1
|
Barboro P, Rubagotti A, Poddine S, Grillo F, Mastracci L, Boccardo F. The prognostic value of aspartate beta-hydroxylase in early breast cancer. Int J Biol Markers 2022; 37:328-335. [PMID: 35726161 DOI: 10.1177/03936155221108412] [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] [Indexed: 11/16/2022]
Abstract
PURPOSE Aspartate beta-hydroxylase (ASPH) is a transmembrane protein involved in cancer progression, which has been shown to imply a worse prognosis in several solid tumors. The aim of the present study was to further investigate the prognostic value of ASPH in early breast cancer. METHODS ASPH expression was investigated through immunohistochemistry in a cohort of 153 breast cancer patients with long-term follow-up, and correlated with clinical-pathological features plus all-cause and breast-cancer-specific mortality. Appropriate statistics were utilized. RESULTS ASPH negatively correlated with all-cause and breast-cancer-specific mortality. CONCLUSIONS The results of this cohort study support the prognostic value of ASPH in early breast cancer.
Collapse
Affiliation(s)
- Paola Barboro
- Proteomic and Mass Spectrometry Unit, 9246IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Alessandra Rubagotti
- Department of Health Sciences (DISSAL), School of Medicine, 9302University of Genoa, 16132 Genoa, Italy
| | - Silvia Poddine
- Department of Medicine and Medical Specialties (DIMI), School of Medicine, 9302University of Genoa, 16132, Genoa, Italy
| | - Federica Grillo
- Anatomic Pathology Unit, 9246IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.,Department of Surgical and Integrated Diagnostic Sciences (DISC), 9302University of Genoa, 16132, Genoa, Italy
| | - Luca Mastracci
- Anatomic Pathology Unit, 9246IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.,Department of Surgical and Integrated Diagnostic Sciences (DISC), 9302University of Genoa, 16132, Genoa, Italy
| | - Francesco Boccardo
- Department of Medicine and Medical Specialties (DIMI), School of Medicine, 9302University of Genoa, 16132, Genoa, Italy
| |
Collapse
|
2
|
Cattrini C, Barboro P, Rubagotti A, Zinoli L, Zanardi E, Capaia M, Boccardo F. Integrative Analysis of Periostin in Primary and Advanced Prostate Cancer. Transl Oncol 2020; 13:100789. [PMID: 32416542 PMCID: PMC7248449 DOI: 10.1016/j.tranon.2020.100789] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 03/23/2020] [Revised: 04/11/2020] [Accepted: 04/13/2020] [Indexed: 01/16/2023] Open
Abstract
Periostin (POSTN) is an extracellular matrix protein associated with tumor progression and shorter survival in prostate cancer (PCa). Here, we performed an integrative analysis of POSTN's role in patients with PCa. Clinical and POSTN data from large-scale datasets were analyzed. POSTN cutoffs were identified with X-Tile, and STRING was used for protein-protein interaction analysis. In a cohort of 48 patients with metastatic castration-resistant prostate cancer (mCRPC), we used the AdnaTest platform to isolate circulating tumor cells and extract POSTN mRNA. Plasma samples were also tested for POSTN protein expression by dot blot assay. Data from large-scale datasets did not reveal any association between POSTN genetic alterations and outcome. In primary tumors, we found a significant correlation between POSTN mRNA overexpression, worse baseline prognostic features, and shorter disease-free survival. POSTN was overexpressed in mCRPC and correlated with aggressive features. In our cohort of mCRPC patients, we found a positive correlation between POSTN plasma levels and androgen-receptor variant 7 positivity and an association with shorter overall survival. Our integrative analysis shows that POSTN is associated with poor clinical features and worse outcome in patients with PCa. Further studies are warranted to uncover the function of POSTN in PCa progression and to validate the prognostic significance of POSTN in mCRPC.
Collapse
Affiliation(s)
- Carlo Cattrini
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, Genoa, Italy; Prostate Cancer Clinical Research Unit, Spanish National Cancer Research Centre (CNIO), Madrid, Spain.
| | - Paola Barboro
- Academic Unit of Medical Oncology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alessandra Rubagotti
- Academic Unit of Medical Oncology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Health Sciences (DISSAL), School of Medicine, University of Genoa, Genoa, Italy
| | - Linda Zinoli
- Academic Unit of Medical Oncology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Elisa Zanardi
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, Genoa, Italy; Academic Unit of Medical Oncology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Matteo Capaia
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, Genoa, Italy
| | - Francesco Boccardo
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, Genoa, Italy; Academic Unit of Medical Oncology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| |
Collapse
|
3
|
Zanardi E, Di Meglio A, Boccardo C, Zinoli L, Salvi S, Rubagotti A. Insights from a Long-Term Follow-Up Evaluation of Early Breast Cancer Outcomes by Tumor Subtype. Oncol Res Treat 2020; 43:362-371. [PMID: 32512573 DOI: 10.1159/000507736] [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] [Received: 11/20/2019] [Accepted: 04/04/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Our understanding of the granularity of breast cancer (BC) clinical outcomes by biologic subtype may be impaired by limited study follow-up times. OBJECTIVE We evaluated the impact of modern immunohistochemistry (IHC)-based BC subtypes on long-term mortality. METHOD We used a cohort of 200 women diagnosed with stage I-III BC in the period 1985-1990. Surgical samples underwent centralized pathology review. Multivariate models assessed associations of subtype with overall survival (OS) and BC-related survival (BCRS). RESULT 42.0% women had luminal A-like, 32.5% luminal B-like/human epidermal growth factor receptor (HER)2-negative, 8.5% had HER2-positive, and 17.0% had triple-negative BC. 53.0% had tumor size (T) >2 cm and 47.5% had a positive nodal status (N). Over 18.7 years of median follow-up (range 0.3-32.0 years),140 deaths were recorded (75 BC-related). Median OS was longest for patients with luminal A-like tumors (21.2 years; 95% confidence interval [CI] 17.4-24.9]). The luminal B-like/HER2-negative subtype was significantly associated with worse BCRS (adjusted hazard ratio [HR] = 1.86; 95% CI 1.09-3.16). After multivariable analysis, T >2 cm (HR [vs. ≤2 cm] = 1.71 [95% CI 1.03-2.84]) and positive N (HR [vs. negative] = 2.19 [95% CI 1.03-4.65]) impacted BCRS. CONCLUSION IHC-defined subtype will continue informing treatment algorithms for BC, until more precise tools like molecular profiling become widely available. Although confirmation in larger and adequately powered studies is warranted, modern surrogate subtype definitions produced a valid long-term prognostic stratification in this mature cohort.
Collapse
Affiliation(s)
- Elisa Zanardi
- Academic Unit of Medical Oncology, IRCCS-Ospedale Policlinico San Martino, Genoa, Italy, .,Department of Medicine (DiMI), School of Medicine, University of Genoa, Genoa, Italy,
| | - Antonio Di Meglio
- Academic Unit of Medical Oncology, IRCCS-Ospedale Policlinico San Martino, Genoa, Italy.,Department of Medical Oncology, INSERM Unit 981, Institut Gustave Roussy, Villejuif Cedex, France
| | - Chiara Boccardo
- Department of Surgery, IRCCS-Ospedale Policlinico San Martino, Genoa, Italy
| | - Linda Zinoli
- Academic Unit of Medical Oncology, IRCCS-Ospedale Policlinico San Martino, Genoa, Italy.,Department of Medicine (DiMI), School of Medicine, University of Genoa, Genoa, Italy
| | - Sandra Salvi
- Histopathology and Cytology Unit, IRCCS -Ospedale Policlinico San Martino, Genoa, Italy
| | - Alessandra Rubagotti
- Academic Unit of Medical Oncology, IRCCS-Ospedale Policlinico San Martino, Genoa, Italy.,Department of Health Sciences (DISSAL), School of Medicine, University of Genoa, Genoa, Italy
| |
Collapse
|
4
|
Cattrini C, Zanardi E, Rubagotti A, Zinoli L, Capaia M, Barboro P, Boccardo F. Real-world survival improvements in patients with newly diagnosed metastatic prostate cancer treated in the United States. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.48] [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
48 Background: New drugs have become available for the treatment of metastatic prostate cancer (mPCa) during the last two decades. Here, we explored the clinical outcomes of de novo mPCa in 3 large cohorts of patients diagnosed in 3 treatment eras: pre-docetaxel 2000-2003 (T1), docetaxel 2004-2010 (T2) and new androgen-receptor signalling inhibitors (ARSi) + cabazitaxel 2011-2016 (T3). Methods: The USA Surveillance Epidemiology and End Results (SEER) Incidence Data were investigated using the SEER*Stat software. We used the Kaplan – Meier method, log-rank test, Cox regression, hazard ratio (HR) and confidence intervals (CI) to analyse overall survival (OS) and cancer-specific survival (CSS). The maximum follow-up time point was 5 years. Results: A total 34.034 patients with de novo mPCa were analysed for OS, of these 6.621 T1, 12.711 T2 and 14.702 T3. Median OS was 29 months (mo) [95% CI: 28.5-29.5], 28 mo [27.0-28.9], 28 mo [27.3-28.7] and 31 mo [30.2-31.8] in whole, T1, T2 and T3 cohorts, respectively. In the multivariable model, adjusted for age and race, T3 patients showed better OS compared to T1 and T2 patients (HR: 0,92 [95% CI: 0,88-0,95] and 0,92 [0,89 to 0,95], respectively, p<0.001). A total of 33.641 patients were analysed for CSS, of these 6.514 T1, 12.540 T2 and 14.587 T3. Median CSS was 36 mo [35.3-36.7], 34 mo [32.6-35.3], 34 mo [33.0-35.0] and 38 mo [36.9-39.1] in whole, T1, T2, T3 cohorts, respectively. T3 patients had better CSS compared to T1 and T2 patients (HR: 0,93 [0,89-0,97] and 0,92 [0,89 to 0,96], respectively, p<0.001). No difference in OS or CSS was found between T1 and T2 cohorts. Conclusions: The prognosis of patients with de novo mPCa remains poor, with a median CSS of 3 years and a 5-year CSS of 35%. Approximately 8% decrease in the risk of death was found in the era of ARSi and cabazitaxel. The recent intensification of therapy in metastatic hormone-sensitive setting might lead to better outcomes in the next years.[Table: see text]
Collapse
Affiliation(s)
| | - Elisa Zanardi
- IRCCS Ospedale Policlinico S. Martino, Genova, Italy
| | | | - Linda Zinoli
- IRCCS Ospedale Policlinico S. Martino, Genova, Italy
| | - Matteo Capaia
- IRCCS Ospedale Policlinico S. Martino, Genova, Italy
| | - Paola Barboro
- IRCCS Ospedale Policlinico S. Martino, Genova, Italy
| | | |
Collapse
|
5
|
Cattrini C, Rubagotti A, Zinoli L, Cerbone L, Zanardi E, Capaia M, Barboro P, Boccardo F. Role of Circulating Tumor Cells (CTC), Androgen Receptor Full Length (AR-FL) and Androgen Receptor Splice Variant 7 (AR-V7) in a Prospective Cohort of Castration-Resistant Metastatic Prostate Cancer Patients. Cancers (Basel) 2019; 11:E1365. [PMID: 31540293 PMCID: PMC6770005 DOI: 10.3390/cancers11091365] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/06/2019] [Accepted: 09/10/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Circulating tumor cells (CTC), androgen receptor full-length (AR-FL), and androgen receptor splice variant 7 (AR-V7) are prognostic in patients (pts) with metastatic castration-resistant prostate cancer (mCRPC). AR-V7 seems to predict resistance to androgen-receptor signaling inhibitors (ARSi). METHODS We assessed the association of CTC, AR-FL, and AR-V7 with prostate-specific antigen (PSA) response and overall survival (OS). We used a modified AdnaTest CTC-based AR-FL and AR-V7 mRNA assay. Chi-square test, Fisher Exact test, Kaplan-Meier method, log-rank test, Cox proportional hazards models were used as appropriate. RESULTS We enrolled 39 mCRPC pts, of those 24 started a first-line treatment for mCRPC (1L subgroup) and 15 had received at least two lines for mCRPC (>2L subgroup). CTC, AR-FL, and AR-V7 were enriched in >2L compared to 1L subgroup. Detection of these biomarkers was associated with a lower percentage of biochemical responses. Only 1/7 AR-V7+ pts had a PSA response and received cabazitaxel. Median OS was 4.7 months (95% CI 0.6-8.9) in AR-V7+ pts and not reached in AR-V7- pts. AR-V7 was the only variable with prognostic significance in the Cox model. CONCLUSION AR-V7, CTC, and AR-FL are associated with advanced mCRPC and AR-V7+ predicts for shorter OS.
Collapse
Affiliation(s)
- Carlo Cattrini
- Academic Unit of Medical Oncology, IRCCS San Martino Polyclinic Hospital, 16132 Genoa, Italy.
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, 16132 Genoa, Italy.
| | - Alessandra Rubagotti
- Academic Unit of Medical Oncology, IRCCS San Martino Polyclinic Hospital, 16132 Genoa, Italy.
- Department of Health Sciences (DISSAL), School of Medicine, University of Genoa, 16132 Genoa, Italy.
| | - Linda Zinoli
- Academic Unit of Medical Oncology, IRCCS San Martino Polyclinic Hospital, 16132 Genoa, Italy.
| | - Luigi Cerbone
- Academic Unit of Medical Oncology, IRCCS San Martino Polyclinic Hospital, 16132 Genoa, Italy.
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, 16132 Genoa, Italy.
| | - Elisa Zanardi
- Academic Unit of Medical Oncology, IRCCS San Martino Polyclinic Hospital, 16132 Genoa, Italy.
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, 16132 Genoa, Italy.
| | - Matteo Capaia
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, 16132 Genoa, Italy.
| | - Paola Barboro
- Academic Unit of Medical Oncology, IRCCS San Martino Polyclinic Hospital, 16132 Genoa, Italy.
| | - Francesco Boccardo
- Academic Unit of Medical Oncology, IRCCS San Martino Polyclinic Hospital, 16132 Genoa, Italy.
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, 16132 Genoa, Italy.
| |
Collapse
|
6
|
Cattrini C, Rubagotti A, Nuzzo PV, Zinoli L, Salvi S, Boccardo S, Perachino M, Cerbone L, Vallome G, Latocca MM, Zanardi E, Boccardo F. Overexpression of Periostin in Tumor Biopsy Samples Is Associated With Prostate Cancer Phenotype and Clinical Outcome. Clin Genitourin Cancer 2018; 16:e1257-e1265. [PMID: 30170989 DOI: 10.1016/j.clgc.2018.07.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 04/04/2018] [Revised: 07/19/2018] [Accepted: 07/20/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Overexpression of periostin (POSTN) is associated with prostate cancer (PCa) aggressiveness. We investigated the prognostic significance of POSTN expression in tumor biopsy samples of patients with PCa. METHODS We scored POSTN expression by immunohistochemistry analysis on 215 PCa biopsy samples using an anti-POSTN-specific antibody. A total immunoreactive score (T-IRS) was calculated by adding the POSTN staining scores of stromal and epithelial tumor cells. Prostate-specific antigen (PSA) progression/recurrence-free survival (PFS), radiographic progression/recurrence-free survival (rPFS), and overall survival (OS) were the study end points. RESULTS A total of 143 patients received therapy with radical attempt, whereas 72 had locally advanced or metastatic disease and received hormone therapy alone. Median T-IRS was 9 and 12 (range, 0-20), respectively (P = .001). Overall, we found a weak positive correlation of T-IRS with prebiopsy PSA levels (r = 0.166, P = .016) and Gleason score (r = 0.266, P < .000). T-IRS ≥ 8 independently predicted for shorter PSA-PFS and OS (hazard ratio [HR] [95% confidence interval (CI)] ≥ 8 versus < 8: 1.50 [1.06-2.14], P = .024 and 1.92 [1.20-3.07], P = .007, respectively). In the subgroup analysis, the association between T-IRS and patient outcome was retained in patients who received therapy with radical attempt (HR [95% CI] ≥ 8 vs. < 8: rPFS: 2.06 [1.18-3.58], P = .01; OS: 2.36 [1.24-4.50], P = .009) and in those with low to intermediate Gleason scores (HR [95% CI] ≥ 8 vs. < 8: PSA-PFS: 1.65 [1.06-2.59], P = .028; rPFS: 2.09 [1.14-3.87], P = .018; OS: 2.57 [1.31-5.04], P = .006). CONCLUSION POSTN T-IRS on PCa biopsy samples independently predicted the risk of recurrence, progression, and death in patients with localized disease and in those with low to intermediate Gleason scores.
Collapse
Affiliation(s)
- Carlo Cattrini
- Academic Unit of Medical Oncology, IRCCS San Martino Polyclinic Hospital, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, Genoa, Italy
| | - Alessandra Rubagotti
- Academic Unit of Medical Oncology, IRCCS San Martino Polyclinic Hospital, Genoa, Italy; Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Pier Vitale Nuzzo
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, Genoa, Italy
| | - Linda Zinoli
- Academic Unit of Medical Oncology, IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Sandra Salvi
- Pathology Unit, IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Simona Boccardo
- Pathology Unit, IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Marta Perachino
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, Genoa, Italy
| | - Luigi Cerbone
- Academic Unit of Medical Oncology, IRCCS San Martino Polyclinic Hospital, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, Genoa, Italy
| | - Giacomo Vallome
- Academic Unit of Medical Oncology, IRCCS San Martino Polyclinic Hospital, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, Genoa, Italy
| | - Maria Maddalena Latocca
- Academic Unit of Medical Oncology, IRCCS San Martino Polyclinic Hospital, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, Genoa, Italy
| | - Elisa Zanardi
- Academic Unit of Medical Oncology, IRCCS San Martino Polyclinic Hospital, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, Genoa, Italy
| | - Francesco Boccardo
- Academic Unit of Medical Oncology, IRCCS San Martino Polyclinic Hospital, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, Genoa, Italy.
| |
Collapse
|
7
|
Cattrini C, Cerbone L, Rubagotti A, Zinoli L, Latocca MM, Buzzatti G, Vallome G, Rizzo F, Cavo A, Beshiri K, Soldato D, Messina C, Zanardi E, Boccardo F. Prognostic variables in localized small cell neuroendocrine carcinoma of the bladder: A population-based study. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e16506] [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)
- Carlo Cattrini
- Academic Unit of Medical Oncology, San Martino Polyclinic Hospital – Institute for Cancer Research and Treatment, Genoa, Italy
| | - Luigi Cerbone
- Academic Unit of Medical Oncology, San Martino Polyclinic Hospital – Institute for Cancer Research and Treatment, Genoa, Italy
| | - Alessandra Rubagotti
- Academic Unit of Medical Oncology, San Martino Polyclinic Hospital – Institute for Cancer Research and Treatment, Genoa, Italy
| | - Linda Zinoli
- Academic Unit of Medical Oncology, San Martino Polyclinic Hospital – Institute for Cancer Research and Treatment, Genoa, Italy
| | - Maria Maddalena Latocca
- Academic Unit of Medical Oncology, San Martino Polyclinic Hospital – Institute for Cancer Research and Treatment, Genoa, Italy
| | - Giulia Buzzatti
- Academic Unit of Medical Oncology, San Martino Polyclinic Hospital – Institute for Cancer Research and Treatment, Genoa, Italy
| | - Giacomo Vallome
- Academic Unit of Medical Oncology, San Martino Polyclinic Hospital – Institute for Cancer Research and Treatment, Genoa, Italy
| | - Fabio Rizzo
- Academic Unit of Medical Oncology, San Martino Polyclinic Hospital – Institute for Cancer Research and Treatment, Genoa, Italy
| | - Alessia Cavo
- Academic Unit of Medical Oncology, San Martino Polyclinic Hospital – Institute for Cancer Research and Treatment, Genoa, Italy
| | - Kristi Beshiri
- Academic Unit of Medical Oncology, San Martino Polyclinic Hospital – Institute for Cancer Research and Treatment, Genoa, Italy
| | - Davide Soldato
- Academic Unit of Medical Oncology, San Martino Polyclinic Hospital – Institute for Cancer Research and Treatment, Genoa, Italy
| | - Carlo Messina
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Elisa Zanardi
- Academic Unit of Medical Oncology, San Martino Polyclinic Hospital – Institute for Cancer Research and Treatment, Genoa, Italy
| | - Francesco Boccardo
- Academic Unit of Medical Oncology, San Martino Polyclinic Hospital – Institute for Cancer Research and Treatment, Genoa, Italy
| |
Collapse
|
8
|
Boccardo F, Guarneri D, Rubagotti A, Casertelli GL, Bentivoglio G, Conte N, Campanella G, Gaggero G, Comelli G, Zanardi S. Endocrine Effects of Tamoxifen in Postmenopausal Breast Cancer Patients. Tumori 2018; 70:61-8. [PMID: 6538707 DOI: 10.1177/030089168407000110] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The effects of tamoxifen on plasma concentration of gonadotropins, prolactin (PRL), estrone (E1), estradiol-17β (E2), and sex hormone-binding globulin (SHBG) were studied in 40 postmenopausal breast cancer patients. In addition, the changes induced by the drug on endometrium and vaginal epithelium were investigated. After 6–8 weeks of tamoxifen treatment, a significant decrease in FSH, LH and PRL basal levels was observed, whereas the concentrations of E1 and E2 were not significantly affected. A significant increase in SHBG levels was induced by prolonged treatment with the drug. In addition, tamoxifen caused a partial estrogenization of vaginal smears, and a weak stimulatory effect on endometrium was also apparent. These findings indicate that tamoxifen produced agonistic effects on some targets and antagonistic effects on the others.
Collapse
|
9
|
Baldini E, Gardin G, Giannessi P, Brema F, Camorriano A, Carnino F, Naso C, Pastorino G, Pronzato P, Rosso R, Rubagotti A, Torretta G, Conte PF. A Randomized Trial of Chemotherapy with or without Estrogenic Recruitment in Locally Advanced Breast Cancer. Tumori 2018; 83:829-33. [PMID: 9428917 DOI: 10.1177/030089169708300511] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The present phase III trial was carried out to verify whether a kinetic recruitment induced by low doses of diethylstilbes-trol (DES) could increase the killing efficacy of chemotherapy in patients with locally advanced breast cancer. One-hundred and seventeen untreated patients with locally advanced breast cancer (stage IIIA/IIIB) were randomized to receive 3 courses of primary chemotherapy consisting of cyclophosphamide (600 mg/m2 i.v.), doxorubicin (50 mg/m2 i.v.) and fluorouracil (600 mg/m2 i.v.) (CAF) on day 1, or DES-CAF (DES, 1 mg orally days 1-3, CAF on day 4). The courses were repeated every 3 weeks. The patients who achieved an objective response were submitted to mastectomy followed by 3 courses of CAF alternated with 3 courses of CMF (cyclophosphamide, 600 mg/m2 i.v.; methotrexate, 40 mg/m2 i.v.; fluorouracil, 600 mg/m2 i.v.), with or without DES. The two treatment arms were well balanced in terms of clinical and pathologic features. There was no significant difference in response rates to induction chemotherapy between the two treatment arms (objective response rate, 63.3% for CAF and 56.1% for DES-CAF). Median overall survival was 49 and 47 months and median progression-free survival was 24 and 21 months for CAF and DES-CAF patients, respectively. Toxicity was not significantly different in the two groups, with the exception of leukopenia: DES chemotherapy was significantly more myelotoxic than the standard treatment, which resulted in a significant reduction in the actual dose intensity. In spite of the attractive experimental evidence, we conclude that so far there is no clinical advantage in the combination of estrogen and chemotherapy. Further research is needed to investigate different schedules of chemotherapy and hor-mones, or to test the possibility of combining various mitogens.
Collapse
|
10
|
Boccardo F, Rubagotti A, Canobbio L, Galligioni E, Sorio R, Lucenti A, Cognetti F, Ruggeri E, Landonio G, Baiocchi C, Besana C, Citterio G, De Rosa M, Calabresi F. Interleukin-2, Interferon-α and Interleukin-2 plus Interferon-α in Renal Cell Carcinoma. A Randomized Phase Ii Trial. Tumori 2018; 84:534-9. [PMID: 9862512 DOI: 10.1177/030089169808400505] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background The purpose of the present study was to investigate the therapeutic effectiveness of interleukin-2 (IL-2) and interferon (IFN), either alone or in combination, in comparable groups of patients affected by advanced renal cell carcinoma (RCC). Patients and methods In order to limit selection biases, treatment was allocated on a random basis. Patients randomized to IL-2 alone were scheduled to receive eight rIL-2 24-hour i.v. infusion cycles, days 1 to 4, at a daily dose of 18 x 106 IU/m2 for a total of 25 weeks. Patients randomized to IFN alone were scheduled to receive rIFN-α at a daily dose of 6 x 106 IU/m2, days 1, 3 and 5, every week for a total of 52 weeks. Patients randomized to the combination of IFN and IL-2 were given the same drugs at the same daily doses for a total of 24 weeks. Drug dose was modified according to toxicity. Results Twenty-three percent (95% CI: ± 17.5) of patients treated with IL-2 alone showed an objective response to treatment (9% CR). The corresponding figures in patients treated with IFN alone or IFN plus IL-2 were 9% (95% CI: ± 11.9) and 9% (95% CI: ± 11.9), respectively. Complete responses were observed only in patients treated with IL-2. The median duration of response in the IL-2 arm was 18 months (range, 9.5-24). The duration of the two responses achieved by IFN alone was seven and nine, months, respectively. The corresponding figures in the two patients responding to the combination of IFN with IL-2 were 19 and 27 months, respectively. Total IL-2 dose appeared to be a major predictor of response. Only a minority of patients experienced grade 3-4 toxicity, the incidence being higher in those treated with IL-2 or IL-2 plus IFN. Conclusions Neither IFN nor IL-2 or the combination of the two appear to be very active in patients with advanced RCC, even when trial entry was restricted to patients with relatively indolent disease. This stresses the need for the development of new approaches.
Collapse
Affiliation(s)
- F Boccardo
- Department of Medical Oncology II, National Institute for Cancer Research, Genoa, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Boccardo F, Rubagotti A, Battaglia M, Zattoni F, Bertaccini A, Romagnoli A, Conti G. Influence of Bicalutamide with or without Tamoxifen or Anastrozole on Insulin-like Growth Factor 1 and Binding Proteins in Prostate Cancer Patients. Int J Biol Markers 2018. [DOI: 10.1177/172460080602100208] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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 There is growing evidence that IGF-1 and binding proteins may be involved in prostate cancer promotion and progression. Patients and methods IGF-1 and binding proteins (IGFBP-1 and 3) serum levels were measured at baseline and after 3 and 6 months of treatment in a selected group of patients with prostate cancer who were randomly assigned to treatment with bicalutamide, bicalutamide plus anastrozole or bicalutamide plus tamoxifen in a comparative study investigating the role of pharmacological medication in the development of bicalutamide-induced gynecomastia. Results Bicalutamide monotherapy does not appear to alter the IGF-1/IGFBP system. In fact, the increase in IGF-1 levels induced by this treatment was paralleled by comparable increases in binding protein (IGFBP-3). No major changes from baseline up to month 6 either in IGF-1 or in IGFBP-1 and 3 were observed in the bicalutamide plus anastrozole arm. The addition of tamoxifen to bicalutamide produced a sharp decrease in IGF-1 levels (p<0.001) coupled with an increase in both IGFBP-1 (p=0.001) and, to a lesser extent, IGFBP-3 (p=0.5). Conclusions The concurrent administration of tamoxifen and bicalutamide reduces the synthesis and bioavailability of IGF-1. Moreover, increased binding protein levels might exert antiproliferative and proapoptotic effects on prostate cancer cells, independently of the IGF-1/IGF receptor-mediated survival system. Both effects might have a synergistic inhibitory influence on prostate cancer growth.
Collapse
Affiliation(s)
- F. Boccardo
- Department of Medical Oncology, National Cancer Research Institute and University of Genoa
| | - A. Rubagotti
- Department of Medical Oncology, National Cancer Research Institute and University of Genoa
| | | | - F. Zattoni
- Department of Urology, S. Maria della Misericordia Hospital and University of Udine
| | - A. Bertaccini
- Department of Urology, S. Orsola-Malpighi Hospital and University of Bologna
| | - A. Romagnoli
- Department of Urology, S. Martino Hospital and University of Genoa
| | - G. Conti
- Department of Urology, S. Anna Hospital, Como - Italy
| |
Collapse
|
12
|
Cavo A, Rubagotti A, Zanardi E, Fabbroni C, Zinoli L, Di Meglio A, Arboscello E, Bellodi A, Spallarossa P, Cattrini C, Messina C, Boccardo F. Abiraterone acetate and prednisone in the pre- and post-docetaxel setting for metastatic castration-resistant prostate cancer: a mono-institutional experience focused on cardiovascular events and their impact on clinical outcomes. Ther Adv Med Oncol 2018; 10:1758834017745819. [PMID: 29383035 PMCID: PMC5784574 DOI: 10.1177/1758834017745819] [Citation(s) in RCA: 12] [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: 05/04/2017] [Accepted: 10/05/2017] [Indexed: 12/15/2022] Open
Abstract
Background: The aim of this work was to to evaluate the incidence and risk factors of adverse events (AEs), focusing on cardiovascular events (CVEs) and hypokalemia, in patients treated with abiraterone acetate (AA) and prednisone (PDN) outside clinical trials, and their association with survival outcomes. Methods: This was a retrospective cohort study of 105 patients treated from 2011 to 2016. Incidence of AEs was descriptively summarized in the whole cohort and by subgroup (pre- versus post-docetaxel). Multivariable Cox proportional hazards models assessed factors associated with progression-free survival (PFS) and overall survival (OS). Results: Overall, median PFS and OS were 14.9 and 24.6 months, respectively. Prostate-specific antigen (PSA) ⩾ 10 ng/ml (p = 0.007), Gleason Score >7 (p = 0.008), Eastern Cooperative Oncology Group (ECOG) performance status (PS)1–2 (p = 0.002), duration of androgen deprivation therapy (ADT) ⩽ 43.2 months (p = 0.01), and body mass index (BMI) > 25 (p = 0.03) were associated with worse PFS; presence of pain (p = 0.01), ECOG PS1–2 (p = 0.004), duration of ADT ⩽ 43.2 (p = 0.05), and BMI > 25 (p = 0.042) were associated with worse OS. Incidence of CVEs was as follows: hypertension 17.1%, fluid retention 4.8%, cardiac disorders 8.6%. 16.2% of patients developed hypokalemia. Age ⩾ 75 years was associated with higher probability of cardiac disorders (p = 0.001) and fluid retention (p = 0.03). CVEs did not impact on PFS or OS. Hypokalemia was associated with better median OS (p = 0.036). Similar associations were observed after stratification by subgroup. Conclusions: Median PFS and OS estimates and incidence of CVEs and hypokalemia in our series are consistent with those of pivotal trials of AA plus PDN, confirming the efficacy and safety of this regimen also in the real-world setting. Elderly patients have higher odds of developing/worsening CVEs. However, regardless of age, CVEs were not associated with worse outcomes. Treatment-related hypokalemia seemed to be associated with longer OS, albeit this finding needs confirmation within larger, prospective series.
Collapse
Affiliation(s)
- Alessia Cavo
- Academic Unit of Medical Oncology, San Martino Polyclinic Hospital, Institute for Cancer Research and Treatment, Genoa, Italy
| | - Alessandra Rubagotti
- Academic Unit of Medical Oncology, San Martino Polyclinic Hospital, Institute for Cancer Research and Treatment, Genoa, Italy
| | - Elisa Zanardi
- Academic Unit of Medical Oncology, San Martino Polyclinic Hospital, Institute for Cancer Research and Treatment, Genoa, Italy
| | - Chiara Fabbroni
- Academic Unit of Medical Oncology, San Martino Polyclinic Hospital, Institute for Cancer Research and Treatment, Genoa, Italy
| | - Linda Zinoli
- Academic Unit of Medical Oncology, San Martino Polyclinic Hospital, Institute for Cancer Research and Treatment, Genoa, Italy
| | - Antonio Di Meglio
- Academic Unit of Medical Oncology, San Martino Polyclinic Hospital, Institute for Cancer Research and Treatment, Genoa, Italy
| | - Eleonora Arboscello
- Academic Unit of Internal Medicine 3, San Martino Polyclinic Hospital, Institute for Cancer Research and Treatment, Genoa, Italy
| | - Andrea Bellodi
- Academic Unit of Internal Medicine 3, San Martino Polyclinic Hospital, Institute for Cancer Research and Treatment, Genoa, Italy
| | - Paolo Spallarossa
- Clinic of Cardiovascular Disease, San Martino Polyclinic Hospital, Institute for Cancer Research and Treatment, Genoa, Italy
| | - Carlo Cattrini
- Academic Unit of Medical Oncology, San Martino Polyclinic Hospital, Institute for Cancer Research and Treatment, Genoa, Italy
| | - Carlo Messina
- Academic Unit of Medical Oncology, San Martino Polyclinic Hospital, Institute for Cancer Research and Treatment, Genoa, Italy
| | - Francesco Boccardo
- Academic Unit of Medical Oncology, San Martino Polyclinic Hospital, Institute for Cancer Research and Treatment, L.go R. Benzi 10, 16132, Genoa, Italy
| |
Collapse
|
13
|
Cavo A, Rubagotti A, Bellodi A, Zanardi E, Zinoli L, Spallarossa P, Bagnato P, Pane B, Favorini S, Barra S, Arboscello C, Arboscello E, Palombo D, Boccardo F. Cardiovascular disease (CVD) markers in patients(pts) with prostate cancer(PCa) treated with GN-RH agonists(AG) or antagonist(AN): a prospective cohort study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx423.013] [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: 11/13/2022] Open
|
14
|
Zanardi E, Di Meglio A, Rubagotti A, Zinoli L, Salvi S, Boccardo F. Insights from a long-term follow-up evaluation of early breast cancer (BC) outcomes by tumor subtype (TS). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx424.030] [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: 11/13/2022] Open
|
15
|
Boccardo F, Cavo A, Zanardi E, Fabbroni C, Zinoli L, Di Meglio A, Arboscello E, Bellodi A, Spallarossa P, Cattrini C, Messina C, Rubagotti A. Abiraterone acetate (AA) in pre- and post-docetaxel (DX) setting for metastatic castration resistant prostate cancer (mCRPC): a monoinstitutional experience focused on cardiovascular events and on their impact on clinical outcomes. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx423.016] [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
|
16
|
Cattrini C, Zanardi E, Vallome G, Cavo A, Cerbone L, Di Meglio A, Fabbroni C, Latocca MM, Rizzo F, Messina C, Rubagotti A, Barboro P, Boccardo F. Targeting androgen-independent pathways: new chances for patients with prostate cancer? Crit Rev Oncol Hematol 2017; 118:42-53. [PMID: 28917268 DOI: 10.1016/j.critrevonc.2017.08.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 08/21/2017] [Accepted: 08/21/2017] [Indexed: 02/08/2023] Open
Abstract
Androgen deprivation therapy (ADT) is the mainstay treatment for advanced prostate cancer (PC). Most patients eventually progress to a condition known as castration-resistant prostate cancer (CRPC), characterized by lack of response to ADT. Although new androgen receptor signaling (ARS) inhibitors and chemotherapeutic agents have been introduced to overcome resistance to ADT, many patients progress because of primary or acquired resistance to these agents. This comprehensive review aims at exploring the mechanisms of resistance and progression of PC, with specific focus on alterations which lead to the activation of androgen receptor (AR)-independent pathways of survival. Our work integrates available clinical and preclinical data on agents which target these pathways, assessing their potential clinical implication in specific settings of patients. Given the rising interest of the scientific community in cancer immunotherapy strategies, further attention is dedicated to the role of immune evasion in PC.
Collapse
Affiliation(s)
- C Cattrini
- Academic Unit of Medical Oncology, San Martino University Hospital - IST National Cancer Research Institute, L.go R. Benzi 10, 16132, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, V.le Benedetto XV 6, 16132, Genoa, Italy.
| | - E Zanardi
- Academic Unit of Medical Oncology, San Martino University Hospital - IST National Cancer Research Institute, L.go R. Benzi 10, 16132, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, V.le Benedetto XV 6, 16132, Genoa, Italy
| | - G Vallome
- Academic Unit of Medical Oncology, San Martino University Hospital - IST National Cancer Research Institute, L.go R. Benzi 10, 16132, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, V.le Benedetto XV 6, 16132, Genoa, Italy
| | - A Cavo
- Academic Unit of Medical Oncology, San Martino University Hospital - IST National Cancer Research Institute, L.go R. Benzi 10, 16132, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, V.le Benedetto XV 6, 16132, Genoa, Italy
| | - L Cerbone
- Academic Unit of Medical Oncology, San Martino University Hospital - IST National Cancer Research Institute, L.go R. Benzi 10, 16132, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, V.le Benedetto XV 6, 16132, Genoa, Italy
| | - A Di Meglio
- Academic Unit of Medical Oncology, San Martino University Hospital - IST National Cancer Research Institute, L.go R. Benzi 10, 16132, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, V.le Benedetto XV 6, 16132, Genoa, Italy
| | - C Fabbroni
- Academic Unit of Medical Oncology, San Martino University Hospital - IST National Cancer Research Institute, L.go R. Benzi 10, 16132, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, V.le Benedetto XV 6, 16132, Genoa, Italy
| | - M M Latocca
- Academic Unit of Medical Oncology, San Martino University Hospital - IST National Cancer Research Institute, L.go R. Benzi 10, 16132, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, V.le Benedetto XV 6, 16132, Genoa, Italy
| | - F Rizzo
- Academic Unit of Medical Oncology, San Martino University Hospital - IST National Cancer Research Institute, L.go R. Benzi 10, 16132, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, V.le Benedetto XV 6, 16132, Genoa, Italy
| | - C Messina
- Academic Unit of Medical Oncology, San Martino University Hospital - IST National Cancer Research Institute, L.go R. Benzi 10, 16132, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, V.le Benedetto XV 6, 16132, Genoa, Italy
| | - A Rubagotti
- Academic Unit of Medical Oncology, San Martino University Hospital - IST National Cancer Research Institute, L.go R. Benzi 10, 16132, Genoa, Italy; Department of Health Sciences (DISSAL), University of Genoa, Via A. Pastore 1, 16132, Genoa, Italy
| | - P Barboro
- Academic Unit of Medical Oncology, San Martino University Hospital - IST National Cancer Research Institute, L.go R. Benzi 10, 16132, Genoa, Italy
| | - F Boccardo
- Academic Unit of Medical Oncology, San Martino University Hospital - IST National Cancer Research Institute, L.go R. Benzi 10, 16132, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, V.le Benedetto XV 6, 16132, Genoa, Italy
| |
Collapse
|
17
|
Nuzzo PV, Rubagotti A, Zinoli L, Salvi S, Boccardo S, Boccardo F. The prognostic value of stromal and epithelial periostin expression in human breast cancer: correlation with clinical pathological features and mortality outcome. BMC Cancer 2016; 16:95. [PMID: 26872609 PMCID: PMC4752779 DOI: 10.1186/s12885-016-2139-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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: 04/02/2015] [Accepted: 02/08/2016] [Indexed: 11/12/2022] Open
Abstract
Background PN is a secreted cell adhesion protein critical for carcinogenesis. In breast cancer, it is overexpressed compared to normal breast, and a few reports suggest that it has a potential role as a prognostic marker. Methods Tumour samples obtained at the time of mastectomy from 200 women followed for a median time of 18.7 years (range 0.5–29.5 years) were investigated through IHC with a polyclonal anti-PN antibody using tissue microarrays. Epithelial and stromal PN expression were scored independently according to the percentage of coloured cells; the 60th percentile of PN epithelial expression, corresponding to 1 %, and the median value of PN stromal expression, corresponding to 90 %, were used as arbitrary cut-offs. The relationships between epithelial and stromal PN expression and clinical-pathological features, tumour phenotype and the risk of mortality following surgery were analysed. Appropriate statistics, including the Fine and Gray competing risk proportional hazard regression model, were used. Results The expression of PN in tumour epithelial cells was significantly lower than that which was observed in stromal cells (p < 0.000). No specific association between epithelial or stromal PN expression and any of the clinical-pathological parameters analysed was found as it was observed in respect to mortality when these variables were analysed individually. However, when both variables were considered as a function of the other one, the expression of PN in the stromal cells maintained a statistically significant predictive value with respect to both all causes and cancer-specific mortality only in the presence of high epithelial expression levels. No significant differences in either all causes or BCa-specific mortality rates were shown according to epithelial expression for tumours displaying higher stromal PN expression rates. However, the trends were opposite for the higher stromal values and the patients with high epithelial expression levels denoted the group with the worst prognosis, while higher epithelial values in patients with lower stromal expression levels denoted the group with the best prognosis, suggesting that PN epithelial/stromal interactions play a crucial role in breast carcinogenesis, most likely due to functional cross-talk between the two compartments. On the basis of PN expression in both compartments, we defined 4 subgroups of patients with different mortality rates with the group of patients characterized by positive epithelial and low stromal PN expression cells showing the lowest mortality risk as opposed to the groups of patients identified by a high PN expression in both cell compartments or those identified by a low or absent PN expression in both cell compartments showing the worst mortality rates. The differences were highly statistically significant and were also retained after multiparametric analysis. Competing risk analysis demonstrated that PN expression patterns characterizing each of previous groups are specifically associated with cancer-specific mortality. Conclusions Although they require further validation through larger studies, our findings suggest that the patterns of expression of PN in both compartments can allow for the development of IHC “signatures” that maintain a strong independent predictive value of both all causes and, namely, of cancer-specific mortality.
Collapse
Affiliation(s)
- P V Nuzzo
- Academic Unit of Medical Oncology, IRCCS AOU San Martino-IST, San Martino University Hospital and National Cancer Research Institute, L.go R. Benzi 10, 16132, Genoa, Italy.,Department of Internal Medicine, School of Medicine, University of Genoa, L.go R. Benzi 10, 16132, Genoa, Italy
| | - A Rubagotti
- Academic Unit of Medical Oncology, IRCCS AOU San Martino-IST, San Martino University Hospital and National Cancer Research Institute, L.go R. Benzi 10, 16132, Genoa, Italy.,Department of Internal Medicine, School of Medicine, University of Genoa, L.go R. Benzi 10, 16132, Genoa, Italy
| | - L Zinoli
- Academic Unit of Medical Oncology, IRCCS AOU San Martino-IST, San Martino University Hospital and National Cancer Research Institute, L.go R. Benzi 10, 16132, Genoa, Italy
| | - S Salvi
- Histopathology and Cytology Unit, IRCCS AOU San Martino-IST, San Martino University Hospital and National Cancer Research Institute, L.go R. Benzi 10, 16132, Genoa, Italy
| | - S Boccardo
- Histopathology and Cytology Unit, IRCCS AOU San Martino-IST, San Martino University Hospital and National Cancer Research Institute, L.go R. Benzi 10, 16132, Genoa, Italy
| | - F Boccardo
- Academic Unit of Medical Oncology, IRCCS AOU San Martino-IST, San Martino University Hospital and National Cancer Research Institute, L.go R. Benzi 10, 16132, Genoa, Italy. .,Department of Internal Medicine, School of Medicine, University of Genoa, L.go R. Benzi 10, 16132, Genoa, Italy.
| |
Collapse
|
18
|
Nuzzo PV, Rubagotti A, Argellati F, Di Meglio A, Zanardi E, Zinoli L, Comite P, Mussap M, Boccardo F. Prognostic Value of Preoperative Serum Levels of Periostin (PN) in Early Breast Cancer (BCa). Int J Mol Sci 2015; 16:17181-92. [PMID: 26225965 PMCID: PMC4581188 DOI: 10.3390/ijms160817181] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 07/14/2015] [Accepted: 07/17/2015] [Indexed: 01/08/2023] Open
Abstract
PN is a secreted cell adhesion protein critical for carcinogenesis. Elevated serum levels of PN have been implicated as playing an important role in different types of cancer, and a few reports suggest a potential role as a prognostic marker. We evaluated the prognostic significance of preoperative serum PN concentration in patients with BCa receiving curative surgery. Enzyme-Linked Immunosorbent Assay (ELISA) was performed to determine the preoperative serum PN level in 182 patients. The correlations between serum PN concentration with clinical pathological features and PN expression in primary tumor samples were analyzed. The prognostic impact of serum PN levels with all-cause and BCa-specific mortality was also investigated. Appropriate statistics were used. Elevated serum PN levels were significantly associated with patient age (p = 0.005), adjuvant systemic therapy (p = 0.04) and progesterone receptor (PgR) status (p = 0.02). No correlation between PN preoperative serum levels and other clinical-pathological parameters, including either the epithelial or the stromal PN expression of primary tumor or the combination of the two, was found. Similarly, no association between serum PN levels and either all-cause or BCa-specific mortality was found. However, subgroup analysis revealed a correlation between higher PN serum levels and all-cause mortality in patients with node-negative disease (p = 0.05) and in those with a low PgR expression (p = 0.03). Higher levels of serum PN were also found to correlate with BCa-specific mortality in the subgroup of patients who did not receive any adjuvant systemic therapy (p = 0.04). Our findings suggest that PN was detectable in the serum of early BCa patients before surgery and increased base-line serum levels predicted worse long-term survival outcomes in specific subgroups of patients.
Collapse
Affiliation(s)
- Pier Vitale Nuzzo
- Academic Unit of Medical Oncology, IRCCS San Martino University Hospital-IST National Cancer Research Institute, Largo Rosanna Benzi 10, 16132 Genoa, Italy.
- Department of Medicine, School of Medicine, University of Genoa, Largo Rosanna Benzi 10, 16132 Genoa, Italy.
| | - Alessandra Rubagotti
- Academic Unit of Medical Oncology, IRCCS San Martino University Hospital-IST National Cancer Research Institute, Largo Rosanna Benzi 10, 16132 Genoa, Italy.
- Department of Medicine, School of Medicine, University of Genoa, Largo Rosanna Benzi 10, 16132 Genoa, Italy.
| | - Francesca Argellati
- Academic Unit of Medical Oncology, IRCCS San Martino University Hospital-IST National Cancer Research Institute, Largo Rosanna Benzi 10, 16132 Genoa, Italy.
| | - Antonio Di Meglio
- Academic Unit of Medical Oncology, IRCCS San Martino University Hospital-IST National Cancer Research Institute, Largo Rosanna Benzi 10, 16132 Genoa, Italy.
- Department of Medicine, School of Medicine, University of Genoa, Largo Rosanna Benzi 10, 16132 Genoa, Italy.
| | - Elisa Zanardi
- Academic Unit of Medical Oncology, IRCCS San Martino University Hospital-IST National Cancer Research Institute, Largo Rosanna Benzi 10, 16132 Genoa, Italy.
- Department of Medicine, School of Medicine, University of Genoa, Largo Rosanna Benzi 10, 16132 Genoa, Italy.
| | - Linda Zinoli
- Academic Unit of Medical Oncology, IRCCS San Martino University Hospital-IST National Cancer Research Institute, Largo Rosanna Benzi 10, 16132 Genoa, Italy.
| | - Paola Comite
- Department of Laboratory Medicine, IRCCS San Martino University Hospital-IST National Cancer Research Institute Largo Rosanna Benzi 10, 16132 Genoa, Italy.
| | - Michele Mussap
- Department of Laboratory Medicine, IRCCS San Martino University Hospital-IST National Cancer Research Institute Largo Rosanna Benzi 10, 16132 Genoa, Italy.
| | - Francesco Boccardo
- Academic Unit of Medical Oncology, IRCCS San Martino University Hospital-IST National Cancer Research Institute, Largo Rosanna Benzi 10, 16132 Genoa, Italy.
- Department of Medicine, School of Medicine, University of Genoa, Largo Rosanna Benzi 10, 16132 Genoa, Italy.
| |
Collapse
|
19
|
Farolfi A, Scarpi E, Rocca A, Mangia A, Biglia N, Gianni L, Tienghi A, Valerio MR, Gasparini G, Amaducci L, Faedi M, Baldini E, Rubagotti A, Maltoni R, Paradiso A, Amadori D. Time to initiation of adjuvant chemotherapy in patients with rapidly proliferating early breast cancer. Eur J Cancer 2015. [PMID: 26206258 DOI: 10.1016/j.ejca.2015.07.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To evaluate the optimal time interval from definitive surgery to commencing chemotherapy in early breast cancer (EBC). PATIENTS AND METHODS The relationship between time to initiation of adjuvant chemotherapy (TTC), calculated in weeks, and disease-free (DFS) or overall survival (OS), was assessed in 921 EBC patients with rapidly proliferating tumours (thymidine labelling index >3% or G3 or Ki67 >20%), randomised in a phase III clinical trial (NCT01031030) to receive chemotherapy with or without anthracyclines (epirubicin→cyclophosphamide, methotrexate and fluorouracil (CMF) versus CMF→epirubicin versus CMF). DFS, OS and 95% confidence intervals (95% confidence interval (CI)) were calculated by the Kaplan-Meier method. Multivariate Cox analysis was performed in relation with nodal involvement, oestrogen receptor and human epidermal growth factor receptor 2 (HER2) status, Ki67 value, type of adjuvant chemotherapy, menopausal status and tumour size. RESULTS At a median follow-up of 105 months (range 2-188), a prolonged TTC resulted in a significant increase in the risk of relapse: hazard ratio (HR) 1.15 (95% CI 1.02-1.30, p=0.019). Using a backward elimination procedure, TTC, tumour size and nodal involvement remained significantly associated with DFS. A time-dependent receiver-operating characteristic (ROC) curve analysis was subsequently utilised to evaluate the best cut-off for TTC, identifying 7 weeks as the best threshold for longer OS (p=0.043): 8-year OS 88% (95% CI 85-90) for patients with a TTC <7 weeks and 78% (95% CI 68-87) for the other group. CONCLUSIONS Our results confirm that a shorter TTC may reduce relapses and possibly also improve clinical outcome in patients with highly proliferating EBC.
Collapse
Affiliation(s)
- Alberto Farolfi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy.
| | - Emanuela Scarpi
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Andrea Rocca
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Anita Mangia
- Functional Biomorphology Laboratory, Istituto Tumori "Giovanni Paolo II"-IRCCS, Bari, Italy
| | - Nicoletta Biglia
- Obstetrics and Gynaecology Unit, University of Torino Medical School, Torino, Italy
| | - Lorenzo Gianni
- Department of Oncology, Per gli Infermi Hospital, Rimini, Italy
| | - Amelia Tienghi
- Oncology Unit, S. Maria delle Croci Hospital, Ravenna, Italy
| | | | | | | | - Marina Faedi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | | | - Alessandra Rubagotti
- Department of Internal Medicine of the University of Genoa and Academic Unit of Medical Oncology, AOU San Martino-IST, Genoa, Italy
| | - Roberta Maltoni
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Angelo Paradiso
- Clinical Experimental Oncology Laboratory, Istituto Tumori "Giovanni Paolo II"-IRCCS, Bari, Italy
| | - Dino Amadori
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| |
Collapse
|
20
|
Boccardo F, Rubagotti A, Nuzzo PV, Argellati F, Savarino G, Romano P, Damonte G, Rocco M, Profumo A. Matrix-assisted laser desorption/ionisation (MALDI) TOF analysis identifies serum angiotensin II concentrations as a strong predictor of all-cause and breast cancer (BCa)-specific mortality following breast surgery. Int J Cancer 2015; 137:2394-402. [PMID: 25994113 DOI: 10.1002/ijc.29609] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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: 01/17/2015] [Revised: 04/13/2015] [Accepted: 05/05/2015] [Indexed: 12/15/2022]
Abstract
MALDI-TOF MS was used to recognise serum peptidome profiles predictive of mortality in women affected by early BCa. Mortality was analysed based on signal profiling, and appropriate statistics were used. The results indicate that four signals were increased in deceased patients compared with living patients. Three of the four signals were individually associated with all-cause mortality, but only one having mass/charge ratio (m/z) 1,046.49 was associated with BCa-specific mortality and was the only peak to maintain an independent prognostic role after multivariate analysis. Two groups exhibiting different mortality probabilities were identified after clustering patients based on the expression of the four peptides, but m/z 1,046.49 was exclusively expressed in the cluster exhibiting the worst mortality outcome, thus confirming the crucial value of this peptide. The specific role of this peak was confirmed by competing risk analysis. MS findings were validated by ELISA analysis after demonstrating that m/z 1,046.49 structurally corresponded to Angiotensin II (ATII). In fact, mortality results obtained after arbitrarily dividing patients according to an ATII serum value of 255 pg/ml (which corresponds to the 66(th) percentile value) were approximately comparable to those previously demonstrated when the same patients were analysed according to the expression of signal m/z 1,046.49. Similarly, ATII levels were specifically correlated with BCa-related deaths after competing risk analysis. In conclusion, ATII levels were increased in women who exhibited worse mortality outcomes, reinforcing the evidence that this peptide potentially significantly affects the natural history of early BCa. Our findings also confirm that MALDI-TOF MS is an efficient screening tool to identify novel tumour markers and that MS findings can be rapidly validated through less complex techniques, such as ELISA.
Collapse
Affiliation(s)
- Francesco Boccardo
- Academic Unit of Medical Oncology, IRCCS AOU San Martino-IST (San Martino University Hospital and National Cancer Research Institute), Genoa, Italy.,Department of Internal Medicine, School of Medicine, University of Genoa, Genoa, Italy
| | - Alessandra Rubagotti
- Academic Unit of Medical Oncology, IRCCS AOU San Martino-IST (San Martino University Hospital and National Cancer Research Institute), Genoa, Italy.,Department of Internal Medicine, School of Medicine, University of Genoa, Genoa, Italy
| | - Pier Vitale Nuzzo
- Academic Unit of Medical Oncology, IRCCS AOU San Martino-IST (San Martino University Hospital and National Cancer Research Institute), Genoa, Italy.,Department of Internal Medicine, School of Medicine, University of Genoa, Genoa, Italy
| | - Francesca Argellati
- Academic Unit of Medical Oncology, IRCCS AOU San Martino-IST (San Martino University Hospital and National Cancer Research Institute), Genoa, Italy
| | - Grazia Savarino
- Academic Unit of Medical Oncology, IRCCS AOU San Martino-IST (San Martino University Hospital and National Cancer Research Institute), Genoa, Italy.,Department of Internal Medicine, School of Medicine, University of Genoa, Genoa, Italy
| | - Paolo Romano
- Biopolymers and Proteomics Unit, IRCCS AOU San Martino-IST (San Martino University Hospital and National Cancer Research Institute), Genoa, Italy
| | - Gianluca Damonte
- Department of Experimental Medicine and Center of Excellence for Biomedical Research (CEBR), School of Medicine, University of Genoa, Genoa, Italy
| | - Mattia Rocco
- Biopolymers and Proteomics Unit, IRCCS AOU San Martino-IST (San Martino University Hospital and National Cancer Research Institute), Genoa, Italy
| | - Aldo Profumo
- Biopolymers and Proteomics Unit, IRCCS AOU San Martino-IST (San Martino University Hospital and National Cancer Research Institute), Genoa, Italy
| |
Collapse
|
21
|
Nuzzo P, Rubagotti A, Zinoli L, Salvi S, Boccardo S, Boccardo F. Prognostic value of periostin (PN) expression in early breast cancer (BCa): Long-term mortality outcomes. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv117.30] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
22
|
Abstract
INTRODUCTION Antiandrogens are a treatment option in patients with prostate cancer, given either in combination with androgen deprivation or, in selected cases, as monotherapy. New-generation antiandrogens have been recently introduced in clinical practice (enzalutamide) or are under evaluation in clinical trials (ARN-509). AREAS COVERED This review elucidates the safety profile of antiandrogens, in particular focusing on the tolerability profile of each drug either when employed in combination with castration or as monotherapy, in hormone-naive or in castration-resistant patients. EXPERT OPINION Non-steroidal antiandrogens are widely used in the management of hormone-sensitive disease in combination with luteinizing hormone-releasing hormone agonists or in patients failing front-line treatment with androgen-deprivative maneuvers. In selected patients, non-steroidal antiandrogen monotherapy appears to yield comparable results as castration. Novel non-steroidal antiandrogens have been investigated with promising results in castration-resistant prostate cancer. Beyond the safety profile specific to any individual compound, increased testosterone and 17β-estradiol levels are commonly observed during antiandrogen monotherapy, leading to gynecomastia and breast pain. The safety profile of old and novel antiandrogens should be taken into account by clinicians in decision making and in selecting the most suitable patients. Beyond patient selection, full clinical evaluation of patient co-morbidities that might affect the drug tolerability and clinical monitoring are anyway required.
Collapse
Affiliation(s)
- Francesco Ricci
- University of Genoa, School of Medicine, Department of Internal Medicine , Genoa , Italy
| | | | | | | |
Collapse
|
23
|
Nuzzo PV, Buzzatti G, Ricci F, Rubagotti A, Argellati F, Zinoli L, Boccardo F. Periostin: a novel prognostic and therapeutic target for genitourinary cancer? Clin Genitourin Cancer 2014; 12:301-11. [PMID: 24656869 DOI: 10.1016/j.clgc.2014.02.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 01/29/2014] [Accepted: 02/12/2014] [Indexed: 01/21/2023]
Abstract
Many of the cellular abnormalities present in solid tumors are structural in nature and involve the proteins of the extracellular matrix (ECM). Periostin is a protein produced and secreted by the fibroblasts as a component of the ECM where it is involved in regulating intercellular adhesion. The expression of periostin has an important physiological role during embryogenesis and growth, namely at the level of bone, dental, and cardiac tissues. Many studies indicate that periostin plays an important role for tumor progression in various types of cancer, such as colon, lung, head and neck, breast, ovarian, and prostate. To the best of our knowledge, a limited number of studies have investigated periostin expression in urogenital cancer, such as prostate, bladder, penile, and renal cancer, and no studies were performed in testis cancer. In this review article, we summarize the most recent knowledge of periostin, its genetic and protein structure, and the role of the different isoforms identified and sequenced so far. In particular, we focus our attention on the role of this protein in genitourinary tumors, trying to emphasize the role not only as a possible prognostic marker, but also as a possible target for the development of future anticancer therapies.
Collapse
Affiliation(s)
- Pier Vitale Nuzzo
- Academic Unit of Medical Oncology (Medical Oncology B), University of Genoa, School of Medicine, Genoa, Italy; Department of Internal Medicine, University of Genoa, School of Medicine, Genoa, Italy
| | - Giulia Buzzatti
- Academic Unit of Medical Oncology (Medical Oncology B), University of Genoa, School of Medicine, Genoa, Italy; Department of Internal Medicine, University of Genoa, School of Medicine, Genoa, Italy
| | - Francesco Ricci
- Academic Unit of Medical Oncology (Medical Oncology B), University of Genoa, School of Medicine, Genoa, Italy; IRCCS San Martino University Hospital - IST National Cancer Research Institute, Genoa, Italy
| | - Alessandra Rubagotti
- Academic Unit of Medical Oncology (Medical Oncology B), University of Genoa, School of Medicine, Genoa, Italy; Department of Internal Medicine, University of Genoa, School of Medicine, Genoa, Italy; IRCCS San Martino University Hospital - IST National Cancer Research Institute, Genoa, Italy
| | - Francesca Argellati
- Academic Unit of Medical Oncology (Medical Oncology B), University of Genoa, School of Medicine, Genoa, Italy; IRCCS San Martino University Hospital - IST National Cancer Research Institute, Genoa, Italy
| | - Linda Zinoli
- Academic Unit of Medical Oncology (Medical Oncology B), University of Genoa, School of Medicine, Genoa, Italy; Department of Internal Medicine, University of Genoa, School of Medicine, Genoa, Italy; IRCCS San Martino University Hospital - IST National Cancer Research Institute, Genoa, Italy
| | - Francesco Boccardo
- Academic Unit of Medical Oncology (Medical Oncology B), University of Genoa, School of Medicine, Genoa, Italy; Department of Internal Medicine, University of Genoa, School of Medicine, Genoa, Italy; IRCCS San Martino University Hospital - IST National Cancer Research Institute, Genoa, Italy.
| |
Collapse
|
24
|
Profumo A, Mangerini R, Rubagotti A, Romano P, Damonte G, Guglielmini P, Facchiano A, Ferri F, Ricci F, Rocco M, Boccardo F. Complement C3f serum levels may predict breast cancer risk in women with gross cystic disease of the breast. J Proteomics 2013; 85:44-52. [PMID: 23639844 DOI: 10.1016/j.jprot.2013.04.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 04/02/2013] [Accepted: 04/13/2013] [Indexed: 01/19/2023]
Abstract
UNLABELLED Gross cystic disease (GCDB) is a breast benign condition predisposing to breast cancer. Cryopreserved sera from GCDB patients, some of whom later developed a cancer (cases), were studied to identify potential risk markers. A MALDI-TOF mass spectrometry analysis found several complement C3f fragments having a significant increased abundance in cases compared to controls. After multivariate analysis, the full-length form of C3f maintained a predictive value of breast cancer risk. Higher levels of C3f in the serum of women affected by a benign condition like GCDB thus appears to be correlated to the development of breast cancer even 20 years later. BIOLOGICAL SIGNIFICANCE Increased complement system activation has been found in the sera of women affected by GCDB who developed a breast cancer, even twenty or more years later. C3f may predict an increased breast cancer risk in the healthy population and in women affected by predisposing conditions.
Collapse
Affiliation(s)
- Aldo Profumo
- Biopolymers and Proteomics Unit, IRCCS AOU San Martino-IST, San Martino University Hospital and National Cancer Research Institute, Genoa, Italy
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Argellati F, Nuzzo PV, Ricci F, Mangerini R, Rubagotti A, Boccardo F. Dihydrotestosterone and bicalutamide do not affect periostin expression in androgen-dependent LNCaP prostate cancer cell lines. Anticancer Res 2013; 33:815-820. [PMID: 23482749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND/AIM To investigate periostin (POSTN) expression in the LNCaP cell line. MATERIALS AND METHODS Our LNCaP strain did not constitutively express the POSTN gene. Through cell transfection with a cloning vector, we developed an LNCaP cell line that stably expressed POSTN. LNCaP wild-type and transfected cells were incubated with dihydrotestosterone (DHT) in the presence/or absence of bicalutamide (BIC). POSTN mRNA was detected by quantitative real-time reverse transcription-polymerase chain reaction (qRT-PCR) and growth was measured with the MTT assay. RESULTS POSTN transfection stimulated LNCaP cell growth. While POSTN transfection did not interfere with the stimulatory effect of DHT, BIC had an inhibitory effect on cell proliferation. However, exposure to either DHT and/or BIC was not able to interfere with POSTN expression per se. CONCLUSION We confirmed the role of POSTN in promoting cancer cell growth. Although POSTN transcription is not likely to be androgen-dependent, the fact that increased cell proliferation POSTN-mediated was impaired by BIC suggests an androgen modulation of POSTN interaction proteins.
Collapse
Affiliation(s)
- Francesca Argellati
- IRCCS San Martino University Hospital - IST National Cancer Research Institute and the University of Genoa, Academic Unit of Medical Oncology (UOC Oncologia Medica B), Largo Rosanna Benzi 10, 16132 Genoa, Italy.
| | | | | | | | | | | |
Collapse
|
26
|
Nuzzo PV, Rubagotti A, Zinoli L, Ricci F, Salvi S, Boccardo S, Boccardo F. Prognostic value of stromal and epithelial periostin expression in human prostate cancer: correlation with clinical pathological features and the risk of biochemical relapse or death. BMC Cancer 2012; 12:625. [PMID: 23273263 PMCID: PMC3553030 DOI: 10.1186/1471-2407-12-625] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [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: 07/05/2012] [Accepted: 12/17/2012] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The purpose of the present study was to evaluate the prognostic value of POSTN expression following prostatectomy. METHODS Periostin (POSTN) expression in prostate cancer (PCa) and in normal specimens was evaluated in 90 patients by an immuno-reactive score(IRS) based on the intensity of immunostaining and on the quantity of stained cells. The t-test was applied to compare IRS values in cancer specimens to values in normal specimens. Pearson's test was used to correlate POSTN expression to clinical pathologic features. PSA progression-free and survival curves were constructed by the Kaplan-Meier method and compared using the log-rank test. Multi-parametric models were constructed according to the Cox technique adding all the covariates predicting for either PSA progression or death into the models after univariate analysis. RESULTS Both stromal and epithelial POSTN expression were significantly increased in tumor tissues. In particular, we found stromal expression to be significantly higher than epithelial expression as compared to normal tissues (p<0.000 and p=0.001).A significant correlation between POSTN epithelial expression and extra-prostatic extension was found (p=0.03). While high stromal expression was significantly associated with shorter survival (p=0.008), a low epithelial score significantly correlated with shorter PSA-free survival (p=0.04), suggesting that POSTN plays an apparently opposing biological role depending on its compartmentalization.Regardless of the mechanism that is involved, patients showing both high stromal and low epithelial expression made up a subgroup with a very bleak prognosis. CONCLUSIONS Although requiring further validation through larger studies, our findings show that POSTN might represent a novel prognostic marker for PCa.
Collapse
Affiliation(s)
- Pier Vitale Nuzzo
- IRCCS San Martino University Hospital - IST National Cancer Research Institute and the University of Genoa, Academic Unit of Medical Oncology UOC Oncologia Medica B, Largo Rosanna Benzi 10, 16132 Genoa, Italy
| | | | | | | | | | | | | |
Collapse
|
27
|
Nuzzo P, Rubagotti A, Zinoli L, Ricci F, Salvi S, Boccardo S, Truini M, Boccardo F. The Prognostic Value of Periostin Expression in Human Prostate Cancer. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)33472-4] [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
|
28
|
Ricci F, Rubagotti A, Zinoli L, Mangerini R, Nuzzo PV, Carmignani G, Simonato A, Barboro P, Balbi C, Boccardo F. Prognostic value of nuclear matrix protein expression in localized prostate cancer. J Cancer Res Clin Oncol 2012; 138:1379-84. [PMID: 22488172 DOI: 10.1007/s00432-012-1216-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Accepted: 03/22/2012] [Indexed: 12/22/2022]
Abstract
PURPOSE The aim of the study was to correlate nuclear matrix (NM) protein expression profiles with the risk of PSA progression or death in early prostate cancer (PCa). METHODS High-resolution two-dimensional gel electrophoresis (2D-PAGE) was used to identify tumor-associated NM proteins in the PCa specimens obtained from 94 patients. The association between the expression of each protein and the probability of PSA progression or death was studied through univariate analysis. Unsupervised hierarchical clustering analysis was then used to generate patient clusters showing comparable outcomes by including the proteins that were predictive at univariate analysis. PSA-free and overall survival curves relative to each cluster were constructed by means of the Kaplan-Meier method and curves compared by the log-rank test. Multi-parametric models were constructed according to Cox proportional hazard technique. RESULTS After a median follow-up of 11.7 years (range, 6.5-16.2), 50 patients progressed and 22 died. Of the eight NM proteins identified through 2D-PAGE, proteins NM-6, NM-7 and NM-8 were confirmed to be individually associated with a higher risk of PSA progression at univariate analysis. Proteins NM-6 and NM-8 were also predictive of survival probability. Hierarchical clustering analysis of these proteins allowed to identify one cluster of tumors co-expressing the three proteins or proteins NM-6 and NM-8, characterized by a very poor outcome, suggesting a specific role for these proteins in PCa progression. The predictive value of this mini-signature in respect to PSA-free survival was confirmed by multivariate analysis. CONCLUSIONS Changes in NM scaffolding are strongly associated with the clinical outcome of patients following radical prostatectomy.
Collapse
Affiliation(s)
- Francesco Ricci
- Department of Internal Medicine, School of Medicine, University of Genoa, Genoa, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Cognetti F, Ruggeri EM, Felici A, Gallucci M, Muto G, Pollera CF, Massidda B, Rubagotti A, Giannarelli D, Boccardo F. Adjuvant chemotherapy with cisplatin and gemcitabine versus chemotherapy at relapse in patients with muscle-invasive bladder cancer submitted to radical cystectomy: an Italian, multicenter, randomized phase III trial. Ann Oncol 2012; 23:695-700. [PMID: 21859900 DOI: 10.1093/annonc/mdr354] [Citation(s) in RCA: 158] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The purpose of the study was to evaluate the benefit of adjuvant chemotherapy (AC) versus surgery alone in patients with muscle-invasive bladder cancer (MIBC). PATIENTS AND METHODS One hundred and ninety-four patients with pT2G3, pT3-4, N0-2 transitional cell bladder carcinoma were randomly allocated to control (92 patients) or to four courses of AC (102 patients). These latter patients were further randomly assigned to receive gemcitabine 1000 mg/m(2) days 1, 8 and 15 and cisplatin 70 mg/m(2) day 2 or gemcitabine as above plus cisplatin 70 mg/m(2) day 15, every 28 days. RESULTS At a median follow-up of 35 months, the 5-year overall survival (OS) was 48.5%, with no difference between the two arms [P = 0.24, hazard ratio (HR) 1.29, 95% confidence interval (CI) 0.84-1.99]. Mortality hazard was significantly correlated with Nodes (N) and Tumor (T) stage. The control and AC arms had comparable disease-free survival (42.3% and 37.2%, respectively; P = 0.70, HR 1.08, 95% CI 0.73-1.59). Only 62% of patients received the planned cycles. A significant higher incidence of thrombocytopenia was observed in patients receiving cisplatin on day 2 (P = 0.006). A similar global quality of life was observed in the two arms. CONCLUSION The study was underpowered to demonstrate that AC with cisplatin and gemcitabine improves OS and disease-free survival in patients with MIBC.
Collapse
Affiliation(s)
- F Cognetti
- Department of Medical Oncology, Regina Elena Cancer Institute, Rome.
| | - E M Ruggeri
- Division of Medical Oncology, Belcolle Hospital, Viterbo
| | - A Felici
- Department of Medical Oncology, Regina Elena Cancer Institute, Rome
| | - M Gallucci
- Department of Urology, Regina Elena Cancer Institute, Rome
| | - G Muto
- Department of Urology, San Giovanni Bosco Hospital, Torino
| | - C F Pollera
- Division of Medical Oncology, Belcolle Hospital, Viterbo
| | - B Massidda
- Department of Medical Oncology, Policlinico Universitario, Cagliari
| | - A Rubagotti
- Departments of Medical Oncology and of Oncology, Biology and Genetics (Biostatistics Unit), National Cancer Research Institute and University, Genova; Departments of Medical Oncology and of Oncology, Biology and Genetics, National Cancer Research Institute and University, Genova
| | - D Giannarelli
- Department of Biostatistics, Regina Elena Cancer Institute, Rome, Italy
| | - F Boccardo
- Departments of Medical Oncology and of Oncology, Biology and Genetics, National Cancer Research Institute and University, Genova
| |
Collapse
|
30
|
Barboro P, Repaci E, Ferrari N, Rubagotti A, Boccardo F, Balbi C. Androgen receptor and heterogeneous nuclear ribonucleoprotein K colocalize in the nucleoplasm and are modulated by bicalutamide and 4-hydroxy-tamoxifen in prostatic cancer cell lines. Prostate 2011; 71:1466-79. [PMID: 21321982 DOI: 10.1002/pros.21366] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [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: 08/10/2010] [Accepted: 01/24/2011] [Indexed: 01/18/2023]
Abstract
BACKGROUND Bicalutamide (BIC) is widely used in prostate cancer therapy. The dose and schedule employed are well tolerated, but about 50% of patients develop gynecomastia. Several studies have shown a significant reduction of the troublesome effects when Tamoxifen is concomitantly administered with BIC. However, the results reported in the literature seem to be preliminary and possible interferences could be present. In order to clarify the molecular mechanisms of the combination of the two drugs, we have investigated whether the expression of the proteins belonging to nuclear matrix (NM), one modulator of hormone action, is altered by BIC and/or 4-hydroxy-tamoxifen (4OHT) in LNCaP cells. We focused above all on heterogeneous nuclear ribonucleoprotein K (hnRNP K) a NM protein with a key role in prostate carcinoma. METHODS NM proteins were analyzed by two-dimensional gel electrophoresis. Modulation and compartmentalization of the androgen receptor and the hnRNP K were studied by Western blotting, confocal microscopy, and immunoprecipitation. RESULTS Proteomic analysis revealed that there is a similarity in the changes of the NM proteins elicited by drugs alone but that their combination does not result in a simple additive effect. Moreover, we found that in the nucleoplasm the androgen receptor and the hnRNP K colocalize in a complex that is highly proximal to DNA and that both proteins were synchronously modulated by BIC and/or 4OHT treatment. CONCLUSION This study confirm the pivotal role of hnRNP K in prostate carcinoma and suggest that this role might be played by the interaction with the androgen receptor.
Collapse
Affiliation(s)
- Paola Barboro
- Istituto Nazionale per la Ricerca sul Cancro, Università di Genova, Largo Rosanna Benzi, Genova, Italy
| | | | | | | | | | | |
Collapse
|
31
|
Boccardo F, Guglielmini P, Parodi A, Rubagotti A. Chemotherapy versus tamoxifen versus chemotherapy plus tamoxifen in node-positive, oestrogen receptor-positive breast cancer patients. Very late results of the ‘gruppo di ricerca per la chemio-ormonoterapia adiuvante (GROCTA)’ 01-Trial in early breast cancer. Breast Cancer Res Treat 2011; 126:653-61. [DOI: 10.1007/s10549-011-1405-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Accepted: 02/09/2011] [Indexed: 01/07/2023]
|
32
|
Boccardo F, Guglielmini P, Marasco A, Rubagotti A. Chemotherapy (CT) versus tamoxifen (T) versus chemoterapy plus tamoxifen (CTT) in patients with node-positive (N+), estrogen receptor-positive (ER+) breast cancer (bca): Very late results of an Italian multicentric trial. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.575] [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: 11/20/2022] Open
|
33
|
Boccardo F, Amadori D, Guglielmini P, Sismondi P, Farris A, Agostara B, Gambi A, Catalano G, Faedi M, Rubagotti A. Epirubicin Followed by Cyclophosphamide, Methotrexate and 5-Fluorouracil versus Paclitaxel Followed by Epirubicin and Vinorelbine in Patients with High-Risk Operable Breast Cancer. Oncology 2010; 78:274-81. [DOI: 10.1159/000315735] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Accepted: 02/17/2010] [Indexed: 11/19/2022]
|
34
|
|
35
|
Santini G, Chisesi T, Nati S, Porcellini A, Zoli V, Rizzoli V, Zupo S, Marino G, Rubagotti A, Polacco A, Spriano M, Vimercati R, Congiu AM, Ravetti JL, Aversa S, Candela M, Patti C. Fludarabine, Cyclophosphamide and Mitoxantrone for Untreated Follicular Lymphoma: a Report from the Non-Hodgkin's Lymphoma Co-operative Study Group. Leuk Lymphoma 2009; 45:1141-7. [PMID: 15359993 DOI: 10.1080/10428190310001623874] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The aim of the study was to determine the safety and efficacy of the combination of fludarabine (FLU), cyclophosphamide (CY) and mitoxantrone (FLU/CY/MITO) in untreated follicular lymphomas (FL), Sixty patients with newly diagnosed stage II bulky to IV FL, median age 59 years (range 36-70), received FLU/CY/MITO regimen (FLU 25 mg/m2 days 1-3, CY 300 mg/m2 days 1-3, Mito 10 mg/m2 day 1). Patients received antibiotic oral prophylaxis during all treatments, and growth factors (G-CSF) when grade III granulocytopenia (WHO) occurred. The overall response rate was 87%: 46 patients achieved complete response (CR) (77%), 6 a partial response (10%) and 8 were non-responders. Fifty patients are surviving with a median observation time of 31 months. The 4-year estimated probability of overall survival and failure-free survival were 78.2% and 45% respectively. Thirty-five patients (58%) are still in CR. Sixty percent of patients experienced grade III-IV granulocytopenia. Two patients suffered grade III pulmonary infection and one grade III liver toxicity. In a subset of 46 patients, bcl-2 translocation was positive in bone marrow (BM) and/or peripheral blood (PB) of 36 patients. At the end of treatment, 25 of these patients had CR and 19 (76%) converted to polymerase chain reaction (PCR) negativity. FLU/CY/MITO regimen showed a high level of activity in follicular lymphoma. Toxicity, mainly hematological, was acceptable and the treatment was made feasible by the use of antibiotic prophylaxis and G-CSF. Significant non-hematological toxicities were seen, but no patients died. The conversion of bcl-2 from positive to negative by PCR in BM and/or PB suggests a possible role for this treatment in clearing minimal residual disease and improving patients' outcome.
Collapse
Affiliation(s)
- Gino Santini
- Division of Haematology I, S. Martino Hospital, Genoa, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Boccardo F, Rubagotti A, Guglielmini P, Sismondi P, Farris A, Amadori D, Agostara B, Gambi A, Catalano G, Faedi M. Epirubicin (E) followed by cyclophosphamide, methotrexate, 5-fluorouracil (CMF) versus paclitaxel (T) followed by epirubicin and vinorelbine (EV) in patients (pts) with high-risk operable breast cancer. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e11521] [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
e11521 Background: > 3 N+ pts have a poor outcome, even in the presence of otherwise favourable phenotypic features. CT, alone or combined with endocrine therapy (ET) in hormone receptor (HOR)+ pts, is the gold standard for these women. However questions still exist about the optimal CT regimen. Methods: 244 >3N+ pts were randomized to either four 3-weekly courses of E (100 mg/sqm,d 1)followed by four 4-weekly cycles of CMF (600, 40, 600 mg/sqm, dd 1,8)(E-CMF:N=122)or four 3-weekly courses of T (175 mg/sqm, d1) followed by four 3-weekly cycles of EV (E:75 mg/sqm, da 1; V: 25 mg/sqm dd 1,8;.) (T-EV:N=122). After CT, tamoxifen (plus a LH-RH analog in menstruating women ) was given for 5 years to all HOR+ pts.S was the primary end-point. Results: At 82 mos median f-up, S and RFS did not differ significantly between groups (7-yr S: E-CMF:76%,T- EV:74%;adjust. HR: 0.89;0.54–1.49;p=0.7; 7-yr RFS: E-CMF:67%,T-EV:63%;adjust. HR: 0.95;0.61–1.47;p=0.8;).Cox analysis confirmed no difference between treatments. However RFS forest plots showed some heterogenity in CT effect according to HOR and HER2 status: E- CMF was superior to E-TV in HOR + pts (HR=0.43; CI 0.20–0.93 p=0.03),irrespective of HER2 status, but it was inferior (HR=1.91;CI 0.48- 7.64;p=0.4) in triple negative pts. The two regimens showed different toxicity profiles;however toxicities were manageable and there were no difference in the %of pts receiving all the 8 planned CT cycles (E-CMF: 87.6%;T-EV:81.1% p=0.2) or who discontinued CT (E-CMF: 12.8%; T-EV: 18.9% p=0.2). Conclusions: T-EV was not superior to E-CMF which,combined with ET, still represents an adequate choice for this high risk pts subset, especially for HOR+ pts. No significant financial relationships to disclose.
Collapse
Affiliation(s)
- F. Boccardo
- University of Genoa - National Cancer Research Institute, Genova, Italy; University and Mauriziano Hospital, Turin, Italy; University of Sassari, Sassari, Italy; Tumor Institute Meldola, Forlì, Italy; M. Ascoli Hospital, Palermo, Italy; Infermi Hospital, Faenza, Italy; General Hospital, Pesaro, Italy; M. Bufalini Hospital, Cesena, Italy
| | - A. Rubagotti
- University of Genoa - National Cancer Research Institute, Genova, Italy; University and Mauriziano Hospital, Turin, Italy; University of Sassari, Sassari, Italy; Tumor Institute Meldola, Forlì, Italy; M. Ascoli Hospital, Palermo, Italy; Infermi Hospital, Faenza, Italy; General Hospital, Pesaro, Italy; M. Bufalini Hospital, Cesena, Italy
| | - P. Guglielmini
- University of Genoa - National Cancer Research Institute, Genova, Italy; University and Mauriziano Hospital, Turin, Italy; University of Sassari, Sassari, Italy; Tumor Institute Meldola, Forlì, Italy; M. Ascoli Hospital, Palermo, Italy; Infermi Hospital, Faenza, Italy; General Hospital, Pesaro, Italy; M. Bufalini Hospital, Cesena, Italy
| | - P. Sismondi
- University of Genoa - National Cancer Research Institute, Genova, Italy; University and Mauriziano Hospital, Turin, Italy; University of Sassari, Sassari, Italy; Tumor Institute Meldola, Forlì, Italy; M. Ascoli Hospital, Palermo, Italy; Infermi Hospital, Faenza, Italy; General Hospital, Pesaro, Italy; M. Bufalini Hospital, Cesena, Italy
| | - A. Farris
- University of Genoa - National Cancer Research Institute, Genova, Italy; University and Mauriziano Hospital, Turin, Italy; University of Sassari, Sassari, Italy; Tumor Institute Meldola, Forlì, Italy; M. Ascoli Hospital, Palermo, Italy; Infermi Hospital, Faenza, Italy; General Hospital, Pesaro, Italy; M. Bufalini Hospital, Cesena, Italy
| | - D. Amadori
- University of Genoa - National Cancer Research Institute, Genova, Italy; University and Mauriziano Hospital, Turin, Italy; University of Sassari, Sassari, Italy; Tumor Institute Meldola, Forlì, Italy; M. Ascoli Hospital, Palermo, Italy; Infermi Hospital, Faenza, Italy; General Hospital, Pesaro, Italy; M. Bufalini Hospital, Cesena, Italy
| | - B. Agostara
- University of Genoa - National Cancer Research Institute, Genova, Italy; University and Mauriziano Hospital, Turin, Italy; University of Sassari, Sassari, Italy; Tumor Institute Meldola, Forlì, Italy; M. Ascoli Hospital, Palermo, Italy; Infermi Hospital, Faenza, Italy; General Hospital, Pesaro, Italy; M. Bufalini Hospital, Cesena, Italy
| | - A. Gambi
- University of Genoa - National Cancer Research Institute, Genova, Italy; University and Mauriziano Hospital, Turin, Italy; University of Sassari, Sassari, Italy; Tumor Institute Meldola, Forlì, Italy; M. Ascoli Hospital, Palermo, Italy; Infermi Hospital, Faenza, Italy; General Hospital, Pesaro, Italy; M. Bufalini Hospital, Cesena, Italy
| | - G. Catalano
- University of Genoa - National Cancer Research Institute, Genova, Italy; University and Mauriziano Hospital, Turin, Italy; University of Sassari, Sassari, Italy; Tumor Institute Meldola, Forlì, Italy; M. Ascoli Hospital, Palermo, Italy; Infermi Hospital, Faenza, Italy; General Hospital, Pesaro, Italy; M. Bufalini Hospital, Cesena, Italy
| | - M. Faedi
- University of Genoa - National Cancer Research Institute, Genova, Italy; University and Mauriziano Hospital, Turin, Italy; University of Sassari, Sassari, Italy; Tumor Institute Meldola, Forlì, Italy; M. Ascoli Hospital, Palermo, Italy; Infermi Hospital, Faenza, Italy; General Hospital, Pesaro, Italy; M. Bufalini Hospital, Cesena, Italy
| |
Collapse
|
37
|
Bedognetti D, Rubagotti A, Conti G, Francesca F, De Cobelli O, Canclini L, Gallucci M, Aragona F, Di Tonno P, Boccardo F. An open, randomized, multicentre, phase III trial comparing the efficacy of two tamoxifen (T) schedules in preventing gynecomastia (gy) induced by bicalutamide monotherapy (BM) in prostate cancer patients (pca pts). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e16080] [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
e16080 Background: BM is a valuable option for pca pts who wish to avoid the consequences of androgen deprivation and to mantain sexually active.BM is commonly well tolerated:however gy and mastalgia virtually develop in all pts and represent a major cause of treatment discontinuation. We had previously demonstrated that T is safe and effective in preventing breast events induced by BM without affecting B tumor activity (Boccardo, J Clin Oncol. 2005;23:808). However possible interferences between B and T,especially after prolonged administration, remain a matter of concern.In order to reduce the exposure to T,we considered the putative advantages of a weekly administration based on T effects being dose -dependent and on drug long half-life. Methods: This was a non inferiority trial. 80 pts with localized, locally advanced or biochemically recurrent pca were randomly assigned to receive daily B (150 mg) plus T 20 (mg) continuously (d group: n = 41) or same but with T at 20 mg/weekly after the first 8 weeks (wk group: n = 39). Gy (primary endpoint), breast pain (bp), serum PSA levels and sexual functioning scores were evaluated. Results: At a median F.U. of 24.2 mos (95% CI: 23.7 -24.6) gy developed in 31.7% of pts in d group and in 74.4% of pts in wk group (p < 0.000). Bp occurred in 12.2% and 46.1% of pts respectively (p = 0.008) and it was more severe in patients switched to weekly T. The incidence of Aes was comparable (d group:58.8%;wk goup: 56.4%). However most events were mild and easily manageable. There were no major differences among treat. schedules relative to sexual functioning scores, PSA behaviour and disease progression. Conclusions: This study failed to demonstrate that it might be possible to maintain comparable prophylactic effect of T by switching from a daily to a weekly schedule and confirms that T at the daily dose of 20mg is safe and effective in preventing the incidence and severity of BM induced breast events. No significant financial relationships to disclose.
Collapse
Affiliation(s)
- D. Bedognetti
- University and National Cancer Research Institute of Genoa, Genoa, Italy; S. Anna Hospital, Como, Italy; S. Chiara Hospital, Pisa, Italy; European Institute of Oncology, Milan, Italy; Bergamo Hospital, Bergamo, Italy; Regina Elena Cancer Institute, Rome, Italy; Cannizzaro Hospital, Catania, Italy; University of Bari, Bari, Italy; University and National Cancer Research Institute, Genoa, Italy
| | - A. Rubagotti
- University and National Cancer Research Institute of Genoa, Genoa, Italy; S. Anna Hospital, Como, Italy; S. Chiara Hospital, Pisa, Italy; European Institute of Oncology, Milan, Italy; Bergamo Hospital, Bergamo, Italy; Regina Elena Cancer Institute, Rome, Italy; Cannizzaro Hospital, Catania, Italy; University of Bari, Bari, Italy; University and National Cancer Research Institute, Genoa, Italy
| | - G. Conti
- University and National Cancer Research Institute of Genoa, Genoa, Italy; S. Anna Hospital, Como, Italy; S. Chiara Hospital, Pisa, Italy; European Institute of Oncology, Milan, Italy; Bergamo Hospital, Bergamo, Italy; Regina Elena Cancer Institute, Rome, Italy; Cannizzaro Hospital, Catania, Italy; University of Bari, Bari, Italy; University and National Cancer Research Institute, Genoa, Italy
| | - F. Francesca
- University and National Cancer Research Institute of Genoa, Genoa, Italy; S. Anna Hospital, Como, Italy; S. Chiara Hospital, Pisa, Italy; European Institute of Oncology, Milan, Italy; Bergamo Hospital, Bergamo, Italy; Regina Elena Cancer Institute, Rome, Italy; Cannizzaro Hospital, Catania, Italy; University of Bari, Bari, Italy; University and National Cancer Research Institute, Genoa, Italy
| | - O. De Cobelli
- University and National Cancer Research Institute of Genoa, Genoa, Italy; S. Anna Hospital, Como, Italy; S. Chiara Hospital, Pisa, Italy; European Institute of Oncology, Milan, Italy; Bergamo Hospital, Bergamo, Italy; Regina Elena Cancer Institute, Rome, Italy; Cannizzaro Hospital, Catania, Italy; University of Bari, Bari, Italy; University and National Cancer Research Institute, Genoa, Italy
| | - L. Canclini
- University and National Cancer Research Institute of Genoa, Genoa, Italy; S. Anna Hospital, Como, Italy; S. Chiara Hospital, Pisa, Italy; European Institute of Oncology, Milan, Italy; Bergamo Hospital, Bergamo, Italy; Regina Elena Cancer Institute, Rome, Italy; Cannizzaro Hospital, Catania, Italy; University of Bari, Bari, Italy; University and National Cancer Research Institute, Genoa, Italy
| | - M. Gallucci
- University and National Cancer Research Institute of Genoa, Genoa, Italy; S. Anna Hospital, Como, Italy; S. Chiara Hospital, Pisa, Italy; European Institute of Oncology, Milan, Italy; Bergamo Hospital, Bergamo, Italy; Regina Elena Cancer Institute, Rome, Italy; Cannizzaro Hospital, Catania, Italy; University of Bari, Bari, Italy; University and National Cancer Research Institute, Genoa, Italy
| | - F. Aragona
- University and National Cancer Research Institute of Genoa, Genoa, Italy; S. Anna Hospital, Como, Italy; S. Chiara Hospital, Pisa, Italy; European Institute of Oncology, Milan, Italy; Bergamo Hospital, Bergamo, Italy; Regina Elena Cancer Institute, Rome, Italy; Cannizzaro Hospital, Catania, Italy; University of Bari, Bari, Italy; University and National Cancer Research Institute, Genoa, Italy
| | - P. Di Tonno
- University and National Cancer Research Institute of Genoa, Genoa, Italy; S. Anna Hospital, Como, Italy; S. Chiara Hospital, Pisa, Italy; European Institute of Oncology, Milan, Italy; Bergamo Hospital, Bergamo, Italy; Regina Elena Cancer Institute, Rome, Italy; Cannizzaro Hospital, Catania, Italy; University of Bari, Bari, Italy; University and National Cancer Research Institute, Genoa, Italy
| | - F. Boccardo
- University and National Cancer Research Institute of Genoa, Genoa, Italy; S. Anna Hospital, Como, Italy; S. Chiara Hospital, Pisa, Italy; European Institute of Oncology, Milan, Italy; Bergamo Hospital, Bergamo, Italy; Regina Elena Cancer Institute, Rome, Italy; Cannizzaro Hospital, Catania, Italy; University of Bari, Bari, Italy; University and National Cancer Research Institute, Genoa, Italy
| |
Collapse
|
38
|
Boccardo F, Guglielmini P, Rubagotti A. Upfront aromatase inhibitors (AI) in early breast cancer: Against. EJC Suppl 2008. [DOI: 10.1016/j.ejcsup.2008.06.027] [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
|
39
|
Cognetti F, Ruggeri EM, Felici A, Gallucci M, Muto G, Pollera CF, Massidda B, Rubagotti A, Giannarelli D, Boccardo F. Adjuvant chemotherapy (AC) with cisplatin + gemcitabine (CG) versus chemotherapy (CT) at relapse (CR) in patients (pts) with muscle-invasive bladder cancer (MIBC) submitted to radical cystectomy (RC). An Italian multicenter randomised phase III trial. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.5023] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
40
|
Tomasello L, Sertoli MR, Rubagotti A, Guglielmini P, Tacchini L, Bedognetti D, Ricci F, Sanguineti S, Cassata A, Boccardo F. Combination of sorafenib and weekly gemcitabine in patients (pts) with metastatic renal cell Cancer (MRCC): A phase II study, preliminary results. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.16011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
41
|
Boccardo F, Rubagotti A, Conti G, Battaglia M, Cruciani G, Manganelli A, Ricci S, Lapini A. Prednisone plus Gefitinib versus Prednisone plus Placebo in the Treatment of Hormone-Refractory Prostate Cancer: A Randomized Phase II Trial. Oncology 2008; 74:223-8. [DOI: 10.1159/000151391] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2008] [Accepted: 03/28/2008] [Indexed: 11/19/2022]
|
42
|
Boccardo F, Rubagotti A, Aldrighetti D, Buzzi F, Cruciani G, Farris A, Mustacchi G, Porpiglia M, Schieppati G, Sismondi P. O-54 Switching to an aromatase inhibitor provides mortality benefit in early breast-carcinoma: Pooled analysis of 2 consecutive trials. EJC Suppl 2007. [DOI: 10.1016/s1359-6349(07)71744-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
|
43
|
Boccardo F, Rubagotti A, Guglielmini P, Mesiti D, Durando A, Bolognesi A, Farris A. O-4 Ovarian suppression (OS) and tamoxifen (TAM) as an alternative to chemotherapy in early breast cancer. Long-term results of the GROCTA02 trial. EJC Suppl 2007. [DOI: 10.1016/s1359-6349(07)71694-4] [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: 11/25/2022] Open
|
44
|
Boccardo F, Rubagotti A, Tacchini L, Lapini A, Cruciani G, De Rubertis G, Battaglia M, Conti G. Gefitinib (G) plus prednisone (P) versus placebo (pl) plus prednisone in the treatment of hormone-refractory prostate cancer (HRPC): A randomized phase II trial. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.5070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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
5070 Background: In spite of EGF-R overexpression in 40%-80% of pts with HRPC, the results achieved so far with G, a selective EGF-R tyrosine kinase inhibitor have been dismal. This trial was designed to investigate the activity of G when combined with P, a common therapeutic option for HRPC pts. Methods: HRPC pts unresponsive to antiandrogen withdrawal were given P (10 mg/d) plus G (250 mg/d) or pl. On progression, pts initially assigned to pl were offered the possibility to receive G. This was a one-stage trial, and 37 pts per arm were required. Best PSA response (any decrease = 50% in baseline PSA confirmed 4 wks apart) was the primary end-point. Time to disease progression, OS and toxicity were secondary end-points. Results: 82 pts were enrolled (GP: 38; plP: 44). Groups were well balanced in respect to median age (75 vs 74 yrs); WHO PS (0 in both); baseline PSA (52 vs 44 ng/ml); bone disease (87% vs 84%) Gleason score 7 (58% vs 52%); prior treatment. At a median follow-up time of 29 mos (26–32), overall 77 pts progression and 51 died. PSA resp was recorded in 16% and 11% of pts in GP and plP groups. Median time to progression was 4.0 (3.5–4.5) and 4.5 (3.5–5.0) mos, respectively. In both groups, median PSA level increased during the first 8 wks of treatment (GP:13%; plP: 32%) while it decreased thereafter. Median time to death was 26.5 (16–37) and 20.5 (14–27) mos in the GP and plP groups, respectively (HR: 0.69, 0.39–1.23; p=.2). However, OS of pts given either early or delayed treatment with G was significantly longer (26.5 vs 17.5 mos; HR: 0.49, 0.28–0.87, p=.01). This advantage was maintained also after multivariate analysis by Gleason score, baseline PSA, Hb and PAL, WHO PS and pain score. AEs (any grade) occurred in 19 pts in each arm. However diarrhea and skin rash were more common in the GP group (12% vs 0% and 14% vs 2%, respectively). Conclusions: G when combined to P showed a moderate toxicity, achieved PSA control and prolonged pts survival. The efficacy of GP in HRPC warrants to be further investigated. [Table: see text] No significant financial relationships to disclose.
Collapse
Affiliation(s)
- F. Boccardo
- University and National Cancer Institute, Genova, Italy; University and Careggi Hospital, Florence, Italy; Umberto I Hospital, Lugo di Romagna, Italy; University and Le Scotte Hospital, Siena, Italy; University and Policlinico, Bari, Italy; S. Anna Hospital, Como, Italy
| | - A. Rubagotti
- University and National Cancer Institute, Genova, Italy; University and Careggi Hospital, Florence, Italy; Umberto I Hospital, Lugo di Romagna, Italy; University and Le Scotte Hospital, Siena, Italy; University and Policlinico, Bari, Italy; S. Anna Hospital, Como, Italy
| | - L. Tacchini
- University and National Cancer Institute, Genova, Italy; University and Careggi Hospital, Florence, Italy; Umberto I Hospital, Lugo di Romagna, Italy; University and Le Scotte Hospital, Siena, Italy; University and Policlinico, Bari, Italy; S. Anna Hospital, Como, Italy
| | - A. Lapini
- University and National Cancer Institute, Genova, Italy; University and Careggi Hospital, Florence, Italy; Umberto I Hospital, Lugo di Romagna, Italy; University and Le Scotte Hospital, Siena, Italy; University and Policlinico, Bari, Italy; S. Anna Hospital, Como, Italy
| | - G. Cruciani
- University and National Cancer Institute, Genova, Italy; University and Careggi Hospital, Florence, Italy; Umberto I Hospital, Lugo di Romagna, Italy; University and Le Scotte Hospital, Siena, Italy; University and Policlinico, Bari, Italy; S. Anna Hospital, Como, Italy
| | - G. De Rubertis
- University and National Cancer Institute, Genova, Italy; University and Careggi Hospital, Florence, Italy; Umberto I Hospital, Lugo di Romagna, Italy; University and Le Scotte Hospital, Siena, Italy; University and Policlinico, Bari, Italy; S. Anna Hospital, Como, Italy
| | - M. Battaglia
- University and National Cancer Institute, Genova, Italy; University and Careggi Hospital, Florence, Italy; Umberto I Hospital, Lugo di Romagna, Italy; University and Le Scotte Hospital, Siena, Italy; University and Policlinico, Bari, Italy; S. Anna Hospital, Como, Italy
| | - G. Conti
- University and National Cancer Institute, Genova, Italy; University and Careggi Hospital, Florence, Italy; Umberto I Hospital, Lugo di Romagna, Italy; University and Le Scotte Hospital, Siena, Italy; University and Policlinico, Bari, Italy; S. Anna Hospital, Como, Italy
| |
Collapse
|
45
|
Jonat W, Gnant M, Boccardo F, Kaufmann M, Rubagotti A, Zuna I, Greenwood M, Jakesz R. Effectiveness of switching from adjuvant tamoxifen to anastrozole in postmenopausal women with hormone-sensitive early-stage breast cancer: a meta-analysis. Lancet Oncol 2007; 7:991-6. [PMID: 17138220 DOI: 10.1016/s1470-2045(06)70948-2] [Citation(s) in RCA: 198] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND For more than 20 years, tamoxifen has been the mainstay of adjuvant endocrine therapy for women with hormone-sensitive early-stage breast cancer. However, not only does tamoxifen have potential side-effects such as an increased risk of endometrial cancer and thromboembolic events, but patients can also develop resistance to the drug. We aimed to investigate whether switching treatment of postmenopausal women with such breast cancer to anastrozole after 2-3 years of tamoxifen would be more effective than continuing on tamoxifen for a total of 5 years. METHODS We did a meta-analysis of three clinical trials--the Austrian Breast and Colorectal Cancer Study Group (ABCSG 8), Arimidex-Nolvadex (ARNO 95), and the Italian Tamoxifen Anastrozole (ITA) studies--in which postmenopausal women with histologically confirmed, hormone-sensitive early-stage breast cancer were randomised to 1 mg/day anastrozole (n=2009) after 2-3 years of tamoxifen treatment or to continued 20 or 30 mg/day tamoxifen (n=1997). We analysed the data with a stratified Cox proportional hazards model with the covariates of age, tumour size, nodal status, grade, surgery, and chemotherapy. FINDINGS Patients who switched to anastrozole had fewer disease recurrences (92 vs 159) and deaths (66 vs 90) than did those who remained on tamoxifen, resulting in significant improvements in disease-free survival (hazard ratio 0.59 [95% CI 0.48-0.74]; p<0.0001), event-free survival (0.55 [0.42-0.71]; p<0.0001), distant recurrence-free survival (0.61 [0.45-0.83]; p=0.002), and overall survival (0.71 [0.52-0.98]; p=0.04). INTERPRETATION Our results show that the clinical benefits in terms of event-free survival seen in individual trials for those patients who switched to anastrozole translate into a benefit in overall survival. These findings confirm that clinicians should consider switching postmenopausal women who have taken adjuvant tamoxifen for 2-3 years to anastrozole.
Collapse
|
46
|
Boccardo F, Rubagotti A, Aldrighetti D, Buzzi F, Cruciani G, Farris A, Mustacchi G, Porpiglia M, Schieppati G, Sismondi P. Switching to an aromatase inhibitor provides mortality benefit in early breast carcinoma. Cancer 2007; 109:1060-7. [PMID: 17295293 DOI: 10.1002/cncr.22513] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The superiority of new generation aromatase inhibitors over tamoxifen in the adjuvant treatment of early breast carcinoma has emerged from several randomized trials. However, until now not all previous studies have shown a mortality benefit. METHODS A pooled analysis of 2 prospective multicentric trials, sharing the same study design and nearly identical inclusion criteria, was performed. In both trials, women treated previously with tamoxifen for 2 or 3 years were randomly assigned to either continuing tamoxifen for an additional 2 or 3 years or to having their treatment switched to aminoglutethimide or anastrozole for a comparable time period. Mortality was analyzed according to allocated treatment and other patient and tumor variables. RESULTS In all, 828 postmenopausal women, mostly with estrogen receptor (ER)-positive and node-positive tumors who had been monitored for a median time of 78 months (range, 6-141 months) were analyzed. Of these women, 415 were randomly selected to continue tamoxifen and 413 switched to aminoglutethimide or anastrozole. All-cause mortality and breast cancer-specific mortality were significantly improved by the switch: all-cause mortality: hazard ratio (HR) = 0.61 (0.42-0.88) P = .007; breast cancer-specific mortality: HR = 0.61 (0.39-0.94) P = .025. No increase was recorded in breast cancer-unrelated mortality in women after switching. Multivariate analysis showed that patient age, tumor size, allocated treatment, and nodal status, in that order, were independent mortality predictors. CONCLUSIONS Switching to an aromatase inhibitor after 2 or 3 years of tamoxifen therapy significantly improves survival compared with continuing 2 or 3 years of additional tamoxifen treatment.
Collapse
|
47
|
Affiliation(s)
- Francesco Boccardo
- Department of Medical Oncology, National Cancer Research Institute, Genoa, Italy.
| | | |
Collapse
|
48
|
Boccardo F, Rubagotti A, Battaglia M, Zattoni F, Bertaccini A, Romagnoli A, Conti G. Influence of bicalutamide with or without tamoxifen or anastrozole on insulin-like growth factor 1 and binding proteins in prostate cancer patients. Int J Biol Markers 2006; 21:123-6. [PMID: 16847815 DOI: 10.5301/jbm.2008.4771] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND There is growing evidence that IGF-1 and binding proteins may be involved in prostate cancer promotion and progression. PATIENTS AND METHODS IGF-1 and binding proteins (IGFBP-1 and 3) serum levels were measured at baseline and after 3 and 6 months of treatment in a selected group of patients with prostate cancer who were randomly assigned to treatment with bicalutamide, bicalutamide plus anastrozole or bicalutamide plus tamoxifen in a comparative study investigating the role of pharmacological medication in the development of bicalutamide-induced gynecomastia. RESULTS Bicalutamide monotherapy does not appear to alter the IGF-1/IGFBP system. In fact, the increase in IGF-1 levels induced by this treatment was paralleled by comparable increases in binding protein (IGFBP-3). No major changes from baseline up to month 6 either in IGF-1 or in IGFBP-1 and 3 were observed in the bicalutamide plus anastrozole arm. The addition of tamoxifen to bicalutamide produced a sharp decrease in IGF-1 levels (p<0.001) coupled with an increase in both IGFBP-1 (p=0.001) and, to a lesser extent, IGFBP-3 (p=0.5). CONCLUSIONS The concurrent administration of tamoxifen and bicalutamide reduces the synthesis and bioavailability of IGF-1. Moreover, increased binding protein levels might exert antiproliferative and proapoptotic effects on prostate cancer cells, independently of the IGF-1/IGF receptor-mediated survival system. Both effects might have a synergistic inhibitory influence on prostate cancer growth.
Collapse
Affiliation(s)
- F Boccardo
- Department of Medical Oncology, National Cancer Research Institute and University of Genoa, Italy.
| | | | | | | | | | | | | |
Collapse
|
49
|
Galmozzi F, Rubagotti A, Romagnoli A, Carmignani G, Perdelli L, Gatteschi B, Boccardo F. Prognostic value of cell cycle regulatory proteins in muscle-infiltrating bladder cancer. J Cancer Res Clin Oncol 2006; 132:757-64. [PMID: 16804724 DOI: 10.1007/s00432-006-0123-7] [Citation(s) in RCA: 9] [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] [Subscribe] [Scholar Register] [Received: 03/07/2006] [Accepted: 05/15/2006] [Indexed: 10/24/2022]
Abstract
PURPOSE The aims of this study were to investigate the expression levels of proteins involved in cell cycle regulation in specimens of bladder cancer and to correlate them with the clinicopathological characteristics, proliferative activity and survival. METHODS Eighty-two specimens obtained from patients affected by muscle-invasive bladder cancer were evaluated immunohistochemically for p53, p21 and cyclin D1 expression, as well as for the tumour proliferation index, Ki-67. The statistical analysis included Kaplan-Meier curves with log-rank test and Cox proportional hazards models. RESULTS In univariate analyses, low Ki-67 proliferation index (P = 0.045) and negative p21 immunoreactivity (P = 0.04) were associated to patient's overall survival (OS), but in multivariate models p21 did not reach statistical significance. When the combinations of the variables were assessed in two separate multivariate models that included tumour stage, grading, lymph node status, vascular invasion and perineural invasion, the combined variables p21/Ki-67 or p21/cyclin D1 expression were independent predictors for OS; in particular, patients with positive p21/high Ki-67 (P = 0.015) or positive p21/negative cyclin D1 (P = 0.04) showed the worst survival outcome. CONCLUSIONS Important alterations in the cell cycle regulatory pathways occur in muscle-invasive bladder cancer and the combined use of cell cycle regulators appears to provide significant prognostic information that could be used to select the patients most suitable for multimodal therapeutic approaches.
Collapse
Affiliation(s)
- Fabia Galmozzi
- Department of Medical Oncology, University of Genova, Genova, Italy
| | | | | | | | | | | | | |
Collapse
|
50
|
Boccardo FM, Guglielmini P, Rubagotti A. Mortality benefit of switching to an aromatase inhibitor in early breast carcinoma: Pooled analysis of two consecutive trials. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.548] [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
548 Background: The superiority of new generation aromatase inhibitors (AI) over tamoxifen (T) in the adjuvant treatment of early breast ca. has emerged from several randomized trials. However no mortality benefit has emerged so far from previous trials. Methods: A pooled analysis of GROCTA 4 and ITA trials, two consecutive, multicentric trials performed by our group and sharing the same study design, was performed. The results of both trials have been published previously [JCO 19:4209–15, 2001; JCO 23:5138–47, 2005] and have been updated for the present analysis. In both trials women already on treatment with T for 2 or 3 years have been randomly assigned to continue T for additional 3–2 years or to be switched to aminoglutethimide (AG) or anastrozole (AN) for a comparable time period. In each treatment group mortality was analysed according to cause of death and patient and tumor variables. Results: 828 postmenopausal ER+ve women, most of whom were also node +ve, who had been followed up for a median time of 68 months (range 1–141 months) were analysed. Of these women, 415 had been randomized to continue T and 413 to be switched to AG or AN. In both groups total duration of endocrine therapy was 5 years. All-cause mortality and breast cancer specific mortality were significantly improved by switching: HR=0.60 (0.41–0.87) p=0.007; HR=0.62 (0.39–0.97) p=0.03 respectively. Though more women continued to T died in absence of obvious disease relapse, there was no significant difference between groups in breast cancer unrelated mortality (p=0.1). Multivariate analysis showed that patient age, tumor size, allocated treatment and N status in the order were independent mortality predictors. Tumor size, N status and allocated treatment were independent predictors of breast cancer related mortality as well. Noteworthy, age at randomization was the only statistically significant predictor of breast cancer unrelated mortality. Conclusions: Switching to an AI after 2 or 3 years of T therapy significantly improved survival as compared to 3 or 2 years of additional treatment with T. These findings reinforce the indication to switching for the women actually receiving adjuvant treatment with T. No significant financial relationships to disclose.
Collapse
Affiliation(s)
- F. M. Boccardo
- University of Genoa National Cancer Research Institute, Genova, Italy
| | - P. Guglielmini
- University of Genoa National Cancer Research Institute, Genova, Italy
| | - A. Rubagotti
- University of Genoa National Cancer Research Institute, Genova, Italy
| |
Collapse
|