1
|
Roma C, Esposito Abate R, Sacco A, Califano D, Arenare L, Bergantino F, Pisano C, Cecere SC, Scambia G, Lorusso D, Artioli G, Tasca G, Spina A, Russo D, Gadducci A, De Angelis C, Bologna A, Marchini S, Capoluongo ED, Perrone F, Pignata S, Normanno N. Harmonization of homologous recombination deficiency testing in ovarian cancer: Results from the MITO16A/MaNGO-OV2 trial. Eur J Cancer 2024; 206:114127. [PMID: 38797038 DOI: 10.1016/j.ejca.2024.114127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 05/16/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Homologous Recombination Deficiency (HRD) status predicts response to treatment with poly(ADP-ribose) polymerase inhibitors in Ovarian Cancer (OC) patients. The Myriad myChoiceCDx Assay is approved by Food and Drug Agency for the HRD assessment. Here we compared the HRD status obtained by three commercial panels with the results from Myriad reference test. METHODS The HRD analysis was performed on DNA from formalin-fixed and paraffin-embedded tumor samples of 100 untreated OC patients for which Myriad assay results were available, using TruSight Oncology 500 HRD assay (Illumina), Oncomine Comprehensive Assay Plus (Thermo Fisher Scientific) and SOPHiA DDM HRD solution panel (SOPHiA Genetics). RESULTS A good overall concordance with the reference method was demonstrated at three different levels: BRCA mutational status (from 94.4 % to 97.7 %), the genomic instability value (from 88.2 % to 95.3 %) and for the HRD status (from 90.4 % to 97.6 %). Moreover, a trend in favour of HRD positive patients for response rate, progression-free survival and overall survival similar to Myriad was observed for all three tests. DISCUSSION Our data suggest the feasibility of commercial testing for assessing HRD status, with a good concordance with the reference method and association with clinical outcome.
Collapse
Affiliation(s)
- Cristin Roma
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Riziero Esposito Abate
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Alessandra Sacco
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Daniela Califano
- Microenvironment Molecular Targets Unit, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Laura Arenare
- Clinical Trial Unit, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Francesca Bergantino
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Carmela Pisano
- Uro-Gynecological Medical Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Sabrina Chiara Cecere
- Uro-Gynecological Medical Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Giovanni Scambia
- Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy; Department of Life Science and Public Health, Catholic University of Sacred Heart, Rome, Italy
| | - Domenica Lorusso
- Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy; Department of Life Science and Public Health, Catholic University of Sacred Heart, Rome, Italy
| | - Grazia Artioli
- Oncologia Medica, ULSS2 Marca Trevigiana, Treviso, Italy
| | - Giulia Tasca
- Division of Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Anna Spina
- Microenvironment Molecular Targets Unit, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Daniela Russo
- Microenvironment Molecular Targets Unit, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Angiolo Gadducci
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Italy
| | - Carmine De Angelis
- Department of Clinical Medicine and Surgery, Università degli Studi di Napoli Federico II, Naples, Italy
| | | | - Sergio Marchini
- Molecular Pharmacology lab., Group of Cancer Pharmacology IRCCS Humanitas Research Hospital, Rozzano, Milano, Italy
| | - Ettore Domenico Capoluongo
- Department of Molecular Medicine and Medical Biotechnology, Università degli Studi di Napoli Federico II, Naples, Italy; Azienda Ospedaliera per l'Emergenza, Cannizzaro, Catania, Italy
| | - Francesco Perrone
- Clinical Trial Unit, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Sandro Pignata
- Uro-Gynecological Medical Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Nicola Normanno
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy.
| |
Collapse
|
2
|
Frezzini S, Lonardi S. Spotlight on New Hallmarks of Drug-Resistance towards Personalized Care for Epithelial Ovarian Cancer. Cells 2024; 13:611. [PMID: 38607050 PMCID: PMC11011744 DOI: 10.3390/cells13070611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/28/2024] [Accepted: 03/29/2024] [Indexed: 04/13/2024] Open
Abstract
Epithelial ovarian cancer (EOC) is the deadliest gynecological malignancy worldwide. Despite the latest advances, a major clinical issue in EOC is the disappointing prognosis related to chemoresistance in almost one-third of cases. Drug resistance relies on heterogeneous cancer stem cells (CSCs), endowed with tumor-initiating potential, leading to relapse. No biomarkers of chemoresistance have been validated yet. Recently, major signaling pathways, micro ribonucleic acids (miRNAs), and circulating tumor cells (CTCs) have been advocated as putative biomarkers and potential therapeutic targets for drug resistance. However, further investigation is mandatory before their routine implementation. In accordance with the increasing rate of therapeutic efforts in EOC, the need for biomarker-driven personalized therapies is growing. This review aims to discuss the emerging hallmarks of drug resistance with an in-depth insight into the underlying molecular mechanisms lacking so far. Finally, a glimpse of novel therapeutic avenues and future challenges will be provided.
Collapse
Affiliation(s)
- Simona Frezzini
- Unit of Medical Oncology 3, Veneto Institute of Oncology IOV—IRCCS, 35128 Padova, Italy;
| | | |
Collapse
|
3
|
Peters I, Marchetti C, Scambia G, Fagotti A. New windows of surgical opportunity for gynecological cancers in the era of targeted therapies. Int J Gynecol Cancer 2024; 34:352-362. [PMID: 38438181 DOI: 10.1136/ijgc-2023-004580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Abstract
Precision medicine through molecular profiling has taken a prominent role in the treatment of solid tumors and it is widely expected that this will continue to expand. With respect to gynecological cancers, a major change has particularly been observed in the treatment landscape of epithelial ovarian, endometrial, and cervical cancers. Regarding the former, maintenance therapy with either poly(ADP-ribose) polymerase inhibitors (PARPi) and/or bevacizumab has become an indispensable treatment option following the traditional combination of cytoreductive surgery and platinum-based chemotherapy. Considering endometrial cancer, the molecular classification system has now been incorporated into virtually every guideline available and molecular-directed treatment strategies are currently being researched, presumably leading to a further transformation of its treatment paradigm. After all, treatment with immune-checkpoint inhibitors that target the programmed cell death 1 (PD-1) receptor has already been shown to significantly improve disease outcomes in these patients, especially in those with mismatch repair deficient, microsatellite stability-high (MMRd-MSI-H) disease. Similarly, in recurrent/metastatic cervical cancer patients, these agents elicited improved survival rates when being added to platinum-based chemotherapy with or without bevacizumab. Interestingly, implications of these targeted therapies for surgical management have been touched on to a minor extent, but are at least as intriguing. This review therefore aims to address the wide-ranging opportunities the molecular tumor characteristics and their corresponding targeted therapies have to offer for the surgical management of epithelial ovarian, endometrial, and cervical cancers, both in the primary and recurrent setting.
Collapse
Affiliation(s)
- Inge Peters
- Department of Woman's and Child Health and Public Health Sciences, Gynecologic Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Claudia Marchetti
- Department of Woman's and Child Health and Public Health Sciences, Gynecologic Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Giovanni Scambia
- Department of Woman's and Child Health and Public Health Sciences, Gynecologic Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Anna Fagotti
- Department of Woman's and Child Health and Public Health Sciences, Gynecologic Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| |
Collapse
|
4
|
Giannini A, Di Dio C, Di Donato V, D'oria O, Salerno MG, Capalbo G, Cuccu I, Perniola G, Muzii L, Bogani G. PARP Inhibitors in Newly Diagnosed and Recurrent Ovarian Cancer. Am J Clin Oncol 2023; 46:414-419. [PMID: 37314974 DOI: 10.1097/coc.0000000000001024] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Ovarian cancer is the most lethal gynecologic malignancy, characterized by a high death-to-incidence ratio. Platinum-based chemotherapy is the mainstay of treatment for newly diagnosed and platinum-sensitive recurrent ovarian cancer. Poly (ADP-ribose) polymerase inhibitors (PARP inhibitors) have been incorporated into the treatment strategy for ovarian cancer. PARP inhibitors showed particular benefit for patients harboring defects in DNA repair pathways. Accumulating evidence showed that PARP inhibitors provide a benefit in newly diagnosed advanced ovarian cancer, even in the absence of BRCA mutation, as reported in the PRIMA, PRIME, and ATHENA-mono trials. Interestingly, the PAOLA-1 study provides another important finding, supporting the adoption of olaparib plus bevacizumab in patients with homologous recombination deficiency. Although those results are exciting, several patients develop resistance to PARP inhibitors. Hence, new combinations are under investigation to identify new treatment strategies to overcome this resistance. Currently, researchers are focused on the possibility to adopt PARP inhibitors even in the setting of platinum-resistant disease. The present critical review aims to report the current landscape and further perspective for strengthening PARP inhibitors' effectiveness in newly diagnosed and recurrent ovarian cancer.
Collapse
Affiliation(s)
- Andrea Giannini
- Department of Gynecological, Obstetrical, and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Camilla Di Dio
- Department of Gynecological, Obstetrical, and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Violante Di Donato
- Department of Gynecological, Obstetrical, and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Ottavia D'oria
- Department of Woman's and Child's Health, Obstetrics and Gynecological Unit, San Camillo-Forlanini Hospital, Rome, Italy
| | - Maria Giovanna Salerno
- Department of Woman's and Child's Health, Obstetrics and Gynecological Unit, San Camillo-Forlanini Hospital, Rome, Italy
| | - Giuseppe Capalbo
- Department of Gynecological, Obstetrical, and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Ilaria Cuccu
- Department of Gynecological, Obstetrical, and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Giorgia Perniola
- Department of Gynecological, Obstetrical, and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Ludovico Muzii
- Department of Gynecological, Obstetrical, and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Giorgio Bogani
- Department of Gynecological, Obstetrical, and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| |
Collapse
|
5
|
Polano M, Bedon L, Dal Bo M, Sorio R, Bartoletti M, De Mattia E, Cecchin E, Pisano C, Lorusso D, Lissoni AA, De Censi A, Cecere SC, Scollo P, Marchini S, Arenare L, De Giorgi U, Califano D, Biagioli E, Chiodini P, Perrone F, Pignata S, Toffoli G. Machine Learning Application Identifies Germline Markers of Hypertension in Patients With Ovarian Cancer Treated With Carboplatin, Taxane, and Bevacizumab. Clin Pharmacol Ther 2023; 114:652-663. [PMID: 37243926 DOI: 10.1002/cpt.2960] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/22/2023] [Indexed: 05/29/2023]
Abstract
Pharmacogenomics studies how genes influence a person's response to treatment. When complex phenotypes are influenced by multiple genetic variations with little effect, a single piece of genetic information is often insufficient to explain this variability. The application of machine learning (ML) in pharmacogenomics holds great potential - namely, it can be used to unravel complicated genetic relationships that could explain response to therapy. In this study, ML techniques were used to investigate the relationship between genetic variations affecting more than 60 candidate genes and carboplatin-induced, taxane-induced, and bevacizumab-induced toxicities in 171 patients with ovarian cancer enrolled in the MITO-16A/MaNGO-OV2A trial. Single-nucleotide variation (SNV, formerly SNP) profiles were examined using ML to find and prioritize those associated with drug-induced toxicities, specifically hypertension, hematological toxicity, nonhematological toxicity, and proteinuria. The Boruta algorithm was used in cross-validation to determine the significance of SNVs in predicting toxicities. Important SNVs were then used to train eXtreme gradient boosting models. During cross-validation, the models achieved reliable performance with a Matthews correlation coefficient ranging from 0.375 to 0.410. A total of 43 SNVs critical for predicting toxicity were identified. For each toxicity, key SNVs were used to create a polygenic toxicity risk score that effectively divided individuals into high-risk and low-risk categories. In particular, compared with low-risk individuals, high-risk patients were 28-fold more likely to develop hypertension. The proposed method provided insightful data to improve precision medicine for patients with ovarian cancer, which may be useful for reducing toxicities and improving toxicity management.
Collapse
Affiliation(s)
- Maurizio Polano
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico di Aviano, Istituto di Ricovero e Cura a Carattere Scientifico, Aviano, Italy
| | - Luca Bedon
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico di Aviano, Istituto di Ricovero e Cura a Carattere Scientifico, Aviano, Italy
| | - Michele Dal Bo
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico di Aviano, Istituto di Ricovero e Cura a Carattere Scientifico, Aviano, Italy
| | - Roberto Sorio
- Dipartimento di Oncologia Medica, Centro di Riferimento Oncologico di Aviano, Istituto di Ricovero e Cura a Carattere Scientifico, Aviano, Italy
| | - Michele Bartoletti
- Dipartimento di Oncologia Medica, Centro di Riferimento Oncologico di Aviano, Istituto di Ricovero e Cura a Carattere Scientifico, Aviano, Italy
| | - Elena De Mattia
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico di Aviano, Istituto di Ricovero e Cura a Carattere Scientifico, Aviano, Italy
| | - Erika Cecchin
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico di Aviano, Istituto di Ricovero e Cura a Carattere Scientifico, Aviano, Italy
| | - Carmela Pisano
- Uro-Gynecologic Oncology Unit, Istituto Nazionale Tumori Istituto di Ricovero e Cura a Carattere Scientifico Fondazione G. Pascale, Naples, Italy
| | - Domenica Lorusso
- Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
- Department of Life Science and Public Health, Catholic University of Sacred Heart Largo Agostino Gemelli, Rome, Italy
| | - Andrea Alberto Lissoni
- Clinica Ostetrica e Ginecologica, Istituto di Ricovero e Cura a Carattere Scientifico S. Gerardo Monza, Università di Milano Bicocca, Milano, Italy
| | | | - Sabrina Chiara Cecere
- Uro-Gynecologic Oncology Unit, Istituto Nazionale Tumori Istituto di Ricovero e Cura a Carattere Scientifico Fondazione G. Pascale, Naples, Italy
| | - Paolo Scollo
- Unità Operativa Ostetricia e Ginecologia, Dipartimento Materno-Infantile, Ospedale Cannizzaro, Catania, Italy
| | - Sergio Marchini
- Molecular Pharmacology laboratory, Group of Cancer Pharmacology Istituto di Ricovero e Cura a Carattere Scientifico Humanitas Research Hospital, Rozzano, Italy
| | - Laura Arenare
- Clinical Trial Unit, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico, Fondazione G. Pascale, Naples, Italy
| | - Ugo De Giorgi
- Istituto di Ricovero e Cura a Carattere Scientifico Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy
| | - Daniela Califano
- Microenvironment Molecular Targets Unit, Istituto Nazionale Tumori IRCCS, Fondazione G. Pascale, Naples, Italy
| | - Elena Biagioli
- Department Of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS Milano, Milano, Italy
| | - Paolo Chiodini
- Department of Mental Health and Public Medicine, Section of Statistics, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | - Francesco Perrone
- Clinical Trial Unit, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico, Fondazione G. Pascale, Naples, Italy
| | - Sandro Pignata
- Uro-Gynecologic Oncology Unit, Istituto Nazionale Tumori Istituto di Ricovero e Cura a Carattere Scientifico Fondazione G. Pascale, Naples, Italy
| | - Giuseppe Toffoli
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico di Aviano, Istituto di Ricovero e Cura a Carattere Scientifico, Aviano, Italy
| |
Collapse
|
6
|
Guo Z, Li K, Liu P, Zhang X, Lv J, Zeng X, Zhang P. Targeted therapy for head and neck squamous cell carcinoma microenvironment. Front Med (Lausanne) 2023; 10:1257898. [PMID: 37711747 PMCID: PMC10498927 DOI: 10.3389/fmed.2023.1257898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 08/14/2023] [Indexed: 09/16/2023] Open
Abstract
Head and neck squamous cell carcinoma (HNSCC) originates from the squamous epithelium of the oral cavity, oropharynx, larynx, and hypopharynx. HNSCC in the oral cavity and larynx is strongly associated with tobacco smoking and alcohol consumption, while oropharyngeal cancer is increasingly attributed to infection by human papillomavirus (HPV), particularly HPV-16. The tumor microenvironment (TME) is a complex network of cancer cells, immune cells, stromal cells, surrounding blood vessels, and signaling molecules, and plays a critical role in tumor cell survival, invasion, and recurrence. Therefore, it is critical to elucidate the molecular basis of the interaction between tumor cells and the TME in order to develop innovative anti-cancer therapeutic strategies.
Collapse
Affiliation(s)
- Zhaomeng Guo
- Department of Otorhinolaryngology, Longgang Otorhinolaryngology Hospital and Shenzhen Key Laboratory of Otorhinolaryngology, Shenzhen Institute of Otorhinolaryngology, Shenzhen, Guangdong, China
| | - Kang Li
- Department of Otorhinolaryngology, Longgang Otorhinolaryngology Hospital and Shenzhen Key Laboratory of Otorhinolaryngology, Shenzhen Institute of Otorhinolaryngology, Shenzhen, Guangdong, China
- Department of Graduate and Scientific Research, Zunyi Medical University Zhuhai Campus, Zhuhai, Guangdong, China
| | - Peng Liu
- Department of Otorhinolaryngology, Longgang Otorhinolaryngology Hospital and Shenzhen Key Laboratory of Otorhinolaryngology, Shenzhen Institute of Otorhinolaryngology, Shenzhen, Guangdong, China
- Department of Graduate and Scientific Research, Zunyi Medical University Zhuhai Campus, Zhuhai, Guangdong, China
| | - Xiangmin Zhang
- Department of Otorhinolaryngology, Longgang Otorhinolaryngology Hospital and Shenzhen Key Laboratory of Otorhinolaryngology, Shenzhen Institute of Otorhinolaryngology, Shenzhen, Guangdong, China
| | - Jie Lv
- School of Computer Science and Engineering, Yulin Normal University, Yulin, Guangxi, China
| | - Xianhai Zeng
- Department of Otorhinolaryngology, Longgang Otorhinolaryngology Hospital and Shenzhen Key Laboratory of Otorhinolaryngology, Shenzhen Institute of Otorhinolaryngology, Shenzhen, Guangdong, China
| | - Peng Zhang
- Department of Otorhinolaryngology, Longgang Otorhinolaryngology Hospital and Shenzhen Key Laboratory of Otorhinolaryngology, Shenzhen Institute of Otorhinolaryngology, Shenzhen, Guangdong, China
| |
Collapse
|
7
|
Forlani L, De Cecco L, Simeon V, Paolini B, Bagnoli M, Cecere SC, Spina A, Citeroni E, Bignotti E, Lorusso D, Arenare L, Russo D, De Angelis C, Ardighieri L, Scognamiglio G, Del Sesto M, Tognon G, Califano D, Schettino C, Chiodini P, Perrone F, Mezzanzanica D, Pignata S, Tomassetti A. Biological and clinical impact of membrane EGFR expression in a subgroup of OC patients from the phase IV ovarian cancer MITO-16A/MANGO-OV2A trial. J Exp Clin Cancer Res 2023; 42:83. [PMID: 37041632 PMCID: PMC10088260 DOI: 10.1186/s13046-023-02651-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 03/21/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND Validated prognostic biomarkers for anti-angiogenic therapy using the anti-VEGF antibody Bevacizumab in ovarian cancer (OC) patients are still an unmet clinical need. The EGFR can contribute to cancer-associated biological mechanisms in OC cells including angiogenesis, but its targeting gave disappointing results with less than 10% of OC patients treated with anti-EGFR compounds showing a positive response, likely due to a non adequate selection and stratification of EGFR-expressing OC patients. METHODS EGFR membrane expression was evaluated by immunohistochemistry in a cohort of 310 OC patients from the MITO-16A/MANGO-OV2A trial, designed to identify prognostic biomarkers of survival in patients treated with first line standard chemotherapy plus bevacizumab. Statistical analyses assessed the association between EGFR and clinical prognostic factors and survival outcomes. A single sample Gene Set Enrichment-like and Ingenuity Pathway Analyses were applied to the gene expression profile of 195 OC samples from the same cohort. In an OC in vitro model, biological experiments were performed to assess specific EGFR activation. RESULTS Based on EGFR-membrane expression, three OC subgroups of patients were identified being the subgroup with strong and homogeneous EGFR membrane localization, indicative of possible EGFR out/in signalling activation, an independent negative prognostic factor for overall survival of patients treated with an anti-angiogenic agent. This OC subgroup resulted statistically enriched of tumors of histotypes different than high grade serous lacking angiogenic molecular characteristics. At molecular level, among the EGFR-related molecular traits identified to be activated only in this patients' subgroup the crosstalk between EGFR with other RTKs also emerged. In vitro, we also showed a functional cross-talk between EGFR and AXL RTK; upon AXL silencing, the cells resulted more sensitive to EGFR targeting with erlotinib. CONCLUSIONS Strong and homogeneous cell membrane localization of EGFR, associated with specific transcriptional traits, can be considered a prognostic biomarker in OC patients and could be useful for a better OC patients' stratification and the identification of alternative therapeutic target/s in a personalized therapeutic approach.
Collapse
Affiliation(s)
- Luca Forlani
- Integrated Biology of Rare Tumors, Department of Experimental Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Loris De Cecco
- Integrated Biology of Rare Tumors, Department of Experimental Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Vittorio Simeon
- Department of Mental Health and Public Medicine, Section of Statistics, Università Degli Studi Della Campania Luigi Vanvitelli, 80138, Naples, Italy
| | - Biagio Paolini
- Department of Pathology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Marina Bagnoli
- Integrated Biology of Rare Tumors, Department of Experimental Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Sabrina Chiara Cecere
- Urogynaecological Medical Oncology, Istituto Nazionale Tumori IRCCS, Fondazione G. Pascale, 80131, Naples, Italy
| | - Anna Spina
- Microenvironment Molecular Targets Unit, Istituto Nazionale Tumori IRCCS, Fondazione G. Pascale, 80131, Naples, Italy
| | - Eleonora Citeroni
- Integrated Biology of Rare Tumors, Department of Experimental Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Eliana Bignotti
- Division of Obstetrics and Gynecology, ASST Spedali Civili Di Brescia, Brescia, Italy
- Angelo Nocivelli Institute of Molecular Medicine, ASST Spedali Civili of Brescia- University of Brescia, Brescia, Italy
| | - Domenica Lorusso
- Department of Life Science and Public Health, Catholic University of Sacred Heart Largo Agostino Gemelli, and Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Laura Arenare
- Clinical Trials Unit, Istituto Nazionale Tumori IRCCS, Fondazione G. Pascale, 80131, Naples, Italy
| | - Daniela Russo
- Microenvironment Molecular Targets Unit, Istituto Nazionale Tumori IRCCS, Fondazione G. Pascale, 80131, Naples, Italy
| | - Carmine De Angelis
- Department of Clinical Medicine and Surgery, Federico II University, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Laura Ardighieri
- Department of Pathology, Azienda Socio Sanitaria Territoriale Spedali Civili Di Brescia, Brescia, Italy
| | - Giosuè Scognamiglio
- Pathology Unit, Istituto Nazionale Tumori IRCCS, Fondazione G. Pascale, 80131, Naples, Italy
| | - Michele Del Sesto
- Pathology Unit, Istituto Nazionale Tumori IRCCS, Fondazione G. Pascale, 80131, Naples, Italy
| | - Germana Tognon
- Division of Obstetrics and Gynecology, ASST Spedali Civili Di Brescia, Brescia, Italy
| | - Daniela Califano
- Microenvironment Molecular Targets Unit, Istituto Nazionale Tumori IRCCS, Fondazione G. Pascale, 80131, Naples, Italy
| | - Clorinda Schettino
- Clinical Trials Unit, Istituto Nazionale Tumori IRCCS, Fondazione G. Pascale, 80131, Naples, Italy
| | - Paolo Chiodini
- Department of Mental Health and Public Medicine, Section of Statistics, Università Degli Studi Della Campania Luigi Vanvitelli, 80138, Naples, Italy
| | - Francesco Perrone
- Clinical Trials Unit, Istituto Nazionale Tumori IRCCS, Fondazione G. Pascale, 80131, Naples, Italy
| | - Delia Mezzanzanica
- Integrated Biology of Rare Tumors, Department of Experimental Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.
| | - Sandro Pignata
- Microenvironment Molecular Targets Unit, Istituto Nazionale Tumori IRCCS, Fondazione G. Pascale, 80131, Naples, Italy
| | - Antonella Tomassetti
- Integrated Biology of Rare Tumors, Department of Experimental Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.
| |
Collapse
|
8
|
Huang X, Huang Y, Li P. How do serum lipid levels change and influence progression-free survival in epithelial ovarian cancer patients receiving bevacizumab treatment? Front Oncol 2023; 13:1168996. [PMID: 37064140 PMCID: PMC10090393 DOI: 10.3389/fonc.2023.1168996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 03/10/2023] [Indexed: 03/30/2023] Open
Abstract
BackgroundThis study aimed to investigate how serum lipid levels affect epithelial ovarian cancer (EOC) patients receiving bevacizumab treatment and to develop a model for predicting the patients’ prognosis.MethodsA total of 139 EOC patients receiving bevacizumab treatment were involved in this study. Statistical analysis was used to compare the median and average values of serum lipid level variables between the baseline and final follow-up. Additionally, a method based on machine learning was proposed to identify independent risk factors for estimating progression-free survival (PFS) in EOC patients receiving bevacizumab treatment. A PFS nomogram dividing the patients into low- and high-risk categories was created based on these independent prognostic variables. Finally, Kaplan–Meier curves and log-rank tests were utilized to perform survival analysis.ResultsAmong EOC patients involved in this study, statistical analysis of serum lipid level variables revealed a substantial increase in total cholesterol, triglycerides, apolipoprotein A1, and free fatty acids, and a significant decrease in apolipoprotein B from baseline to final follow-up. Our method identified FIGO stage, combined chemotherapy regimen, activated partial thromboplastin time, globulin, direct bilirubin, free fatty acids, blood urea nitrogen, high-density lipoprotein cholesterol, and triglycerides as risk factors. These risk factors were then included in our nomogram as independent predictors for EOC patients. PFS was substantially different between the low-risk group (total score < 298) and the high-risk group (total score ≥ 298) according to Kaplan–Meier curves (P < 0.05).ConclusionSerum lipid levels changed variously in EOC patients receiving bevacizumab treatment. A prediction model for PFS of EOC patients receiving bevacizumab treatment was constructed, and it can be beneficial in determining the prognosis, selecting a treatment plan, and monitoring these patients’ long-term care.
Collapse
Affiliation(s)
- Xiaoyu Huang
- Department of Chinese Integrative Medicine Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- First Clinical Medical College, Anhui Medical University, Hefei, China
| | - Yong Huang
- Department of Medical Oncology, The Second People’s Hospital of Hefei, Hefei, China
| | - Ping Li
- Department of Chinese Integrative Medicine Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- *Correspondence: Ping Li,
| |
Collapse
|
9
|
Micha JP, Rettenmaier MA, Bohart RD, Goldstein BH. A phase II, open-label, non-randomized, prospective study assessing paclitaxel, carboplatin and metformin in the treatment of advanced stage ovarian carcinoma. J Gynecol Oncol 2023; 34:e15. [PMID: 36509462 PMCID: PMC9995875 DOI: 10.3802/jgo.2023.34.e15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 08/02/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The purpose of this study was to assess the efficacy and tolerability of a paclitaxel, carboplatin and metformin regimen in the first-line treatment of advanced-stage ovarian, fallopian tube, and primary peritoneal carcinoma. METHODS Eligible subjects underwent surgery and 6 cycles of neoadjuvant or adjuvant dose-dense intravenous paclitaxel (80 mg/m²), carboplatin (area under the curve 5 or 6 on Day 1), and oral metformin (850 mg daily). Study participants who completed their primary therapy and attained a clinically defined complete or partial response (PR) were treated with a planned 12 cycles of paclitaxel (135 mg/m² every 21 days) and metformin (850 mg twice daily) maintenance therapy. RESULTS Thirty subjects received a median of 6 cycles (range, 5-6) of primary induction chemotherapy and were eligible for response evaluation; twenty-three patients exhibited a complete response, while 3 study patients obtained a PR (an overall response rate of 86.7%). Grade 3-4 hematological toxicity included neutropenia (43.3%), thrombocytopenia (10%) and anemia (36.7%). There was no incidence of grade 3-4 neuropathy although 15 patients (50%) developed grade ≤2 neurotoxicity. Additionally, we observed grade ≤2 diarrhea in 20 (66.7%) subjects. The median progression-free survival was 21 months (range, 3-52) and overall median survival was 35 months (range, 15-61). The subjects also received an aggregate 103 cycles (median, 12; range, 6-12) of maintenance chemotherapy. CONCLUSION The study results suggest that the combination of paclitaxel, carboplatin and metformin is associated with moderate efficacy and a reasonable toxicity profile.
Collapse
Affiliation(s)
- John P Micha
- Women's Cancer Research Foundation, Laguna Beach, CA, USA
| | | | | | | |
Collapse
|
10
|
Fischetti M, Di Donato V, Palaia I, Perniola G, Tomao F, Perrone C, Giancotti A, Di Mascio D, Monti M, Muzii L, Benedetti Panici P, Bogani G. Advances in small molecule maintenance therapies for high-grade serous ovarian cancer. Expert Opin Pharmacother 2023; 24:65-72. [PMID: 36458890 DOI: 10.1080/14656566.2022.2154144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
INTRODUCTION Ovarian cancer is one of the most lethal gynecological tumors with a lack of effective treatment modalities especially in advanced/recurrent disease. Nevertheless, recently, new small molecules have emerged as an effective approach for the management of ovarian cancer patients, especially in the maintenance setting. AREAS COVERED This review summarizes the role of small molecules used in the management of high-grade serous ovarian cancer. The authors performed a critical review of current evidence and ongoing studies. Of note, tyrosine kinase inhibitors (TKIs) and poly(ADP-ribose) polymerase (PARP) inhibitors are the most intriguing medications in this setting. EXPERT OPINION Protein-targeted therapies against tumor tissues have progressed significantly in the last years due to an enhanced knowledge of the biological and molecular processes of carcinogenesis. Treatment with small molecules allows the targeting of specific proteins involved in cancer biology. TKIs seem promising but further data are necessary to assess the pros and cons of adopting this treatment modality. PARP inhibitors represent the new standard of care for ovarian cancer patients harboring either a BRCA mutation or with homologous recombination deficiency (HRD). Interestingly, the accumulation of data has highlighted that PARP inhibitors provide benefits even in patients with HR proficient tumors.
Collapse
Affiliation(s)
- Margherita Fischetti
- Department of Maternal and Child Health and Urological Sciences, Sapienza University, Umberto I Hospital, Rome, Italy
| | - Violante Di Donato
- Department of Maternal and Child Health and Urological Sciences, Sapienza University, Umberto I Hospital, Rome, Italy
| | - Innocenza Palaia
- Department of Maternal and Child Health and Urological Sciences, Sapienza University, Umberto I Hospital, Rome, Italy
| | - Giorgia Perniola
- Department of Maternal and Child Health and Urological Sciences, Sapienza University, Umberto I Hospital, Rome, Italy
| | - Federica Tomao
- Department of Maternal and Child Health and Urological Sciences, Sapienza University, Umberto I Hospital, Rome, Italy
| | - Chiara Perrone
- Department of Maternal and Child Health and Urological Sciences, Sapienza University, Umberto I Hospital, Rome, Italy
| | - Antonella Giancotti
- Department of Maternal and Child Health and Urological Sciences, Sapienza University, Umberto I Hospital, Rome, Italy
| | - Daniele Di Mascio
- Department of Maternal and Child Health and Urological Sciences, Sapienza University, Umberto I Hospital, Rome, Italy
| | - Marco Monti
- Department of Maternal and Child Health and Urological Sciences, Sapienza University, Umberto I Hospital, Rome, Italy
| | - Ludovico Muzii
- Department of Maternal and Child Health and Urological Sciences, Sapienza University, Umberto I Hospital, Rome, Italy
| | - Pierluigi Benedetti Panici
- Department of Maternal and Child Health and Urological Sciences, Sapienza University, Umberto I Hospital, Rome, Italy
| | - Giorgio Bogani
- Department of Maternal and Child Health and Urological Sciences, Sapienza University, Umberto I Hospital, Rome, Italy
| |
Collapse
|
11
|
Capoluongo ED, Pellegrino B, Arenare L, Califano D, Scambia G, Beltrame L, Serra V, Scaglione GL, Spina A, Cecere SC, De Cecio R, Normanno N, Colombo N, Lorusso D, Russo D, Nardelli C, D'Incalci M, Llop-Guevara A, Pisano C, Baldassarre G, Mezzanzanica D, Artioli G, Setaro M, Tasca G, Roma C, Campanini N, Cinieri S, Sergi A, Musolino A, Perrone F, Chiodini P, Marchini S, Pignata S. Alternative academic approaches for testing homologous recombination deficiency in ovarian cancer in the MITO16A/MaNGO-OV2 trial. ESMO Open 2022; 7:100585. [PMID: 36156447 PMCID: PMC9512829 DOI: 10.1016/j.esmoop.2022.100585] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/28/2022] [Accepted: 08/16/2022] [Indexed: 11/26/2022] Open
Abstract
Background The detection of homologous recombination deficiency (HRD) can identify patients who are more responsive to platinum and poly ADP ribose polymerase inhibitors (PARPi). MyChoice CDx (Myriad) is the most used HRD test in ovarian cancer (OC). However, some limitations of commercial tests exist, because of the high rate of inconclusive results, costs, and the impossibility of evaluating functional resistance mechanisms. Patients and methods Two academic genomic tests and a functional assay, the RAD51 foci, were evaluated to detect HRD. One hundred patients with high-grade OC enrolled in the MITO16A/MaNGO-OV2 trial and treated with first-line therapy with carboplatin, paclitaxel, and bevacizumab were analyzed. Results The failure rate of the two genomic assays was 2%. The sensitivity in detecting HRD when compared with Myriad was 98.1% and 90.6%, respectively. The agreement rate with Myriad was 0.92 and 0.87, with a Cohen’s κ coefficient corresponding to 0.84 and 0.74, respectively. For the RAD51 foci assay, the failure rate was 30%. When the test was successful, discordant results for deficient and proficient tumors were observed, and additional HRD patients were identified compared to Myriad; sensitivity was 82.9%, agreement rate was 0.65, and Cohen’s κ coefficient was 0.18. The HRD detected by genomic assays and residual tumor at primary surgery and stage was correlated with progression-free survival at multivariate analysis. Conclusions Results suggest the feasibility of academic tests for assessing HRD status that show robust concordance with Myriad and correlation with clinical outcome. The contribution of the functional information related to the RAD51 foci test to the genomic data needs further investigation. Deficiency in homologous recombination repair of DNA generates genomic instability and permanent genomic changes. HRD status is fundamental for identifying OC patients suitable for platinum and PARPi treatment. HRD testing is considered a topic with urgent need for improvement, going beyond those available commercially. Within this study, two academic genomic tests and a functional assay, the RAD51 foci, were evaluated to detect HRD. Our tests compare favorably with the reference Myriad assay and correlate with the outcome of high-grade OC patients.
Collapse
Affiliation(s)
- E D Capoluongo
- Department of Molecular Medicine and Medical Biotechnology, Università degli Studi di Napoli Federico II, Naples; Azienda Ospedaliera per L'Emergenza, Cannizzaro, Catania
| | - B Pellegrino
- Department of Medicine and Surgery, University of Parma, Parma; Medical Oncology and Breast Unit, University Hospital of Parma, Parma; Gruppo Oncologico Italiano di Ricerca Clinica (GOIRC), Parma
| | - L Arenare
- Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Naples
| | - D Califano
- Microenvironment Molecular Targets Unit, Istituto Nazionale Tumori IRCCS - Fondazione G. Pascale, Naples
| | - G Scambia
- Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome; Department of Life Science and Public Health, Catholic University of Sacred Heart Largo Agostino Gemelli, Rome
| | - L Beltrame
- Molecular Pharmacology laboratory., Group of Cancer Pharmacology IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - V Serra
- Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - G L Scaglione
- Advanced Biotechnology, Università Federico II-CEINGE, Naples; IDI-IRCSS, Rome
| | - A Spina
- Microenvironment Molecular Targets Unit, Istituto Nazionale Tumori IRCCS - Fondazione G. Pascale, Naples
| | - S C Cecere
- Uro-Gynecologic Oncology Unit, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples
| | - R De Cecio
- Pathology Unit, Istituto Nazionale Tumori 'Fondazione Giovanni Pascale', IRCCS, Napoli
| | - N Normanno
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori 'Fondazione Giovanni Pascale', IRCCS, Napoli
| | - N Colombo
- University of Milan-Bicocca and European Institute of Oncology IRCCS, Milan
| | - D Lorusso
- Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome; Department of Life Science and Public Health, Catholic University of Sacred Heart Largo Agostino Gemelli, Rome
| | - D Russo
- Microenvironment Molecular Targets Unit, Istituto Nazionale Tumori IRCCS - Fondazione G. Pascale, Naples
| | - C Nardelli
- Department of Molecular Medicine and Medical Biotechnology, Università degli Studi di Napoli Federico II, Naples; Advanced Biotechnology, Università Federico II-CEINGE, Naples
| | - M D'Incalci
- Molecular Pharmacology laboratory., Group of Cancer Pharmacology IRCCS Humanitas Research Hospital, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan
| | | | - C Pisano
- Uro-Gynecologic Oncology Unit, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples
| | - G Baldassarre
- Molecular Oncology Unit, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, National Cancer Institute, Aviano
| | - D Mezzanzanica
- Molecular Therapies Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - G Artioli
- Oncologia Medica, ULSS2 Marca Trevigiana, Treviso
| | - M Setaro
- Advanced Biotechnology, Università Federico II-CEINGE, Naples
| | - G Tasca
- Division of Oncology 2, Istituto Oncologico Veneto IRCCS, Padova
| | - C Roma
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori 'Fondazione Giovanni Pascale', IRCCS, Napoli
| | - N Campanini
- Unit of Pathological Anatomy, Department of Medicine and Surgery, University Hospital of Parma, Parma
| | - S Cinieri
- Oncologia Medica, Ospedale Senatore Antonio Perrino, Brindisi
| | - A Sergi
- Molecular Pharmacology laboratory., Group of Cancer Pharmacology IRCCS Humanitas Research Hospital, Rozzano, Italy; Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan
| | - A Musolino
- Department of Medicine and Surgery, University of Parma, Parma; Medical Oncology and Breast Unit, University Hospital of Parma, Parma; Gruppo Oncologico Italiano di Ricerca Clinica (GOIRC), Parma
| | - F Perrone
- Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Naples
| | - P Chiodini
- Department of Mental Health and Public Medicine, Section of Statistics, Università degli Studi della Campania Luigi Vanvitelli, Napoli, Italy
| | - S Marchini
- Molecular Pharmacology laboratory., Group of Cancer Pharmacology IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - S Pignata
- Uro-Gynecologic Oncology Unit, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples.
| |
Collapse
|
12
|
Fabbi M, Costa D, Russo D, Arenare L, Gaggero G, Signoriello S, Scambia G, Pisano C, Colombo N, Losito NS, Filaci G, Spina A, Califano D, Scognamiglio G, Gadducci A, Mezzanzanica D, Bagnoli M, Ferrini S, Canzonieri V, Chiodini P, Perrone F, Pignata S. Analysis of A Disintegrin and Metalloprotease 17 (ADAM17) Expression as a Prognostic Marker in Ovarian Cancer Patients Undergoing First-Line Treatment Plus Bevacizumab. Diagnostics (Basel) 2022; 12:diagnostics12092118. [PMID: 36140519 PMCID: PMC9498026 DOI: 10.3390/diagnostics12092118] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/20/2022] [Accepted: 08/29/2022] [Indexed: 11/16/2022] Open
Abstract
To find prognostic factors for advanced ovarian cancer patients undergoing first-line therapy with carboplatin, paclitaxel and bevacizumab, we investigated the expression of a disintegrin and metalloprotease 17 (ADAM17) in cancer tissues. ADAM17 has been involved in ovarian cancer development, progression and cell resistance to cisplatin. Tissue microarrays from 309 ovarian cancer patients enrolled in the MITO16A/MANGO-OV2 clinical trial were analyzed by immunohistochemistry for ADAM17 protein expression. Intensity and extent of staining were combined into a semi-quantitative visual grading system (H score) which was related to clinicopathological characteristics of cases and the clinical outcome of patients by univariate and multivariate Cox regression models. ADAM17 immunostaining was detected in most samples, mainly localized in the tumor cells, with variable intensity across the cohort. Kaplan–Meier survival curves, generated according to the best cut-off value for the ADAM17 H score, showed that high ADAM17 expression was associated with worse prognosis for PFS and OS. However, after the application of a shrinkage procedure to adjust for overfitting hazard ratio estimates, the ADAM17 value as prognostic factor was lost. As subgroup analysis suggested that ADAM17 expression could be prognostically relevant in cases with no residual disease at baseline, further studies in this patient category may be worth planning.
Collapse
Affiliation(s)
- Marina Fabbi
- UO Bioterapie, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Correspondence:
| | - Delfina Costa
- UO Oncologia Molecolare e Angiogenesi, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Daniela Russo
- Microenvironment Molecular Targets Unit, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, 80131 Naples, Italy
| | - Laura Arenare
- Clinical Trials Unit, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, 80131 Naples, Italy
| | - Gabriele Gaggero
- UO Anatomia Patologica Ospedaliera, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Simona Signoriello
- Department of Mental Health and Public Medicine, Section of Statistics, Università degli Studi della Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Giovanni Scambia
- Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Life Science and Public Health, Catholic University of Sacred Heart, Largo Agostino Gemelli, 00168 Rome, Italy
| | - Carmela Pisano
- Urogynecological Medical Oncology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, 80131 Naples, Italy
| | - Nicoletta Colombo
- European Institute of Oncology IRCCS, University of Milan-Bicocca, 20126 Milan, Italy
| | - Nunzia Simona Losito
- Pathology Unit, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, 80131 Naples, Italy
| | - Gilberto Filaci
- UO Bioterapie, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Department of Internal Medicine, University of Genoa, 16132 Genoa, Italy
| | - Anna Spina
- Microenvironment Molecular Targets Unit, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, 80131 Naples, Italy
| | - Daniela Califano
- Microenvironment Molecular Targets Unit, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, 80131 Naples, Italy
| | - Giosuè Scognamiglio
- Pathology Unit, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, 80131 Naples, Italy
| | - Angiolo Gadducci
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, 56127 Pisa, Italy
| | - Delia Mezzanzanica
- Molecular Therapies Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Marina Bagnoli
- Molecular Therapies Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Silvano Ferrini
- UO Bioterapie, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Vincenzo Canzonieri
- Pathology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34127 Trieste, Italy
| | - Paolo Chiodini
- Department of Mental Health and Public Medicine, Section of Statistics, Università degli Studi della Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Francesco Perrone
- Clinical Trials Unit, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, 80131 Naples, Italy
| | - Sandro Pignata
- Urogynecological Medical Oncology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, 80131 Naples, Italy
| |
Collapse
|
13
|
Elebiyo TC, Rotimi D, Evbuomwan IO, Maimako RF, Iyobhebhe M, Ojo OA, Oluba OM, Adeyemi OS. Reassessing vascular endothelial growth factor (VEGF) in anti-angiogenic cancer therapy. Cancer Treat Res Commun 2022; 32:100620. [PMID: 35964475 DOI: 10.1016/j.ctarc.2022.100620] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 06/02/2022] [Accepted: 08/05/2022] [Indexed: 05/23/2023]
Abstract
Vascularization is fundamental to the growth and spread of tumor cells to distant sites. As a consequence, angiogenesis, the sprouting of new blood vessels from existing ones, is a characteristic trait of cancer. In 1971, Judah Folkman postulated that tumour growth is angiogenesis dependent and that by cutting off blood supply, a neoplastic lesion could be potentially starved into remission. Decades of research have been devoted to understanding the role that vascular endothelial growth factor (VEGF) plays in tumor angiogenesis, and it has been identified as a significant pro-angiogenic factor that is frequently overexpressed within a tumor mass. Today, anti-VEGF drugs such as Sunitinib, Sorafenib, Axitinib, Tanibirumab, and Ramucirumab have been approved for the treatment of advanced and metastatic cancers. However, anti-angiogenic therapy has turned out to be more complex than originally thought. The failure of this therapeutic option calls for a reevaluation of VEGF as the major target in anti-angiogenic cancer therapy. The call for reassessment is based on two rationales: first, tumour blood vessels are abnormal, disorganized, and leaky; this not only prevents optimal drug delivery but it also promotes hypoxia and metastasis; secondly, tumour growth or regrowth might be blood vessel dependent and not angiogenesis dependent as tumour cells can acquire blood vessels via non-angiogenic mechanisms. Therefore, a critical assessment of VEGF, VEGFRs, and their inhibitors could glean newer options such as repurposing anti-VEGF drugs as vascular normalizing agents to enhance drug delivery of immune checkpoint inhibitors.
Collapse
Affiliation(s)
| | - Damilare Rotimi
- Department of Biochemistry, Landmark University, Omu-Aran, Nigeria
| | | | | | | | - Oluwafemi Adeleke Ojo
- Phytomedicine, Molecular Toxicology, and Computational Biochemistry Research Laboratory (PMTCB-RL), Department of Biochemistry, Bowen University, Iwo, 232101, Nigeria..
| | | | | |
Collapse
|
14
|
Bella Á, Arrizabalaga L, Di Trani CA, Fernández-Sendin M, Teijeira A, Russo-Cabrera JS, Melero I, Berraondo P, Aranda F. Omentum: Friend or foe in ovarian cancer immunotherapy? INTERNATIONAL REVIEW OF CELL AND MOLECULAR BIOLOGY 2022; 371:117-131. [PMID: 35964998 DOI: 10.1016/bs.ircmb.2022.04.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Ovarian cancer often spreads out of the ovary before a patient is diagnosed and is the deadliest gynecological malignancy. The aggressiveness of ovarian cancer is determined by the progression in the form of peritoneal carcinomatosis, a stage with a poor prognosis and an untreatable condition in most patients. One of the first tumor nests or the origin of metastasis in the peritoneal cavity is the omentum. The omentum contains immune aggregates, called milky spots, embedded in adipose tissue, which support tumor growth by various mechanisms, including immunosuppressive immune cells and metabolic functions. In this sense, the abundance of blood vessels, omental resident macrophages, and chemokines, among other factors, are known to promote invasiveness, proliferation and resistance to cancer therapies. As a result, surgical practice employed in advanced-stage ovarian cancer almost constantly includes omentectomy. Paradoxically, the omentum is considered the "abdominal policeman" that contributes to peritoneal immunity by capturing antigens and pathogens from the peritoneal cavity and promoting effective immune responses against microbes. Why immunosurveillance against the metastatic tumor does not take place in the omentum? Could omental immune responses be activated with immunotherapeutic interventions? The omentum has largely been ignored in cancer immunology and immunotherapy, and the potential translational implications of this in ovarian cancer are still unclear. Here, we focus on the dual role of the omentum in ovarian cancer: its role in antitumor immune responses versus its activities fostering cancer progression.
Collapse
Affiliation(s)
- Ángela Bella
- Program of Immunology and Immunotherapy, Cima Universidad de Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.
| | - Leire Arrizabalaga
- Program of Immunology and Immunotherapy, Cima Universidad de Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Claudia Augusta Di Trani
- Program of Immunology and Immunotherapy, Cima Universidad de Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Myriam Fernández-Sendin
- Program of Immunology and Immunotherapy, Cima Universidad de Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Alvaro Teijeira
- Program of Immunology and Immunotherapy, Cima Universidad de Navarra, Pamplona, Spain; Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Joan Salvador Russo-Cabrera
- Program of Immunology and Immunotherapy, Cima Universidad de Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Ignacio Melero
- Program of Immunology and Immunotherapy, Cima Universidad de Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain; Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain; Translational Oncology Group, Program in Solid Tumors, Cima Universidad de Navarra, Pamplona, Spain; Department of Immunology and Immunotherapy, Clinica Universidad de Navarra, Pamplona, Spain
| | - Pedro Berraondo
- Program of Immunology and Immunotherapy, Cima Universidad de Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain; Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Fernando Aranda
- Program of Immunology and Immunotherapy, Cima Universidad de Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.
| |
Collapse
|
15
|
D’Alterio C, Spina A, Arenare L, Chiodini P, Napolitano M, Galdiero F, Portella L, Simeon V, Signoriello S, Raspagliesi F, Lorusso D, Pisano C, Colombo N, Zannoni GF, Losito NS, De Cecio R, Scognamiglio G, Califano D, Russo D, Tuninetti V, Piccirillo MC, Gargiulo P, Perrone F, Pignata S, Scala S. Biological Role of Tumor/Stromal CXCR4-CXCL12-CXCR7 in MITO16A/MaNGO-OV2 Advanced Ovarian Cancer Patients. Cancers (Basel) 2022; 14:cancers14071849. [PMID: 35406620 PMCID: PMC8997727 DOI: 10.3390/cancers14071849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/07/2022] [Accepted: 04/01/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary Despite rapid progress in the research on epithelial ovarian cancer (EOC), it is usually diagnosed during the advanced stage with only 30% of patients surviving longer than 5 years. This is the first study in which the whole CXCR4-CXCL12-CXCR7 axis was systematically evaluated in tumor and stromal cells, through rigorous statistical methods in a prospective clinical trial. CXCL12 expression in cancer cells is associated with worse progression-free survival in stage III EOC patients, and deserves further attention as a potential prognostic and therapeutic target. Abstract This study investigated the prognostic role of the CXCR4-CXCL12-CXCR7 axis in advanced epithelial ovarian cancer (EOC) patients receiving first-line treatment within the MITO16A/MaNGO-OV2 phase-IV trial. CXCR4-CXCL12-CXCR7 expression was evaluated in the epithelial and stromal component of 308 EOC IHC-stained tumor samples. The statistical analysis focused on biomarkers’ expression, their association with other variables and prognostic value. Zero-inflated tests, shrinkage, bootstrap procedures, and multivariable models were applied. The majority of EOC (75.0%) expressed CXCR4 and CXCR7, 56.5% expressed the entire CXCR4-CXCL12-CXCR7 axis, while only 4.6% were negative for CXCL12 and its cognate receptors, in regard to the epithelial component. Stromal CXCL12 and CXCR7, expressed in 11.2% and 65.5%, respectively, were associated with the FIGO stage. High CXCL12 in epithelial cancer cells was associated with shorter progression-free and overall survival. However, after adjusting for overfitting due to best cut-off multiplicity testing, the significance was lost. This is a wide-ranging, prospective study in which CXCR4-CXCL12-CXCR7 were systematically evaluated in epithelial and stromal components, in selected stage III-IV EOC. Although CXCL12 was not prognostic, epithelial expression identified high-risk FIGO stage III patients for PFS. These data suggest that it might be worth studying the CXCL12 axis as a therapeutic target to improve treatment efficacy in EOC patients.
Collapse
Affiliation(s)
- Crescenzo D’Alterio
- Microenvironment Molecular Targets Unit, Istituto Nazionale Tumori IRCCS—Fondazione G. Pascale, 80131 Napoli, Italy; (C.D.); (A.S.); (M.N.); (F.G.); (L.P.); (D.C.); (D.R.)
| | - Anna Spina
- Microenvironment Molecular Targets Unit, Istituto Nazionale Tumori IRCCS—Fondazione G. Pascale, 80131 Napoli, Italy; (C.D.); (A.S.); (M.N.); (F.G.); (L.P.); (D.C.); (D.R.)
| | - Laura Arenare
- Clinical Trials Unit, Istituto Nazionale Tumori IRCCS—Fondazione G. Pascale, 80131 Napoli, Italy; (L.A.); (M.C.P.); (P.G.); (F.P.)
| | - Paolo Chiodini
- Section of Statistics, Department of Mental Health and Public Medicine, Università degli Studi della Campania Luigi Vanvitelli, 80138 Napoli, Italy; (P.C.); (V.S.); (S.S.)
| | - Maria Napolitano
- Microenvironment Molecular Targets Unit, Istituto Nazionale Tumori IRCCS—Fondazione G. Pascale, 80131 Napoli, Italy; (C.D.); (A.S.); (M.N.); (F.G.); (L.P.); (D.C.); (D.R.)
| | - Francesca Galdiero
- Microenvironment Molecular Targets Unit, Istituto Nazionale Tumori IRCCS—Fondazione G. Pascale, 80131 Napoli, Italy; (C.D.); (A.S.); (M.N.); (F.G.); (L.P.); (D.C.); (D.R.)
| | - Luigi Portella
- Microenvironment Molecular Targets Unit, Istituto Nazionale Tumori IRCCS—Fondazione G. Pascale, 80131 Napoli, Italy; (C.D.); (A.S.); (M.N.); (F.G.); (L.P.); (D.C.); (D.R.)
| | - Vittorio Simeon
- Section of Statistics, Department of Mental Health and Public Medicine, Università degli Studi della Campania Luigi Vanvitelli, 80138 Napoli, Italy; (P.C.); (V.S.); (S.S.)
| | - Simona Signoriello
- Section of Statistics, Department of Mental Health and Public Medicine, Università degli Studi della Campania Luigi Vanvitelli, 80138 Napoli, Italy; (P.C.); (V.S.); (S.S.)
| | - Francesco Raspagliesi
- Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy;
| | - Domenica Lorusso
- Division of Gynecologic Oncology, Department of Women and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
- Department of Life Science and Public Health, Catholic University of Sacred Heart, Largo Agostino Gemelli, 00168 Rome, Italy
| | - Carmela Pisano
- Urogynaecological Medical Oncology, Istituto Nazionale Tumori IRCCS—Fondazione G. Pascale, 80131 Napoli, Italy; (C.P.); (S.P.)
| | - Nicoletta Colombo
- Gynecologic Cancer Program, Università degli Studi di Milano-Bicocca, 20126 Milan, Italy;
| | - Gian Franco Zannoni
- Gynecopathology and Breast Pathology Unit, Department of Woman, Child and Public Health Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
- Pathological Anatomy Institute, Catholic University of Sacred Hearth, 00168 Rome, Italy
| | - Nunzia Simona Losito
- Pathology Unit, Istituto Nazionale Tumori IRCCS—Fondazione G. Pascale, 80131 Napoli, Italy; (N.S.L.); (R.D.C.); (G.S.)
| | - Rossella De Cecio
- Pathology Unit, Istituto Nazionale Tumori IRCCS—Fondazione G. Pascale, 80131 Napoli, Italy; (N.S.L.); (R.D.C.); (G.S.)
| | - Giosuè Scognamiglio
- Pathology Unit, Istituto Nazionale Tumori IRCCS—Fondazione G. Pascale, 80131 Napoli, Italy; (N.S.L.); (R.D.C.); (G.S.)
| | - Daniela Califano
- Microenvironment Molecular Targets Unit, Istituto Nazionale Tumori IRCCS—Fondazione G. Pascale, 80131 Napoli, Italy; (C.D.); (A.S.); (M.N.); (F.G.); (L.P.); (D.C.); (D.R.)
| | - Daniela Russo
- Microenvironment Molecular Targets Unit, Istituto Nazionale Tumori IRCCS—Fondazione G. Pascale, 80131 Napoli, Italy; (C.D.); (A.S.); (M.N.); (F.G.); (L.P.); (D.C.); (D.R.)
| | | | - Maria Carmela Piccirillo
- Clinical Trials Unit, Istituto Nazionale Tumori IRCCS—Fondazione G. Pascale, 80131 Napoli, Italy; (L.A.); (M.C.P.); (P.G.); (F.P.)
| | - Piera Gargiulo
- Clinical Trials Unit, Istituto Nazionale Tumori IRCCS—Fondazione G. Pascale, 80131 Napoli, Italy; (L.A.); (M.C.P.); (P.G.); (F.P.)
| | - Francesco Perrone
- Clinical Trials Unit, Istituto Nazionale Tumori IRCCS—Fondazione G. Pascale, 80131 Napoli, Italy; (L.A.); (M.C.P.); (P.G.); (F.P.)
| | - Sandro Pignata
- Urogynaecological Medical Oncology, Istituto Nazionale Tumori IRCCS—Fondazione G. Pascale, 80131 Napoli, Italy; (C.P.); (S.P.)
| | - Stefania Scala
- Microenvironment Molecular Targets Unit, Istituto Nazionale Tumori IRCCS—Fondazione G. Pascale, 80131 Napoli, Italy; (C.D.); (A.S.); (M.N.); (F.G.); (L.P.); (D.C.); (D.R.)
- Correspondence: ; Tel.: +39-081-590-3820
| |
Collapse
|
16
|
Califano D, Gallo D, Rampioni Vinciguerra GL, De Cecio R, Arenare L, Signoriello S, Russo D, Ferrandina G, Citron F, Losito NS, Gargiulo P, Simeon V, Scambia G, Cecere SC, Montella M, Colombo N, Tognon G, Bignotti E, Zannoni GF, Canzonieri V, Ciucci A, Spina A, Scognamiglio G, Del Sesto M, Schettino C, Piccirillo MC, Perrone F, Chiodini P, Pignata S, Baldassarre G. Evaluation of Angiogenesis-Related Genes as Prognostic Biomarkers of Bevacizumab Treated Ovarian Cancer Patients: Results from the Phase IV MITO16A/ManGO OV-2 Translational Study. Cancers (Basel) 2021; 13:cancers13205152. [PMID: 34680301 PMCID: PMC8533892 DOI: 10.3390/cancers13205152] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 01/07/2023] Open
Abstract
Simple Summary The possibility to identify, with appropriate biomarkers, patients that might mostly benefit from any given treatment is the basis of personalized oncology. Cancer biomarkers should be properly identified and validated on a large number of patients possibly enrolled in dedicated clinical trials. Here, we report the first molecular results of the MITO16A-ManGo-OV2 phase IV trial that was specifically designed to identify prognostic biomarkers of survival in epithelial ovarian cancer patients treated in first line with carboplatin-paclitaxel plus Bevacizumab (NCT01706120), a treatment for which validated predictive or prognostic biomarkers are still lacking. With this work we propose not only novel possible biomarkers for Bevacizumab-treated patients but also a way through which they can be properly collected, analyzed and statistically evaluated in the frame of large multicenter clinical trials. Abstract Background. Epithelial ovarian cancer (EOC) is a rare, highly lethal disease. In a subset of high grade EOC patients, maintenance therapy with the antiangiogenic drug Bevacizumab (BEV) is a valuable option. To date, no validated predictive or prognostic biomarkers exist for selecting EOC patients that might benefit from BEV treatment. Methods. Immunohistochemistry and RT-qPCR evaluated the expression of seven angiogenesis-related proteins and of a twelve microRNAs angio-signature in EOC patients, treated in first line with chemotherapy plus BEV (MITO16A/ManGO OV-2 phase IV trial). Centralized statistical analyses assessed the associations between each biomarker, clinical prognostic factors and survival outcomes. Results. High miR-484 expression was associated with longer progression-free and overall survival. Notably, the combined expression of miR-484 and its target VEGFB identified a subset of patients that might mostly benefit from BEV treatment. No other significant correlations were found between the other analyzed biomarkers and patients’ survival. The application of a shrinkage procedure to adjust for over-fitting hazard ratio estimates reduced the association significance. Conclusions. The analysis of angiogenesis related biomarkers in EOC patients homogenously treated with BEV in first line provides novel insight in their prognostic value and suggests that some of them might merit to be tested as predictive markers of drug activity in dedicated randomized trials.
Collapse
Affiliation(s)
- Daniela Califano
- Microenvironment Molecular Targets Unit, Istituto Nazionale Tumori IRCCS, Fondazione G. Pascale, 80131 Napoli, Italy; (D.C.); (D.R.); (A.S.)
| | - Daniela Gallo
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy; (D.G.); (G.F.); (G.S.); (G.F.Z.); (A.C.)
| | - Gian Luca Rampioni Vinciguerra
- Molecular Oncology Unit, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, National Cancer Institute, 33081 Aviano, Italy; (G.L.R.V.); (F.C.)
| | - Rossella De Cecio
- Pathology Unit, Istituto Nazionale Tumori IRCCS, Fondazione G. Pascale, 80131 Napoli, Italy; (R.D.C.); (N.S.L.); (G.S.); (M.D.S.)
| | - Laura Arenare
- Clinical Trials Unit, Istituto Nazionale Tumori IRCCS, Fondazione G. Pascale, 80131 Napoli, Italy; (L.A.); (P.G.); (C.S.); (M.C.P.); (F.P.)
| | - Simona Signoriello
- Department of Mental Health and Public Medicine, Section of Statistics, Università degli Studi della Campania Luigi Vanvitelli, 80138 Napoli, Italy; (S.S.); (V.S.); (P.C.)
| | - Daniela Russo
- Microenvironment Molecular Targets Unit, Istituto Nazionale Tumori IRCCS, Fondazione G. Pascale, 80131 Napoli, Italy; (D.C.); (D.R.); (A.S.)
| | - Gabriella Ferrandina
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy; (D.G.); (G.F.); (G.S.); (G.F.Z.); (A.C.)
- Istituto di Ginecologia e Ostetricia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Francesca Citron
- Molecular Oncology Unit, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, National Cancer Institute, 33081 Aviano, Italy; (G.L.R.V.); (F.C.)
| | - Nunzia Simona Losito
- Pathology Unit, Istituto Nazionale Tumori IRCCS, Fondazione G. Pascale, 80131 Napoli, Italy; (R.D.C.); (N.S.L.); (G.S.); (M.D.S.)
| | - Piera Gargiulo
- Clinical Trials Unit, Istituto Nazionale Tumori IRCCS, Fondazione G. Pascale, 80131 Napoli, Italy; (L.A.); (P.G.); (C.S.); (M.C.P.); (F.P.)
| | - Vittorio Simeon
- Department of Mental Health and Public Medicine, Section of Statistics, Università degli Studi della Campania Luigi Vanvitelli, 80138 Napoli, Italy; (S.S.); (V.S.); (P.C.)
| | - Giovanni Scambia
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy; (D.G.); (G.F.); (G.S.); (G.F.Z.); (A.C.)
- Istituto di Ginecologia e Ostetricia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Sabrina Chiara Cecere
- Urogynaecological Medical Oncology, Istituto Nazionale Tumori IRCCS, Fondazione G. Pascale, 80131 Napoli, Italy; (S.C.C.); (S.P.)
| | - Marco Montella
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy;
| | - Nicoletta Colombo
- Gynecologic Cancer Program, Università degli Studi di Milano, 20126 Bicocca, Italy;
| | - Germana Tognon
- Division of Obstetrics and Gynecology, ASST Spedali Civili di Brescia, 25123 Brescia, Italy; (G.T.); (E.B.)
| | - Eliana Bignotti
- Division of Obstetrics and Gynecology, ASST Spedali Civili di Brescia, 25123 Brescia, Italy; (G.T.); (E.B.)
| | - Gian Franco Zannoni
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy; (D.G.); (G.F.); (G.S.); (G.F.Z.); (A.C.)
| | - Vincenzo Canzonieri
- Pathology Unit, IRCCS CRO Aviano, National Cancer Institute, 33081 Aviano, Italy;
| | - Alessandra Ciucci
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy; (D.G.); (G.F.); (G.S.); (G.F.Z.); (A.C.)
| | - Anna Spina
- Microenvironment Molecular Targets Unit, Istituto Nazionale Tumori IRCCS, Fondazione G. Pascale, 80131 Napoli, Italy; (D.C.); (D.R.); (A.S.)
| | - Giosuè Scognamiglio
- Pathology Unit, Istituto Nazionale Tumori IRCCS, Fondazione G. Pascale, 80131 Napoli, Italy; (R.D.C.); (N.S.L.); (G.S.); (M.D.S.)
| | - Michele Del Sesto
- Pathology Unit, Istituto Nazionale Tumori IRCCS, Fondazione G. Pascale, 80131 Napoli, Italy; (R.D.C.); (N.S.L.); (G.S.); (M.D.S.)
| | - Clorinda Schettino
- Clinical Trials Unit, Istituto Nazionale Tumori IRCCS, Fondazione G. Pascale, 80131 Napoli, Italy; (L.A.); (P.G.); (C.S.); (M.C.P.); (F.P.)
| | - Maria Carmela Piccirillo
- Clinical Trials Unit, Istituto Nazionale Tumori IRCCS, Fondazione G. Pascale, 80131 Napoli, Italy; (L.A.); (P.G.); (C.S.); (M.C.P.); (F.P.)
| | - Francesco Perrone
- Clinical Trials Unit, Istituto Nazionale Tumori IRCCS, Fondazione G. Pascale, 80131 Napoli, Italy; (L.A.); (P.G.); (C.S.); (M.C.P.); (F.P.)
| | - Paolo Chiodini
- Department of Mental Health and Public Medicine, Section of Statistics, Università degli Studi della Campania Luigi Vanvitelli, 80138 Napoli, Italy; (S.S.); (V.S.); (P.C.)
| | - Sandro Pignata
- Urogynaecological Medical Oncology, Istituto Nazionale Tumori IRCCS, Fondazione G. Pascale, 80131 Napoli, Italy; (S.C.C.); (S.P.)
| | - Gustavo Baldassarre
- Molecular Oncology Unit, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, National Cancer Institute, 33081 Aviano, Italy; (G.L.R.V.); (F.C.)
- Correspondence: ; Tel.: +39-0434-659-759
| |
Collapse
|
17
|
Bevacizumab Combined with Platinum-Taxane Chemotherapy as First-Line Treatment for Advanced Ovarian Cancer: Results of the NOGGO Non-Interventional Study (OTILIA) in 824 Patients. Cancers (Basel) 2021; 13:cancers13194739. [PMID: 34638225 PMCID: PMC8507543 DOI: 10.3390/cancers13194739] [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: 08/18/2021] [Revised: 09/15/2021] [Accepted: 09/16/2021] [Indexed: 12/30/2022] Open
Abstract
Simple Summary The OTILIA non-interventional study aimed to assess the safety and effectiveness of a standard treatment regimen for advanced ovarian cancer in Germany. All of the women participating in the study received chemotherapy combined with a targeted treatment called bevacizumab. Among the 824 women who received treatment in this study, the median duration of progression-free survival (time alive without their disease returning) was 19.4 months. This is similar to the results in previous randomized phase 3 trials in more restricted populations of women. The safety and effectiveness of treatment seemed to be similar in older (at least 70 years) and younger (less than 70 years) women. Quality of life improved over time. Abstract In the single-arm non-interventional OTILIA study, patients with newly diagnosed International Federation of Gynecology and Obstetrics (FIGO) stage IIIB–IV ovarian cancer received bevacizumab (15 mg/kg every 3 weeks for up to 15 months) and standard carboplatin–paclitaxel. The primary aim was to assess safety and progression-free survival (PFS). Subgroup analyses according to age were prespecified. The analysis population included 824 patients (453 aged <70 years, 371 aged ≥70 years). At data cutoff, the median bevacizumab duration was 13.8 months. Grade ≥3 adverse events (AEs), serious AEs, and AEs leading to bevacizumab discontinuation were more common in older than younger patients, whereas treatment-related AEs were less common. Median PFS was 19.4 months, with no clear difference according to age (20.0 vs. 19.3 months in patients <70 vs. ≥70 years, respectively). One-year OS rates were 92% and 90%, respectively. Mean change from baseline in global health status/quality of life showed a clinically meaningful increase over time. In German routine oncology practice, PFS and safety were similar to reported randomized phase 3 bevacizumab trials in more selected populations. There was no notable reduction in effectiveness and tolerability in patients aged ≥70 years; age alone should not preclude use of bevacizumab-containing therapy. ClinicalTrials.gov: NCT01697488.
Collapse
|
18
|
Di Liello R, Arenare L, Raspagliesi F, Scambia G, Pisano C, Colombo N, Frezzini S, Tognon G, Artioli G, Gadducci A, Lauria R, Ferrero A, Cinieri S, De Censi A, Breda E, Scollo P, De Giorgi U, Lissoni AA, Katsaros D, Lorusso D, Salutari V, Cecere SC, Lapresa M, Nardin M, Bogani G, Distefano M, Greggi S, Gargiulo P, Schettino C, Gallo C, Daniele G, Califano D, Perrone F, Pignata S, Piccirillo MC. Thromboembolic events and antithrombotic prophylaxis in advanced ovarian cancer patients treated with bevacizumab: secondary analysis of the phase IV MITO-16A/MaNGO-OV2A trial. Int J Gynecol Cancer 2021; 31:1348-1355. [PMID: 34462317 DOI: 10.1136/ijgc-2021-002786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 08/16/2021] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION The use of routine antithrombotic prophylaxis is not recommended for advanced cancer patients receiving chemotherapy. The effect of bevacizumab-containing therapy on the risk of thromboembolic events remains controversial in ovarian cancer patients. We report on the incidence of thromboembolic events and the prevalence of antithrombotic therapy in patients enrolled in the single arm, phase IV, MITO-16A/MaNGO-OV2A trial. METHODS In this trial, potential prognostic factors for patients with previously untreated ovarian cancer receiving a combination of platinum-based chemotherapy and bevacizumab were explored and the final analysis has already been reported. In this secondary analysis, the occurrence of thromboembolic events and the use of antithrombotic therapy were described according to the clinical characteristics of the patients. The prognostic role of thromboembolic events for progression-free and overall survival were also evaluated. RESULTS From October 2012 to November 2014, 398 eligible patients were enrolled. 76 patients (19.1%) were receiving some type of anticoagulant or anti-aggregant treatment at baseline. Overall, 24 thromboembolic events were reported (cumulative incidence of 6.0%). The occurrence of thromboembolic events was not associated with baseline patient characteristics and was not modified by the use of antithrombotic prophylaxis (HR 0.60, 95% CI 0.18 to 2.0). Occurrence of thromboembolic events was not associated with progression-free survival (HR 1.34, 95% CI 0.83 to 2.15) or overall survival (HR 0.78, 95% CI 0.37 to 1.61). CONCLUSIONS In our study, a 6.0% rate of thromboembolic events was reported during treatment with bevacizumab plus chemotherapy. Thromboembolic events were not associated with the clinical characteristics of the patients or with the use of antithrombotic prophylaxis, nor did they significantly affect the long-term prognosis. TRIAL REGISTRATION NUMBER NCT01706120.
Collapse
Affiliation(s)
- Raimondo Di Liello
- Unità Sperimentazioni Cliniche, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Napoli, Italy
| | - Laura Arenare
- Unità Sperimentazioni Cliniche, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Napoli, Italy
| | - Francesco Raspagliesi
- Dipartimento di Chirurgia, SC Chirurgia Ginecologica, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Giovanni Scambia
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Ginecologia Oncologica, Fondazione Policlinico Universitario Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Carmela Pisano
- Oncologia Clinica Sperimentale Uro-Ginecologica, Istituto Nazionale Tumori IRCCS Fondazione G Pascale, Napoli, Italy
| | - Nicoletta Colombo
- Istituto Europeo di Oncologia IRCCS, and Dipartimento di Medicina e Chirurgia, Università degli Studi di Milano-Bicocca, Milano, Italy
| | - Simona Frezzini
- Oncologia Medica II e Radiologia, Istituto Oncologico Veneto IRCCS, and Università di Padova, Padova, Italy
| | - Germana Tognon
- Divisione di Ostetricia e Ginecologia, ASST Spedali Civili di Brescia, Università di Brescia, Brescia, Italy
| | - Grazia Artioli
- Oncologia Medica, ULSS2 Marca Trevigiana, Treviso, Italy
| | - Angiolo Gadducci
- Dipartimento di Medicina Clinica e Sperimentale, UO Ginecologia e Ostetricia, Università di Pisa, Pisa, Italy
| | - Rossella Lauria
- Oncologia Medica, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Napoli, Italy
| | - Annamaria Ferrero
- Divisione Universitaria di Ginecologia e Ostetricia, AO Ordine Mauriziano, Torino, Italy
| | - Saverio Cinieri
- Oncologia Medica, Ospedale Senatore Antonio Perrino, Brindisi, Italy
| | | | - Enrico Breda
- Dipartimento di Oncologia, Ospedale S. Giovanni Calibita Fatebenefratelli, Roma, Italy
| | - Paolo Scollo
- UO Ostetricia e Ginecologia, Dipartimento Materno-Infantile, Ospedale Cannizzaro, Catania, Italy
| | - Ugo De Giorgi
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Italy
| | | | - Dionyssios Katsaros
- AOU Città della Salute, Dipartimento di Scienze Chirurgiche, Ginecologia Oncologica, Ospedale Ostetrico Ginecologico S Anna, Torino, Italy
| | - Domenica Lorusso
- Divisione di Ginecologia Medica, Istituto Europeo di Oncologia IRCCS, Milano, Italy
| | - Vanda Salutari
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Ginecologia Oncologica, Fondazione Policlinico Universitario Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Sabrina Chiara Cecere
- Oncologia Clinica Sperimentale Uro-Ginecologica, Istituto Nazionale Tumori IRCCS Fondazione G Pascale, Napoli, Italy
| | - Mariateresa Lapresa
- Divisione di Ginecologia Medica, Istituto Europeo di Oncologia IRCCS, Milano, Italy
| | - Margherita Nardin
- Oncologia Medica II e Radiologia, Istituto Oncologico Veneto IRCCS, and Università di Padova, Padova, Italy
| | - Giorgio Bogani
- Dipartimento di Chirurgia, SC Chirurgia Ginecologica, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Mariagrazia Distefano
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Ginecologia Oncologica, Fondazione Policlinico Universitario Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Stefano Greggi
- SC Ginecologia Oncologica, Istituto Nazionale Tumori IRCCS Fondazione G Pascale, Napoli, Campania, Italy
| | - Piera Gargiulo
- Unità Sperimentazioni Cliniche, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Napoli, Italy
| | - Clorinda Schettino
- Unità Sperimentazioni Cliniche, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Napoli, Italy
| | - Ciro Gallo
- Dipartimento di Salute Mentale e Fisica e Medicina Preventiva, Università degli Studi della Campania Luigi Vanvitelli, Napoli, Italy
| | - Gennaro Daniele
- Direzione Scientifica, Fondazione Policlinico Universitario A Gemelli IRCCS, Roma, Italy
| | - Daniela Califano
- Bersagli Molecolari del Microambiente, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - Francesco Perrone
- Unità Sperimentazioni Cliniche, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Napoli, Italy
| | - Sandro Pignata
- Oncologia Clinica Sperimentale Uro-Ginecologica, Istituto Nazionale Tumori IRCCS Fondazione G Pascale, Napoli, Italy
| | - Maria Carmela Piccirillo
- Unità Sperimentazioni Cliniche, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Napoli, Italy
| |
Collapse
|