1
|
Erk N, Bouali W, Genc AA, Salamat Q, Soylak M. An Ultrasensitive Electrochemical Sensor Using Banana Peel Activated Carbon/NiFe 2O 4/MnCoFe-LDH Nanocomposites for Anticancer Drug Determination. ACS OMEGA 2024; 9:27446-27457. [PMID: 38947832 PMCID: PMC11209681 DOI: 10.1021/acsomega.4c02460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/06/2024] [Accepted: 05/31/2024] [Indexed: 07/02/2024]
Abstract
In the current study, we report the synthesis of a novel composite material composed of banana peel activated carbon (BPAC), nickel iron oxide (NiFe2O4), and manganese cobalt iron layered double hydroxide (MnCoFe-LDH) to create a high-performance electrochemical sensor to detect Palbociclib (PLB). The composite was successfully immobilized on a glassy carbon electrode (GCE) surface to create a modified electrode. The performance of the electrode was thoroughly evaluated, considering parameters such as electroactive surface areas (ESA), electron transfer rate constant (k0), and exchange current density (j0). The developed BPAC/NiFe2O4/MnCoFe-LDH/GCE exhibited a wide linear dynamic range of 0.01-13.0 μM for PLB concentration, accompanied by a detection limit at a low level (3.5 nM). Furthermore, it can be applied to the determination of PLB in human urine and pharmaceutical samples with excellent recoveries (98.5-102.9%) and RSD values lower than 3%, establishing its potential for precise PLB determination in pharmaceutical and biological samples. This research contributes to the advancement of electrochemical sensor technology for the detection of important anticancer drugs in real-world applications.
Collapse
Affiliation(s)
- Nevin Erk
- Faculty
of Pharmacy, Department of Analytical Chemistry, Ankara University, Ankara 06560, Turkey
| | - Wiem Bouali
- Faculty
of Pharmacy, Department of Analytical Chemistry, Ankara University, Ankara 06560, Turkey
- The
graduate school of the health sciences, Ankara University, Ankara 06110, Turkey
| | - Asena Ayse Genc
- Faculty
of Pharmacy, Department of Analytical Chemistry, Ankara University, Ankara 06560, Turkey
- The
graduate school of the health sciences, Ankara University, Ankara 06110, Turkey
| | - Qamar Salamat
- Faculty
of Sciences, Department of Chemistry, Erciyes
University, Kayseri 38039, Turkey
| | - Mustafa Soylak
- Faculty
of Sciences, Department of Chemistry, Erciyes
University, Kayseri 38039, Turkey
- Technology
Research & Application Center (TAUM), Erciyes University, Kayseri 38039, Turkey
- Turkish
Academy of Sciences (TUBA), Cankaya, Ankara 06670, Turkey
| |
Collapse
|
2
|
Franco R, Cao JQ, Yassa M, Hijal T. Safety of CDK4/6 Inhibitors Combined with Radiotherapy in Patients with Metastatic Breast Cancer: A Review of the Literature. Curr Oncol 2023; 30:5485-5496. [PMID: 37366898 DOI: 10.3390/curroncol30060415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/25/2023] [Accepted: 06/03/2023] [Indexed: 06/28/2023] Open
Abstract
Recent evidence suggests that cyclin-dependent kinase 4/6 (CDK4/6) inhibitors significantly improve progression-free survival and overall survival among metastatic breast cancer patients. However, given the effects on cell cycle arrest, there is potential for CDK4/6 inhibitors and radiotherapy (RT) to work synergistically, enhancing the effect and toxicities of RT. A comprehensive review of the literature on the combination of RT and CDK4/6 inhibitors was performed with 19 eligible studies included in the final analysis. A total of 373 patients who received radiotherapy combined with CDK4/6 inhibitors were evaluated across 9 retrospective studies, 4 case reports, 3 case series, and 3 letters to the editor. The CDK4/6 inhibitor used, RT target, and RT technique were assessed in terms of toxicities. This literature review demonstrates generally limited toxicities with the combination of CDK4/6 inhibitors and palliative radiotherapy to metastatic breast cancer patients. The current evidence is nonetheless limited, and further results of ongoing prospective clinical trials will help clarify whether these treatments can be safely combined.
Collapse
Affiliation(s)
- Rejane Franco
- Division of Radiation Oncology, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | - Jeffrey Q Cao
- Division of Radiation Oncology, Department of Oncology, University of Calgary, Calgary, AB T2N 4N2, Canada
| | - Michael Yassa
- Division of Radiation Oncology, Hôpital Maisonneuve-Rosemont, CIUSSS de l'Est-de-l'Île-de-Montréal, Montreal, QC H1T 2M4, Canada
| | - Tarek Hijal
- Division of Radiation Oncology, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| |
Collapse
|
3
|
Visani L, Livi L, Ratosa I, Orazem M, Ribnikar D, Saieva C, Becherini C, Salvestrini V, Scoccimarro E, Valzano M, Cerbai C, Desideri I, Bernini M, Orzalesi L, Nori J, Bianchi S, Morandi A, Meattini I. Safety of CDK4/6 inhibitors and concomitant radiation therapy in patients affected by metastatic breast cancer. Radiother Oncol 2022; 177:40-45. [PMID: 36349599 DOI: 10.1016/j.radonc.2022.10.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 10/12/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE Cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) currently represent the standard of care for the initial treatment of patients with metastatic hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2-) breast cancer. The aim of our study is to evaluate the safety of the use of concomitant radiation therapy (RT) in a consecutive series of HR+/HER2- patients treated in two academic institutions with CDK4/6i in the metastatic setting. METHODS AND MATERIALS From September 2017 to February 2020, we retrospectively collected and analysed data on a sequential series of patients treated with CDK4/6i, receiving RT or not, at two European institutions. Primary outcome of the study was the association between RT and any adverse events (AEs) ≥ G3. Secondary outcomes were the association between RT and any AEs (any grade), CDK4/6i dose reduction rate, and CDK4/6i treatment discontinuation rate. RESULTS We analysed a total of 132 consecutive women; RT was prescribed in 57 (43.2%) patients (70 irradiated lesions). The median age of the series was 52.1 years (range 32.3-78.2). Concomitant RT administration was not significantly related to higher AEs ≥ G3 (p = 0.19) and any grade AEs (p = 1.0); there was no association with RT and CDK4/6i dose reduction (p = 0.49) and discontinuation rates (p = 0.14). At a median follow-up of 18.8 months, the progression-free survival (PFS) rate was 35% and the overall survival (OS) rate was 38.7% in the whole group. The use of concomitant RT did not affect both PFS (p = 0.71) and OS rates (p = 0.55). CONCLUSIONS Our data are encouraging regarding the safety of this combination, showing that concurrent RT did not increase severe toxicity and did not have an impact on systemic treatment conduction.
Collapse
Affiliation(s)
- Luca Visani
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Lorenzo Livi
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy; Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Ivica Ratosa
- Division of Radiation Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Miha Orazem
- Division of Radiation Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Domen Ribnikar
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia; Division of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Calogero Saieva
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research Prevention and Clinical Network, Florence, Italy
| | - Carlotta Becherini
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Viola Salvestrini
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy; Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Erika Scoccimarro
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy; Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Marianna Valzano
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy; Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Cecilia Cerbai
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy; Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Isacco Desideri
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy; Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Marco Bernini
- Breast Surgery Unit, Careggi University Hospital, Florence, Italy
| | - Lorenzo Orzalesi
- Breast Surgery Unit, Careggi University Hospital, Florence, Italy
| | - Jacopo Nori
- Diagnostic Senology Unit, Careggi University Hospital, Florence, Italy
| | - Simonetta Bianchi
- Division of Pathological Anatomy, Department of Health Sciences, University of Florence, Florence, Italy
| | - Andrea Morandi
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy; Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
| |
Collapse
|
4
|
Al-Rashdan A, Quirk S, Roumeliotis M, Abedin T, Amaro CP, Barbera L, Lupichuk S, Cao JQ. Radiotherapy with Cyclin-Dependent Kinase 4/6 Inhibitors: A Multi-institutional Safety and Toxicity Study. Int J Radiat Oncol Biol Phys 2022; 114:399-408. [PMID: 35870712 DOI: 10.1016/j.ijrobp.2022.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/26/2022] [Accepted: 07/02/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To investigate radiotherapy (RT) toxicity when given with Cyclin-Dependent Kinase 4/6 inhibitors (CDK4/6i) compared to RT alone. METHODS AND MATERIALS We conducted a retrospective cohort study of patients with hormonal receptor-positive and human epidermal growth factor-2 negative metastatic breast cancer treated with RT at four cancer centers in Alberta, Canada between 2016 and 2020. Toxicity in patients treated with RT within 30 days of initiating to discontinuing CDK4/6i (RT+CDK4/6i) was compared to toxicity of RT in CDK4/6i naïve patients (RT alone). The primary outcome was acute grade (G) II or higher, non-hematological toxicity within 30 days of RT. We also explored toxicity based on the timing of RT (prior, concurrent, post) in relation to CDK4/6i. Propensity score matching was applied to create comparable cohorts. A generalized linear mixed model was used to evaluate factors associated with acute toxicity. RESULTS 132 patients (220 RT sites) in the RT+CDK4/6i and 53 patients (93 RT sites) in RT alone were eligible. The rate of acute GII or higher non-hematological toxicity was 11.5% vs. 7%, respectively (p=0.439), and acute GIII or higher non-hematological toxicity was 3.7% vs. 0%, respectively (p=0.151). Acute toxicity in RT+CDK4/6i group was mainly observed when RT was given concurrently (67%) with most of the GIII toxicity recorded. After propensity score matching, the association of acute toxicity with RT+CDK4/6i vs. RT alone was not significant on multivariable analysis, Odds Ratio 3.13 (95% confidence interval: 0.74 - 13.2; p=0.121). CONCLUSIONS We did not observe a significant association between CDK4/6i use and acute, GII or higher, non-hematological toxicity, in women with metastatic breast cancer receiving palliative RT. Given the findings of GIII toxicity, caution is advised whenever CDK4/6i is given concurrently with RT.
Collapse
Affiliation(s)
- Abdulla Al-Rashdan
- Dalhousie University School of Medicine, Dalhousie University, Halifax, NS, B3H 1V7, Canada; Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Sarah Quirk
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; Tom Baker Cancer Centre, Calgary, AB T2N 4N2, Canada; Department of Physics and Astronomy, University of Calgary, Calgary, Alberta, Canada
| | - Michael Roumeliotis
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; Tom Baker Cancer Centre, Calgary, AB T2N 4N2, Canada; Department of Physics and Astronomy, University of Calgary, Calgary, Alberta, Canada
| | - Tasnima Abedin
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; Tom Baker Cancer Centre, Calgary, AB T2N 4N2, Canada
| | - Carla Paris Amaro
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; Tom Baker Cancer Centre, Calgary, AB T2N 4N2, Canada
| | - Lisa Barbera
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; Tom Baker Cancer Centre, Calgary, AB T2N 4N2, Canada
| | - Sasha Lupichuk
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; Tom Baker Cancer Centre, Calgary, AB T2N 4N2, Canada
| | - Jeffrey Q Cao
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; Tom Baker Cancer Centre, Calgary, AB T2N 4N2, Canada.
| |
Collapse
|
5
|
Guimond E, Tsai CJ, Hosni A, O'Kane G, Yang J, Barry A. Safety and Tolerability of Metastasis Directed Radiotherapy in the Era of Evolving Systemic, Immune and Targeted Therapies. Adv Radiat Oncol 2022; 7:101022. [PMID: 36177487 PMCID: PMC9513086 DOI: 10.1016/j.adro.2022.101022] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 07/02/2022] [Indexed: 11/17/2022] Open
Abstract
AbstractPurpose Systemic, immune, and target therapies are growing in use in the management of metastatic cancers. The aim of this review was to describe up-to-date published data on the safety and tolerability of metastasis-directed hypofractionated radiation therapy (RT) when combined with newer systemic, immune, and targeted therapies and to provide suggested strategies to mitigate potential toxicities in the clinical setting. Methods and Materials A comprehensive search was performed for the time period between 1946 and August 2021 using predetermined keywords describing the use of noncentral nervous system palliative RT with commonly used targeted systemic therapies on PubMed and Medline databases. A total of 1022 articles were screened, and 130 met prespecified criteria to be included in this review. Results BRAF and MEK inhibitors are reported to be toxic when given concurrently with RT; suspension 3 days and 1 to 2 days, respectively, prior and post-RT is suggested. Cetuximab, erlotinib/gefitinib, and osimertinib were generally safe to use concomitantly with conventional radiation. But in a palliative/hypofractionated RT setting, suspending cetuximab during radiation week, erlotinib/gefitinib 1 to 2 days, and osimertinib ≥2 days pre- and post-RT is suggested. Vascular endothelial growth factor inhibitors such as bevacizumab reported substantial toxicities, and the suggestion is to suspend 4 weeks before and after radiation. Less data exist on sorafenib and sunitinib; 5 to 10 days suspension before and after RT should be considered. As a precaution, until further data are available, for cyclin-dependent kinase 4-6 inhibitors, consideration of suspending treatment 1 to 2 days before and after RT should be given. Ipilimumab should be suspended 2 days before and after RT, and insufficient data exist for other immunotherapy agents. Trastuzumab and pertuzumab are generally safe to use in combination with RT, but insufficient data exist for other HER2 target therapy. Conclusions Suggested approaches are described, using up-to-date literature, to aid clinicians in navigating the integration of newer targeted agents with hypofractionated palliative and/or ablative metastatic RT. Further prospective studies are required.
Collapse
Affiliation(s)
- Elizabeth Guimond
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
- University of Toronto, Toronto, Ontario
- Corresponding author: Elizabeth Guimond, MD, FRCPC
| | - Chiaojung Jillian Tsai
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ali Hosni
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
- University of Toronto, Toronto, Ontario
| | - Grainne O'Kane
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
- University of Toronto, Toronto, Ontario
| | - Jonathan Yang
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Aisling Barry
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
- University of Toronto, Toronto, Ontario
| |
Collapse
|
6
|
Meattini I, Livi L, Lorito N, Becherini C, Bacci M, Visani L, Fozza A, Belgioia L, Loi M, Mangoni M, Lambertini M, Morandi A. Integrating radiation therapy with targeted treatments for breast cancer: from bench to bedside. Cancer Treat Rev 2022; 108:102417. [PMID: 35623219 DOI: 10.1016/j.ctrv.2022.102417] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/14/2022] [Accepted: 05/17/2022] [Indexed: 11/02/2022]
|
7
|
van Aken ESM, Beeker A, Houtenbos I, Pos FJ, Linn SC, Elkhuizen PHM, de Jong MC. Unexpected toxicity of CDK4/6 inhibitor palbociclib and radiotherapy. Cancer Rep (Hoboken) 2021; 5:e1470. [PMID: 34145976 PMCID: PMC8842704 DOI: 10.1002/cnr2.1470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/07/2021] [Accepted: 05/26/2021] [Indexed: 01/02/2023] Open
Abstract
Background Cyclin‐dependent kinase (CDK) 4/6 inhibitors have recently been approved for the treatment of hormone receptor–positive and HER2‐negative metastatic breast cancer in association with endocrine therapy in postmenopausal women. Data on the interaction of CDK4/6 inhibition and radiotherapy are scarce, but some studies show unexpected toxicity. Cases We report three cases of unexpected severe or prolonged soft tissue, skin, and gastrointestinal toxicity in patients treated with a combination of radiotherapy and the CDK4/6 inhibitor palbociclib. Conclusion These cases indicate a possible interaction between radiotherapy and palbociclib. Therefore, we recommend using radiotherapy cautiously when combined with CDK4/6 inhibitors.
Collapse
Affiliation(s)
- Evert S M van Aken
- Department of Radiation Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Aart Beeker
- Department of Medical Oncology, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - Ilse Houtenbos
- Department of Medical Oncology, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - Floris J Pos
- Department of Radiation Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Sabine C Linn
- Department of Medical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Paula H M Elkhuizen
- Department of Radiation Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Monique C de Jong
- Department of Radiation Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| |
Collapse
|
8
|
Gagliano A, Prestifilippo A, Cantale O, Ferini G, Fisichella G, Fontana P, Sciacca D, Giuffrida D. Role of the Combination of Cyclin-Dependent Kinase Inhibitors (CDKI) and Radiotherapy (RT) in the Treatment of Metastatic Breast Cancer (MBC): Advantages and Risks in Clinical Practice. Front Oncol 2021; 11:643155. [PMID: 34221963 PMCID: PMC8247460 DOI: 10.3389/fonc.2021.643155] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 05/07/2021] [Indexed: 11/24/2022] Open
Abstract
Targeting cell cycle has become the gold standard for metastatic breast cancer (MBC), being cyclin-dependent kinase inhibitors (CDKIs) cornerstones of its treatment, alongside radiotherapy (RT). To date, no definite evidence regarding safety and efficacy of the combination of CDKIs plus radiotherapy (RT) is currently available. Purpose of this review is to collect data in favor or against the feasibility of the association of CDKIs + RT, describing its potential adverse events. Our review shows how CDKI + RT allows an overall satisfying disease control, proving to be effective and causing a grade of toxicity mainly influenced by the site of irradiation, leaning to favourable outcomes for sites as liver, spine or brain and to poorer outcomes for thoracic lesions or sites close to viscera; controversial evidence is instead for bone treatment. Toxicity also varies from patient to patient. To sum up, our contribution enriches and enlightens a still indefinite field regarding the feasibility of CDKIs + RT, giving cues for innovative clinical management of hormone-responsive MBC.
Collapse
Affiliation(s)
- Ambrogio Gagliano
- Department of Medical Oncology, The Mediterranean Institute of Oncology, Viagrande, Italy
| | - Angela Prestifilippo
- Department of Medical Oncology, The Mediterranean Institute of Oncology, Viagrande, Italy
| | - Ornella Cantale
- Department of Medical Oncology, The Mediterranean Institute of Oncology, Viagrande, Italy
| | - Gianluca Ferini
- Department of Medical Oncology, The Mediterranean Institute of Oncology, Viagrande, Italy
| | - Giacomo Fisichella
- Department of Medical Oncology, The Mediterranean Institute of Oncology, Viagrande, Italy
| | - Paolo Fontana
- Department of Medical Oncology, The Mediterranean Institute of Oncology, Viagrande, Italy
| | - Dorotea Sciacca
- Department of Medical Oncology, The Mediterranean Institute of Oncology, Viagrande, Italy
| | - Dario Giuffrida
- Department of Medical Oncology, The Mediterranean Institute of Oncology, Viagrande, Italy
| |
Collapse
|