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Bruni A, Bertolini F, D'Angelo E, Guaitoli G, Imbrescia J, Cappelli A, Guidi G, Stefani A, Dominici M, Lohr F. Oligorecurrent Non-Small-Cell Lung Cancer Treated by Chemo-Radiation Followed by Immunotherapy and Intracranial Radiosurgery: A Case Report and Mini Review of Literature. Int J Mol Sci 2023; 24. [PMID: 36768209 DOI: 10.3390/ijms24031892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/11/2023] [Accepted: 01/16/2023] [Indexed: 01/21/2023] [Imported: 08/29/2023] Open
Abstract
Locally advanced non-small-cell lung cancer still represents a "grey zone" in terms of the best treatment choice and optimal clinical outcomes. Indeed, most patients may be suitable to receive different treatments with similar outcomes such as chemo-radiotherapy (CHT-RT) followed by immunotherapy (IO) or surgery followed by adjuvant local/systemic therapies. We report a clinical case of a patient submitted to primary thoracic surgery who developed a mediastinal nodal recurrence successfully treated by CHT-RT-IO. Subsequently, a single brain lesion was found to have been successfully treated by single fraction stereotactic ablative radiotherapy. The patient is still on follow-up and she is free from disease having a good quality of life. In this report, we also perform a mini review about the role of CHT-RT followed by IO in treating loco-regional relapse after surgery. The role of SABR after IO is also evaluated, finding that it is safe and well tolerated. More robust and larger clinical data are needed in this particular setting to better define the role of the combination of systemic and local treatments in the management of intrathoracic and intracranial relapse for patients already submitted to CHT-RT followed by immunotherapy.
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Iori F, Bruni A, Cozzi S, Ciammella P, Di Pressa F, Boldrini L, Greco C, Nardone V, Salvestrini V, Desideri I, De Felice F, Iotti C. Can Radiotherapy Empower the Host Immune System to Counterattack Neoplastic Cells? A Systematic Review on Tumor Microenvironment Radiomodulation. Curr Oncol 2022; 29:4612-4624. [PMID: 35877226 PMCID: PMC9319790 DOI: 10.3390/curroncol29070366] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 06/26/2022] [Accepted: 06/28/2022] [Indexed: 11/16/2022] [Imported: 08/29/2023] Open
Abstract
Despite the rising evidence in favor of immunotherapy (IT), the treatment of oncological patients affected by so-called “cold tumors” still represents an open issue. Cold tumors are characterized by an immunosuppressive (so-called cold) tumor microenvironment (TME), which favors host immune system suppression, cancer immune-escape, and a worse response to IT. However, the TME is not a static element, but dynamically mutates and can be changed. Radiotherapy (RT) can modulate a cold microenvironment, rendering it better at tumor killing by priming the quiescent host immune system, with a consequent increase in immunotherapy response. The combination of TME radiomodulation and IT could therefore be a strategy for those patients affected by cold tumors, with limited or no response to IT. Thus, this review aims to provide an easy, rapid, and practical overview of how RT could convert the cold TME and why cold tumor radiomodulation could represent an interesting strategy in combination with IT.
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Affiliation(s)
- Federico Iori
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42124 Reggio Emilia, Italy; (S.C.); (P.C.); (C.I.)
- Correspondence:
| | - Alessio Bruni
- Radiotherapy Unit, Oncology and Hematology Department, University Hospital of Modena, 41121 Modena, Italy; (A.B.); (F.D.P.)
| | - Salvatore Cozzi
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42124 Reggio Emilia, Italy; (S.C.); (P.C.); (C.I.)
| | - Patrizia Ciammella
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42124 Reggio Emilia, Italy; (S.C.); (P.C.); (C.I.)
| | - Francesca Di Pressa
- Radiotherapy Unit, Oncology and Hematology Department, University Hospital of Modena, 41121 Modena, Italy; (A.B.); (F.D.P.)
| | - Luca Boldrini
- Radiation Oncology Unit, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy;
| | - Carlo Greco
- Radiation Oncology, Campus Bio-Medico University, 00128 Rome, Italy;
| | | | - Viola Salvestrini
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, 50134 Florence, Italy; (V.S.); (I.D.)
| | - Isacco Desideri
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, 50134 Florence, Italy; (V.S.); (I.D.)
| | - Francesca De Felice
- Department of Radiotherapy, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy;
| | - Cinzia Iotti
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42124 Reggio Emilia, Italy; (S.C.); (P.C.); (C.I.)
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Bruni A, Scotti V, Borghetti P, Vagge S, Cozzi S, D'Angelo E, Giaj Levra N, Fozza A, Taraborrelli M, Piperno G, Vanoni V, Sepulcri M, Trovò M, Nardone V, Lattanzi E, Bou Selman S, Bertolini F, Franceschini D, Agustoni F, Jereczek-Fossa BA, Magrini SM, Livi L, Lohr F, Filippi AR. Corrigendum: A Real-World, Multicenter, Observational Retrospective Study of Durvalumab After Concomitant or Sequential Chemoradiation for Unresectable Stage III Non-Small Cell Lung Cancer. Front Oncol 2021; 11:802949. [PMID: 34869046 PMCID: PMC8637883 DOI: 10.3389/fonc.2021.802949] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 11/04/2021] [Indexed: 11/13/2022] [Imported: 08/29/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fonc.2021.744956.].
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Affiliation(s)
- Alessio Bruni
- Radiotherapy Unit, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Vieri Scotti
- Department of Oncology, Radiation Therapy Unit, Careggi University Hospital, Florence, Italy
| | - Paolo Borghetti
- Radiation Oncology Department, Spedali Civili and University of Brescia, Brescia, Italy
| | - Stefano Vagge
- Department of Radiation Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Martino, Genova, Italy
| | - Salvatore Cozzi
- Radiation Therapy Department, Arcispedale di Santa Maria Nuova IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Reggio Emilia, Italy
| | - Elisa D'Angelo
- Radiotherapy Unit, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Niccolò Giaj Levra
- Advanced Radiation Oncology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Sacro Cuore Don Calabria Hospital, Verona, Italy
| | - Alessandra Fozza
- Department of Radiation Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Martino, Genova, Italy
| | - Maria Taraborrelli
- Radiation Oncology Department, SS. Annunziata Hospital, "G. D'Annunzio" University of Chieti, Chieti, Italy
| | - Gaia Piperno
- Division of Radiotherapy, European Institute of Oncology (IEO), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) European Institute of Oncology, Milan, Italy
| | - Valentina Vanoni
- Radiation Oncology Department, S. Chiara Hospital, Trento, Italy
| | - Matteo Sepulcri
- Radiation Oncology Unit, Veneto Institute of Oncology Istituto Oncologico Veneto (IOV), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padua, Italy
| | - Marco Trovò
- Radiation Oncology Department, Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | | | | | - Said Bou Selman
- Department of Radiotherapy, Bolzano Hospital, Bolzano, Italy
| | - Federica Bertolini
- Medical Oncology Unit, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Davide Franceschini
- Department of Radiotherapy and Radiosurgery, Humanitas Research Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS)-Humanitas Research Hospital, Milan, Italy
| | - Francesco Agustoni
- Medical Oncology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiotherapy, European Institute of Oncology (IEO), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Stefano Maria Magrini
- Radiation Oncology Department, Spedali Civili and University of Brescia, Brescia, Italy
| | - Lorenzo Livi
- Department of Oncology, Radiation Therapy Unit, Careggi University Hospital, Florence, Italy
| | - Frank Lohr
- Radiotherapy Unit, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Andrea Riccardo Filippi
- Department of Radiation Oncology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo and University of Pavia, Pavia, Italy
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Bruni A, Scotti V, Borghetti P, Vagge S, Cozzi S, D'Angelo E, Giaj Levra N, Fozza A, Taraborrelli M, Piperno G, Vanoni V, Sepulcri M, Trovò M, Nardone V, Lattanzi E, Bou Selman S, Bertolini F, Franceschini D, Agustoni F, Jereczek-Fossa BA, Magrini SM, Livi L, Lohr F, Filippi AR. A Real-World, Multicenter, Observational Retrospective Study of Durvalumab After Concomitant or Sequential Chemoradiation for Unresectable Stage III Non-Small Cell Lung Cancer. Front Oncol 2021; 11:744956. [PMID: 34650927 PMCID: PMC8507147 DOI: 10.3389/fonc.2021.744956] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 09/06/2021] [Indexed: 12/11/2022] [Imported: 08/29/2023] Open
Abstract
Introduction For unresectable stage III non-small cell lung cancer (NSCLC), the standard therapy consists of chemoradiotherapy (CRT) followed by durvalumab maintenance for responding patients. The present study reports on the safety and outcome of durvalumab use after CRT in a real-world, multicenter, retrospective cohort. Methods Two hundred thirty-eight patients have been included. We collected data on systemic therapy, radiation therapy, the timing between CRT and durvalumab, number of durvalumab cycles, reasons for non-starting or discontinuation, incidence and grade of adverse events (AEs), and progression-free survival (PFS) and overall survival (OS). Results One hundred fifty-five patients out of 238 (65.1%) received at least one durvalumab dose: 91 (58.7%) after concomitant CRT (cCRT) and 64 (41.3%) after sequential CRT (sCRT). Programmed-death ligand 1 (PD-L1) status was unknown in 7/155 (4.5%), negative in 14 (9.1%), and positive ≥1% in 134/155 (86.4%). The main reasons for non-starting durvalumab were progression (10.1%), PD-L1 negativity (7.5%), and lung toxicity (4.6%). Median follow-up time was 14 months (range 2–29); 1-year PFS and OS were 65.5% (95%CI: 57.6-74.4) and 87.9% (95%CI: 82.26.6-93.9), respectively. No significant differences in PFS or OS were detected for cCRT vs. sCRT, but the median PFS was 13.5 months for sCRT vs. 23 months for cCRT. Potentially immune-related AEs were recorded in 76/155 patients (49.0%). Pneumonitis was the most frequent, leading to discontinuation in 11/155 patients (7.1%). Conclusions Durvalumab maintenenace after concurrent or sequential chemoradiation for unresectable, stage III NSCLC showed very promising short-term survival results in a large, multicenter, restrospective, real-world study. Durvalumab was the first drug obtaining a survival benefit over CRT within the past two decades, and the present study contributes to validating its use in clinical practice.
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Affiliation(s)
- Alessio Bruni
- Radiotherapy Unit, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Vieri Scotti
- Department of Oncology, Radiation Therapy Unit, Careggi University Hospital, Florence, Italy
| | - Paolo Borghetti
- Radiation Oncology Department, Spedali Civili and University of Brescia, Brescia, Italy
| | - Stefano Vagge
- Department of Radiation Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Martino, Genova, Italy
| | - Salvatore Cozzi
- Radiation Therapy Department, Arcispedale di Santa Maria Nuova IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Reggio Emilia, Italy
| | - Elisa D'Angelo
- Radiotherapy Unit, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Niccolò Giaj Levra
- Advanced Radiation Oncology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Sacro Cuore Don Calabria Hospital, Verona, Italy
| | - Alessandra Fozza
- Department of Radiation Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Martino, Genova, Italy
| | - Maria Taraborrelli
- Radiation Oncology Department, SS. Annunziata Hospital, "G. D'Annunzio" University of Chieti, Chieti, Italy
| | - Gaia Piperno
- Division of Radiotherapy, European Institute of Oncology (IEO), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) European Institute of Oncology, Milan, Italy
| | - Valentina Vanoni
- Radiation Oncology Department, S. Chiara Hospital, Trento, Italy
| | - Matteo Sepulcri
- Radiation Oncology Unit, Veneto Institute of Oncology Istituto Oncologico Veneto (IOV), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padua, Italy
| | - Marco Trovò
- Radiation Oncology Department, Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | | | | | - Said Bou Selman
- Department of Radiotherapy, Bolzano Hospital, Bolzano, Italy
| | - Federica Bertolini
- Medical Oncology Unit, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Davide Franceschini
- Department of Radiotherapy and Radiosurgery, Humanitas Research Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS)-Humanitas Research Hospital, Milan, Italy
| | - Francesco Agustoni
- Medical Oncology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiotherapy, European Institute of Oncology (IEO), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Stefano Maria Magrini
- Radiation Oncology Department, Spedali Civili and University of Brescia, Brescia, Italy
| | - Lorenzo Livi
- Department of Oncology, Radiation Therapy Unit, Careggi University Hospital, Florence, Italy
| | - Frank Lohr
- Radiotherapy Unit, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Andrea Riccardo Filippi
- Department of Radiation Oncology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo and University of Pavia, Pavia, Italy
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