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Leonetti A, Perrone F, Puntoni M, Maglietta G, Bordi P, Bria E, Vita E, Gelsomino F, De Giglio A, Gelibter A, Siringo M, Mazzoni F, Caliman E, Genova C, Bertolini F, Guaitoli G, Passiglia F, Delcuratolo MD, Montrone M, Cerea G, Pasello G, Roca E, Belluomini L, Cecere FL, Guida A, Manzo A, Adamo V, Rastelli F, Bulotta A, Citarella F, Toschi L, Zoratto F, Cortinovis DL, Berardi R, Follador A, Carta A, Camerini A, Salerno F, Silva RR, Baldini E, Cortellini A, Brighenti M, Santoni M, Malorgio F, Caminiti C, Tiseo M. Real-world outcomes of Italian patients with advanced non-squamous lung cancer treated with first-line pembrolizumab plus platinum-pemetrexed. Eur J Cancer 2024; 202:114006. [PMID: 38489861 DOI: 10.1016/j.ejca.2024.114006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/03/2024] [Indexed: 03/17/2024]
Abstract
PURPOSE The aim of this multi-center, retrospective/prospective cohort observational study was to evaluate outcomes in routine clinical practice of first-line chemo-immunotherapy with cis/carboplatin, pemetrexed and pembrolizumab in patients with advanced non-squamous non-small cell lung cancer (NSCLC) in 33 Italian centers. METHODS The outcome measure was to evaluate overall survival (OS) in a real-world patient population. Secondary endpoints were: progression-free survival (PFS), objective response rate (ORR), duration of response (DoR) and incidence of treatment-related adverse events (AEs). RESULTS 1068 patients were enrolled at the time of data cut-off (January 31st, 2023), and 812 (76.0%) belonged to the retrospective cohort. Median age was 66 years (27-85), ECOG PS was ≥ 2 in 91 (8.6%) patients; 254 (23.8%) patients had brain metastases at baseline; 38 (3.6%) patients had tumor with PD-L1 expression ≥ 50%. After a median follow-up of 17.0 months (95% CI, 16.1-17.9), median OS was 16.1 months (95% CI, 14.4-18.8) and PFS was 9.9 months (95% CI, 8.8-11.2). Median DoR (n = 493) was 14.7 months (95% CI, 13.6-17.1). ORR was 43.4% (95% CI, 40.4-46.4). Any-grade AEs occurred in 636 (59.6%) patients and grade ≥ 3 in 253 (23.7%) patients. Most common grade ≥ 3 AEs were neutropenia (6.3%) and anemia (6.3%). CONCLUSIONS First-line chemo-immunotherapy was effective and tolerable in this large, real-world Italian study of patients with advanced non-squamous NSCLC. Our results were in line with the KEYNOTE-189 registration study, also considering the low number of PD-L1 ≥ 50% patients included in our study.
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Affiliation(s)
| | - Fabiana Perrone
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy.
| | - Matteo Puntoni
- Clinical & Epidemiological Research Unit, University Hospital of Parma, Parma, Italy
| | - Giuseppe Maglietta
- Clinical & Epidemiological Research Unit, University Hospital of Parma, Parma, Italy
| | - Paola Bordi
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Emilio Bria
- UOSD Oncologia Toraco-Polmonare, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Medical Oncology, Department of Traslational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Emanuele Vita
- UOSD Oncologia Toraco-Polmonare, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Medical Oncology, Department of Traslational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Gelsomino
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andrea De Giglio
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alain Gelibter
- Medical Oncology (B), Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Marco Siringo
- Medical Oncology (B), Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | | | - Enrico Caliman
- Medical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - Carlo Genova
- Academic Oncology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Internal Medicine and Medical Specialties, University of Genoa, Genoa, Italy
| | - Federica Bertolini
- Division of Medical Oncology, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Giorgia Guaitoli
- Division of Medical Oncology, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Francesco Passiglia
- Department of Oncology, University of Turin, AOU San Luigi Gonzaga, Orbassano, Turin, Italy
| | | | - Michele Montrone
- Medical Thoracic Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Giulio Cerea
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giulia Pasello
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Elisa Roca
- Thoracic Oncology - Lung Unit, Pederzoli Hospital, Peschiera del Garda, Italy
| | - Lorenzo Belluomini
- Medical Oncology, Department of Medicine, University of Verona Hospital Trust, Verona, Italy
| | | | - Annalisa Guida
- Department of Medical Oncology, St. Mary's Hospital, Terni, Italy
| | - Anna Manzo
- Thoracic Medical Oncology, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Naples, Italy
| | - Vincenzo Adamo
- Medical Oncology Unit, Azienda Ospedaliera Papardo, Messina, Italy
| | - Francesca Rastelli
- Medical Oncology, AST (Azienda Sanitaria Territoriale) of Ascoli Piceno, Ascoli Piceno, Italy
| | - Alessandra Bulotta
- Department of Oncology, Istituto di Ricerca a Carattere Scientifico (IRCCS) San Raffaele Hospital, Milan, Italy
| | - Fabrizio Citarella
- Department of Medical Oncology, Campus Bio-Medico University, Rome, Italy
| | - Luca Toschi
- IRCCS Humanitas Clinical and Research Center - Humanitas Cancer Center, Rozzano, Milan, Italy
| | | | - Diego Luigi Cortinovis
- SC Medical Oncology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy; Medicine and Surgery Department, University of Milano Bicocca, Milan, Italy
| | - Rossana Berardi
- Oncology Clinic, Università Politecnica Delle Marche, Ospedali Riuniti Di Ancona, Ancona, Italy
| | - Alessandro Follador
- Medical Oncology Unit San Daniele - Tolmezzo, ASUFC Azienda Sanitaria Universitaria Friuli Centrale, Italy
| | - Annamaria Carta
- Pathology and Oncology Unit, Businco Oncological Hospital, Cagliari, Italy
| | - Andrea Camerini
- Medical Oncology, Versilia Hospital, Azienda USL Toscana Nord Ovest, Lido di Camaiore, Italy
| | - Flavio Salerno
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, Turin, Italy
| | - Rosa Rita Silva
- Department of Oncology, ASUR Marche, Area Vasta 2, Fabriano, Italy
| | | | - Alessio Cortellini
- Operative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128, Roma, Italy; Department of Surgery and Cancer, Hammersmith Hospital Campus, Imperial College London, London, UK
| | | | | | | | - Caterina Caminiti
- Clinical & Epidemiological Research Unit, University Hospital of Parma, Parma, Italy
| | - Marcello Tiseo
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy; Department of Medicine and Surgery, University of Parma, Parma, Italy
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2
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Ceresoli GL, Rossi G, Agustoni F, Bonomi L, Borghetti P, Bulotta A, Casartelli C, Cerea G, Colonese F, Del Signore E, Finocchiaro G, Gianoncelli L, Grisanti S, Maiolani M, Pagni F, Proto C, Rijavec E, Vittimberga I, Arcangeli S, Filippi AR. Management of patients with extensive small-cell lung cancer in the immunotherapy era: an Italian consensus through a Delphi approach. Crit Rev Oncol Hematol 2024:104247. [PMID: 38307393 DOI: 10.1016/j.critrevonc.2023.104247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 12/06/2023] [Accepted: 12/19/2023] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Immunotherapy represented a turning point for treating extensive small-cell lung cancer (ES-SCLC). Although, many issues remain debated. METHODS A group of Italian medical and radiation oncologists with expertise in managing patients with ES-SCLC developed a list of statements divided in six areas of interest. The Delphi method was used to assess the consensus on the defined list of statements. RESULTS 32 statements were included in the final list to be voted by the Delphi panel, and 26 reached a consensus on the agreement. A prompt involvement of a multidisciplinary team is a priority to provide an integrated treatment strategy. First-line recommended treatment is immunotherapy in combination with platinum-based chemotherapy and etoposide for four cycles followed by maintenance immunotherapy. CONCLUSIONS While awaiting new data from clinical trials and real-world studies, these recommendations can represent a useful tool to guide the management of ES-SCLC patients in daily practice.
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Affiliation(s)
| | - Giulio Rossi
- Pathology Unit, Hospital Institute Fondazione Poliambulanza, Via Bissolati 57, 25124 Brescia, Italy
| | - Francesco Agustoni
- Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy; Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Lucia Bonomi
- Unit of Oncology, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Paolo Borghetti
- Radiation Oncology Department, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | - Alessandra Bulotta
- Department of Oncology, IRCCS San Raffaele, via Olgettina 60, Milan, Italy
| | | | - Giulio Cerea
- Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | | | - Ester Del Signore
- Division of Thoracic Oncology, European Institute of Oncology, IEO, Milan, Italy
| | - Giovanna Finocchiaro
- Medical Oncology and Hematologic Unit, Humanitas Cancer Center, Istituto Clinico Humanitas-IRCCS, Rozzano, Italy
| | - Letizia Gianoncelli
- Medical Oncology Unit, San Paolo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Salvatore Grisanti
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Martina Maiolani
- U.O.C Oncologia Medica ASST Valtellina e Alto Lario, Sondrio, Italy
| | - Fabio Pagni
- Pathology, Department of Medicine and Surgery, University Milan Bicocca, Via Cadore 48, 20900 Monza
| | - Claudia Proto
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Erika Rijavec
- Unit of Medical Oncology, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi, Varese, Italy
| | | | - Stefano Arcangeli
- Department of Radiation Oncology, University of Milan Bicocca, Milan, Italy
| | - Andrea Riccardo Filippi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Radiation Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Passiglia F, Lucia Reale M, Lo Russo G, Pasello G, Minuti G, Bulotta A, Galetta D, Pelizzari G, Sini C, Bria E, Roca E, Pilotto S, Genova C, Metro G, Citarella F, Chiari R, Cortinovis D, Delmonte A, Russo A, Tiseo M, Cerea G, Carta A, Scotti V, Vavalà T, Brambilla M, Buffoni L, Buosi R, Catania C, Gori S, Grisanti S, Agustoni F, Garbo E, Malapelle U, Novello S. Sotorasib in KRASp.G12C mutated advanced NSCLC: Real-world data from the Italian expanded access program. Lung Cancer 2024; 187:107444. [PMID: 38157806 DOI: 10.1016/j.lungcan.2023.107444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/09/2023] [Accepted: 12/12/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Sotorasib showed a significant improvement of progression free survival (PFS), safety and quality of life over docetaxel in patients with KRASp.G12C-mutated advanced non-small-cell lung cancer (NSCLC) within the CodeBreak-200 study. Here we report real-world efficacy and tolerability data from NSCLC patients who received sotorasib within the Italian expanded access program (EAP). METHODS Sotorasib (960 mg, orally, once daily) was available on physician request for KRASp.G12C mutant advanced NSCLC patients. Clinical-pathological and molecular data were collected from the Italian ATLAS real-world registry. Patients underwent CT-scan and responses were evaluated by RECIST criteria. Efficacy and tolerability outcomes have been assessed. RESULTS A total of 196 advanced NSCLC patients were treated across 30 Italian centers. Median age was 69 years old (range 33-86). Most patients were male (61 %), former (49 %) or current smokers (43 %), with ECOG-PS 0/1 (84 %) and adenocarcinoma subtype (90 %). 45 % and 32 % of patients received sotorasib in 2nd and 3rd line, respectively. Overall, response rate was 26 % and the median duration of response was 5.7 months (95 % CI: 4.4-7.0). Median PFS and OS were 5.8 months (95 % CI: 5 - 6.5) and 8.2 months (95 % CI: 6.3 - 9.9). Grade 3-4 TRAEs occurred in 16.5 % of patients, with Grade ≥ 3 liver enzyme increase and TRAEs-related discontinuation reported in 12 % and 4.6 % of cases. CONCLUSION Real-world data from the Italian EAP confirm the tolerability and effectiveness of sotorasib in patients with KRASp.G12C-mutated advanced NSCLC and highlight the value of the national ATLAS network as source of real-world evidence driving the clinical management of NSCLC patients.
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Affiliation(s)
- Francesco Passiglia
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | | | - Giuseppe Lo Russo
- Thoracic Unit, Department of Medical Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy
| | - Giulia Pasello
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Italy; Medical Oncology 2, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Gabriele Minuti
- Clinical Trial Unit: Phase 1 and Precision Medicine, National Cancer Institute, IRCCS, Regina Elena, Rome, Italy
| | | | - Domenico Galetta
- Medical Thoracic Oncology Unit, Istituto Tumori Giovanni Paolo II, Bari, Italy
| | - Giacomo Pelizzari
- Dipartimento di Oncologia, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Claudio Sini
- Medical Oncology, Ospedale Giovanni Paolo II - ATS Sardegna - ASSL Olbia, Olbia, Italy
| | - Emilio Bria
- Medical Oncology, Department of Traslational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Elisa Roca
- Thoracic Oncology, Lung Unit, P. Pederzoli Hospital, Peschiera Del Garda (VR), Italy
| | - Sara Pilotto
- Department of Engineering for Innovation Medicine University of Verona, Section of Oncology, Verona, Italy
| | - Carlo Genova
- Lung Cancer Unit, Università degli Studi di Genova e Ospedale Policlinico San Martino IRCCS - DiMI, Genova, Italy
| | - Giulio Metro
- Medical Oncology Department, Ospedale S. Maria della Misericordia, Perugia, Italy
| | - Fabrizio Citarella
- Oncology Department, Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Rita Chiari
- UOC Oncologia, AST Pesaro Urbino, Pesaro, Italy
| | | | - Angelo Delmonte
- Department of Medical Oncology, Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori" (IRST) Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Meldola, Italy
| | - Alessandro Russo
- Medical Oncology Unit, Centro Oncologico Ospedale Papardo, Messina, Italy
| | - Marcello Tiseo
- Department of Medicine and Surgery, University of Parma and Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Giulio Cerea
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Annamaria Carta
- SC Oncologia Medica, Ospedale Businco - ARNAS G. Brotzu, Cagliari, Italy
| | - Vieri Scotti
- Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Tiziana Vavalà
- Azienda Ospedaliero Universitaria (AOU) Città della Salute e della Scienza, Department of Oncology, SC Oncologia 1, Torino, Italy
| | - Marta Brambilla
- Thoracic Unit, Department of Medical Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy
| | - Lucio Buffoni
- Medical Oncology Department, Humanitas Gradenigo, Turin, Italy
| | - Roberta Buosi
- Department of Medical Oncology, Ospedale Santo Spirito, Casale Monferrato, Alessandria, Italy
| | - Chiara Catania
- Medical Oncology Department, Humanitas Gavazzeni, Bergamo, Italy
| | - Stefania Gori
- Department of Medical Oncology, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Salvatore Grisanti
- Medical Oncology Department, Azienda Ospedaliera Spedali Civili, Brescia, Italy
| | - Francesco Agustoni
- Department of Internal Medicine and Medical Therapy, University of Pavia, and Department of Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Edoardo Garbo
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Umberto Malapelle
- Department of Public Health, University Federico II of Naples, Naples, Italy
| | - Silvia Novello
- Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, Orbassano (TO), Italy.
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Nuccio A, Viscardi G, Salomone F, Servetto A, Venanzi FM, Riva ST, Oresti S, Ogliari FR, Viganò M, Bulotta A, Cameron R, Esposito A, Hines J, Bianco R, Reni M, Cascone T, Garassino MC, Torri V, Veronesi G, Cinquini M, Ferrara R. Systematic review and meta-analysis of immune checkpoint inhibitors as single agent or in combination with chemotherapy in early-stage non-small cell lung cancer: Impact of clinicopathological factors and indirect comparison between treatment strategies. Eur J Cancer 2023; 195:113404. [PMID: 37948842 DOI: 10.1016/j.ejca.2023.113404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/19/2023] [Accepted: 10/24/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND In non-small cell lung cancer (NSCLC), the immune checkpoint inhibitors (ICI) revolution is rapidly moving from metastatic to early-stage, however, the impact of clinicopathological variables and optimal treatment sequencing remain unclear. METHODS Randomized controlled trials (RCTs) in patients with early-stage NSCLC treated with ICI as single agent or in combination with platinum-based chemotherapy (PCT) were included. Primary outcomes were pathological complete response (pCR), event free survival (EFS) (neoadjuvant/perioperative), and disease-free survival (DFS) (adjuvant). Secondary outcomes were major pathological response (MPR), overall survival (OS), toxicity, surgical outcomes (neoadjuvant/perioperative); OS and toxicity (adjuvant). An additional secondary endpoint was to compare EFS and OS between neoadjuvant and perioperative strategies. RESULTS 8 RCTs (2 neoadjuvant, 4 perioperative, 2 adjuvant) (4661 participants) were included. Neoadjuvant/perioperative ICI+PCT significantly improved pCR, EFS, OS, MPR and R0 resection compared to PCT. Adjuvant ICI significantly improved DFS compared to placebo. There was a significant subgroup interaction by PD-L1 status (χ2 = 10.72, P = 0.005), pCR (χ2 = 17.80, P < 0.0001), and stage (χ2 = 4.46, P = 0.003) for EFS. No difference according to PD-L1 status was found for pCR, with 14% of patients having PD-L1 negative tumors still experiencing a pCR. No interaction by PD-L1 status was found for DFS upon adjuvant ICI. Indirect comparison showed no difference in EFS and OS between neoadjuvant and perioperative ICI+PCT. CONCLUSIONS PD-L1 status, pCR and stage impact on survival upon neoadjuvant/perioperative ICI. The restriction of neoadjuvant/perioperative ICI to PD-L1 + patients could preclude pCR and long-term benefit in the PD-L1- subgroup. Neoadjuvant and perioperative could be equivalent strategies.
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Affiliation(s)
- Antonio Nuccio
- Università Vita-Salute San Raffaele, Milan, Italy; IRCCS Ospedale San Raffaele, Department of Medical Oncology, Milan, Italy
| | - Giuseppe Viscardi
- Department of Pneumology and Oncology, PO Monaldi-AORN Ospedali dei Colli, Naples, Italy
| | - Fabio Salomone
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Alberto Servetto
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | | | | | - Sara Oresti
- IRCCS Ospedale San Raffaele, Department of Medical Oncology, Milan, Italy
| | | | - Mariagrazia Viganò
- IRCCS Ospedale San Raffaele, Department of Medical Oncology, Milan, Italy
| | - Alessandra Bulotta
- IRCCS Ospedale San Raffaele, Department of Medical Oncology, Milan, Italy
| | - Robert Cameron
- Department of Medicine, Hematology Oncology Section, Thoracic Oncology Program, The University of Chicago, Chicago, USA
| | - Alessandra Esposito
- Department of Medicine, Hematology Oncology Section, Thoracic Oncology Program, The University of Chicago, Chicago, USA
| | - Jacobi Hines
- Department of Medicine, Hematology Oncology Section, Thoracic Oncology Program, The University of Chicago, Chicago, USA
| | - Roberto Bianco
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Michele Reni
- Università Vita-Salute San Raffaele, Milan, Italy; IRCCS Ospedale San Raffaele, Department of Medical Oncology, Milan, Italy
| | - Tina Cascone
- Department of Thoracic-Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Marina Chiara Garassino
- Department of Medicine, Hematology Oncology Section, Thoracic Oncology Program, The University of Chicago, Chicago, USA
| | - Valter Torri
- Oncology Department, IRCCS-Mario Negri Institute, Milan, Italy
| | - Giulia Veronesi
- Università Vita-Salute San Raffaele, Milan, Italy; Department of Thoracic Surgery, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Roberto Ferrara
- Università Vita-Salute San Raffaele, Milan, Italy; IRCCS Ospedale San Raffaele, Department of Medical Oncology, Milan, Italy.
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5
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Venanzi FM, Bini M, Nuccio A, De Toma A, Lambertini M, Ogliari FR, Oresti S, Viganò MG, Brioschi E, Polignano M, Naldini MM, Riva S, Ferrara M, Fogale N, Damiano G, Russo V, Reni M, Veronesi G, Foggetti G, Conforti F, Bulotta A, Ferrara R. Sex dimorphism and cancer immunotherapy: May pregnancy solve the puzzle? Cancer Treat Rev 2023; 121:102648. [PMID: 37918169 DOI: 10.1016/j.ctrv.2023.102648] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/09/2023] [Accepted: 10/25/2023] [Indexed: 11/04/2023]
Abstract
In the immunoncology era, growing evidence has shown a clear sex dimorphism in antitumor immune response with a potential impact on outcomes upon immunecheckpoint blockade (ICI) in patients with cancer. Sex dimorphism could affect tumor microenvironment composition and systemic anticancer immunity; however, the modifications induced by sex are heterogeneous. From a clinical perspective, six metanalyses have explored the role of sex in cancer patients receiving ICI with conflicting results. Environmental and reproductive factors may further jeopardize the sex-related heterogeneity in anticancer immune response. In particular, pregnancy is characterized by orchestrated changes in the immune system, some of which could be long lasting. A persistence of memory T-cells with a potential fetal-antigen specificity has been reported both in human and mice, suggesting that a previous pregnancy may positively impact cancer development or response to ICI, in case of fetal-antigen sharing from tumor cells. On the other hand, a previous pregnancy may also be associated with a regulatory memory characterized by increased tolerance and anergy towards cancer-fetal common antigens. Finally, fetal-maternal microchimerism could represent an additional source of chronic exposure to fetal antigens and may have important immunological implications on cancer development and ICI activity. So far, the role of pregnancy dimorphism (nulliparous vs parous) in women and the impact of pregnancy-related variables remain largely underexplored in cancer patients. In this review, we summarize the evidence regarding sex and pregnancy dimorphism in the context of immune response and anticancer immunotherapy and advocate the importance of analyzing pregnancy variables on ICIs clinical trials.
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Affiliation(s)
- Francesco Maria Venanzi
- Department of Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy
| | - Marta Bini
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Antonio Nuccio
- Department of Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy
| | | | - Matteo Lambertini
- Department of Medical Oncology, Clinical di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa, Italy
| | - Francesca Rita Ogliari
- Department of Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy
| | - Sara Oresti
- Department of Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Grazia Viganò
- Department of Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elena Brioschi
- Department of Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maggie Polignano
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Matteo Maria Naldini
- Department of Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy
| | - Silvia Riva
- Department of Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy
| | - Michele Ferrara
- Department of Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Fogale
- Department of Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Damiano
- Department of Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy
| | - Vincenzo Russo
- Department of Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy
| | - Michele Reni
- Department of Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy
| | - Giulia Veronesi
- Università Vita-Salute San Raffaele, Milan, Italy; Division of Thoracic Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giorgia Foggetti
- Department of Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy
| | - Fabio Conforti
- Oncology Unit, Humanitas Gavazzeni, 24125 Bergamo, Italy
| | - Alessandra Bulotta
- Department of Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Roberto Ferrara
- Department of Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy.
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6
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Pecciarini L, Brunetto E, Grassini G, De Pascali V, Ogliari FR, Talarico A, Marra G, Magliacane G, Redegalli M, Arrigoni G, Lazzari C, Gregorc V, Bulotta A, Doglioni C, Cangi MG. Gene Fusion Detection in NSCLC Routine Clinical Practice: Targeted-NGS or FISH? Cells 2023; 12:cells12081135. [PMID: 37190044 DOI: 10.3390/cells12081135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/05/2023] [Accepted: 04/10/2023] [Indexed: 05/17/2023] Open
Abstract
The ability to identify the broadest range of targetable gene fusions is crucial to facilitate personalized therapy selection for advanced lung adenocarcinoma (LuADs) patients harboring targetable receptor tyrosine kinase (RTK) genomic alterations. In order to evaluate the most effective testing approach for LuAD targetable gene fusion detection, we analyzed 210 NSCLC selected clinical samples, comparing in situ (Fluorescence In Situ Hybridization, FISH, and ImmunoHistoChemistry, IHC) and molecular (targeted RNA Next-Generation Sequencing, NGS, and RealTime-PCR, RT-PCR) approaches. The overall concordance among these methods was high (>90%), and targeted RNA NGS was confirmed to be the most efficient technique for gene fusion identification in clinical practice, allowing the simultaneous analysis of a large set of genomic rearrangements at the RNA level. However, we observed that FISH was useful to detect targetable fusions in those samples with inadequate tissue material for molecular testing as well as in those few cases whose fusions were not identified by the RNA NGS panel. We conclude that the targeted RNA NGS analysis of LuADs allows accurate RTK fusion detection; nevertheless, standard methods such as FISH should not be dismissed, as they can crucially contribute to the completion of the molecular characterization of LuADs and, most importantly, the identification of patients as candidates for targeted therapies.
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Affiliation(s)
- Lorenza Pecciarini
- Pathology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Emanuela Brunetto
- Pathology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Greta Grassini
- Pathology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Valeria De Pascali
- Pathology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | | | - Anna Talarico
- Pathology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Giovanna Marra
- Pathology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Gilda Magliacane
- Pathology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Miriam Redegalli
- Pathology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Gianluigi Arrigoni
- Pathology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Chiara Lazzari
- Candiolo Cancer Institute, FPO-IRCCS, 10060 Turin, Italy
| | - Vanesa Gregorc
- Candiolo Cancer Institute, FPO-IRCCS, 10060 Turin, Italy
| | - Alessandra Bulotta
- Department of Oncology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Claudio Doglioni
- Pathology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Maria Giulia Cangi
- Pathology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
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7
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Nuccio A, Torrisi M, Ogliari F, Giannini L, Pasetti M, Fodor A, Gigliotti C, Fiorino C, Arcangeli S, Bulotta A, Dell'Oca I, Cascinu S, Di Muzio N. 105P Thoracic radiotherapy and tyrosine kinase inhibitors association: Results from a monoinstitutional experience. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.100963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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8
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Lazzari C, Yacoub MR, Campochiaro C, Bulotta A, Palumbo D, Ogliari FR, Dagna L, Marchesi S, Ponzoni M, Gregorc V. Case report: Successful use of mepolizumab for immune checkpoint inhibitors-induced hypereosinophilic syndrome in two patients with solid malignancies. Front Oncol 2023; 13:1079034. [PMID: 36776300 PMCID: PMC9911301 DOI: 10.3389/fonc.2023.1079034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 01/04/2023] [Indexed: 01/28/2023] Open
Abstract
Hypereosinophilic syndrome (HES) represents a group of blood disorders characterized by an absolute eosinophil count (AEC) > 1.5 × 103/μl in the peripheral blood, which eventually extravasate and cause organ damage. It can be primary or secondary to infections or tumors. The infiltration of eosinophils in tissue and organs is associated with different disorders and, in some cases, with life-threatening manifestations. Albeit the pathogenesis of HES in patients with solid tumo\rs is not yet clarified; recently, HES has also been described as an immune-related adverse event in patients with solid tumors receiving immune checkpoint inhibitors. Treatment of HES is still debated, especially in patients with concomitant solid tumors, and different drugs including imatinib, hydroxyurea, interferon-ɑ, glucocorticoids, and the monoclonal antibody targeting circulating IL-5 mepolizumab have been proposed according to the underlying cause and the severity of HES. Herein, we describe, for the first time, the successful use of mepolizumab for the treatment of immune checkpoint-induced HES in two patients with metastatic solid tumor.
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Affiliation(s)
- Chiara Lazzari
- Department of Oncology, Candiolo Cancer Institute Fondazione Piemontese per l'Oncologia-Istituto di Ricerca a Carattere Scientifico (FPO-IRCCS) Candiolo, Torino, Italy,*Correspondence: Chiara Lazzari,
| | - Mona Rita Yacoub
- Department of Rheumatology and Clinical Immunology, Istituto di Ricerca a Carattere Scientifico (IRCCS) San Raffaele Hospital, Milano, Italy
| | - Corrado Campochiaro
- Department of Rheumatology and Clinical Immunology, Istituto di Ricerca a Carattere Scientifico (IRCCS) San Raffaele Hospital, Milano, Italy
| | - Alessandra Bulotta
- Department of Oncology, Istituto di Ricerca a Carattere Scientifico (IRCCS) San Raffaele Hospital, Milano, Italy
| | - Diego Palumbo
- Department of Radiology, Istituto di Ricerca a Carattere Scientifico (IRCCS) San Raffaele Hospital, Milano, Italy
| | - Francesca Rita Ogliari
- Department of Oncology, Istituto di Ricerca a Carattere Scientifico (IRCCS) San Raffaele Hospital, Milano, Italy
| | - Lorenzo Dagna
- Department of Rheumatology and Clinical Immunology, Istituto di Ricerca a Carattere Scientifico (IRCCS) San Raffaele Hospital, Milano, Italy
| | - Silvia Marchesi
- Department of Oncology, Candiolo Cancer Institute Fondazione Piemontese per l'Oncologia-Istituto di Ricerca a Carattere Scientifico (FPO-IRCCS) Candiolo, Torino, Italy
| | - Maurilio Ponzoni
- Vita-Salute San Raffaele University, Milano, Italy,Pathology Unit, Istituto di Ricerca a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milano, Italy
| | - Vanesa Gregorc
- Department of Oncology, Candiolo Cancer Institute Fondazione Piemontese per l'Oncologia-Istituto di Ricerca a Carattere Scientifico (FPO-IRCCS) Candiolo, Torino, Italy
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9
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Lazzari C, Pecciarini L, Doglioni C, Pedica F, Gajate AMS, Bulotta A, Gregorc V, Cangi MG. Case report: EML4::NTRK3 gene fusion in a patient with metastatic lung adenocarcinoma successfully treated with entrectinib. Front Oncol 2022; 12:1038774. [PMID: 36419889 PMCID: PMC9676932 DOI: 10.3389/fonc.2022.1038774] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 10/07/2022] [Indexed: 01/03/2024] Open
Abstract
Rearrangements involving the neurotrophin kinase (NTRK) genes NTRK1, NTRK2 and NTRK3 with different fusion partners have been observed in both adult and pediatric solid tumors. Larotrectinib and entrectinib have been the first tumor-agnostic compounds approved for the treatment of NTRK fusion-positive tumors. Here, we report the first case of a female patient with a diagnosis of stage IV lung adenocarcinoma harboring the EML4::NTRK3 gene fusion, and successfully treated with entrectinib.
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Affiliation(s)
- Chiara Lazzari
- Candiolo Cancer Institute, Fondazione del Piemonte per l'Oncologia (FPO)-IRCCS, Turin, Italy
| | - Lorenza Pecciarini
- Department of Pathology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Claudio Doglioni
- Department of Pathology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federica Pedica
- Department of Pathology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Alessandra Bulotta
- Department of Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vanesa Gregorc
- Candiolo Cancer Institute, Fondazione del Piemonte per l'Oncologia (FPO)-IRCCS, Turin, Italy
| | - Maria Giulia Cangi
- Department of Pathology, IRCCS San Raffaele Scientific Institute, Milan, Italy
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10
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Gagliardi F, Snider S, Roncelli F, Pompeo E, De Domenico P, Klungtvedt V, Barzaghi LR, Comai S, Zuber V, Bulotta A, Bandiera A, Castellano A, Ruban A, Mortini P. P14.03.B Glutamate excitotoxicity in brain metastases from lung, breast, and melanoma treated with stereotactic radiosurgery. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Brain metastases (BM) are the most frequent neoplasm in the central nervous system (CNS) and primary tumors frequently involved are melanoma, lung cancer and breast cancer. CNS localisation is associated with poor prognosis, and stereotactic radiosurgery (SRS) represents a treatment option for patients with a good performance status. Glutamate (Glu) is a neurotransmitter which plays a facilitating role in carcinogenesis and progression of malignant tumors, as well as in excitotoxicity. Glu efflux from the brain is regulated by scavengers glutamic oxaloacetic transaminase (GOT), glutamate-pyruvate transaminase (GPT) and lactate dehydrogenase (LDH), with aspartate and lactate as catabolites. Glu efflux from the brain seems to be impaired in advanced-stage cancers, resulting in increased blood Glu levels where scavengers exert a protective role. Our hypothesis is that serum Glu and scavengers’ levels are related to neuroinvasion and treatment response in patients with BM and may represent potential biomarkers for BM course and prognosis.
Material and Methods
Serum Glu scavengers (GOT1, GPT and LDH), serum Glu, aspartate and lactate levels are collected in included patients treated and grouped in A) BM group of patients affected by BM from lung or breast cancer or melanoma, treated with SRS; B) Control-1 group of patients affected by lung cancer, breast cancer or melanoma but without BM and C) Control-2 group of patients with benign intracranial lesions (meningiomas, acoustic schwannomas) treated with SRS.In A) and C) serum metabolites and scavengers will be analyzed before and after SRS treatment (at 3, 6, 9 months) while in B) analyzed once. Blood levels in A) and C) help in identifying differences related to malignancy, the role of SRS and the association with disease control, while blood levels in A) and B) help in detecting differences related to BMs. Exclusion criteria are surgical or previous radiosurgical treatment for BM. This study has received Institutional Ethical Committee approval on 3rd August 2020 (Project NCH04-2020, Clinicaltrials.gov identifier: NCT04785521).
Preliminary results
Comparison between BM group (n = 32) and Control-1 (n=18) revealed a significant difference in LDH (271.93 vs 217.56 U/L; p 0.041) and lactate (1.86 vs 1.34 mmol/L, p = 0.022) and a trend towards significance in glutamate (103.43 vs 73.74 µmol/L, p = 0.07). Comparison between BM group (n=32) and Control-2 (n = 37) revealed a difference in LDH (271.93 vs 210.89 U/L; p < 0.001), lactate (1.86 vs 1.24 mmol/L; p < 0.001), aspartate (16.36 vs 10.22 µmol/L, p 0.006) and glutamate levels (123 vs 103 µmol/L, p = 0.052).
Conclusion
The present study is the first one addressing serum glutamate and scavenger levels in patients with BM. If the hypothesis will be confirmed, new targets in glutamate signalling pathway could be identified to define new therapeutic strategies in this challenging disease.
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Affiliation(s)
- F Gagliardi
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University , Milan , Italy
| | - S Snider
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University , Milan , Italy
| | - F Roncelli
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University , Milan , Italy
| | - E Pompeo
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University , Milan , Italy
| | - P De Domenico
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University , Milan , Italy
| | | | - L R Barzaghi
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University , Milan , Italy
| | - S Comai
- Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute University , Milan , Italy
| | - V Zuber
- Breast Surgery Unit, San Raffaele Scientific Institute, Vita-Salute Universitye , Milan , Italy
| | - A Bulotta
- Department of Oncology, San Raffaele Scientific Institute, Vita-Salute University , Milan , Italy
| | - A Bandiera
- Department of Thoracic Surgery, San Raffaele Scientific Institute, Vita-Salute University , Milan , Italy
| | - A Castellano
- Neuroradiology Unit and CERMAC, San Raffaele Scientific Institute, Vita-Salute University , Milan , Italy
| | - A Ruban
- Nursing Deparment, Steyer School of Health Professions, Sackler Faculty of Medicine, Sagol School of Neuroscience, Tel-Aviv University (TAU) , Tel Aviv , Israel
| | - P Mortini
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University , Milan , Italy
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11
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Gagliardi F, Snider S, Roncelli F, Pompeo E, De Domenico P, Klungtvedt V, Barzaghi L, Bulotta A, Lazzari C, Del Vecchio A, Mortini P. P11.43.B The impact of neutrophils-to-lymphocytes ratio on survival in patients affected by brain metastases and treated with Gamma Knife Radiosurgery. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The Neutrophil-to-Lymphocyte ratio (NLR) is a biomarker for host systemic inflammation. Elevated NLR may result from neutrophilia, lymphopenia or both and is associated with poor prognosis and treatment responses in various malignant tumors, such as breast, gastric, colorectal and lung cancer. It was found that in patients treated with GK-SRS for brain metastases (BM) from non-small cell lung cancer (NSCLC), median survival was significantly longer in patients with NLR < 5 at the time of radiosurgery and after treatment (within 1 month from SRS). High percentage of neutrophils, low percentage of lymphocytes and elevated platelet-to-lymphocyte ratio were predictive of poor OS in patients with brain metastases. Further evidences are needed to support and better define these findings.
Material and Methods
We retrospectively examined 111 consecutive patients with BMs from NSCLC (95 patients) and melanoma (16 patients) treated with GK-SRS. A total of 695 lesions were treated (median lesion number per patient 6; range 1-18), the median volume was 0.108 cc (range 0.004-33.44 cc).
NLR was calculated using N/L, where N and L, respectively, refer to peripheral blood neutrophils (N) and lymphocyte (L) counts at the timepoint nearest to the SRS treatment. Kaplan-Meier analysis described the survival time according to NLR. Univariable and multivariable Cox regression analyses were used to confirm the impact of NLR on overall survival.
Results
Median (IQR) age at diagnosis of brain metastases was 64 yrs (55-70), median (IQR) NLR was 6.7 (1.3-32), and median (IQR) overall survival was 13.5 months (1-42). At univariable Cox-regression analyses, lower NLR was associated with improved overall survival (HR: 1.05; p=0.004). Total number of lymphocytes, neutrophils and monocytes were not associated with improved overall survival (all p>0.1). At multivariable Cox regression analyses, after adjusting for patient age, sex and the use of DEX therapy, NLR represented an independent predictor of overall survival (HR: 1.06; p=0.003).
Conclusion
NLR represents an independent prognostic factor in patients affected by BMs from NSCLC and melanoma. Inflammation and immunity may play a critical role in these patients. Further analysis examining more specific neutrophils or lymphocytes subsets may increase our understanding of cancer etiology and progression.
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Affiliation(s)
- F Gagliardi
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University , Milan , Italy
| | - S Snider
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University , Milan , Italy
| | - F Roncelli
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University , Milan , Italy
| | - E Pompeo
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University , Milan , Italy
| | - P De Domenico
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University , Milan , Italy
| | | | - L Barzaghi
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University , Milan , Italy
| | - A Bulotta
- Department of Oncology, San Raffaele Scientific Institute, Vita-Salute University , Milan , Italy
| | - C Lazzari
- Department of Oncology, San Raffaele Scientific Institute, Vita-Salute University , Milan , Italy
| | - A Del Vecchio
- Medical Physics, San Raffaele Scientific Institute, Vita-Salute University , Milan , Italy
| | - P Mortini
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University , Milan , Italy
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12
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Campochiaro C, Farina N, Tomelleri A, Ferrara R, Viola S, Lazzari C, De Luca G, Raggi D, Bulotta A, Matucci-Cerinic M, Necchi A, Garassino M, Gregorc V, Dagna L. Autoantibody positivity predicts severity of rheumatic immune-related adverse events to immune-checkpoint inhibitors. Eur J Intern Med 2022; 103:95-99. [PMID: 35821192 DOI: 10.1016/j.ejim.2022.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/30/2022] [Accepted: 07/03/2022] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Immune-related adverse events (irAEs) due to immune checkpoint inhibitors are responsible for a considerable burden of morbidity and mortality. Predictors of severity of rheumatic irAEs have not been identified yet. The objective of this study was to test the hypothesis whether the presence of autoantibodies could be associated with a more severe and difficult-to-treat clinical phenotype of rheumatic irAEs. METHODS Patients referred to our centre due to the onset of rheumatic irAEs were prospectively recruited between June 2018 and December 2020. A pre-specified panel of autoantibodies was tested in each patient at baseline visit. All patients were started on glucocorticoids and then followed-up. Conventional or biologic immunosuppressants were started in case of steroid-refractory or relapsing disease. Logistic regression analysis was performed to evaluate the association between the baseline positivity of at least one autoantibody and the necessity of an add-on therapy. RESULTS Fourty-three patients with rheumatic irAEs were enrolled. Twenty-five (58%) patients had positivity of at least one of the tested autoantibodies. Twenty-two (51%) patients required the start of an additional immunosuppressant during follow-up. The only factor associated with the necessity of an add-on therapy was autoantibody positivity (OR=9.65, 95% CI:2.09-44.56; p-value 0.004). CONCLUSIONS The presence of autoantibodies in patients with cancer who develop rheumatic irAEs could predict their progression to difficult-to-treat clinical manifestations. This finding might prompt a future therapeutic approach based on a tailored and earlier immunosuppressive treatment in selected cases.
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Affiliation(s)
- Corrado Campochiaro
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele, via Olgettina 60, Milan 20132, Italy; Vita-Salute San Raffaele University, via Olgettina 60, Milan 20132, Italy.
| | - Nicola Farina
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele, via Olgettina 60, Milan 20132, Italy; Vita-Salute San Raffaele University, via Olgettina 60, Milan 20132, Italy
| | - Alessandro Tomelleri
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele, via Olgettina 60, Milan 20132, Italy; Vita-Salute San Raffaele University, via Olgettina 60, Milan 20132, Italy
| | - Roberto Ferrara
- Thoracic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, via Venezian 1, Milan, Italy
| | - Silvia Viola
- Vita-Salute San Raffaele University, via Olgettina 60, Milan 20132, Italy
| | - Chiara Lazzari
- Department of Oncology, IRCCS San Raffaele, via Olgettina 60, Milan, Italy
| | - Giacomo De Luca
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele, via Olgettina 60, Milan 20132, Italy; Vita-Salute San Raffaele University, via Olgettina 60, Milan 20132, Italy
| | - Daniele Raggi
- Department of Urology, Fondazione IRCCS Istituto Nazionale dei Tumori, via Venezian 1, Milan, Italy
| | - Alessandra Bulotta
- Department of Oncology, IRCCS San Raffaele, via Olgettina 60, Milan, Italy
| | - Marco Matucci-Cerinic
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele, via Olgettina 60, Milan 20132, Italy
| | - Andrea Necchi
- Department of Urology, Fondazione IRCCS Istituto Nazionale dei Tumori, via Venezian 1, Milan, Italy
| | - Marina Garassino
- The University of Chicago, 5167 Maryland Avenue, Chicago, United States
| | - Vanesa Gregorc
- Department of Oncology, IRCCS San Raffaele, via Olgettina 60, Milan, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele, via Olgettina 60, Milan 20132, Italy; Vita-Salute San Raffaele University, via Olgettina 60, Milan 20132, Italy
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13
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Abstract
PURPOSE OF REVIEW In the current review, we will explore the molecular bases that have determined the design of clinical trials exploring the efficacy of antivascular agents in combination with chemotherapy, immune check point inhibitors and epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) in patients with advanced nonsmall cell lung cancer. RECENT FINDINGS Recent clinical trials have demonstrated the synergistic effect of antivascular agents with immune checkpoint inhibitors and EGFR-TKIs, despite no molecular marker has been identified yet to select patients. SUMMARY Lung cancer remains one of the first causes of cancer-related death. However, thanks to the development of stratified molecular medicine and the introduction of immune checkpoint inhibitors, patients' survival has significantly improved. Due to the critical role of pro-angiogenic factors in cancer progression, antivascular agents targeting the vascular endothelial growth factor (VEGF) and its receptor (VEGFR) have been developed. Their efficacy has been explored in combination with chemotherapy, and immune checkpoint inhibitors, with promising but not definitive conclusions about their impact on prolonging patients' survival.
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Affiliation(s)
- Chiara Lazzari
- Department of Oncology, IRCCS Ospedale San Raffaele Scientific Institute
| | - Alessandra Bulotta
- Department of Oncology, IRCCS Ospedale San Raffaele Scientific Institute
| | - Giuseppe Damiano
- Department of Oncology, IRCCS Ospedale San Raffaele Scientific Institute
| | - Aurora Mirabile
- Department of Oncology, IRCCS Ospedale San Raffaele Scientific Institute
| | - Mariagrazia Viganó
- Department of Oncology, IRCCS Ospedale San Raffaele Scientific Institute
| | - Giulia Veronesi
- Faculty of Medicine and Surgery-Vita-Salute San Raffaele University
- Division of Thoracic Surgery, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Vanesa Gregorc
- Department of Oncology, IRCCS Ospedale San Raffaele Scientific Institute
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14
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Campochiaro C, Farina N, Tomelleri A, Ferrara R, Lazzari C, De Luca G, Bulotta A, Signorelli D, Palmisano A, Vignale D, Peretto G, Sala S, Esposito A, Garassino M, Gregorc V, Dagna L. Tocilizumab for the treatment of immune-related adverse events: a systematic literature review and a multicentre case series. Eur J Intern Med 2021; 93:87-94. [PMID: 34391591 DOI: 10.1016/j.ejim.2021.07.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/12/2021] [Accepted: 07/20/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Research is moving towards a more personalized management of immune-related adverse events (irAEs) due to immune checkpoint inhibitors (ICI). Our objective was to evaluate the efficacy and safety of tocilizumab in the treatment of these clinical manifestations. METHODS A systematic literature review was performed to retrieve data about the use of tocilizumab in the treatment of irAEs. Additionally, data from cancer patients referred to our Immune-related Adverse Event Clinic and treated with tocilizumab were collected. RESULTS Our literature review identified 20 articles and 11 meeting abstracts. Data about 91 cancer patients who received tocilizumab for the treatment of irAEs were collected. In 85% of cases, this therapy was associated with clinical benefit and no case of disease progression was reported. ICI therapy was continued following irAE onset and biologic therapy initiation in only three patients. Five patients developed irAEs upon ICI initiation and were subsequently treated with tocilizumab at our Centre. At a median follow-up of eight months, tocilizumab was safely continued along with ICI in three out of five patients, and an adequate control of irAE was obtained in all cases. No significant adverse reactions to tocilizumab were reported. Only one patient experienced a disease progression 18 months after ICI discontinuation. CONCLUSION Both our systematic literature review and case series highlight the efficacy and safety of tocilizumab in the treatment of irAEs. Furthermore, they both support the possibility of a combined approach with tocilizumab and ICI, to guarantee an effective irAEs management without losing the oncologic response.
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Affiliation(s)
- Corrado Campochiaro
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele, via Olgettina 60, Milan, Italy; Vita-Salute San Raffaele University, via Olgettina 60, Milan, Italy.
| | - Nicola Farina
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele, via Olgettina 60, Milan, Italy; Vita-Salute San Raffaele University, via Olgettina 60, Milan, Italy
| | - Alessandro Tomelleri
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele, via Olgettina 60, Milan, Italy; Vita-Salute San Raffaele University, via Olgettina 60, Milan, Italy
| | - Roberto Ferrara
- Thoracic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, via Venezian 1, Milan, Italy
| | - Chiara Lazzari
- Department of Oncology, IRCCS San Raffaele, via Olgettina 60, Milan, Italy
| | - Giacomo De Luca
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele, via Olgettina 60, Milan, Italy; Vita-Salute San Raffaele University, via Olgettina 60, Milan, Italy
| | - Alessandra Bulotta
- Department of Oncology, IRCCS San Raffaele, via Olgettina 60, Milan, Italy
| | - Diego Signorelli
- Thoracic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, via Venezian 1, Milan, Italy
| | - Anna Palmisano
- Department of Radiology, IRCCS San Raffaele Hospital, via Olgettina 60, Milan, Italy
| | - Davide Vignale
- Department of Radiology, IRCCS San Raffaele Hospital, via Olgettina 60, Milan, Italy
| | - Giovanni Peretto
- Department of Arrhythmology, IRCCS San Raffaele Hospital, via Olgettina 60, Milan, Italy
| | - Simone Sala
- Department of Arrhythmology, IRCCS San Raffaele Hospital, via Olgettina 60, Milan, Italy
| | - Antonio Esposito
- Department of Radiology, IRCCS San Raffaele Hospital, via Olgettina 60, Milan, Italy
| | - Marina Garassino
- Thoracic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, via Venezian 1, Milan, Italy
| | - Vanesa Gregorc
- Department of Oncology, IRCCS San Raffaele, via Olgettina 60, Milan, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele, via Olgettina 60, Milan, Italy; Vita-Salute San Raffaele University, via Olgettina 60, Milan, Italy
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15
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Gagliardi F, De Domenico P, Snider S, Roncelli F, Pompeo E, Barzaghi LR, Bulotta A, Gregorc V, Lazzari C, Cascinu S, Finocchiaro G, Mortini P. Role of stereotactic radiosurgery for the treatment of brain metastasis in the era of immunotherapy: A systematic review on current evidences and predicting factors. Crit Rev Oncol Hematol 2021; 165:103431. [PMID: 34324961 DOI: 10.1016/j.critrevonc.2021.103431] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 07/17/2021] [Accepted: 07/25/2021] [Indexed: 11/25/2022] Open
Abstract
Stereotactic radiosurgery (SRS) in combination with immunotherapy (IT) is increasingly used in the setting of melanoma and non-small cell lung cancer (NSCLC) brain metastases (BM). The synergistic properties of this treatment combination are still not deeply understood. IT-SRS appropriate combination has been envisioned as a strategic point in patients' management. Authors performed a systematic review on current evidences up to December 2020. The impact of SRS-IT and different IT schedules on survival, local/distant intracranial control and toxicity, as well as predictive factors for relevant oncological and radiological outcomes has been analyzed. Authors retrieved 23 pertinent studies. Combining SRS with IT resulted in a significant improvement in OS and lesion response with no increase in radionecrosis, hemorrhage or other complications. The present review suggests that combining IT to SRS is safe and effective in providing a significant improvement in relevant clinical and radiological outcomes in melanoma and NSCLC BMs patients.
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Affiliation(s)
- Filippo Gagliardi
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
| | - Pierfrancesco De Domenico
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Silvia Snider
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Francesca Roncelli
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Edoardo Pompeo
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Lina Raffaella Barzaghi
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Alessandra Bulotta
- Department of Oncology, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Vanesa Gregorc
- Department of Oncology, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Chiara Lazzari
- Department of Oncology, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Stefano Cascinu
- Department of Oncology, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Gaetano Finocchiaro
- Department of Neurology, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Pietro Mortini
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
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16
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Paolino G, Cicinelli MV, Brianti P, Prezioso C, Bulotta A, Rizzo N, Bandello F, Lugini L, Federici C, Gregorc V, Modorati GM, Mercuri SR. Eruptive cherry angiomas and uveal melanoma: beyond a simple association. Clin Exp Dermatol 2021; 46:946-948. [PMID: 33577088 DOI: 10.1111/ced.14609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 02/11/2021] [Indexed: 02/06/2023]
Affiliation(s)
- G Paolino
- Unit of Dermatology and Departments of Oncology, IRCCS San Raffaele Hospital, Milan, Italy
| | - M V Cicinelli
- Department of, Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - P Brianti
- Unit of Dermatology and Departments of Oncology, IRCCS San Raffaele Hospital, Milan, Italy
| | - C Prezioso
- Unit of Dermatology and Departments of Oncology, IRCCS San Raffaele Hospital, Milan, Italy
| | - A Bulotta
- Department of, Oncology, IRCCS San Raffaele Hospital, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - N Rizzo
- Surgical Pathology, IRCCS San Raffaele, Milan, Italy
| | - F Bandello
- Department of, Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - L Lugini
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - C Federici
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - V Gregorc
- Department of, Oncology, IRCCS San Raffaele Hospital, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - G M Modorati
- Department of, Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - S R Mercuri
- Unit of Dermatology and Departments of Oncology, IRCCS San Raffaele Hospital, Milan, Italy
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17
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Gregorc V, Lazzari C, Mandalá M, Ippati S, Bulotta A, Cangi MG, Khater A, Viganò MG, Mirabile A, Pecciarini L, Ogliari FR, Arrigoni G, Grassini G, Veronesi G, Doglioni C. Intratumoral Cellular Heterogeneity: Implications for Drug Resistance in Patients with Non-Small Cell Lung Cancer. Cancers (Basel) 2021; 13:cancers13092023. [PMID: 33922215 PMCID: PMC8122731 DOI: 10.3390/cancers13092023] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 04/15/2021] [Accepted: 04/19/2021] [Indexed: 12/14/2022] Open
Abstract
Simple Summary The number of druggable tumor-specific molecular alterations in the treatment of non-small cell lung cancer (NSCLC) has grown significantly in the past decade. Emerging technologies such as liquid biopsy and single-cell methods allow for studying targetable drivers and develop personalized treatments. However, although new therapies confer prolonged disease control and high tumor response rates, most patients eventually progress on targeted treatments. Intratumoral heterogeneity is a frequent event in NSCLC, driving the tumor cells to develop adaptive or new resistance mechanisms within the drug environment. This review summarizes the current and upcoming research on the biological role of tumor heterogeneity, highlighting the link between early and acquired drug resistance and tumoral heterogeneity in targetable driver mutated NSCLC. Abstract Tailored therapies based on the identification of molecular targets currently represent a well-established therapeutic scenario in the treatment of non-small cell lung cancer (NSCLC) patients. However, while aiming to improve patients’ response to therapy, development of resistance is frequently observed in daily clinical practice. Intratumoral heterogeneity is a frequent event in NSCLC, responsible for several critical issues in patients’ diagnosis and treatment. Advances in single-cell sequencing technologies have allowed in-depth profiling of tumors and attributed intratumoral heterogeneity to genetic, epigenetic, and protein modification driven diversities within cancer cell populations. This review highlights current research on the biological role of tumor heterogeneity and its impact on the development of acquired resistance in NSCLC patients.
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Affiliation(s)
- Vanesa Gregorc
- Department of Oncology, IRCCS San Raffaele, 20132 Milan, Italy; (C.L.); (S.I.); (A.B.); (M.G.V.); (A.M.); (F.R.O.)
- Correspondence:
| | - Chiara Lazzari
- Department of Oncology, IRCCS San Raffaele, 20132 Milan, Italy; (C.L.); (S.I.); (A.B.); (M.G.V.); (A.M.); (F.R.O.)
| | - Mario Mandalá
- Division of Pathological Anatomy, Papa Giovanni XXIII Hospital, 24100 Bergamo, Italy;
- Unit of Medical Oncology, University of Perugia, 06123 Perugia, Italy
| | - Stefania Ippati
- Department of Oncology, IRCCS San Raffaele, 20132 Milan, Italy; (C.L.); (S.I.); (A.B.); (M.G.V.); (A.M.); (F.R.O.)
| | - Alessandra Bulotta
- Department of Oncology, IRCCS San Raffaele, 20132 Milan, Italy; (C.L.); (S.I.); (A.B.); (M.G.V.); (A.M.); (F.R.O.)
| | - Maria Giulia Cangi
- Pathology Unit, San Raffaele Scientific Institute, IRCCS, 20132 Milan, Italy; (M.G.C.); (L.P.); (G.A.); (G.G.); (C.D.)
| | - Abdelrahman Khater
- San Raffaele Hospital, IRCCS, University Vita Salute, 20132 Milan, Italy;
| | - Maria Grazia Viganò
- Department of Oncology, IRCCS San Raffaele, 20132 Milan, Italy; (C.L.); (S.I.); (A.B.); (M.G.V.); (A.M.); (F.R.O.)
| | - Aurora Mirabile
- Department of Oncology, IRCCS San Raffaele, 20132 Milan, Italy; (C.L.); (S.I.); (A.B.); (M.G.V.); (A.M.); (F.R.O.)
| | - Lorenza Pecciarini
- Pathology Unit, San Raffaele Scientific Institute, IRCCS, 20132 Milan, Italy; (M.G.C.); (L.P.); (G.A.); (G.G.); (C.D.)
| | - Francesca Rita Ogliari
- Department of Oncology, IRCCS San Raffaele, 20132 Milan, Italy; (C.L.); (S.I.); (A.B.); (M.G.V.); (A.M.); (F.R.O.)
| | - Gianluigi Arrigoni
- Pathology Unit, San Raffaele Scientific Institute, IRCCS, 20132 Milan, Italy; (M.G.C.); (L.P.); (G.A.); (G.G.); (C.D.)
| | - Greta Grassini
- Pathology Unit, San Raffaele Scientific Institute, IRCCS, 20132 Milan, Italy; (M.G.C.); (L.P.); (G.A.); (G.G.); (C.D.)
| | - Giulia Veronesi
- Division of Thoracic Surgery, San Raffaele Scientific Institute, IRCCS, 20132 Milan, Italy;
| | - Claudio Doglioni
- Pathology Unit, San Raffaele Scientific Institute, IRCCS, 20132 Milan, Italy; (M.G.C.); (L.P.); (G.A.); (G.G.); (C.D.)
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18
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Lazzari C, Bulotta A, Cangi MG, Bucci G, Pecciarini L, Bonfiglio S, Lorusso V, Ippati S, Arrigoni G, Grassini G, Doglioni C, Gregorc V. Next Generation Sequencing in Non-Small Cell Lung Cancer: Pitfalls and Opportunities. Diagnostics (Basel) 2020; 10:E1092. [PMID: 33333743 PMCID: PMC7765222 DOI: 10.3390/diagnostics10121092] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/07/2020] [Accepted: 12/10/2020] [Indexed: 12/19/2022] Open
Abstract
Lung cancer remains the first cause of cancer-related deaths worldwide. Thanks to the improvement in the knowledge of the biology of non-small cell lung cancer (NSCLC), patients' survival has significantly improved. A growing number of targetable molecular alterations have been identified. Next-generation sequencing (NGS) has become one of the methodologies entered in clinical practice and was recently recommended by the European society for medical oncology (ESMO) to perform a comprehensive molecular characterization in patients with cancer. The current review provides an overview of the clinical trials that have explored the impact of NGS in patients with cancer, its limits, and advantages.
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Affiliation(s)
- Chiara Lazzari
- Department of Oncology, IRCCS San Raffaele, 20132 Milan, Italy; (A.B.); (V.L.); (S.I.); (V.G.)
| | - Alessandra Bulotta
- Department of Oncology, IRCCS San Raffaele, 20132 Milan, Italy; (A.B.); (V.L.); (S.I.); (V.G.)
| | - Maria Giulia Cangi
- Department of Pathology, IRCCS San Raffaele, 20132 Milan, Italy; (M.G.C.); (L.P.); (G.A.); (G.G.); (C.D.)
| | - Gabriele Bucci
- Center for Omics Science, IRCCS San Raffaele, 20132 Milan, Italy; (G.B.); (S.B.)
| | - Lorenza Pecciarini
- Department of Pathology, IRCCS San Raffaele, 20132 Milan, Italy; (M.G.C.); (L.P.); (G.A.); (G.G.); (C.D.)
| | - Silvia Bonfiglio
- Center for Omics Science, IRCCS San Raffaele, 20132 Milan, Italy; (G.B.); (S.B.)
| | - Vincenza Lorusso
- Department of Oncology, IRCCS San Raffaele, 20132 Milan, Italy; (A.B.); (V.L.); (S.I.); (V.G.)
| | - Stefania Ippati
- Department of Oncology, IRCCS San Raffaele, 20132 Milan, Italy; (A.B.); (V.L.); (S.I.); (V.G.)
| | - Gianluigi Arrigoni
- Department of Pathology, IRCCS San Raffaele, 20132 Milan, Italy; (M.G.C.); (L.P.); (G.A.); (G.G.); (C.D.)
| | - Greta Grassini
- Department of Pathology, IRCCS San Raffaele, 20132 Milan, Italy; (M.G.C.); (L.P.); (G.A.); (G.G.); (C.D.)
| | - Claudio Doglioni
- Department of Pathology, IRCCS San Raffaele, 20132 Milan, Italy; (M.G.C.); (L.P.); (G.A.); (G.G.); (C.D.)
| | - Vanesa Gregorc
- Department of Oncology, IRCCS San Raffaele, 20132 Milan, Italy; (A.B.); (V.L.); (S.I.); (V.G.)
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19
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Paolino G, Bearzi P, Pampena R, Longo C, Frascione P, Rizzo N, Raucci M, Carbone A, Cantisani C, Ricci F, Didona D, Frattini F, Bulotta A, Gregorc V, Mercuri SR. Clinicopathological and dermoscopic features of amelanotic and hypomelanotic melanoma: a retrospective multicentric study. Int J Dermatol 2020; 59:1371-1380. [PMID: 32726478 DOI: 10.1111/ijd.15064] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/13/2020] [Accepted: 06/18/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Amelanotic and hypomelanotic melanoma (AHM) has a higher risk of delayed diagnosis and a significant lower 5-year melanoma-specific survival compared to pigmented melanoma. Our aim was the evaluation of the clinicopathological/dermoscopic features of amelanotic melanoma (AM) and hypomelanotic melanoma (HM). METHODS All participants had a personal history of AHM. We defined HM as showing clinical/dermoscopic pigmentation in < 25% of the lesion's surface and histopathological focal pigmentation, while AM as melanomas with clinical/dermoscopic and histopathological absence of pigmentation. RESULTS The most common phenotypic traits among the 145 AHM patients were as follows: phototype II, blue-grey eyes, and dark brown hair. Red hair was present in 23.8% AHM cases (AM = 22.60%; HM = 25.80%). The most affected area was the back (29.5%). A total of 67.1% were classified as AM and 32.9% as HM. The most represented hair colors in AM and HM were, respectively, blonde and dark brown hair. Median Breslow thickness was 1.7 mm, superficial spreading melanoma (SSM) and nodular melanoma (NM) were the most represented histotypes, and mitotic rate > 1 × mm2 was reported in 73.3% cases, and regression was significantly more present in HM. Dermoscopy showed high prevalence of white structureless zones (63.4%), linear looped vessels (58.8%), linear irregular vessels (50.0%), and arborizing vessels (47.2%). Multivariate logistic regression confirmed the association between the presence of pigmentation and the following: histological regression, dermoscopic globules, and arborizing vessels. CONCLUSIONS Predominance of red hair in AHM patients was not confirmed. AHM affects mostly intermittent sun-exposed body areas. The deeper median Breslow thickness (versus pigmented melanoma), the association of AM with the nodular histotype, and the high mitotic rate highlight the AHM's aggressiveness. HM's higher levels of regression can be explained by the presence of pigmentation, driving the underlying immune response. AHM showed a polymorphous vascular pattern and significant presence of arborizing vessels (especially HM).
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Affiliation(s)
- Giovanni Paolino
- Unit of Dermatology, IRCCS Ospedale San Raffaele, Milan, Italy.,Dermatologic Clinic, La Sapienza University of Rome, Rome, Italy
| | - Pietro Bearzi
- Unit of Dermatology, IRCCS Ospedale San Raffaele, Milan, Italy.,Università Vita Salute San Raffaele, Milano, Italy
| | - Riccardo Pampena
- Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Caterina Longo
- Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Pasquale Frascione
- Oncologic and Preventative Dermatology, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Nathalie Rizzo
- Department of Pathology, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Anna Carbone
- Oncologic and Preventative Dermatology, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Carmen Cantisani
- Dermatologic Clinic, La Sapienza University of Rome, Rome, Italy
| | - Francesco Ricci
- Melanoma Unit, Istituto Dermopatico dell'Immacolata (IDI), Rome, Italy
| | - Dario Didona
- Melanoma Unit, Istituto Dermopatico dell'Immacolata (IDI), Rome, Italy
| | | | - Alessandra Bulotta
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Vanesa Gregorc
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Santo R Mercuri
- Unit of Dermatology, IRCCS Ospedale San Raffaele, Milan, Italy
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20
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Paolino G, Rizzo N, Pampena R, Bearzi P, Bulotta A, Gregorc V, Brianti P, Moliterni E, Mercuri SR. Spontaneous Regression of Primary Melanoma and Multiple Melanocytic Nevi in a Patient With Metastatic Melanoma. Dermatol Pract Concept 2020; 10:e2020052. [PMID: 32685272 DOI: 10.5826/dpc.1003a52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2020] [Indexed: 10/31/2022] Open
Affiliation(s)
- Giovanni Paolino
- Unit of Dermatology, IRCCS Ospedale San Raffaele, Milan, Italy.,Dermatologic Clinic, La Sapienza University of Rome, Italy
| | - Nathalie Rizzo
- Department of Pathology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Riccardo Pampena
- Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Italy
| | - Pietro Bearzi
- Unit of Dermatology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alessandra Bulotta
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Vanesa Gregorc
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Pina Brianti
- Unit of Dermatology, IRCCS Ospedale San Raffaele, Milan, Italy
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21
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Campochiaro C, Tomelleri A, Ferrara R, Lazzari C, De Luca G, Signorelli D, Bulotta A, Gregorc V, Garassino M, Dagna L. FRI0478 SEROLOGICAL AUTOIMMUNITY IN PATIENTS WITH RHEUMATIC IMMUNE-RELATED ADVERSE EVENTS: CORRELATION WITH SEVERITY AND TREATMENT. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.6275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Immune checkpoint inhibitors (ICIs) can induce a variety of rheumatic immune-related adverse events (Rh-irAEs). Few data are available on which features can predict the occurrence of long-lasting and severe Rh-irAEObjectives:To describe the serological features associated with long-lasting and severe Rh-irAE.Methods:ICI-treated patients were identified. Patients’ demographics, histotype of cancer, ICI, time interval from ICI start to Rh-irAE onset, characteristics of Rh-irAEs were recorded. Patients were tested for autoimmunity panel (a-IP): RF, ACPA, ANA, anti-SSA, anti-SSB, anti-Sm, anti-RNP, anti-Jo1, ANCA, ASMA, AMA, anti-dsDNA, anti-tireoglobulin, anti-tireoperoxidas, IgM and IgG anti-cardiolipin and anti-β2 glicoprotein I, crioglobulins. All patients were treated with steroids (CS). In case of flare of the Rh-irAE, csDMARDs or bDMARDs were started. Associations between a-IP status and need for DMARD start was evaluated. Non parametric tests were used.Results:22 Rh-irAE were included (see Table 1). Median age at Rh-irAE onset was 70 (50 – 84) years. 2 patients (9%) had a personal history of psoriasis. Median time from ICI start to Rh-irAE onset was 5 (1 – 26) months. 11 patients (50%) developed 1 Rh-irAE, 10 (45.4%) 2 and 1 (4.5%) 3. The most frequent were arthritis (A, 14, 63.6%), cutaneous vasculitis (CV, 5, 22.7%), PMR-like (4, 18.2%), polymyositis (PM, 4, 18.2%), myocarditis (Myo, 3, 13.6%) and dermatomyositis (DM, 2, 9.1%). Median initial prednisone dose was 25 (10 – 75) mg daily. In 14 patients (63.6%) a csDMARD was started upon steroids tapering. 9 patients (41%) were treated with methotrexate (MTX, 4, 18.2%) with hydroxychloroquine (HCQ, 2, 9.1%) with mycophenolate (MMF, 2, 9.1%) with colchicine (colch). 6 patients were treated with bDMARDs. 3 patients (50%) were treated with anakinra (ANK), 2 (33.3%) with IVIG and 3 (50%) with tocilizumab (TCZ). 13 patients (59.1%) were a-IP+. A significantly higher percentage of a-IP+ patients received DMARDs (11, 84.6%) compared to a-IP- patients (2, 22.2%,p = 0.0007). A significantly higher percentage of a-IP+ patients were treated with bDMARDs (5, 38.5%) compared to a-IP- patients (0, 0%, p = 0.05). We analysed whether in csDMARD-treated patients the need for bDMARDs was higher in a-IP+ but we found no statistical significance (45.4% vs 0%, p = 0.487).Table 1.Characteristics and treatment of Rh-irAEs patients.Age, SexCancerICIOnset (monts)Rhem-irAETreatmentResponseICI stopAutoAb169, MLung, adenoNivo3MyoCS, MMF, ANK, TCZLDAY, DpANCA270, MBladderAtezo1A,CS, MTXRemY, TNeg379, MLung SCCPembro1ACSRemNoRo52452, MLung, LCCNivo6A, CVCS, MTX, ANK, TCZLDANoANA 1:160 s582, MLung, LCCPembro3PMRCSRemNoNeg656, MMelanomaPembro26PMR, PMCS, MTXDeathY, DANA 1:160 s, pANCA772, MLung, adenoPembro5A, CVCS, MTX, TCZHDA (TCZ)Y, TANA 1:160 s874, MLung, adenoPembro1PMRCS, MTXLDANoANA 1:160 s975, MLung, adenoPembro1PM, MyoCSRemY, DNeg1075, MLung, adenoNivo9ACSRemNoNeg1168, FLung, adenoAtezo18ACS, MTXLDAY, TNeg1235, MMelanomaNivo2ACS, MTXLDANoANA 1:640 s1379, MLung, SCCNivo15A, PMRCS, MTX, ANKDeath (NR)Y, DRo521477, MLung, adenoPembro8DMCS, HCQ, IVIGLDAY, DANA 1:320 PCNA1567, MLung, adenoNivo13ACS, MTXLDANoASMA1674, MLung, SCCAtezo1A, CVCS, HCQ, ColchLDAY, DNeg1770, MLung, adenoNivo5A, CVCSRemY, DNeg1870, MLung, adenoPembro15ACSLDANoASMA1969, MLung, adenoNivo5DMCS, HCQ, MMF, IVIG, TacroMDAY, TANA 1:!60 s2084, MH&N, SCCNivo3PhCSRemY, DNeg2167, MLung, adenoDurva5A, PM, MyoCSLDAY, DANA 1:160 h2250, FLung, LCCNivo1A, CVCS, HCQRemY, DNegConclusion:The presence of serological autoimmunity might be helpful in detecting patients with Rh-irAEs refractory to steroid therapy.Disclosure of Interests:Corrado Campochiaro Speakers bureau: Novartis, Pfizer, Roche, GSK, SOBI, Alessandro Tomelleri: None declared, Roberto Ferrara: None declared, Chiara Lazzari: None declared, Giacomo De Luca Speakers bureau: SOBI, Novartis, Celgene, Pfizer, MSD, Diego Signorelli: None declared, Alessandra Bulotta: None declared, Vanesa Gregorc: None declared, Marina Garassino: None declared, Lorenzo Dagna Grant/research support from: Abbvie, BMS, Celgene, Janssen, MSD, Mundipharma Pharmaceuticals, Novartis, Pfizer, Roche, SG, SOBI, Consultant of: Abbvie, Amgen, Biogen, BMS, Celltrion, Novartis, Pfizer, Roche, SG, and SOBI
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Pontara A, Paolino G, Gregorc V, Mercuri SR, Bulotta A, Bearzi P, Doglioni C, Rizzo N. Immunohistochemical Evaluation and Clinicopathological Correlation of Mer and Axl Tyrosine Kinase TAM Receptors in Cutaneous Melanoma. Dermatol Pract Concept 2020; 10:e2020029. [PMID: 32363092 DOI: 10.5826/dpc.1002a29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2019] [Indexed: 10/31/2022] Open
Abstract
Background Malignant melanoma (MM) is potentially the most dangerous form of skin tumor. In the last few years, the so-called TAM receptors, a unique family of tyrosine kinase (TK) receptors, have become increasingly important. Objectives To evaluate Mer and Axl TAM receptor expression to find clinicopathological features that could explain the biological behavior of MM. Patients and Methods Clinicopathological data were obtained from an MM electronic database at our Institute. We reviewed 24 cutaneous MM specimens. TAM receptor expression was assayed using immunohistochemistry. Combinative semiquantitative scoring was used for the evaluation of TAM receptor expression (MerTK and AxlTK). Appropriate statistical methods were used to evaluate a possible correlation between TAM receptor expression and the clinicopathological variables of the MM samples (univariate analysis and multivariate analysis). Results MerTK and AxlTK were expressed differently in the MM samples, with a major expression of the first receptor. The cells of the tumor microenvironment contributed to the majority of the total score. A significant association was found between AxlScore and the site of the tumor and between AxlScore and the variable ulceration; another correlation was found between MerScore and the following characteristics: pathological stage of the tumor (pT), sex, ulceration, and tumor-infiltrating lymphocytes. Conclusions All correlations between the expression of MerTK and AxlTK with the clinical and histological variables of MM should be validated in a large group of people in order to increase the validity and the impact of our observations, with subsequently therapeutic implications in the era of the "targeted therapy."
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Affiliation(s)
- Andrea Pontara
- Internal Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Paolino
- Unit of Dermatology, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Department of Internal Medicine and Medical Specialties, Dermatology Clinic, La Sapienza-University of Rome, Italy
| | - Vanesa Gregorc
- Department of Medical Oncology, IRCCS, San Raffaele Scientific Institute, Milan, Italy
| | | | - Alessandra Bulotta
- Department of Medical Oncology, IRCCS, San Raffaele Scientific Institute, Milan, Italy
| | - Pietro Bearzi
- Unit of Dermatology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Claudio Doglioni
- Department of Pathology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nathalie Rizzo
- Department of Pathology, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Lazzari C, Gregorc V, Cangi MG, Giovannetti E, Bulotta A, Santarpia M. Combined exosomal RNA and circulating tumor DNA for epidermal growth factor mutation detection in non-small cell lung cancer. J Thorac Dis 2019; 10:S4023-S4027. [PMID: 30631545 DOI: 10.21037/jtd.2018.10.17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Chiara Lazzari
- Department of Oncology, Division of Experimental Medicine, IRCCS San Raffaele, Milan, Italy
| | - Vanesa Gregorc
- Department of Oncology, Division of Experimental Medicine, IRCCS San Raffaele, Milan, Italy
| | - Maria Giulia Cangi
- Unit of Pathology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elisa Giovannetti
- Department of Medical Oncology, VU University Medical Center, Amsterdam, The Netherlands.,CNR-Nano, Institute of Nanoscience and Nanotechnology, Pisa, Italy.,Cancer Pharmacology Lab, AIRC Start-Up Unit, University of Pisa, Pisa, Italy
| | - Alessandra Bulotta
- Department of Oncology, Division of Experimental Medicine, IRCCS San Raffaele, Milan, Italy
| | - Mariacarmela Santarpia
- Medical Oncology Unit, Department of Human Pathology of Adult and Evolutive Age "G. Barresi", University of Messina, Messina, Italy
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Lazzari C, Gregorc V, Bulotta A, Dottore A, Altavilla G, Santarpia M. Temozolomide in combination with either veliparib or placebo in patients with relapsed-sensitive or refractory small-cell lung cancer. Transl Lung Cancer Res 2018; 7:S329-S333. [PMID: 30705847 DOI: 10.21037/tlcr.2018.12.02] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Chiara Lazzari
- Department of Oncology, Division of Experimental Medicine, IRCCS San Raffaele Hospital, Milano, Italy
| | - Vanesa Gregorc
- Department of Oncology, Division of Experimental Medicine, IRCCS San Raffaele Hospital, Milano, Italy
| | - Alessandra Bulotta
- Department of Oncology, Division of Experimental Medicine, IRCCS San Raffaele Hospital, Milano, Italy
| | - Alessia Dottore
- Medical Oncology Unit, Department of Human Pathology "G. Barresi", University of Messina, Messina, Italy
| | - Giuseppe Altavilla
- Medical Oncology Unit, Department of Human Pathology "G. Barresi", University of Messina, Messina, Italy
| | - Mariacarmela Santarpia
- Medical Oncology Unit, Department of Human Pathology "G. Barresi", University of Messina, Messina, Italy
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Francaviglia I, Magliacane G, Grassini G, Girlando S, Medicina D, Lazzari C, Bulotta A, Pecciarini L, Doglioni C, Cangi MG. Abstract 5580: Identification and monitoring of somatic mutations in circulating cell-free DNA by next-generation sequencing in patients with lung adenocarcinoma. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-5580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
The analysis of circulating cell-free tumor DNA (ctDNA), which can be obtained from plasma by non-invasive procedures, was proven useful to provide biomarkers in the management of non-small-cell lung cancer (NSCLC) patients. Several studies assessed ctDNA prognostic and predictive value as source of key data for therapeutic target selection and drug resistance in such patients. The purpose of the present study was to compare the assessment of NSCLC common hot spot mutations in ctDNA samples using the NGS Oncomine cfDNA Lung Cancer assay (ThermoFisher) to the standard clinical tests (i.e. real-time quantitative PCR and droplet digital PCR), performed in both FFPE tumor and ctDNA samples. In particular we aimed to evaluate the feasibility and accuracy of this assay for (1) the detection of EGFR/KRAS mutations in 50 patients with newly diagnosed lung cancer and no possibility to obtain tissue samples and (2) the identification of anti-EGFR treatment acquired resistance mutations in 50 NSCLC EGFR-mutated patients with disease progression. The Oncomine cfDNA Lung assay is a multiplexed sequencing test, designed to detect 150 hotspot mutations in 11 lung cancer-related genes (ALK, BRAF, EGFR, ERBB2, KRAS, MAP2K1, MET, NRAS, PIK3CA, ROS1, and TP53) with a limit of detection as low as 0.1%. We analyzed a total of 100 ctDNAs which were sequenced using the Ion S5 system. Libraries were templated using the Ion Chef and multiplexed as 8 libraries on a 520 chip. Data analysis was performed in Torrent Suite using the variant Caller plugin. The total process time, from ctDNA isolation to result reporting, was as short as 4 days, supporting a workflow where blood samples are received early on day 1 and final variant calls are available on day 4. ctDNA NGS analysis for the newly diagnosed patients with no available tumor sample identified KRAS mutations (7%) and more importantly, targetable EGFR mutations (10%). For the patients with progression disease, EGFR acquired resistance mutations were found in 78% of the cases. Overall, the most frequently mutated genes were EGFR (85%), TP53 (26%), PIK3CA (18%), ALK (10%), and MET (8%). Taken the EGFR mutation detected by routine methods as the gold standard, the concordance with EGFR variants detected by NGS was 97%. Interestingly, the NGS approach detected the same EGFR mutations with the same allelic frequency of standard methods. These preliminary data confirm the potential of the Oncomine cfDNA lung assay for plasma genotyping which allows both noninvasive multiplexed detection of targetable genomic alterations and monitoring of acquired resistance mutations in lung cancer.
Citation Format: Ilaria Francaviglia, Gilda Magliacane, Greta Grassini, Salvatore Girlando, Daniela Medicina, Chiara Lazzari, Alessandra Bulotta, Lorenza Pecciarini, Claudio Doglioni, Maria Giulia Cangi. Identification and monitoring of somatic mutations in circulating cell-free DNA by next-generation sequencing in patients with lung adenocarcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 5580.
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Gregorc V, Lazzari C, Bulotta A, Viganò MG, Ghio D, Fontana F, Salini G, Lambiase A. Long-term survival outcomes of a placebo-controlled phase 3 trial with NGR-hTNF in combination with best investigator choice in relapsed malignant pleural mesothelioma (MPM). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.8567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Vanesa Gregorc
- Department of Oncology, San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Lazzari
- Department of Oncology, San Raffaele Scientific Institute, Milan, Italy
| | | | | | - Domenico Ghio
- Department of Radiology, San Raffaele Scientific Institute, Milan, Italy
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Lazzari C, Karachaliou N, Bulotta A, Viganó M, Mirabile A, Brioschi E, Santarpia M, Gianni L, Rosell R, Gregorc V. Combination of immunotherapy with chemotherapy and radiotherapy in lung cancer: is this the beginning of the end for cancer? Ther Adv Med Oncol 2018; 10:1758835918762094. [PMID: 29662546 PMCID: PMC5894901 DOI: 10.1177/1758835918762094] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 02/05/2018] [Indexed: 12/26/2022] Open
Abstract
Immune checkpoint inhibitors have significantly improved overall survival with an acceptable safety profile in a substantial proportion of non-small cell lung cancer (NSCLC) patients. However, not all patients are sensitive to immune checkpoint blockade and, in some cases, programmed death 1 (PD-1) or programmed death ligand 1 (PD-L1) inhibitors accelerate tumor progression. Several combination strategies are under evaluation, including the concomitant or sequential evaluation of chemotherapy or radiotherapy with immunotherapy. The current review provides an overview on the molecular rationale for the investigation of combinatorial approaches with chemotherapy or radiotherapy. Moreover, the results of completed clinical studies will be reported.
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Affiliation(s)
- Chiara Lazzari
- Department of Oncology, Division of Experimental Medicine, IRCCS San Raffaele, via Olgettina 60, Milan, Lombardia, 20132, Italy
| | - Niki Karachaliou
- Instituto Oncológico Dr Rosell (IOR), University Hospital Sagrat Cor, Barcelona, Spain Coyote Research Group, Pangaea Oncology, Laboratory of Molecular Biology, Quirón-Dexeus University Institute, Barcelona, Spain
| | - Alessandra Bulotta
- Department of Oncology, Division of Experimental Medicine, IRCCS San Raffaele, Milan, Italy
| | - Mariagrazia Viganó
- Department of Oncology, Division of Experimental Medicine, IRCCS San Raffaele, Milan, Italy
| | - Aurora Mirabile
- Department of Oncology, Division of Experimental Medicine, IRCCS San Raffaele, Milan, Italy
| | - Elena Brioschi
- Department of Oncology, Division of Experimental Medicine, IRCCS San Raffaele, Milan, Italy
| | - Mariacarmela Santarpia
- Medical Oncology Unit, Department of Human Pathology "G. Barresi", University of Messina, Messina, Italy
| | - Luca Gianni
- Department of Oncology, Division of Experimental Medicine, IRCCS San Raffaele, Milan, Italy
| | - Rafael Rosell
- Instituto Oncológico Dr Rosell (IOR), Quirón-Dexeus University Institute, Barcelona, Spain Institut d'Investigació en Ciències Germans Trias i Pujol, Badalona, Spain Institut Català d'Oncologia, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Vanesa Gregorc
- Department of Oncology, Division of Experimental Medicine, IRCCS San Raffaele, Milan, Italy
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Finocchiaro CY, Rota A, Barbieri V, Bettini A, Bianco R, Borra G, Buffoni L, Bulotta A, Carta A, Cortinovis D, Costanzo R, Cusmai A, Danesi R, D’Argento E, Del Conte A, Franchina T, Gilli M, Gregorc V, Irtelli L, Landi L, Malorgio F, Mancuso G, Martelli O, Mazzanti P, Melotti B, Migliorino MR, Minotti V, Montrone M, Morabito A, Roca E, Romano G, Rossi A, Savio G, Tiseo M, Boscardini I, Piccolo L, Pilotto S, Malapelle U. Listening understanding and acting (lung): focus on communicational issue in thoracic oncology. Transl Cancer Res 2018; 8:S16-S22. [PMID: 35117061 PMCID: PMC8798889 DOI: 10.21037/tcr.2018.12.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 12/21/2018] [Indexed: 12/03/2022]
Abstract
Background In the field of oncological assistance, nowadays we have to deal with a complex scenario where patients got used to obtain a huge amount of information through internet or social media and to apply them in performing their health-related decisions. This landscape requires that clinicians become able to handle therapeutical approaches and adequate skills in communication tools to satisfy the current needs. Our project aimed to build a communication model based on clinical oncologists’ real experiences in order to find a simple way to share with patients all the innovative therapeutical opportunities today available in lung cancer. The final goal is to design a flexible and personalized model adaptable to clinician’s personal characteristics and to the specific patient he is facing. We applied both traditional educational tools and innovative techniques in order to make the results effective and applicable to support peer learning. Methods The first step consisted in a Board synthesized the definition of the diagnostic process, the identification of treatment strategies and any potential communication barrier clinicians may face dealing with patients. The second step consisted in teamwork including a theoretical part and a training part. In the third step we produce five training videos and video interviews regarding communication praxis and a “Small communication manual”. The last step consisted in the publication of the produced material on website and its diffusion through the social media. Results In medicine, the universal application of a single model of communication does not represent the optimal solution. By contrary, the availability of simple and practical suggestions to improve the communicative style could allow clinicians to abandon stereotyped formulas identically repurposed to all patients. The “from bottom to top” training, starting from real-life to take advantage of the clinician’s experience, give the clinicians the possibility to meditate about their own communicative style and to train in the context of a protected environment. Applying these rules, we design an effective communication model, based on healthcare humanization, which could represent a fundamental support for the patient in order to be gently driven by the clinician to the most appropriate therapeutical choice, balancing efficacy and quality of life. The relational training may improve the quality of clinician-patient communication and could be widespread to other clinicians through the media. Conclusions Considering the innovative therapeutical options available, particularly for lung cancer patients, and the increasing access of health-related information through internet or social media the clinician-patient communication has become crucial to support the achievement of the most appropriate therapeutical choice for the patient, facing the intricate illness experience. Building a shareable and easy-to-apply communication model represents a challenge aimed to help clinicians and including technology not as a threat, but as a positive tool.
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Affiliation(s)
| | | | - Vito Barbieri
- UO Oncologia Medica, AOU “Mater Domini”, Germaneto, Catanzaro, Italy
| | - Anna Bettini
- ASST Papa Giovanni XXIII, UO Oncologia, Bergamo, Italy
| | | | - Gloria Borra
- AOU Maggiore della Carità di Novara, Novara, Italy
| | - Lucio Buffoni
- AOU San Luigi Orbassano, Oncologia Medica, Torino, Italy
| | - Alessandra Bulotta
- Dipartimento di Oncologia Medica, IRCCS Ospedale Scientifico San Raffaele, Milano, Italy
| | - Annamaria Carta
- AOB Cagliari, UO Oncologia Medica, Ospedale Businco, Cagliari, Italy
| | - Diego Cortinovis
- Struttura Semplice Lung Unit, Ospedale San Gerardo, ASST Monza, Monza, Italy
| | - Raffaele Costanzo
- UO Complessa di Oncologia medica Toraco-Polmonare, Istituto Nazionale Tumori, Napoli, Italy
| | | | - Romano Danesi
- Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa, Pisa, Italy
| | - Ettore D’Argento
- UOC di Oncologia Medica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Alessandro Del Conte
- IRCCS, Centro di Riferimento Oncologico, SOC Oncologia Medica e dei Tumori Immunocorrelati, Aviano (PN), Italy
| | - Tindara Franchina
- Dipartimento di Patologia Umana “G.Barresi”, Università degli studi di Messina, Messina, Italy
| | - Marina Gilli
- AORN dei Colli, UOSD DH PNL Oncologico, Napoli, Italy
| | - Vanesa Gregorc
- Dipartimento di Oncologia Medica, IRCCS Ospedale Scientifico San Raffaele, Milano, Italy
| | - Luciana Irtelli
- Clinica Oncologica, ASL Lanciano Vasto Chieti, Chieti, Italy
| | - Lorenza Landi
- Unità Operativa di Oncologia ed Ematologia, AUSL Romagna, Ravenna, Italy
| | | | | | - Olga Martelli
- AO Complesso Ospedaliero San Giovanni-Addolorata, Roma, Italy
| | - Paola Mazzanti
- UO Clinica Oncologica, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Barbara Melotti
- Oncologia Medica, Azienda Ospedaliera S.Orsola-Malpighi, Bologna, Italy
| | - Maria Rita Migliorino
- UOSD di Pneumologia Oncologica Azienda Ospedaliera San Camillo-Forlanini, Roma, Italy
| | - Vincenzo Minotti
- Divisione Struttura Complessa Oncologia Medica, Ospedale S. Maria della Misericordia Perugia, Perugia, Italy
| | - Michele Montrone
- SSD Oncologia Medica per la Patologia Toracica, IRCCS Istituto Tumori “Giovanni Paolo II” di Bari, Bari, Italy
| | - Alessandro Morabito
- Struttura Complessa Oncologia Medica Toraco-Polmonare, Divisione di Oncologia Medica, Istituto Nazionale Tumori Fondazione Pascale, Napoli, Italy
| | - Elisa Roca
- Oncologia Medica, Spedali Civili di Brescia, Brescia, Italy
| | | | - Antonio Rossi
- Divisione di Oncologia Medica, Fondazione IRCCS Casa Sollievo della Sofferenza, S. Giovanni Rotondo, Foggia, Italy
| | | | - Marcello Tiseo
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Parma, Parma, Italy
| | - Ivano Boscardini
- Docente di tecniche di comunicazione, CREMS Centro di Ricerca in Economia e Management in Sanità e nel Sociale, Università Cattaneo LIUC, Castellanza, VA, Italy
| | | | - Sara Pilotto
- Università degli Studi di Verona, UO Oncologia Medica, AOUI Verona, Verona, Italy
| | - Umberto Malapelle
- Anatomia Patologica, Dip.to di Sanità Pubblica, Università degli Studi di Napoli Federico II, Naples, Italy
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Magliacane G, Grassini G, Francaviglia I, DalCin E, Lazzari C, Bulotta A, Ducceschi M, Gregorc V, Pecciarini L, Doglioni C, Cangi MG. Abstract 744: ctDNA use in molecular diagnostics. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
The analysis of circulating cell-free tumor DNA (ctDNA), which can be obtained from plasma by non-invasive procedures, is expected to provide useful biomarkers in the management of non-small-cell lung cancer (NSCLC) patients. Indeed, several studies have assessed ctDNA prognostic and predictive value as source of key data for therapeutic targets and drug resistance in carcinoma patients. The expanding number of targeted therapeutics for NSCLC always expects a real-time wider tumor genotyping, and the use of ctDNA as either a complement or an alternative to tumor tissue DNA (ttDNA) could be a valid option for Next-Generation Sequencing (NGS) of key cancer genes.
However, isolation and enrichment of ctDNA is a big challenge because of its high degree of fragmentation and its low concentration against the normally occurring background of cell-free DNA derived from healthy cells. Therefore standardized methods for ctDNA extraction and analysis are crucial aspects in the setting-up of a molecular diagnostic approach.
In this study we aimed to evaluate the ctDNA use for molecular profiling, also analyzing the impact of both pre-analytical and analytical variables on DNA yield and mutation detection.
Matched ttDNA and ctDNA from 30 NSCLC patients were extracted, quantified and quality-controlled, and then investigated by different standard methods (real-time PCR, digital PCR, Mass Spectrometry genotyping) for EGFR, KRAS, BRAF, PIK3CA status. Mutational screening of ctDNA samples by IonTorrent NGS (Oncomine™ Lung cfDNA Assay, ThermoFisher) was also performed. Further, we extended ctDNA evaluation to additional 30 lung cancer patients with no available tumor sample.
We found that cell free DNA concentration in plasma correlated with both stage and number of metastatic sites. Analyzing matched ttDNA and ctDNA by standard methods, we identified mutations in EGFR, KRAS, PIK3CA genes, with an overall concordance of 77%. Interestingly, Oncomine Lung cfDNA assay detected these same mutations with the same allelic frequency of standard methods; mutations in TP53 and ALK genes were also found.
In the 30 patients with no available tumor sample, we found EGFR (10%) and KRAS (7%) mutations on ctDNA by standard methods; NGS analysis is under evaluation.
This study evaluated the use of multiple different methods to detect mutations in NSCLC and showed that ctDNA can be a feasible option for clinical monitoring of lung cancers, including for those patients who cannot undergo invasive diagnostic procedures, due to either comorbidities or absence of biopsable tumor lesions.
Citation Format: Gilda Magliacane, Greta Grassini, Ilaria Francaviglia, Elena DalCin, Chiara Lazzari, Alessandra Bulotta, Monika Ducceschi, Vanesa Gregorc, Lorenza Pecciarini, Claudio Doglioni, Maria Giulia Cangi. ctDNA use in molecular diagnostics [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 744. doi:10.1158/1538-7445.AM2017-744
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Lazzari C, Karachaliou N, Gregorc V, Bulotta A, Gonzalez-Cao M, Verlicchi A, Altavilla G, Rosell R, Santarpia M. Second-line therapy of squamous non-small cell lung cancer: an evolving landscape. Expert Rev Respir Med 2017; 11:469-479. [PMID: 28467720 DOI: 10.1080/17476348.2017.1326822] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The treatment of lung cancer has radically changed over the last few years. The discovery of druggable oncogenic alterations and the introduction of immunotherapy have provided lung cancer patients with the possibility of more efficient and less toxic therapeutic alternatives than chemotherapy. In the case of lung squamous cell carcinoma (LSCC), the treatment progress is slower than adenocarcinoma, for which several targeted agents have been already approved. The standard first-line therapy for LSCC, in most sites of the world, is platinum-based chemotherapy. After disease progression, these patients now have novel treatment options, including antiangiogenic agents and immune checkpoint blockade. Areas covered: We provide a summary of the recent novelties for the second-line therapy of LSCC, emphasizing on the results of the most important clinical trials that have led to regulatory approvals. Expert commentary: Immune checkpoint inhibitors have changed the therapeutic algorithm for LSCC patients. Other treatment options in the second-line setting include ramucirumab in combination with docetaxel and afatinib. However, we still lack biomarkers to predict which patients could respond better to each treatment. Despite the identification of several actionable molecular alterations, there are no approved targeted agents specific for advanced LSCC. Results from ongoing biomarker-driven studies are eagerly awaited to establish effective treatments for molecularly selected subgroups of patients.
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Affiliation(s)
- Chiara Lazzari
- a Department of Oncology, Division of Experimental Medicine , IRCCS San Raffaele , Milan , Italy
| | - Niki Karachaliou
- b Medical Oncology Department , Institute of Oncology Rosell (IOR), University Hospital Sagrat Cor , Barcelona , Spain
| | - Vanesa Gregorc
- a Department of Oncology, Division of Experimental Medicine , IRCCS San Raffaele , Milan , Italy
| | - Alessandra Bulotta
- a Department of Oncology, Division of Experimental Medicine , IRCCS San Raffaele , Milan , Italy
| | - Maria Gonzalez-Cao
- c Translational Cancer Research Unit, Instituto Oncológico Dr Rosell , Dexeus University Hospital-Quirónsalud Group , Barcelona , Spain
| | - Alberto Verlicchi
- d S.C. Oncologia , Fondazione IRCCS Policlinico San Matteo , Pavia , Italy
| | - Giuseppe Altavilla
- e Medical Oncology Unit, Department of Human Pathology "G. Barresi" , University of Messina , Messina , Italy
| | - Rafael Rosell
- c Translational Cancer Research Unit, Instituto Oncológico Dr Rosell , Dexeus University Hospital-Quirónsalud Group , Barcelona , Spain
- f Germans Trias i Pujol Research Institute , Badalona , Spain
- g Catalan Institute of Oncology , Germans Trias i Pujol University Hospital , Badalona , Spain
| | - Mariacarmela Santarpia
- e Medical Oncology Unit, Department of Human Pathology "G. Barresi" , University of Messina , Messina , Italy
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Lazzari C, Bulotta A, Ducceschi M, Viganò MG, Brioschi E, Corti F, Gianni L, Gregorc V. Historical Evolution of Second-Line Therapy in Non-Small Cell Lung Cancer. Front Med (Lausanne) 2017; 4:4. [PMID: 28168189 PMCID: PMC5253463 DOI: 10.3389/fmed.2017.00004] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 01/06/2017] [Indexed: 12/26/2022] Open
Abstract
Innovative therapeutic agents have significantly improved outcome with an acceptable safety profile in a substantial proportion of non-small cell lung cancer (NSCLC) patients, who depend on oncogenic molecular alterations for their malignant phenotype. Despite the survival improvement achieved with first-line chemotherapy, about 30% of patients do not obtain a tumor response. Moreover, those patients, initially sensitive to treatment, acquire resistance and develop tumor progression after a median of about 5 months. Approximately 60% of the patients progressing from first-line chemotherapy receive further systemic treatment in the second-line setting. Moreover, new options have emerged in the second-line armamentarium for the treatment of patients with NSCLC, including immune checkpoint inhibitors and antiangiogenic agents. The current review provides an overview on the clinical studies that gained the approval of chemotherapy agents (docetaxel and pemetrexed) and epidermal growth factor receptor gene–tyrosine kinase inhibitors as second-line treatment options for NSCLC patients, not carrying molecular alterations.
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Affiliation(s)
- Chiara Lazzari
- Department of Oncology, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - Alessandra Bulotta
- Department of Oncology, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - Monika Ducceschi
- Department of Oncology, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - Maria Grazia Viganò
- Department of Oncology, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - Elena Brioschi
- Department of Oncology, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - Francesca Corti
- Department of Oncology, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - Luca Gianni
- Department of Oncology, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - Vanesa Gregorc
- Department of Oncology, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute , Milan , Italy
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Brioschi E, Corti F, Lazzari C, Foti S, Nigro O, Corti A, Doglioni C, Righi L, Bulotta A, Viganò M, Ducceschi M, Torri V, Porcu L, Hirsch FR, Roder H, Novello S, Gianni L, Gregorc V. P3.02b-009 Plasma and Tissue Inflammatory and Angiogenic Biomarkers to Explore Resistance to EGFR-TKIs and Association with VeriStrat Status. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.1676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Gregorc V, Bulotta A, Viganò M, Citterio G, Petrella G, Brioschi E, Ducceschi M, Gianni L, Colombi S, Rossoni G, Salini G, Savia V, Lambiase A, Bordignon C. Patient-reported outcomes (PROs) and impact of lactate dehydrogenase (LDH) levels on outcomes in a phase 3 trial (NGR015) with best investigator choice (BIC) plus or minus NGR-hTNF in previously treated patients with malignant pleural mesothelioma (MPM). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw391.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Gregorc V, Viganò MG, Bulotta A, Citterio G, Petrella G, Brioschi E, Ducceschi M, Gianni L, Colombi S, Rossoni G, Salini G, Redaelli E, Lambiase A, Bordignon C. Impact of lactate dehydrogenase (LDH) and absolute lymphocyte count (ALC) on outcome of previously treated patients with malignant pleural mesothelioma (MPM) receiving chemotherapy (CT) with or without NGR-hTNF in the phase 3 trial NGR015. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e20075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Vanesa Gregorc
- Department of Oncology, San Raffaele Scientific Institute, Milan, Italy
| | - Maria G Viganò
- Department of Oncology, San Raffaele Scientific Institute, Milan, Italy
| | | | - Giovanni Citterio
- Department of Oncology, San Raffaele Scientific Institute, Milan, Italy
| | - Giovanna Petrella
- Department of Oncology, San Raffaele Scientific Institute, Milan, Italy
| | - Elena Brioschi
- Department of Oncology, San Raffaele Scientific Institute, Milan, Italy
| | - Monika Ducceschi
- Department of Oncology, San Raffaele Scientific Institute, Milan, Italy
| | - Luca Gianni
- Department of Oncology, San Raffaele Scientific Institute, Milan, Italy
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Gregorc V, Bulotta A, Viganò MG, Citterio G, Petrella G, Brioschi E, Ducceschi M, Gianni L, Colombi S, Rossoni G, Salini G, Savia V, Lambiase A, Bordignon C. Patient-reported outcomes (PROs) in the double-blind phase 3 trial (NGR015) with NGR-hTNF plus best investigator choice (BIC) versus placebo plus BIC for previously treated patients with malignant pleural mesothelioma (MPM). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e20077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Vanesa Gregorc
- Department of Oncology, San Raffaele Scientific Institute, Milan, Italy
| | | | - Maria G Viganò
- Department of Oncology, San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Citterio
- Department of Oncology, San Raffaele Scientific Institute, Milan, Italy
| | - Giovanna Petrella
- Department of Oncology, San Raffaele Scientific Institute, Milan, Italy
| | - Elena Brioschi
- Department of Oncology, San Raffaele Scientific Institute, Milan, Italy
| | - Monika Ducceschi
- Department of Oncology, San Raffaele Scientific Institute, Milan, Italy
| | - Luca Gianni
- Department of Oncology, San Raffaele Scientific Institute, Milan, Italy
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Gregorc V, Ghio D, Sallemi C, Bulotta A, Rossoni G, Viganò MG, Fontana F, Rossoni G, Colombi S, Lambiase A, Bordignon C. Treatment-free interval (TFI) after first-line therapy as a prognostic and predictive factor in malignant pleural mesothelioma (MPM): Findings from the NGR015 phase III trial with NGR-hTNF plus best investigator choice (BIC) versus placebo plus BIC. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.7557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Vanesa Gregorc
- Department of Oncology, San Raffaele Scientific Institute, Milan, Italy
| | - Domenico Ghio
- Department of Radiology, San Raffaele Scientific Institute, Milan, Italy
| | - Claudio Sallemi
- Department of Oncology, San Raffaele Scientific Institute, Milan, Italy
| | | | - Gilda Rossoni
- Department of Oncology, San Raffaele Scientific Institute, Milan, Italy
| | - Maria G Viganò
- Department of Oncology, San Raffaele Scientific Institute, Milan, Italy
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Bulotta A, Gregorc V, Viganò MG, Rossoni G, Fontana F, Ammannati C, Colombi S, Lambiase A, Bordignon C. Prognostic and predictive value of neutrophil-to-lymphocyte ratio (NLR) in previously treated patients with malignant pleural mesothelioma (MPM) enrolled in the NGR015 phase 3 trial. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.7558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Vanesa Gregorc
- Department of Oncology, San Raffaele Scientific Institute, Milan, Italy
| | - Maria G Viganò
- Department of Oncology, San Raffaele Scientific Institute, Milan, Italy
| | - Gilda Rossoni
- Department of Oncology, San Raffaele Scientific Institute, Milan, Italy
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Nicolucci A, Rossi MC, Lucisano G, Pintaudi B, Gentile S, Bulotta A, Skovlund SE, Vespasiani G. Benchmarking activities based on person centered measures: a diabetes case study from Italy. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku151.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Bulotta A, Gregorc V, Rossoni G, Viganò MG, Todisco G, Lambiase A, Bordignon C. Relationships between occurrence of chills and clinical outcome during NGR-hTNF therapy. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.2538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Vanesa Gregorc
- Department of Oncology, Istituto Scientifico San Raffaele, Milan, Italy
| | - Gilda Rossoni
- Department of Oncology, Istituto Scientifico San Raffaele, Milan, Italy
| | | | - Gabriele Todisco
- Department of Oncology, Istituto Scientifico San Raffaele, Milan, Italy
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Gregorc V, Bulotta A, Viganò MG, Ghio D, Rossoni G, Sallemi C, Fontana F, Ammannati C, Colombi S, Lambiase A, Bordignon C. Impact of treatment-free interval (TFI) and disease control rate (DCR) on survival outcome in relapsed malignant pleural mesothelioma (MPM). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.7584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Vanesa Gregorc
- Department of Oncology, Istituto Scientifico San Raffaele, Milan, Italy
| | | | | | - Domenico Ghio
- Department of Radiology, Istituto Scientifico San Raffaele, Milan, Italy
| | - Gilda Rossoni
- Department of Oncology, Istituto Scientifico San Raffaele, Milan, Italy
| | - Claudio Sallemi
- Department of Oncology, Istituto Scientifico San Raffaele, Milan, Italy
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Gregorc V, Novello S, Lazzari C, Barni S, Aieta M, Mencoboni M, Grossi F, De Pas T, de Marinis F, Bearz A, Floriani I, Torri V, Bulotta A, Cattaneo A, Grigorieva J, Tsypin M, Roder J, Doglioni C, Levra MG, Petrelli F, Foti S, Viganò M, Bachi A, Roder H. Predictive value of a proteomic signature in patients with non-small-cell lung cancer treated with second-line erlotinib or chemotherapy (PROSE): a biomarker-stratified, randomised phase 3 trial. Lancet Oncol 2014; 15:713-21. [PMID: 24831979 DOI: 10.1016/s1470-2045(14)70162-7] [Citation(s) in RCA: 139] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND An established multivariate serum protein test can be used to classify patients according to whether they are likely to have a good or poor outcome after treatment with EGFR tyrosine-kinase inhibitors. We assessed the predictive power of this test in the comparison of erlotinib and chemotherapy in patients with non-small-cell lung cancer. METHODS From Feb 26, 2008, to April 11, 2012, patients (aged ≥18 years) with histologically or cytologically confirmed, second-line, stage IIIB or IV non-small-cell lung cancer were enrolled in 14 centres in Italy. Patients were stratified according to a minimisation algorithm by Eastern Cooperative Oncology Group performance status, smoking history, centre, and masked pretreatment serum protein test classification, and randomly assigned centrally in a 1:1 ratio to receive erlotinib (150 mg/day, orally) or chemotherapy (pemetrexed 500 mg/m(2), intravenously, every 21 days, or docetaxel 75 mg/m(2), intravenously, every 21 days). The proteomic test classification was masked for patients and investigators who gave treatments, and treatment allocation was masked for investigators who generated the proteomic classification. The primary endpoint was overall survival and the primary hypothesis was the existence of a significant interaction between the serum protein test classification and treatment. Analyses were done on the per-protocol population. This trial is registered with ClinicalTrials.gov, number NCT00989690. FINDINGS 142 patients were randomly assigned to chemotherapy and 143 to erlotinib, and 129 (91%) and 134 (94%), respectively, were included in the per-protocol analysis. 88 (68%) patients in the chemotherapy group and 96 (72%) in the erlotinib group had a proteomic test classification of good. Median overall survival was 9·0 months (95% CI 6·8-10·9) in the chemotherapy group and 7·7 months (5·9-10·4) in the erlotinib group. We noted a significant interaction between treatment and proteomic classification (pinteraction=0·017 when adjusted for stratification factors; pinteraction=0·031 when unadjusted for stratification factors). Patients with a proteomic test classification of poor had worse survival on erlotinib than on chemotherapy (hazard ratio 1·72 [95% CI 1·08-2·74], p=0·022). There was no significant difference in overall survival between treatments for patients with a proteomic test classification of good (adjusted HR 1·06 [0·77-1·46], p=0·714). In the group of patients who received chemotherapy, the most common grade 3 or 4 toxic effect was neutropenia (19 [15%] vs one [<1%] in the erlotinib group), whereas skin toxicity (one [<1%] vs 22 [16%]) was the most frequent in the erlotinib group. INTERPRETATION Our findings indicate that serum protein test status is predictive of differential benefit in overall survival for erlotinib versus chemotherapy in the second-line setting. Patients classified as likely to have a poor outcome have better outcomes on chemotherapy than on erlotinib. FUNDING Italian Ministry of Health, Italian Association of Cancer Research, and Biodesix.
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Affiliation(s)
- Vanesa Gregorc
- Department of Medical Oncology, Istituto di Ricovero e Cura a Carattere Scientifico, Ospedale San Raffaele, Milan, Italy.
| | - Silvia Novello
- Department of Oncology, University of Turin, Azienda Ospedaliera Universitaria San Luigi Orbassano, Turin, Italy
| | - Chiara Lazzari
- Department of Medical Oncology, Istituto di Ricovero e Cura a Carattere Scientifico, Ospedale San Raffaele, Milan, Italy
| | - Sandro Barni
- Division of Medical Oncology, Department of Medical Oncology, Azienda Ospedaliera Treviglio, Treviglio, Italy
| | - Michele Aieta
- Division of Medical Oncology, Centro di Riferimento Oncologico di Basilicata, Istituto di Ricovero e Cura a Carattere Scientifico, Rionero in Vulture, Italy
| | - Manlio Mencoboni
- Oncology Unit, Villa Scassi Hospital, Azienda Sanitaria Locale 3, Genoa, Italy
| | - Francesco Grossi
- Lung Cancer Unit, Istituto di Ricovero e Cura a Carattere Scientifico, Azienda Ospedaliera Universitaria San Martino, Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
| | - Tommaso De Pas
- Division of Thoracic Oncology, European Institute of Oncology, Milan, Italy
| | - Filippo de Marinis
- Division of Thoracic Oncology, European Institute of Oncology, Milan, Italy; 1st Oncological Pulmonary Unit, San Camillo, High Specialization Hospital, Rome, Italy
| | - Alessandra Bearz
- Department of Medical Oncology, National Cancer Institute of Aviano, Aviano, Italy
| | - Irene Floriani
- Department of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico-Istituto di Richerche Farmacologiche Mario Negri, Milan, Italy
| | - Valter Torri
- Department of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico-Istituto di Richerche Farmacologiche Mario Negri, Milan, Italy
| | - Alessandra Bulotta
- Department of Medical Oncology, Istituto di Ricovero e Cura a Carattere Scientifico, Ospedale San Raffaele, Milan, Italy
| | - Angela Cattaneo
- Department of Medical Oncology, Istituto di Ricovero e Cura a Carattere Scientifico, Ospedale San Raffaele, Milan, Italy
| | | | | | | | - Claudio Doglioni
- Università Vita-Salute San Raffaele, School of Medicine, Department of Pathology, Istituto di Ricovero e Cura a Carattere Scientifico, Ospedale San Raffaele, Milan, Italy
| | - Matteo Giaj Levra
- Department of Oncology, University of Turin, Azienda Ospedaliera Universitaria San Luigi Orbassano, Turin, Italy
| | - Fausto Petrelli
- Division of Medical Oncology, Department of Medical Oncology, Azienda Ospedaliera Treviglio, Treviglio, Italy
| | - Silvia Foti
- Department of Medical Oncology, Istituto di Ricovero e Cura a Carattere Scientifico, Ospedale San Raffaele, Milan, Italy
| | - Mariagrazia Viganò
- Department of Medical Oncology, Istituto di Ricovero e Cura a Carattere Scientifico, Ospedale San Raffaele, Milan, Italy
| | - Angela Bachi
- Department of Medical Oncology, Istituto di Ricovero e Cura a Carattere Scientifico, Ospedale San Raffaele, Milan, Italy
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Lazzari C, Novello S, Barni S, Aieta M, De Marinis F, De Pas T, Grossi F, Mencoboni M, Bearz A, Floriani I, Torri V, Bulotta A, Grigorieva J, Roder J, Doglioni C, Roder H, Righi L, Foti S, Bachi A, Gregorc V. Randomized proteomic stratified phase III study of second-line erlotinib (E) versus chemotherapy (CT) in patients with inoperable non-small cell lung cancer (PROSE). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.18_suppl.lba8005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
LBA8005 Background: Second-line therapy for advanced NSCLC patients (pts) after progression on platinum-based regimens typically employs CT or E. Improved PFS in E-treated pts is associated with EGFR sensitizing mutations. However, a test for optimizing treatment in pts with wild-type or unknown EGFR mutation status or squamous histology is of clinical value. VeriStrat (VS) is a serum protein test that assigns "good" (VSG) or "poor" (VSP) classification and has demonstrated prognostic and predictive utility. PROSE is a multicenter prospective randomized biomarker validation trial, designed to evaluate the ability of VS to predict survival in second-line NSCLC pts treated with E or CT. It is the first completed prospective randomized biomarker validation trial following the MARVEL design (Freidlin et al. JNCI. 2010). Methods: 285 pts, stratified by ECOG-PS, smoking, and blinded pretreatment VS classification, were randomized 1:1 to receive E or CT at standard doses. Primary endpoint was overall survival (OS) and the primary hypothesis was significant interaction between VS status and treatment. Sample size was calculated based on an estimated 65%/35% VSG:VSP ratio and hazard ratio (HR) for interaction of 2.35, with a 2-sided α=0.05 and 90% power. Results: 285 pts were randomized and 263 (129 CT, 134 E) included in the per protocol primary analysis. 68% of pts in CT arm and 72% in E arm were classified as VSG. Analysis was performed at 226 events. The trial reached its primary objective of significant interaction between treatment and VeriStrat classification with an interaction p value of 0.037. Pts in the VSP group performed worse on E compared to CT (HR: 1.72, 95% CI: 1.08-2.74); there was no significant difference in OS between treatments in the VSG group (HR: 1.09, 95% CI:0.79-1.50). 194/198 pts with histologic diagnosis had tissue available for EGFR and KRAS mutations. Conclusions: The results suggest that VS status is predictive of differential OS benefit for E versus CT in second line setting, complementing the result from a retrospective analysis of NCIC BR.21 where the prognostic behavior of VS was established (Carbone et al. JTO. 2012). Clinical trial information: NCT00989690.
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Affiliation(s)
- Chiara Lazzari
- Department of Oncology, Istituto Scientifico Ospedale San Raffaele, Milan, Italy
| | | | - Sandro Barni
- Department of Medical Oncology, Treviglio and Caravaggio Hospital, Treviglio, Italy
| | - Michele Aieta
- Centro Di Riferimento Oncologico DI Basilicata, Rionero in Vulture, Italy
| | | | - Tommaso De Pas
- Division of Thoracic Oncology, European Institute of Oncology, Milan, Italy
| | - Francesco Grossi
- Lung Cancer Unit, National Institute for Cancer Research, Genova, Italy
| | | | | | - Irene Floriani
- Laboratory of Clinical Trials, Oncology Department, Istituto di Ricerche Farmacologiche, Milano, Italy
| | - Valter Torri
- Oncology Department, Mario Negri Institute, Milan, Italy
| | - Alessandra Bulotta
- Department of Oncology, Istituto Scientifico Ospedale San Raffaele, Milan, Italy
| | | | | | - Claudio Doglioni
- Department of Pathology, Istituto Scientifico Ospedale San Raffaele, Milan, Italy
| | | | - Luisella Righi
- Department of Clinical and Biological Sciences-Pathology, San Luigi Hospital, Orbassano, Italy
| | - Silvia Foti
- Department of Oncology, Istituto Scientifico Ospedale San Raffaele, Milan, Italy
| | - Angela Bachi
- Laboratory of Proteomics, Istituto Scientifico Ospedale San Raffaele, Milan, Italy
| | - Vanesa Gregorc
- Department of Oncology, Istituto Scientifico Ospedale San Raffaele, Milan, Italy
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Bulotta A, Gregorc V, Rossoni G, Todisco G, Viganò MG, Ammannati C, Mazzola G, Lambiase A, Bordignon C. Relationships of peripheral blood lymphocyte counts (PBLC) with antitumor activity of NGR-hTNF given in combination with chemotherapy (CT). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.3038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3038 Background: Antitumor effects of NGR-hTNF (N), a tumor-targeted antivascular agent, are driven at low dose by an early vessel stabilization that greatly enhances both intratumoral CT uptake and T-cell infiltration. Synergism with CT was shown in immunocompetent mice, but not in nude mice lacking functional T cells. Methods: By an individual patient pooled analysis of 396 patients (pts) from 7 ph II trials in 6 tumor types, we estimated the effects of baseline PBLC on the antitumor activity of N (with or without CT) and CT alone. Low dose N (0.8 μg/m2) was given in combination with CT in 171 pts. Control groups of 140 and 85 pts receiving N and CT alone, respectively, were also analyzed. CT was doxorubicin or a platinum-based regimen. In all trials, response to therapy was assessed every 6 weeks by RECIST. Endpoints of interest were response rate (RR, complete plus partial response), disease control rate (DCR, RR plus stable disease), duration of response (DOR) and progression-free survival (PFS). In logistic and Cox regression analyses, PBLC data were dichotomized in high or low levels by the median cutpoint (1.5/mL; 95% CI, 1.4-1.6). Multivariate models included age, sex, PS and tumor type as covariates. Results: In both N-alone and CT-alone groups, there was no statistically significant difference in treatment effect according to baseline PBLC. Conversely, high PBLC were related to better treatment outcome in the N plus CT group, compared to low PBLC. In this N plus CT group, high PBLC (vs low) were associated with higher RR (OR=2.8; 95% CI, 1.2-6.3; p=.01) and DCR (OR=2.6; 1.3-4.9; p=.004), and with longer DOR (HR=0.39; 0.16-0.96; p=.04) and PFS (HR=0.60; 0.43-0.85; p=.004). For high vs low PBLC, RR was 29% vs 14%, DCR 76% vs 57%, median DOR 8.2 vs 6.3 months, and median PFS 5.0 vs 3.0 months, respectively. On multivariate analyses, high PBLC remained an independent predictor of increased RR (OR=2.7; p=.01) and DCR (OR=2.6; p=.005), and improved DOR (HR=0.36; p=.04) and PFS (HR=0.60; p=.005). Conclusions: Consistently with preclinical data, these results highlight the potential value of PBLC in predicting tumor response to NGR-hTNF in combination with CT, which merits further clinical validation Clinical trial information: NCT00994097-NCT00484432-NCT00484276-NCT00484211-NCT00483509-NCT00483080-NCT01358071.
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Affiliation(s)
- Alessandra Bulotta
- Department of Oncology, Istituto Scientifico Ospedale San Raffaele, Milan, Italy
| | - Vanesa Gregorc
- Department of Oncology, Istituto Scientifico San Raffaele, Milan, Italy
| | - Gilda Rossoni
- Department of Oncology, Istituto Scientifico San Raffaele, Milan, Italy
| | - Gabriele Todisco
- Department of Oncology, Istituto Scientifico San Raffaele, Milan, Italy
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Viganò MG, Gregorc V, Ghio D, Bulotta A, Rossoni G, Sallemi C, Colombi S, Rossoni G, Lambiase A, Bordignon C. Treatment-free interval (TFI) after first-line therapy (FLT) and disease control rate (DCR) on second-line therapy (SLT): Impact on overall survival (OS) in relapsed malignant pleural mesothelioma (MPM). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e18528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18528 Background: Both TFI (the time elapsing from FLT completion to SLT initiation) and DCR (the rate of nonprogression at first tumor evaluation) have been found to predict OS in other tumor types. Methods: The impact on outcome of TFI after FLT and DCR on SLT was tested in an individual patient pooled analysis of 261 MPM patients (pts) who had radiologic progressive disease (PD) after a pemetrexed-based FLT before entering a ph 2 trial with single-agent NGR-hTNF (n=50) and a ph 3 trial with single-agent gemcitabine, vinorelbine or doxorubicin plus NGR-hTNF/placebo (n=211). In both trials, response to SLT was assessed every 6 weeks by MPM-modified RECIST. Progression-free survival (PFS) and OS were computed from SLT start. By ROC analysis, the cutpoint for estimating TFI in relation to OS was set at 6 months (AUC=0.59; p=.009). Results: After FLT, 60 pts (23%) had partial response (PR), 135 (52%) stable disease (SD), for a DCR of 75%, and 66 (25%) early PD. Median time to PD was 7.0 months (95% CI, 6.2-7.4) and median TFI was 4.4 months (3.8-5.0), with 97 pts (37%) having a TFI > 6 months. Among baseline factors (age, sex, PS and histology) used in logistic regression, only younger age was related to higher odds to attain a TFI > 6 months (OR=1.9; 95% CI, 1.2-3.3). A TFI > 6 months (vs ≤ 6) was weakly related to DCR (Spearman's r=0.16; p=.01) and strongly associated with longer PFS and OS, with HR of 0.48 (0.36-0.65) and 0.59 (0.42-0.83), respectively. After SLT, 9 pts (3%) had PR, 130 (50%) SD, for a DCR of 53%, and 122 (47%) early PD. Of 60 pts responding to FLT, 23 (38%) progressed early on SLT, while of 66 pts progressing early during FLT, 32 (48%) experienced disease control on SLT. Baseline factors did not relate with DCR at week 6. On landmark analysis set at the 6-week time point, DCR (vs PD) was associated with OS benefit (HR=0.46; 0.32-0.65), which persisted after adjusting for baseline factors (HR=0.40; 0.27-0.57). Conclusions: With a smaller HR, an early-look measure such as 6-week DCR on SLT shows some advantage over TFI after FLT in predicting subsequent OS. In relapsed MPM, TFI as stratification factor and DCR as surrogate endpoint may be considered. Clinical trial information: NCT00484276-NCT01098266.
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Affiliation(s)
- Maria G Viganò
- Department of Oncology, Istituto Scientifico San Raffaele, Milan, Italy
| | - Vanesa Gregorc
- Department of Oncology, Istituto Scientifico San Raffaele, Milan, Italy
| | - Domenico Ghio
- Department of Radiology, Istituto Scientifico San Raffaele, Milan, Italy
| | | | - Gilda Rossoni
- Department of Oncology, Istituto Scientifico San Raffaele, Milan, Italy
| | - Claudio Sallemi
- Department of Oncology, Istituto Scientifico San Raffaele, Milan, Italy
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Lazzari C, Novello S, Barni S, Aieta M, De Marinis F, De Pas T, Grossi F, Mencoboni M, Bearz A, Floriani I, Torri V, Bulotta A, Grigorieva J, Roder J, Doglioni C, Roder H, Righi L, Foti S, Bachi A, Gregorc V. Randomized proteomic stratified phase III study of second-line erlotinib (E) versus chemotherapy (CT) in patients with inoperable non-small cell lung cancer (PROSE). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.lba8005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
LBA8005 The full, final text of this abstract will be available at abstract.asco.org at 7:30 AM (EDT) on Monday, June 3, 2013, and in the Annual Meeting Proceedings online supplement to the June 20, 2013, issue of Journal of Clinical Oncology. Onsite at the Meeting, this abstract will be printed in the Monday edition of ASCO Daily News.
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Affiliation(s)
- Chiara Lazzari
- Department of Oncology, Istituto Scientifico Ospedale San Raffaele, Milan, Italy
| | | | - Sandro Barni
- Department of Medical Oncology, Treviglio and Caravaggio Hospital, Treviglio, Italy
| | - Michele Aieta
- Centro Di Riferimento Oncologico DI Basilicata, Rionero in Vulture, Italy
| | | | - Tommaso De Pas
- Division of Thoracic Oncology, European Institute of Oncology, Milan, Italy
| | - Francesco Grossi
- Lung Cancer Unit, National Institute for Cancer Research, Genova, Italy
| | | | | | - Irene Floriani
- Laboratory of Clinical Trials, Oncology Department, Istituto di Ricerche Farmacologiche, Milano, Italy
| | - Valter Torri
- Oncology Department, Mario Negri Institute, Milan, Italy
| | - Alessandra Bulotta
- Department of Oncology, Istituto Scientifico Ospedale San Raffaele, Milan, Italy
| | | | | | - Claudio Doglioni
- Department of Pathology, Istituto Scientifico Ospedale San Raffaele, Milan, Italy
| | | | - Luisella Righi
- Department of Clinical and Biological Sciences-Pathology, San Luigi Hospital, Orbassano, Italy
| | - Silvia Foti
- Department of Oncology, Istituto Scientifico Ospedale San Raffaele, Milan, Italy
| | - Angela Bachi
- Laboratory of Proteomics, Istituto Scientifico Ospedale San Raffaele, Milan, Italy
| | - Vanesa Gregorc
- Department of Oncology, Istituto Scientifico Ospedale San Raffaele, Milan, Italy
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Rossoni G, Gregorc V, Bulotta A, Viganò MG, Todisco G, Lambiase A, Bordignon C. Infusion-related reactions (IRR) during NGR-hTNF therapy as potential predictors of clinical outcome. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e13593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e13593 Background: NGR-hTNF, a selective antivascular agent, transiently modulates the systemic release of cytokines/chemokines. Intravenous infusion of NGR-hTNF is distinguished by an early on-target effect, IRR, which mostly consists of short-lived grade 1/2 chills. Methods: Incidence, predictors of development and relationships of IRR with treatment outcome were assessed in a pooled analysis of individual patient data from 5 phase II trials with NGR-hTNF. Global data set comprised 205 previously treated patients (pts) who had received NGR-hTNF 0.8 µg/m2 every 3 weeks (q3w) or weekly (q1w) alone in mesothelioma, colon and liver cancers or in combination with doxorubicin in small cell lung and ovarian cancers. In all trials, response to therapy (RECIST) was measured q6w until progression. Regression models estimated the effect size of IRR on response rate (RR; complete and partial response), disease control rate (DCR; RR plus stable disease) and progression free survival (PFS). Results: 137/205 pts (67%) experienced IRR on treatment, while 68 pts (33%) did not. In the IRR group, 63% of pts had grade 1 and 37% grade 2. By time to onset, 88% of pts developed IRR during first 6 weeks of therapy and 12% later. According to dosing schedule, IRR rates were higher with q1w than with q3w (85% vs 62%; p=.008). Baseline characteristics were (IRR vs non-IRR groups): median age: 66 vs 64; male: 50% vs 56%; PS ≥ 1: 34% vs 35%, range of prior lines: 1-4 vs 1-5. Among baseline characteristics, logistic regression analysis retained only a lower number of prior lines associated with higher IRR rates (OR=1.4; p=.02). Onset of IRR was related to better treatment outcome. RR was 12% in the IRR and 3% in the non-IRR group (OR=4.4; p=.05), while DCR was 50% in pts who had IRR and 34% in pts who did not (OR=2.0; p=.02). In pts with or without IRR, 6-month PFS was 21% vs 7% (HR=0.62; p=.001), respectively. Improvement in PFS time remained significant in a landmark analysis set at the 6-week time point (p=.004). On multivariate analyses adjusted for baseline variables, IRR independently predicted higher odds of tumor response (p=.05) and lower risk of progression or death (p=.009). Conclusions: Onset of IRR on NGR-hTNF treatment may predict subsequent clinical outcome. Clinical trial information: NCT00483080-NCT00483509-NCT00484211-NCT00484276-NCT00484432.
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Affiliation(s)
- Gilda Rossoni
- Department of Oncology, Istituto Scientifico San Raffaele, Milan, Italy
| | - Vanesa Gregorc
- Department of Oncology, Istituto Scientifico San Raffaele, Milan, Italy
| | | | | | - Gabriele Todisco
- Department of Oncology, Istituto Scientifico San Raffaele, Milan, Italy
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Bulotta A, Gregorc V, Rossoni G, Todisco G, Viganò M, Lambiase A, Bordignon C. Association Between Peripheral Blood Lymphocyte Count (PBLC) and Outcome in Patients with Solid Tumors Treated with Ngr-Htnf. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)33065-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Gregorc V, Zilembo N, Grossi F, De Pas T, Pietrantonio F, Giovannini M, Rossoni G, Bulotta A, Lambiase A, Bordignon C. Front-Line Chemotherapy with or without NGR-HTNF in Non-Small Cell Lung Cancer (NSCLC). Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)33844-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Rossoni G, Gregorc V, Bulotta A, Viganò M, Todisco G, Lambiase A, Bordignon C. Correlation of Infusion-Related Reactions (IRR) and Outcome in Patients Receiving Ngr-Htnf Treatment. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)33048-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Rossoni G, Gregorc V, Viganò MG, Bulotta A, Ghio D, Lambiase A, Bordignon C. NGR-hTNF as second-line treatment in malignant pleural mesothelioma (MPM). J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.7076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7076 Background: NGR-hTNF exploits the asparagine-glycine-arginine (NGR) peptide for selectively targeting tumor necrosis factor (TNF) to cancer endothelial cells. Tumor hypervascularity is an independent predictor of poor overall survival (OS) in MPM patients (pts). Methods: We report long-term results of a phase II trial that assessed NGR-hTNF in MPM pts with performance status (PS) ≤ 2 and radiologic progressive disease (PD) after a pemetrexed-based regimen. NGR-hTNF was given at 0.8 µg/m2 every 3 weeks (q3w) in 43 pts and weekly (q1w) in 14 pts. Primary endpoint was progression free survival (PFS), with restaging done q6w by MPM-modified RECIST criteria, while secondary aims included disease control (DC) rate and OS. We also tested the impact on outcome of neutrophil to lymphocyte ratio (NLR) at baseline (median 3; interquartile range 2-5). Median follow-up was 32.5 months (95% CI 27.5-37.5). Results: Baseline characteristics were (n=57): median age 57 years; M/F 35/22; PS 0/1-2 31/26; EORTC score good/poor 45/12. Median treatment free interval on prior therapy was 4.3 months. Only one drug-related grade ≥ 3 adverse events (AEs) was noted, common grade 1/2 AEs being transient chills (75%). No higher toxicity was reported using the q1w schedule. Median PFS was 2.8 months (95% CI 2.2-3.3). DC rate was 46% (95% CI 32-59; 26/57 pts; 1 partial response, 25 stable diseases) and was maintained for a median time of 4.7 months (95% CI 4.0-5.4). OS rates at 1 and 2 years were 47% and 16%, respectively. Median OS was longer in pts with DC than in those with early PD (16.2 and 8.3 months, respectively; p=.02). According to schedule, 6-month PFS rates were 11% and 36% and 2-year OS rates were 12% and 29% for q3w and q1w, respectively. In pts with DC, median PFS were 4.4 and 9.1 months and median OS were 13.3 and 24.8 months for q3w and q1w, respectively. By Cox analyses, a PS of 0 (p=.01) and a low baseline NLR (p=.004) were the only variables associated with improved OS. Median OS in pts stratified by NLR ≤ 2, 3 to 4, and ≥ 5 were 15.7, 10.5, and 4.2 months, respectively (p=.0002 for trend). Conclusions: NGR-hTNF showed promising PFS and OS in this study. A double-blind phase III trial is currently testing best investigator choice ± NGR-hTNF q1w in pemetrexed-pretreated MPM pts (NCT01098266).
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Affiliation(s)
- Gilda Rossoni
- Department of Oncology, Istituto Scientifico San Raffaele, Milan, Italy
| | - Vanesa Gregorc
- Department of Oncology, Istituto Scientifico San Raffaele, Milan, Italy
| | | | | | - Domenico Ghio
- Department of Radiology, Istituto Scientifico San Raffaele, Milan, Italy
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