotherapy, Pisa, Italy; University of Pisa, Pisa, Italy
| | - E. Giovannetti
- Civil Hospital, Livorno, Italy; Division of Pharmacology and Chemotherapy, Pisa, Italy; University of Pisa, Pisa, Italy
| | - C. Tibaldi
- Civil Hospital, Livorno, Italy; Division of Pharmacology and Chemotherapy, Pisa, Italy; University of Pisa, Pisa, Italy
| | - V. Mey
- Civil Hospital, Livorno, Italy; Division of Pharmacology and Chemotherapy, Pisa, Italy; University of Pisa, Pisa, Italy
| | - S. Nannizzi
- Civil Hospital, Livorno, Italy; Division of Pharmacology and Chemotherapy, Pisa, Italy; University of Pisa, Pisa, Italy
| | - L. Landi
- Civil Hospital, Livorno, Italy; Division of Pharmacology and Chemotherapy, Pisa, Italy; University of Pisa, Pisa, Italy
| | - I. Stasi
- Civil Hospital, Livorno, Italy; Division of Pharmacology and Chemotherapy, Pisa, Italy; University of Pisa, Pisa, Italy
| | - R. Danesi
- Civil Hospital, Livorno, Italy; Division of Pharmacology and Chemotherapy, Pisa, Italy; University of Pisa, Pisa, Italy
| | - M. Del Tacca
- Civil Hospital, Livorno, Italy; Division of Pharmacology and Chemotherapy, Pisa, Italy; University of Pisa, Pisa, Italy
| | - A. Falcone
- Civil Hospital, Livorno, Italy; Division of Pharmacology and Chemotherapy, Pisa, Italy; University of Pisa, Pisa, Italy
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