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Martorana F, Sanò MV, Valerio MR, Fogli S, Vigneri P, Danesi R, Gebbia V. Abemaciclib pharmacology and interactions in the treatment of HR+/HER2- breast cancer: a critical review. Ther Adv Drug Saf 2024; 15:20420986231224214. [PMID: 38665218 PMCID: PMC11044790 DOI: 10.1177/20420986231224214] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 12/17/2023] [Indexed: 04/28/2024] Open
Abstract
Abemaciclib (ABE) in combination with endocrine therapy represents the mainstay treatment for either endocrine-resistant metastatic or high-risk early-stage HR+/HER2- breast cancer patients. Hence, an adequate knowledge of this agent pharmacodynamic, pharmacokinetic, and of its drug-drug interactions (DDIs) is crucial for an optimal patients management. Additionally, ABE interference with food and complementary/alternative medicines should be taken into account in the clinical practice. Several online tools allow to freely check DDIs and can be easily consulted before prescribing ABE. According to one of this instruments, ABE display the lowest number of interactions among the available cyclin-dependent kinase 4/6 inhibitors. Still, clinicians should be aware that online tools cannot replace the technical datasheet of the drug as well as a comprehensive clinical assessment for each patient. Here we critically review the main pharmacological features of ABE, then focusing on its potential interactions with drugs, food, and alternative medicine, in order to provide a guide for its optimal use in the treatment of HR+/HER2- breast cancer patients.
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Affiliation(s)
- Federica Martorana
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Maria Vita Sanò
- Medical Oncology Unit, Istituto Clinico Humanitas, Misterbianco, Catania, Italy
| | - Maria Rosaria Valerio
- Medical Oncology Unit, Policlinico P. Giaccone, University of Palermo, Palermo, Italy
| | - Stefano Fogli
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Paolo Vigneri
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Medical Oncology Unit, Istituto Clinico Humanitas, Misterbianco, Catania, Italy
| | - Romano Danesi
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Vittorio Gebbia
- Faculty of Medicine and Surgery, Kore University of Enna, Piazza dell’Università, Enna 94100, Italy
- Casa di Cura Torina, Palermo, Italy
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Martorana F, Scandurra G, Valerio MR, Cufari S, Vigneri P, Sanò MV, Scibilia G, Scollo P, Gebbia V. A review and metanalysis of metronomic oral single-agent cyclophosphamide for treating advanced ovarian carcinoma in the era of precision medicine. J Oncol Pharm Pract 2024; 30:173-181. [PMID: 38018146 DOI: 10.1177/10781552231216689] [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] [Indexed: 11/30/2023]
Abstract
OBJECTIVE Oral metronomic cyclophosphamide has been used as a single agent or in combination with other drugs for several solid tumors with interesting results in disease palliation and mild to moderate toxicity, notably in patients with recurrent epithelial ovarian cancer (EOC) progressing after systemic chemotherapy. In this paper, we report a review and a metanalysis of heterogeneous data published up to date. DATA SOURCES The literature search was restricted to single-agent MOC. The analysis was conducted through March 2023 by consulting PubMed, Embase, Google Scholar, and The Cochrane Library databases. Research string and Medical Subject Headings included "ovarian tumor," "ovarian carcinoma," or "ovarian cancer," "fallopian tube cancer," "primary peritoneal cancer," "oral chemotherapy," and "metronomic cyclophosphamide." All articles were assessed for quality by at least two investigators independently, and a < 18 patients sample size cutoff was chosen as a lower limit with a Cohen's kappa statistical coefficient for accuracy and reliability. Metanalysis of selected papers was carried out according to a fixed model. DATA SUMMARY The percentage of agreement between investigators on literature study selection was very high, reaching 96.9% with a Cohen's k of 0.929. MOC pooled objective response rate (ORR) and disease control rate for recurrent or platinum-refractory ovarian cancer were 18.8% (range 4-44%) and 36.2% (range 16-58.8%), respectively. The mean progressive-free survival and overall survival were 3.16 months (range 1.9 to 5.0 months) and 8.7 months (range 8 to 13 months), respectively. The fixed model metanalysis of selected studies showed a 16% median ORR (12-20% CI, p < 0.001). CONCLUSIONS Single-agent oral cyclophosphamide in EOC holds promise as a treatment option, even in the era of precision medicine. Genetic factors, such as DNA repair gene polymorphisms, may influence treatment response. Combining cyclophosphamide with biological agents such as PARP inhibitors or immunotherapy agents is an area of active investigation.
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Affiliation(s)
- Federica Martorana
- Medical Oncology Unit, Humanitas istituto Clinico Catanese, Catania, Italy
- Department of Clinical and Experimental Medicine, Center of Experimental Oncology and Hematology, University of Catania, Catania, Italy
| | | | | | | | - Paolo Vigneri
- Medical Oncology Unit, Humanitas istituto Clinico Catanese, Catania, Italy
- Department of Clinical and Experimental Medicine, Center of Experimental Oncology and Hematology, University of Catania, Catania, Italy
| | - Maria Vita Sanò
- Medical Oncology Unit, Humanitas istituto Clinico Catanese, Catania, Italy
| | | | - Paolo Scollo
- Gynecological Oncology Unit, Ospedale Cannizzaro, Catania, Italy
- Faculty of Medicine, Chair of Gynecology Kore University, Enna, Italy
| | - Vittorio Gebbia
- Chair of Medical Oncology, Faculty of Medicine, University of Enna Kore, Enna, Italy
- Medical Oncology Unit, CdC Torina, Palermo, Italy
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Gebbia V, Martorana F, Scandurra G, Valerio MR, Cufari S, Vigneri P, Sanò MV, Scollo P. A retrospective, real-life analysis of metronomic oral single-agent cyclophosphamide for the treatment of platinum-pretreated advanced ovarian carcinoma in Italy. J Oncol Pharm Pract 2023:10781552231189867. [PMID: 37501558 DOI: 10.1177/10781552231189867] [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: 07/29/2023]
Abstract
INTRODUCTION Metronomic oral cyclophosphamide (MOC) presents many potential advantages, such as significantly less severe side effects than standard regimens, ease of administration, and the delivery of a dose-dense but not necessarily dose-intense treatment. These observations prompted us to evaluate in a retrospective, multicenter study the efficacy and toxicity of MOC in a real-life series of pretreated cancer patients. METHODS The study is a multicenter, retrospective analysis of the activity of single-agent MOC in patients with recurrent or residual epithelial ovarian, fallopian tube, or primary. Eligible patients were continuously treated with MOC at 50 mg/day until progression, toxicity, or death. Overall response rate (ORR), stable disease (SD), and disease control rate (DCR) were reported. RESULTS The study included 62 patients. Three patients reached a complete response rate (5%), 11 had a partial response rate (18), and 15 had stabilization of disease (24) for an ORR of 23% and a DCR of 47%. Patients with low-grade indolent tumors showed an ORR and an SD rate higher than that observed in non-indolent ones (33% vs. 18% and 28% vs. 14%, respectively). Overall, progression-free survival was 3.5 months (range 1-9 months). CONCLUSION Single-agent MOC is active and very well tolerated in a significant fraction of patients with refractory, recurrent, or residual epithelial ovarian, fallopian tube, or primary peritoneal cancer. In the vision of a practical approach, single-agent MOC may be a useful palliative treatment option for patients with poor tolerance to high-dose regimens or widely pretreated. Further studies are needed better to characterize the role of such an approach in clinical practice.
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Affiliation(s)
- Vittorio Gebbia
- Casa di Cura Torina, Palermo, Italy
- Faculty of Medicine and Surgery, Kore University, Enna, Italy
| | - Federica Martorana
- Medical Oncology Unit, Humanitas Istituto Clinico Catanese, Catania, Italy
- Department of Clinical and Experimental Medicine, Center of Experimental Oncology and Hematology, University of Catania, Catania, Italy
| | | | | | | | - Paolo Vigneri
- Medical Oncology Unit, Humanitas Istituto Clinico Catanese, Catania, Italy
- Department of Clinical and Experimental Medicine, Center of Experimental Oncology and Hematology, University of Catania, Catania, Italy
| | - Maria Vita Sanò
- Medical Oncology Unit, Humanitas Istituto Clinico Catanese, Catania, Italy
| | - Paolo Scollo
- Faculty of Medicine and Surgery, Kore University, Enna, Italy
- Gynecological Oncology Unit, Ospedale Cannizzaro, Catania, Italy
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Gebbia V, Valerio MR, Martorana F, Sanò MV, Vigneri P. Letter to the Editor: statistics and clinical perception of patients' reported outcomes for palbociclib and abemaciclib: a sliding doors story. J Comp Eff Res 2023; 12:e220212. [PMID: 37114420 PMCID: PMC10402907 DOI: 10.57264/cer-2022-0212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Affiliation(s)
- Vittorio Gebbia
- Kore University of Enna, Enna, 94100, Italy
- Medical Oncology Units, La Maddalena Clinic for Cancer, Palermo, 90100, Italy
| | - Maria Rosaria Valerio
- Medical Oncology Unit, Policlinico P. Giaccone, University of Palermo, Palermo, 90100, Italy
| | - Federica Martorana
- Medical Oncology Unit, Istituto Clinico Humanitas, Catania, 95100Italy
- Department of Clinical & Experimental Medicine, University of Catania, Catania - Italy, & Center of Experimental Oncology & Hematology AOU, Policlinico ‘G. Rodolico – San Marco’, Catania, 95100, Italy
| | - Maria Vita Sanò
- Medical Oncology Unit, Istituto Clinico Humanitas, Catania, 95100Italy
| | - Paolo Vigneri
- Department of Clinical & Experimental Medicine, University of Catania, Catania - Italy, & Center of Experimental Oncology & Hematology AOU, Policlinico ‘G. Rodolico – San Marco’, Catania, 95100, Italy
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Gebbia V, Martorana F, Sanò MV, Valerio MR, Giotta F, Spada M, Piazza D, Caruso M, Vigneri P. Abemaciclib-associated Diarrhea: An Exploratory Analysis of Real-life Data. Anticancer Res 2023; 43:1291-1299. [PMID: 36854501 DOI: 10.21873/anticanres.16276] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND/AIM Abemaciclib is a cyclin-dependent kinase 4/6 inhibitor approved in combination with endocrine therapy for treating hormone receptor-positive and human epidermal growth factor receptor 2-negative early and advanced breast cancer patients. The safety profile of abemaciclib is characterized by frequent gastrointestinal toxicity, especially diarrhea. Therefore, we performed an exploratory analysis of clinical factors that may be potentially associated with diarrhea in patients treated with abemaciclib plus endocrine therapy. PATIENTS AND METHODS Factors potentially predisposing to diarrhea were selected, such as age ≥70 years, concomitant medications and diseases, diet, and use of laxatives. These variables were correlated with the onset of grade 2/3 diarrhea in a cohort of patients treated with abemaciclib from advanced breast cancer. Univariate and multivariate analysis was performed. Sensitivity and specificity were tested using the ROC curve. RESULTS Eighty women with advanced breast cancer were included in the study. The univariate analysis found a statistically significant correlation between grade 2/3 diarrhea and age ≥70 years, polypharmacy, and concomitant gastrointestinal diseases (p<0.05). In the multivariate analysis, the number of risk factors significantly correlated with the outcome of interest (p<0.0001). ROC analysis showed our model's 82% sensitivity and 75% specificity. CONCLUSION Taking into account specific pre-existing factors, it is possible to estimate the risk of diarrhea in hormone receptor-positive and human epidermal growth factor receptor 2-negative - advanced breast cancer patients, candidates for abemaciclib plus endocrine therapy. In these subjects, implementing proactive prevention and adopting a dose-escalation strategy may represent practical approaches to decrease the abemaciclib toxicity burden.
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Affiliation(s)
- Vittorio Gebbia
- Medical Oncology Unit, La Maddalena Clinic for Cancer, and Oncology Section, Department "Promise" of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy;
| | - Federica Martorana
- Department of Clinical and Experimental Medicine, University of Catania, and Center of Experimental Oncology and Hematology AOU, Policlinico "G. Rodolico - San Marco", Catania, Italy
| | - Maria Vita Sanò
- Medical Oncology Unit, Istituto Clinico Humanitas, Catania, Italy
| | - Maria Rosaria Valerio
- Medical Oncology Unit, Policlinico "P. Giaccone", University of Palermo, Palermo, Italy
| | - Francesco Giotta
- Medical Oncology Unit, Istituto Tumori "Giovanni Paolo II", IRCSS, Bari, Italy
| | - Massimiliano Spada
- Medical Oncology Unit, Fondazione Giglio, Ospedale di Cefalù, Palermo, Italy
| | - Dario Piazza
- Medical Oncology Unit, La Maddalena Clinic for Cancer, and Oncology Section, Department "Promise" of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Michele Caruso
- Medical Oncology Unit, Istituto Clinico Humanitas, Catania, Italy
| | - Paolo Vigneri
- Department of Clinical and Experimental Medicine, University of Catania, and Center of Experimental Oncology and Hematology AOU, Policlinico "G. Rodolico - San Marco", Catania, Italy
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Sanò MV, Castellana L, Caffarelli S, Fallica G, Chiarenza M, Ali M, Dimarco R, Vita Maria Grazia DL, Picone A, Aiello RA, Caponnetto D, Casella T, Caruso M. New potential therapeutic-sequence strategies of TDM1 in the revolutionary era of metastatic HER2-positive breast cancer treatment: A monocentric retrospective experience. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e13014] [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
e13014 Background: EMILIA study showed benefits in terms of both progression free survival (PFS) and overall survival (OS) administering Ado-trastuzumab emtansine (T-DM1) vs lapatinib-capecitabine in HER2+ mBC patients (pts) treated at least with a previous trastuzumab-taxane-based therapy. However a paucity of data is available on TDM1 efficacy after dual anti HER2 blockade with pertuzumab and trastuzumab (PT). Instead TH3RESA trial revealed the positive impact on OS of T-DM1 also in heavily pre-treated (at least 2 lines of T, lapatinib and taxanes regimens) pts. We conducted a retrospective analysis reporting innovative findings on the sequence of anti-HER2 treatments and how it could be potentially optimized. Methods: Between June 15, 2014 and January 31, 2020 we identified HER2+ (IHC: 3+ or 2+/FISH amplified) mBC pts treated with T-DM1, either as second-line after progression on dual blockade PT (Cohort PT) or after ≤ 3 anti her2-combined regimens (trastuzumab o lapatinib plus chemotherapy) (Cohort T). 74 pts received T-DM1: Cohort T n = 34 (all females, median age = 52,7), Cohort PT n = 40 (39 females, 1 male, median age = 52,2). Within Cohort T: 64,7 % of pts (n = 22) received T-DM1 after 1 previous anti her2-combined regimen, 20,6 % (n = 7) and 14,7 % (n = 5) in third and fourth lines, respectively. Instead, the whole Cohort PT received second line T-DM1 after pertuzumab/trastuzumab. Results: Median progression- free survival was 10,2 in Cohort T and 3,7 months in Cohort PT. As regards the best response rate, 8,8 % (n = 3/34) and 52,5 % (n = 21/40) of pts reported a progressive disease (PD) into the Cohorts T and PT, respectively: stable disease (SD) 38,2 % (n = 13/34) versus 15 % (n = 6/40); partial response (PR) 23,5 % (n = 8/34) vs 15 % (n = 6/40); complete response (CR) 23,5 % (n = 8/34) vs 12,5 % (n = 5/40). Almost 2/3 (n = 21/34) of Cohort T and half (n = 20/40) of Cohort PT pts had a 3+ IHC status. Conclusions: Our data suggest a lower efficacy of T-DM1 after progression on dual HER2-blockade PT. After all, EMILIA trial did not robustly evaluate the role of T-DM1 in this specific subset of pts. Obviously, larger prospective studies are necessary in order to optimize the best sequence strategy in the treatment of metastatic HER2+ BC, in light of the increasingly innovative anti-HER2 agents.
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Affiliation(s)
| | - Luisa Castellana
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of study, Palermo, Italy
| | | | | | | | - Marco Ali
- Humanitas Centro Catanese di Oncologia, Catania, Italy
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Adamo B, Ricciardi GRR, Ieni A, Franchina T, Fazzari C, Sanò MV, Angelico G, Caruso M, Tuccari G, Adamo V. Correction: The prognostic significance of combined androgen receptor, E-Cadherin, Ki67 and CK5/6 expression in patients with triple negative breast cancer. Oncotarget 2019; 10:917. [PMID: 30783520 PMCID: PMC6368234 DOI: 10.18632/oncotarget.26650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Barbara Adamo
- Department of Medical Oncology, Hospital Clínic of Barcelona, Barcelona, Spain
| | | | - Antonio Ieni
- Department of Human Pathology of Adult and Evolutive Age "Gaetano Barresi", Section of Pathology, University of Messina, AOU Policlinico "G. Martino" Messina, Italy
| | - Tindara Franchina
- Medical Oncology Unit A.O. Papardo & Department of Human Pathology University of Messina, Messina, Italy
| | - Carmine Fazzari
- Pathology Unit, Humanitas Center of Oncology, Catania, Italy
| | - Maria Vita Sanò
- Medical Oncology, Humanitas Catania Oncology Center, Catania, Italy
| | - Giuseppe Angelico
- G. F. Ingrassia Department, Section of Anatomic Pathology, University Hospital "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Michele Caruso
- Medical Oncology, Humanitas Catania Oncology Center, Catania, Italy
| | - Giovanni Tuccari
- Department of Human Pathology of Adult and Evolutive Age "Gaetano Barresi", Section of Pathology, University of Messina, AOU Policlinico "G. Martino" Messina, Italy
| | - Vincenzo Adamo
- Medical Oncology Unit A.O. Papardo & Department of Human Pathology University of Messina, Messina, Italy
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Collovà E, Ferzi A, Scandurra G, Aurilio G, Torri V, Porcu L, Sanò MV, Taibi E, Foglietta J, Generali D, Andreis D, Dazzani MC, Bramati A, Marcon I, Atzori F, Cinieri S, Tondulli L, Grasso D, Nolè F, Petrella MC, Gori S, La Verde N. Efficacy of Trastuzumab in Unselected Patients with HER2-Positive Metastatic Breast Cancer: A Retrospective Analysis. Tumori Journal 2018. [DOI: 10.1177/1636.17902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Elena Collovà
- Ospedale Civile di Legnano, Department of Oncology, Legnano, Milan
| | - Antonella Ferzi
- Ospedale Civile di Legnano, Department of Oncology, Legnano, Milan
| | | | - Gaetano Aurilio
- European Institute of Oncology, Department of Oncology, Milan
| | - Valter Torri
- “Mario Negri” Institute, Laboratory of Methodology for Biomedical Research, Milan
| | - Luca Porcu
- “Mario Negri” Institute, Laboratory of Methodology for Biomedical Research, Milan
| | - Maria Vita Sanò
- Humanitas Centro Catanese di Oncologia, Department of Oncology, Catania
| | - Eleonora Taibi
- Humanitas Centro Catanese di Oncologia, Department of Oncology, Catania
| | - Jennifer Foglietta
- Azienda Ospedaliera Perugia, Department of Oncology, S. Andrea delle Fratte, Perugia
| | - Daniele Generali
- Istituti Ospitalieri di Cremona, Department of Mammarian Pathology, Cremona
| | - Daniele Andreis
- Istituti Ospitalieri di Cremona, Department of Mammarian Pathology, Cremona
| | | | - Annalisa Bramati
- Azienda Ospedaliera Fatebenefratelli e Oftalmico, Department of Oncology, Milan
| | - Ilaria Marcon
- Azienda Ospedaliera di Circolo e Fondazione Macchi, Department of Oncology, Varese
| | - Francesco Atzori
- University Hospital, Department of Oncology, bivio Sestu, Monserrato, Cagliari
| | - Saverio Cinieri
- Ospedale “A Perrino”, Department of Medical Oncology, Division & Breast Unit, Brindisi
| | | | - Donatella Grasso
- IRCC Policlinico San Matteo, Department of Hematology and Oncology, Pavia
| | - Franco Nolè
- European Institute of Oncology, Department of Oncology, Milan
| | | | - Stefania Gori
- Ospedale Sacro Cuore Don Calabria, Department of Oncology, Negrar (VR), Italy
| | - Nicla La Verde
- Azienda Ospedaliera Fatebenefratelli e Oftalmico, Department of Oncology, Milan
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Adamo B, Ricciardi GRR, Ieni A, Franchina T, Fazzari C, Sanò MV, Angelico G, Michele C, Tuccari G, Adamo V. The prognostic significance of combined androgen receptor, E-Cadherin, Ki67 and CK5/6 expression in patients with triple negative breast cancer. Oncotarget 2017; 8:76974-76986. [PMID: 29100362 PMCID: PMC5652756 DOI: 10.18632/oncotarget.20293] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 06/27/2017] [Indexed: 12/29/2022] Open
Abstract
Background Triple Negative Breast Cancer (TNBC) represents a heterogeneous group of tumors with poor prognosis owing to aggressive tumor biology and lack of targeted therapies. No clear prognostic biomarkers have been identified to date for this subgroup. Materials and Methods In this retrospective study we evaluated the prognostic role of 4 different molecular determinants, including androgen receptor (AR), E-cadherin (CDH1), Ki67 index, and basal cytokeratins (CKs) 5/6, in a cohort of 99 patients with TNBC. All patients received neo/adjuvant chemotherapy (mostly anthracycline/taxane-based). Immunohistochemistry (IHC) was performed in formalin-fixed paraffin-embedded primary tumor samples. CDH1 expression was considered positive as ≥ 30% of the membrane cells staining. AR positivity was defined as > 10% of positive tumor cells. High Ki67 was defined as ≥20% positive tumor cells. CK5/6 expression was judged positive if the score was ≥1. Results The absence of AR expression was significantly associated with highly undifferentiated tumors. Univariate analyses showed that lack of expression of CDH1, tumor size and nodal status were significantly correlated with worse RFS and OS (p< 0.05). AR expression and low Ki67 showed a trend towards better RFS and OS. Patients with absent CK5/6 expression in univariate and multivariate analyses had poorer RFS (p=0.02 and p=0.002, respectively) and OS (p=0.05 and p=0.02, respectively). Multivariate analysis showed an independent association between CDH1 expression and better RFS and OS (p< 0.05) beyond tumor size, nodal status, and grade. The Kaplan-Meier curves showed that patients with AR and CDH1 negative expression and high Ki-67 levels have a significant correlation with poor outcome. Conclusions Our study supports the use of IHC expression of AR, CDH1, Ki67, and CK5/6 as prognostic markers in TNBCs and suggests a link between their expression and prognosis and may help to stratify TNBC patients in different prognostic classes.
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Affiliation(s)
- Barbara Adamo
- Department of Medical Oncology, Hospital Clínic of Barcelona, Barcelona, Spain
| | | | - Antonio Ieni
- Department of Human Pathology of Adult and Evolutive Age "Gaetano Barresi", Section of Pathology, University of Messina, AOU Policlinico "G. Martino" Messina, Italy
| | - Tindara Franchina
- Medical Oncology Unit A.O. Papardo & Department of Human Pathology University of Messina, Messina, Italy
| | - Carmine Fazzari
- Pathology Unit, Humanitas Center of Oncology, Catania, Italy
| | - Maria Vita Sanò
- Medical Oncology, Humanitas Catania Oncology Center, Catania, Italy
| | - Giuseppe Angelico
- G. F. Ingrassia Department, Section of Anatomic Pathology, University Hospital "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Caruso Michele
- Medical Oncology, Humanitas Catania Oncology Center, Catania, Italy
| | - Giovanni Tuccari
- Department of Human Pathology of Adult and Evolutive Age "Gaetano Barresi", Section of Pathology, University of Messina, AOU Policlinico "G. Martino" Messina, Italy
| | - Vincenzo Adamo
- Medical Oncology Unit A.O. Papardo & Department of Human Pathology University of Messina, Messina, Italy
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Picone A, Marcianó A, Dimarco R, Miano E, Zacchia A, Sanò MV, La Fauci A, Chiarenza M, Ali M, Di Leo MG, Aiello RA, Taibi E, Fallica G, Caruso M. Salivary miRNA-210 involvement in medication-related osteonecrosis of the jaws. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e23052] [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
e23052 Background: Improved survival rates from cancer have increased the need to understand the health related problems of cancer treatment. Persistent oral health related problems significantly affect patient's quality of life. Medication-related osteonecrosis of the jaws (MR-ONJ) is an oral complication of antiresorptive medications, denosumab and other medications that target angiogenesis for the management of metastatic bone cancer. The purpose of this pilot study, is to investigate, for the first time, microRNAs expression in MR-ONJ. Recent studies reported the miRNA-210 (a specific angiogenic-related miRNA) demethylation in the Osteonecrosis of the Femoral Head. We hypothesized that MiRNA-210 could also be involved in MR-ONJ development. Primary objective of the study is to investigate the role of miRNA-210 in MR-ONJ pathogenesis. Secondary objective is to investigate the feasibility of salivary miRNAs detection as potential non invasive biomarkers for MR-ONJ. Methods: A case-and-control study has been designed. Inclusion criteria are malignant tumors with ongoing treatment or previous history of anti-resorptive or anti-angiogenic medications. The predictor variable is the presence or absence of MR-ONJ. Oral examination and dental x-ray examinations suggestive of MR-ONJ will be performed. Saliva sample will be collected according to the protocol by Navazesh. The methylation status of miRNA-210 will be investigated using quantitative PCR (Q-PCR). Values will be compared between case and control group. Results: The main expected results are to enroll approximatively twenty patients in case group and sixty patients in control group within a one year recruitment period, validate that saliva is a medium for the identification of biomarkers associated with MR-ONJ and confirm the hypothesis that miRNA-210 is involved in MR-ONJ development. Conclusions: Results acquired within this project would represent a contribute to the understanding of the molecular mechanisms driving to the development of MR-ONJ lesions. MiRNA-210 demethylation could serve as a potential therapeutic target for the treatment of MR-ONJ through stimulation of angiogenesis.
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Affiliation(s)
| | | | | | | | | | - Maria Vita Sanò
- Medical Oncology Department, Humanitas Centro Catanese di Oncologia, Catania, Italy
| | | | | | - Marco Ali
- Humanitas Centro Catanese di Oncologia, Catania, Italy
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Collovà E, Ferzi A, Scandurra G, Aurilio G, Torri V, Porcu L, Sanò MV, Taibi E, Foglietta J, Generali D, Andreis D, Dazzani MC, Bramati A, Marcon I, Atzori F, Cinieri S, Tondulli L, Grasso D, Nolè F, Petrella MC, Gori S, La Verde N. Efficacy of trastuzumab in unselected patients with HER2-positive metastatic breast cancer: a retrospective analysis. Tumori 2014; 100:426-31. [PMID: 25296592 DOI: 10.1700/1636.17902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS AND BACKGROUND The addition of trastuzumab to chemotherapy for HER2-positive metastatic breast cancer has significantly improved progression-free survival and overall survival, although most patients develop resistance or have a primarily resistant disease. The aim of the study was to describe the efficacy and safety of a first-line treatment in unselected metastatic HER2-positive breast cancer patients, treated according to clinical practice. METHODS From 2000 to 2009, we conducted a retrospective multi-institutional analysis of 182 consecutive patients with HER2-positive metastatic breast cancer who underwent first-line treatment with trastuzumab. The primary end points were progression-free survival and overall survival; the secondary end points were survival after progression in patients treated with second-line chemotherapy with or without trastuzumab and safety. A total of 172 patients were analyzed. RESULTS Median progression-free survival and overall survival were 1.2 (95% CI, 1.1-1.4) and 4.4 years (95% CI, 3.6-5.4), respectively. For 100 patients who received second-line chemotherapy, median survival after progression was significantly longer in those who also received trastuzumab: 2.8 (95% CI, 2.1-4.0) versus 1.2 years (95% CI, 0.6-1.9). CONCLUSIONS Although based on retrospective data, the study confirms the role of trastuzumab as first-line treatment in metastatic breast cancer outside of a controlled trial. Moreover, information obtained on the use of trastuzumab beyond disease progression supports its use in this setting.
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Sanò MV, Taibi E, Ali M, Di Marco R, Zacchia A, Chiarenza M, Fallica G, Clementi S, Aiello RA, Caruso M. Adjuvant trastuzumab in the treatment of small HER2-positive tumors: A single institution experience. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e11514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Maria Vita Sanò
- Medical oncology Department, Humanitas Centro Catanese di Oncologia, Catania, Italy
| | | | - Marco Ali
- Humanitas Centro Catanese di Oncologia, Catania, Italy
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13
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Caruso M, Adamo V, Tralongo P, Giuffrida D, Gebbia V, Leonardi V, Soto Parra HJ, Valenza R, Borsellino N, Sanò MV, Priolo D, Di Mari AM, Prestifilippo A, Ricciardi G, Miano E, Zacchia A, Ferraú F. Retrast: Retreatment after adjuvant trastuzumab—Our regional southern Italy experience. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e11526] [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
e11526 Background: Trastuzumab (T) is the standard of care for pts with HER2+ve BC. Relapse after adj T remains a rare event. Since the large use of T in adj setting, becomes crucial to evaluate advantages of retreatment with T for pts who relapsed after treatment in early stage. There is still lack of clinical evidence and poor data from CT to say that there is a benefit in T re-exposure after relapse following adj T. Methods: Since Jun 2006 and Dec 2011, we reviewed pts with early BC treated with T in adj therapy, relapsed and re-treated with T in first line therapy, in 10 departments of medical oncology in Sicily. We aimed to study feasibility, responses and treatment outcome. Results: 62 pts with HER2+ve fulfilled the criteria for this analysis and 47 were evaluated. Pts had a median age of 53 ys (29-79). ER/PgR-ve cases were 16 (34 %). Ki67 was > 20% in 34 pts (74%). 31 pts (64%) had >3 nodes+ve. All the pts received adj therapy with anthra+/-taxane. 55% of pts had >2 metastatic sites. 12 (25,5%) pts were revalued for HER2: 10 pts confirmed 3+ and two pts 2+ were FISH+. Median time from diagnosis to relapse was 25 mos (7 – 36). Median time from last dose of T to relapse was 10 ms (2 – 35). 33 (70,2%) pts and 14 pts (29,8%) had early (< 12 ms) and late progression (≥ 12 ms) respectively after adj T. First line of therapy was T in combination with mono/polychemotherapy in 42 pts (89,3%) and 5 pts (10,6%) respectively. 27 pts (57,4%) had objective responses (CR 5, PR 22) and 7 pts (14,8%) stable disease. 13 pts (27,6%) had progression: all of these pts had early progressive disease after adj T, 9 pts (69,2%) had Ki67>20%, 5 pts (38,4%) were ER/PgR-ve and 8 pts (61,5%) ER/PgR+ve. Median TTP was 4 mos (range 2-7). Median TTP for early and late relapses pts were respectively 3,7 and 4,8 mos, (p = 0,4). Median OS from relapse to death was 23 mos (r 12 – 37). LVSD G1 (EF < 60-50%) was observed only in 7 pts (14%). Conclusions: Our data confirm the feasibility and safety of treatment with T after adj T therapy and is active for a disease control rate in 72,4% of cases. These results demonstrate that relapses after adj T occurred early (<12 ms) in 70% of pts. However pts with primary resistance (27,6%) should be well categorized using biomolecular markers to receive up-front drugs that overcome the resistance to T.
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Affiliation(s)
- Michele Caruso
- Medical oncology department, Humanitas Centro Catanese di Oncologia, Catania, Italy
| | - Vincenzo Adamo
- Unit of Medical Oncology, A.O. Papardo; Department of Human Pathology, University of Messina, Messina, Italy
| | - Paolo Tralongo
- Medical Oncology Unit, G Di Maria Hospital, Avola, Italy
| | | | | | | | - Hector J. Soto Parra
- Medical Oncology, University Hospital Policlinico - Vittorio Emanuele, Catania, Italy
| | | | - Nicolo Borsellino
- Medical Oncology Unit - Buccheri La Ferla Fatebenefratelli Hospital, Palermo, Italy
| | - Maria Vita Sanò
- Medical oncology Department, Humanitas Centro Catanese di Oncologia, Catania, Italy
| | - Domenico Priolo
- Medical Oncology Department, Ospedale S Vincenzo, Taormina, Italy
| | | | | | | | | | - Alessandra Zacchia
- Medical oncology department, Humanitas Centro Catanese di Oncologia, Catania, Italy
| | - Francesco Ferraú
- Medical Oncology Department, Ospedale S Vincenzo, Taormina, Italy
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Scandurra G, Aiello RA, Alì M, Taibi E, Sanò MV, Todaro FM, La Rocca R, Licciardello P, Caruso M. Appropriate management of cutaneous adverse events maximizes compliance with sorafenib treatment: a single-center experience. Future Oncol 2012; 8:609-15. [DOI: 10.2217/fon.12.35] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Aims: This report describes a positive experience of adverse event (AE) management of a multidisciplinary clinical team and 18 patients with late-stage renal cell carcinoma and hepatocellular carcinoma attending the Day Hospital Unit of the ‘Centro Catanese di Oncologia Humanitas’ (Italy) over a 2-year period. Methods: The management strategy was based on preventive measures for reducing the development of cutaneous AEs, including pain, risk of infection and patient discomfort, while avoiding the discontinuation or the reduction of the sorafenib dosage. Results: As of July 2011, eight patients were still under treatment with sorafenib; seven patients experienced cutaneous AEs and two reported severe cutaneous AEs. Conclusion: Our treatment approach seemed to reduce the incidence and/or severity of AEs, keeping patients in treatment, which is essential for good treatment outcomes.
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Affiliation(s)
- Giuseppa Scandurra
- Day Hospital – UF Oncologia Medica, Humanitas Centro Catanese di Oncologia, via E. Dabormida 64 95126 Catania, Italy
| | - Rosa Anna Aiello
- Day Hospital – UF Oncologia Medica, Humanitas Centro Catanese di Oncologia, via E. Dabormida 64 95126 Catania, Italy
| | - Marco Alì
- Day Hospital – UF Oncologia Medica, Humanitas Centro Catanese di Oncologia, via E. Dabormida 64 95126 Catania, Italy
| | - Eleonora Taibi
- Day Hospital – UF Oncologia Medica, Humanitas Centro Catanese di Oncologia, via E. Dabormida 64 95126 Catania, Italy
| | - Maria Vita Sanò
- Day Hospital – UF Oncologia Medica, Humanitas Centro Catanese di Oncologia, via E. Dabormida 64 95126 Catania, Italy
| | - Francesco Maurizio Todaro
- Day Hospital – UF Oncologia Medica, Humanitas Centro Catanese di Oncologia, via E. Dabormida 64 95126 Catania, Italy
| | - Rosaria La Rocca
- Day Hospital – UF Oncologia Medica, Humanitas Centro Catanese di Oncologia, via E. Dabormida 64 95126 Catania, Italy
| | - Paolo Licciardello
- Day Hospital – UF Oncologia Medica, Humanitas Centro Catanese di Oncologia, via E. Dabormida 64 95126 Catania, Italy
| | - Michele Caruso
- Day Hospital – UF Oncologia Medica, Humanitas Centro Catanese di Oncologia, via E. Dabormida 64 95126 Catania, Italy
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