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Schettini F, Palleschi M, Mannozzi F, Brasó-Maristany F, Cecconetto L, Galván P, Mariotti M, Ferrari A, Scarpi E, Miserocchi A, Nanni O, Sanfeliu E, Prat A, Rocca A, De Giorgi U. CDK4/6-Inhibitors Versus Chemotherapy in Advanced HR+/HER2-Negative Breast Cancer: Results and Correlative Biomarker Analyses of the KENDO Randomized Phase II Trial. Oncologist 2024; 29:e622-e634. [PMID: 38175669 PMCID: PMC11067809 DOI: 10.1093/oncolo/oyad337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/07/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The optimal treatment approach for hormone receptor-positive/HER2-negative metastatic breast cancer (HR+/HER2-negative MBC) with aggressive characteristics remains controversial, with lack of randomized trials comparing cyclin-dependent kinase (CDK)4/6-inhibitors (CDK4/6i) + endocrine therapy (ET) with chemotherapy + ET. MATERIALS AND METHODS We conducted an open-label randomized phase II trial (NCT03227328) to investigate whether chemotherapy + ET is superior to CDK4/6i + ET for HR+/HER2-negative MBC with aggressive features. PAM50 intrinsic subtypes (IS), immunological features, and gene expression were assessed on baseline samples. RESULTS Among 49 randomized patients (median follow-up: 35.2 months), median progression-free survival (mPFS) with chemotherapy + ET (11.2 months, 95% confidence interval [CI]: 7.7-15.4) was numerically shorter than mPFS (19.9 months, 95% CI: 9.0-30.6) with CDK4/6i + ET (hazard ratio: 1.41, 95% CI: 0.75-2.64). Basal-like tumors under CDK4/6i + ET exhibited worse PFS (mPFS: 11.4 months, 95% CI: 3.00-not reached [NR]) and overall survival (OS; mOS: 18.8 months, 95% CI: 18.8-NR) compared to other subtypes (mPFS: 20.7 months, 95% CI: 9.00-33.4; mOS: NR, 95% CI: 24.4-NR). In the chemotherapy arm, luminal A tumors showed poorer PFS (mPFS: 5.1 months, 95% CI: 2.7-NR) than other IS (mPFS: 13.2 months, 95% CI: 10.6-28.1). Genes/pathways involved in BC cell survival and proliferation were associated with worse outcomes, as opposite to most immune-related genes/signatures, especially in the CDK4/6i arm. CD24 was the only gene significantly associated with worse PFS in both arms. Tertiary lymphoid structures and higher tumor-infiltrating lymphocytes also showed favorable survival trends in the CDK4/6i arm. CONCLUSIONS The KENDO trial, although closed prematurely, adds further evidence supporting CDK4/6i + ET use in aggressive HR+/HER2-negative MBC instead of chemotherapy. PAM50 IS, genomic, and immunological features are promising biomarkers to personalize therapeutic choices.
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Affiliation(s)
- Francesco Schettini
- Translational Genomics and Targeted Therapies in Solid Tumors Group, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
- Medical Oncology Department, Hospital Clinic of Barcelona, Barcelona, Spain
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Michela Palleschi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori,”Meldola, Italy
| | - Francesca Mannozzi
- Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori,”Meldola, Italy
| | - Fara Brasó-Maristany
- Translational Genomics and Targeted Therapies in Solid Tumors Group, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Lorenzo Cecconetto
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori,”Meldola, Italy
| | - Patricia Galván
- Translational Genomics and Targeted Therapies in Solid Tumors Group, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Marita Mariotti
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori,”Meldola, Italy
| | - Alessia Ferrari
- UO Medicina Oncologia, Ospedale Ramazzini, Azienda USL di Modena, Carpi, Italy
| | - Emanuela Scarpi
- Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori,”Meldola, Italy
| | - Anna Miserocchi
- Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori,”Meldola, Italy
| | - Oriana Nanni
- Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori,”Meldola, Italy
| | - Esther Sanfeliu
- Medical Oncology Department, Hospital Clinic of Barcelona, Barcelona, Spain
- Department of Pathology, Biomedical Diagnostic Center, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Aleix Prat
- Translational Genomics and Targeted Therapies in Solid Tumors Group, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- Cancer Institute and Blood Diseases, Hospital Clínic of Barcelona, Barcelona, Spain
- Breast Cancer Unit, Institute of Oncology Barcelona (IOB), Quirónsalud, Barcelona, Spain
- Reveal Genomics, Barcelona, Spain
| | - Andrea Rocca
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Ugo De Giorgi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori,”Meldola, Italy
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Russo G, Di Bartolo P, Candido R, Lucisano G, Manicardi V, Giandalia A, Nicolucci A, Rocca A, Rossi MC, Di Cianni G. Corrigendum to "The AMD ANNALS: A continuous initiative for the improvement of type 2 diabetes care" [Diabetes Res. and Clin. Pract. 199 (2023) 110672]. Diabetes Res Clin Pract 2024; 210:111619. [PMID: 38580525 DOI: 10.1016/j.diabres.2024.111619] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Affiliation(s)
- G Russo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
| | - P Di Bartolo
- Ravenna Diabetes Center - Romagna Local Health Authority, Ravenna, Italy
| | - R Candido
- Department of Medical Surgical and Health Sciences, University of Trieste, Diabetes Center, ASUGI, Trieste, Italy
| | - G Lucisano
- Center for Outcomes Research and Clinical Epidemiology - CORESEARCH, Pescara, Italy
| | | | - A Giandalia
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - A Nicolucci
- Center for Outcomes Research and Clinical Epidemiology - CORESEARCH, Pescara, Italy
| | - A Rocca
- "G. Segalini" H. Bassini Cinisello Balsamo ASST Nord, Milan, Italy
| | - M C Rossi
- Center for Outcomes Research and Clinical Epidemiology - CORESEARCH, Pescara, Italy
| | - G Di Cianni
- USL Tuscany Northwest Location Livorno, Diabetes and Metabolic Disease, Livorno, Italy
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3
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Rocca A, Giudici F, Donofrio CA, Bottin C, Pinamonti M, Ferrari B, Schettini F, Pineda E, Panni S, Cominetti M, D’Auria P, Bianchini S, Varotti E, Ungari M, Ciccarelli S, Filippini M, Brenna S, Fiori V, Di Mambro T, Sparti A, Magnani M, Zanconati F, Generali D, Fioravanti A. CD99 Expression and Prognostic Impact in Glioblastoma: A Single-Center Cohort Study. Cells 2024; 13:597. [PMID: 38607036 PMCID: PMC11012029 DOI: 10.3390/cells13070597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/17/2024] [Accepted: 03/25/2024] [Indexed: 04/13/2024] Open
Abstract
Glioblastoma is the most frequent and aggressive brain tumor in adults. This study aims to evaluate the expression and prognostic impact of CD99, a membrane glycoprotein involved in cellular migration and invasion. In a cohort of patients with glioblastoma treated with surgery, radiotherapy and temozolomide, we retrospectively analyzed tumor expression of CD99 by immunohistochemistry (IHC) and by quantitative real-time polymerase chain reaction (qRT-PCR) for both the wild type (CD99wt) and the truncated (CD99sh) isoforms. The impact on overall survival (OS) was assessed with the Kaplan-Meier method and log-rank test and by multivariable Cox regression. Forty-six patients with glioblastoma entered this study. Immunohistochemical expression of CD99 was present in 83%. Only the CD99wt isoform was detected by qRT-PCR and was significantly correlated with CD99 expression evaluated by IHC (rho = 0.309, p = 0.037). CD99 expression was not associated with OS, regardless of the assessment methodology used (p = 0.61 for qRT-PCR and p = 0.73 for IHC). In an exploratory analysis of The Cancer Genome Atlas, casuistry of glioblastomas CD99 expression was not associated with OS nor with progression-free survival. This study confirms a high expression of CD99 in glioblastoma but does not show any significant impact on survival. Further preclinical studies are needed to define its role as a therapeutic target in glioblastoma.
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Affiliation(s)
- Andrea Rocca
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34147 Trieste, Italy
| | - Fabiola Giudici
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy
| | - Carmine Antonio Donofrio
- Neurosurgery, ASST Cremona, Viale Concordia 1, 26100 Cremona, Italy
- Division of Biology and Genetics, Department of Molecular and Translational Medicine, University of Brescia, Viale Europa 11, 25123 Brescia, Italy
| | - Cristina Bottin
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34147 Trieste, Italy
| | - Maurizio Pinamonti
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34147 Trieste, Italy
| | - Benvenuto Ferrari
- Breast and Brain Unit, ASST Cremona, Viale Concordia 1, 26100 Cremona, Italy
| | - Francesco Schettini
- Translational Genomics and Targeted Therapies in Solid Tumors Group, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), C. Villaroel 170, 08036 Barcelona, Spain
- Medical Oncology Department, Hospital Clínic of Barcelona, 08036 Barcelona, Spain
- Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, 08036 Barcelona, Spain
| | - Estela Pineda
- Medical Oncology Department, Hospital Clínic of Barcelona, 08036 Barcelona, Spain
- Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, 08036 Barcelona, Spain
| | - Stefano Panni
- Breast and Brain Unit, ASST Cremona, Viale Concordia 1, 26100 Cremona, Italy
| | - Marika Cominetti
- Neurosurgery, ASST Cremona, Viale Concordia 1, 26100 Cremona, Italy
| | - Patrizia D’Auria
- Neurosurgery, ASST Cremona, Viale Concordia 1, 26100 Cremona, Italy
| | | | - Elena Varotti
- Pathology Unit, ASST Cremona, Viale Concordia 1, 26100 Cremona, Italy
| | - Marco Ungari
- Pathology Unit, ASST Cremona, Viale Concordia 1, 26100 Cremona, Italy
| | - Stefano Ciccarelli
- Radiotherapy Unit, ASST Cremona, Viale Concordia 1, 26100 Cremona, Italy
| | - Marzia Filippini
- Radiotherapy Unit, ASST Cremona, Viale Concordia 1, 26100 Cremona, Italy
| | - Sarah Brenna
- Radiotherapy Unit, ASST Cremona, Viale Concordia 1, 26100 Cremona, Italy
| | | | | | - Angelo Sparti
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, 61029 Urbino, Italy
| | - Mauro Magnani
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, 61029 Urbino, Italy
| | - Fabrizio Zanconati
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34147 Trieste, Italy
| | - Daniele Generali
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34147 Trieste, Italy
- Breast and Brain Unit, ASST Cremona, Viale Concordia 1, 26100 Cremona, Italy
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Da Porto A, Candido R, Rocca A, Manicardi V, Nicolucci A, Miranda C, Cimino E, Di Bartolo P, Di Cianni G, Russo G. Quality of care and clinical inertia in the management of cardiovascular risk factors in patients with type 1 and type 2 diabetes: data from AMD annals. J Endocrinol Invest 2024:10.1007/s40618-024-02327-0. [PMID: 38436903 DOI: 10.1007/s40618-024-02327-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/29/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Cardiovascular disease is the leading cause of morbidity and mortality among patients with diabetes, and for this reason, all guidelines for CV risk management provide the same targets in controlling traditional CV risk factors in patients with type 1 or type 2 diabetes at equal CV risk class. Aim of our study was to evaluate and compare CV risk management in patients with type 1 and type 2 diabetes included in AMD Annals Database paying particular attention to indicators of clinical inertia. METHODS This was a multicenter, observational, retrospective study of AMD Annals Database during year 2022. Patients with diabetes were stratified on the basis of their cardiovascular risk, according to ESC-EASD guidelines. The proportion of patients not treated with lipid-lowering despite LDL cholesterol > to 100 mg/dl or the proportion of patients not treated with antihypertensive drug despite BP > 140/90 mmhg and proportion of patients with proteinuria not treated with angiotensin converting enzyme inhibitors or angiotensinogen receptor blockers (ACE/ARBs) were considered indicators of clinical inertia. The proportion of patients reaching at the same time HbA1c < 7% LDL < 70 mg/dl and BP < 130/80 mmhg were considered to have good multifactorial control. Overall quality of health care was evaluated by the Q-score. RESULTS Using the inclusion criteria and stratifying patients by ESC/EASD Cardiovascular Risk categories, we included in the analysis 118.442 patients at High Cardiovascular risk and 416.246 patients at Very High Cardiovascular risk. The proportion of patients with good multifactorial risk factor control was extremely low in both T1D and T2D patients in each risk class. At equal risk class, the patients with T1D had lower proportion of subjects reaching HbA1c, LDL, or Blood Pressure targets. Indicators of clinical inertia were significantly higher compared with patients with T2D at equal risk class. Data regarding patients with albuminuria not treated with RAAS inhibitors were available only for those at Very High risk and showed that the proportion of patients not treated was again significantly higher in patients with T1DM. CONCLUSIONS In conclusion, this study provides evidence of wide undertreatment of traditional cardiovascular risk factors among patients with diabetes included in AMD Annals Database. Undertreatment seems to be more pronounced in individuals with T1D compared to those with T2D and is frequently due to clinical inertia.
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Affiliation(s)
- A Da Porto
- Diabetes and Metabolism Unit, Clinica Medica, University of Udine, Udine, Italy.
| | - R Candido
- Department of Medical Surgical and Health Sciences, University of Trieste, Diabetes Center, ASUGI, Trieste, Italy
| | - A Rocca
- "G. Segalini" H. Bassini Cinisello Balsamo ASST Nord, Milan, Italy
| | | | - A Nicolucci
- Center for Outcomes Research and Clinical Epidemiology-CORESEARCH, Pescara, Italy
| | - C Miranda
- Endocrinology and Diabetes Unit, ASFO, Pordenone, Italy
| | - E Cimino
- UOC Medicina Generale ad Indirizzo Metabolico e Diabetologico, ASST Spedali Civili of Brescia, Brescia, Italy
| | - P Di Bartolo
- Ravenna Diabetes Center-Romagna Local Health Authority, Ravenna, Italy
| | - G Di Cianni
- USL Tuscany Northwest Location Livorno, Diabetes and Metabolic Disease, Livorno, Italy
| | - G Russo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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5
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Balduit A, Vidergar R, Zacchi P, Mangogna A, Agostinis C, Grandolfo M, Bottin C, Salton F, Confalonieri P, Rocca A, Zanconati F, Confalonieri M, Kishore U, Ghebrehiwet B, Bulla R. Complement protein C1q stimulates hyaluronic acid degradation via gC1qR/HABP1/p32 in malignant pleural mesothelioma. Front Immunol 2023; 14:1151194. [PMID: 37334363 PMCID: PMC10275365 DOI: 10.3389/fimmu.2023.1151194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 05/19/2023] [Indexed: 06/20/2023] Open
Abstract
Complement component C1q can act as a pro-tumorigenic factor in the tumor microenvironment (TME). The TME in malignant pleural mesothelioma (MPM) is rich in C1q and hyaluronic acid (HA), whose interaction enhances adhesion, migration and proliferation of malignant cells. HA-bound C1q is also capable of modulating HA synthesis. Thus, we investigated whether HA-C1q interaction would affect HA degradation, analyzing the main degradation enzymes, hyaluronidase (HYAL)1 and HYAL2, and a C1q receptor candidate. We first proceeded with the characterization of HYALs in MPM cells, especially HYAL2, since bioinformatics survival analysis revealed that higher HYAL2 mRNA levels have an unfavorable prognostic index in MPM patients. Interestingly, Real-Time quantitative PCR, flow cytometry and Western blot highlighted an upregulation of HYAL2 after seeding of primary MPM cells onto HA-bound C1q. In an attempt to unveil the receptors potentially involved in HA-C1q signaling, a striking co-localization between HYAL2 and globular C1q receptor/HABP1/p32 (gC1qR) was found by immunofluorescence, surface biotinylation and proximity ligation assays. RNA interference experiments revealed a potentially regulatory function exerted by gC1qR on HYAL2 expression, since C1QBP (gene for gC1qR) silencing unexpectedly caused HYAL2 downregulation. In addition, the functional blockage of gC1qR by a specific antibody hindered HA-C1q signaling and prevented HYAL2 upregulation. Thus, C1q-HA interplay is responsible for enhanced HYAL2 expression, suggesting an increased rate of HA catabolism and the release of pro-inflammatory and pro-tumorigenic HA fragments in the MPM TME. Our data support the notion of an overall tumor-promoting property of C1q. Moreover, the overlapping localization and physical interaction between HYAL2 and gC1qR suggests a potential regulatory effect of gC1qR within a putative HA-C1q macromolecular complex.
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Affiliation(s)
- Andrea Balduit
- Institute for Maternal and Child Health, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Burlo Garofolo, Trieste, Italy
| | - Romana Vidergar
- Department of Life Sciences, University of Trieste, Trieste, Italy
| | - Paola Zacchi
- Department of Life Sciences, University of Trieste, Trieste, Italy
| | - Alessandro Mangogna
- Institute for Maternal and Child Health, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Burlo Garofolo, Trieste, Italy
| | - Chiara Agostinis
- Institute for Maternal and Child Health, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Burlo Garofolo, Trieste, Italy
| | - Micaela Grandolfo
- Neuroscience Area, International School for Advanced Studies (SISSA), Trieste, Italy
| | - Cristina Bottin
- Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Francesco Salton
- Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Paola Confalonieri
- Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Andrea Rocca
- Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Fabrizio Zanconati
- Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy
- Struttura Complessa di Anatomia ed Istologia Patologica, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Trieste, Italy
| | - Marco Confalonieri
- Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Uday Kishore
- Department of Veterinary Medicine, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Berhane Ghebrehiwet
- Department of Medicine, Stony Brook University, Stony Brook, NY, United States
| | - Roberta Bulla
- Department of Life Sciences, University of Trieste, Trieste, Italy
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Russo G, Di Bartolo P, Candido R, Lucisano G, Manicardi V, Giandalia A, Nicolucci A, Rocca A, Rossi MC, Di Cianni G. The AMD ANNALS: A continuous initiative for the improvement of type 2 diabetes care. Diabetes Res Clin Pract 2023; 199:110672. [PMID: 37084893 DOI: 10.1016/j.diabres.2023.110672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
Abstract
AIMS Since 2006, the Italian AMD (Associations of Medical Diabetologists) Annals Initiative promoted a continuous monitoring of the quality of diabetes care, that was effective in improving process, treatment and outcome indicators through a periodic assessment of standardized measures. Here, we show the 2022 AMD Annals data on type 2 diabetes (T2D). METHODS A network involving ∼1/3 of diabetes centers in Italy periodically extracts anonymous data from electronic clinical records, by a standardized software. Process, treatment and outcome indicators, and a validated score of overall care, the Q-score, were evaluated. RESULTS 295 centers provided the annual sample of 502,747 T2D patients. Overall, HbA1c value ≤7.0% was documented in 54.6% of patients, blood pressure <130/80 mmHg in 23.0%, and LDL-cholesterol levels <70 mg/dl in 34.3%, but only 5.2% were at- target for all the risk factors. As for innovative drugs, 29.0% of patients were on SGLT2-i, and 27.5% on GLP1-RAs. In particular, 59.7% were treated with either GLP1-RAs or SGLT2-i among those with established cardiovascular disease (CVD), 26.6% and 49.3% with SGLT2-i among those with impaired renal function and heart failure, respectively. Notably, only 3.2% of T2D patients showed a Q score <15, which correlates with a 80% higher risk of incident CVD events compared to scores >25. CONCLUSIONS The 2022 AMD Annals data show an improvement in the use of innovative drugs and in the overall quality of T2D care in everyday clinical practice. However, additional efforts are needed to reach the recommended targets for HbA1c and major CVD risk factors.
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Affiliation(s)
- G Russo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
| | - P Di Bartolo
- Ravenna Diabetes Center - Romagna Local Health Authority, Ravenna, Italy
| | - R Candido
- Department of Medical Surgical and Health Sciences, University of Trieste, Diabetes Center, ASUGI, Trieste, Italy
| | - G Lucisano
- Center for Outcomes Research and Clinical Epidemiology - CORESEARCH, Pescara, Italy
| | | | - A Giandalia
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - A Nicolucci
- Center for Outcomes Research and Clinical Epidemiology - CORESEARCH, Pescara, Italy
| | - A Rocca
- "G. Segalini" H. Bassini Cinisello Balsamo ASST Nord, Milan, Italy
| | - M C Rossi
- Center for Outcomes Research and Clinical Epidemiology - CORESEARCH, Pescara, Italy
| | - G Di Cianni
- USL Tuscany Northwest Location Livorno, Diabetes and Metabolic Disease, Livorno, Italy
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7
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Sobhani N, Bouchè V, Aldegheri G, Rocca A, D’Angelo A, Giudici F, Bottin C, Donofrio CA, Pinamonti M, Ferrari B, Panni S, Cominetti M, Aliaga J, Ungari M, Fioravanti A, Zanconati F, Generali D. Analysis of PD-L1 and CD3 Expression in Glioblastoma Patients and Correlation with Outcome: A Single Center Report. Biomedicines 2023; 11:biomedicines11020311. [PMID: 36830847 PMCID: PMC9953166 DOI: 10.3390/biomedicines11020311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/16/2023] [Accepted: 01/18/2023] [Indexed: 01/24/2023] Open
Abstract
With the advent of immunotherapies, the field of cancer therapy has been revived with new hope, especially for cancers with dismal prognoses, such as the glioblastoma multiforme (GBM). Currently, immunotherapies should potentiate the host's own antitumor immune response against cancer cells, but it has been documented that they are effective only in small subsets of patients. Therefore, accurate predictors of response are urgently needed to identify who will benefit from immune-modulatory therapies. Brain tumors are challenging in terms of treatments. The immune response in the brain is highly regulated, and the immune microenvironment in brain metastases is active with a high density of tumor-infiltrating lymphocytes (TILs, CD3+ T cells) in certain patients and, therefore, may serve as a potential treatment target. In our study, we performed immunohistochemistry for CD3 and PD-L1 along the routine assessment of the O6-methylguanine-methyltransferase (MGMT) promoter methylation status and the IDH1 and 2 status in a single center cohort of 69 patients with GBM (58 primary tumors and 11 recurrences) who underwent standard multimodal therapies (surgery/radiotherapy/adjuvant temozolamide). We analyzed the association of PD-L1 tumor expression and TILs with overall survival (OS). The PD-L1 expression was observed in 25 of 58 (43%) newly diagnosed primary glioblastoma specimens. The sparse-to-moderate density of TILs, identified with CD3+ expression, was found in 48 of 58 (83%) specimens. Neither PD-L1 expression nor TILs were associated with overall survival. In conclusion, TILs and/or PD-L1 expression are detectable in the majority of glioblastoma samples, and even if they slightly relate to the outcome, they do not show a statistically significant correlation.
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Affiliation(s)
- Navid Sobhani
- Department of Medicine, Section of Epidemiology and Population Sciences, Baylor College of Medicine, Houston, TX 77030, USA
- Correspondence: (N.S.); (D.G.)
| | - Victoria Bouchè
- Department of Medical, Surgery and Health Sciences, University of Trieste, 34147 Trieste, Italy
| | - Giovanni Aldegheri
- Department of Medical, Surgery and Health Sciences, University of Trieste, 34147 Trieste, Italy
| | - Andrea Rocca
- Department of Medical, Surgery and Health Sciences, University of Trieste, 34147 Trieste, Italy
| | - Alberto D’Angelo
- Department of Biology & Biochemistry, University of Bath, Bath BA27AY, UK
| | - Fabiola Giudici
- Department of Medical, Surgery and Health Sciences, University of Trieste, 34147 Trieste, Italy
| | - Cristina Bottin
- Department of Medical, Surgery and Health Sciences, University of Trieste, 34147 Trieste, Italy
| | - Carmine Antonio Donofrio
- Neurosurgery, ASST Cremona, Viale Concordia 1, 26100 Cremona, Italy
- Division of Biology and Genetics, Department of Molecular and Translational Medicine, University of Brescia, Viale Europa 11, 25123 Brescia, Italy
| | - Maurizio Pinamonti
- Department of Medical, Surgery and Health Sciences, University of Trieste, 34147 Trieste, Italy
| | - Benvenuto Ferrari
- Breast and Brain Unit, ASST Cremona, Viale Concordia 1, 26100 Cremona, Italy
| | - Stefano Panni
- Breast and Brain Unit, ASST Cremona, Viale Concordia 1, 26100 Cremona, Italy
| | - Marika Cominetti
- Neurosurgery, ASST Cremona, Viale Concordia 1, 26100 Cremona, Italy
| | - Jahard Aliaga
- Neurosurgery, ASST Cremona, Viale Concordia 1, 26100 Cremona, Italy
| | - Marco Ungari
- Pathology Unit, ASST Cremona, Viale Concordia 1, 26100 Cremona, Italy
| | | | - Fabrizio Zanconati
- Department of Medical, Surgery and Health Sciences, University of Trieste, 34147 Trieste, Italy
| | - Daniele Generali
- Department of Medical, Surgery and Health Sciences, University of Trieste, 34147 Trieste, Italy
- Breast and Brain Unit, ASST Cremona, Viale Concordia 1, 26100 Cremona, Italy
- Correspondence: (N.S.); (D.G.)
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8
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Angeletti G, Mazzolini M, Rocca A. Two years follow-up of relapsing eosinophilic pneumonia with concomitant severe asthma successfully treated with benralizumab: A case report and brief review of the literature. Respir Med Case Rep 2022; 41:101795. [PMID: 36579077 PMCID: PMC9791164 DOI: 10.1016/j.rmcr.2022.101795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022] Open
Abstract
Relapsing eosinophilic pneumonia and severe eosinophilic asthma are rare and disabling diseases, which share common inflammatory backgrounds and often require long-term systemic steroid therapy. Benralizumab is a humanized antibody targeting IL-5 receptor that reduces corticosteroid dependence and flares up in severe eosinophilic asthma on long term. In this case report, successful treatment of eosinophilic pneumonia and severe eosinophilic asthma with benralizumab is described after a 2-year follow up, showing the promising results of this therapy for eosinophilic pneumonia management.
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9
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Rocca A, Braga L, Volpe MC, Maiocchi S, Generali D. The Predictive and Prognostic Role of RAS–RAF–MEK–ERK Pathway Alterations in Breast Cancer: Revision of the Literature and Comparison with the Analysis of Cancer Genomic Datasets. Cancers (Basel) 2022; 14:cancers14215306. [PMID: 36358725 PMCID: PMC9653766 DOI: 10.3390/cancers14215306] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 10/24/2022] [Accepted: 10/24/2022] [Indexed: 11/23/2022] Open
Abstract
Simple Summary The RAS/RAF/MEK/ERK pathway is implicated in fundamental processes frequently altered in tumors, such as cell proliferation and survival. In breast cancer, it is rarely affected by genomic alterations, but it is activated by membrane receptors or by epigenetic phenomena or readjustments in intracellular signaling networks. To date, drugs targeting molecules involved in this pathway have not been effective in the treatment of breast cancer: although successful in in vitro experiments, they fail in clinical trials. In this paper, we analyze the frequency and types of alterations in molecules of the RAS/RAF/MEK/ERK pathway in breast cancer, along with their prognostic and predictive impact in response to treatments such as chemotherapy, endocrine therapy, anti-HER2 therapy, and immunotherapy. Currently, with the aim of developing new drugs targeting this pathway, clear information is crucial for designing trials in breast cancer. This information is especially important to identify potential combinations of different agents to delay or overcome resistance in the different breast cancer subtypes. Abstract Although gene alterations of the RAS/RAF/MEK/ERK pathway are uncommon in breast cancer, this pathway is frequently activated in breast tumors, implying its role in tumor progression. We describe, after a revision of the literature, the frequency and types of gene alterations affecting this pathway in breast cancer by analyzing some public datasets from cBioPortal. Moreover, we consider their prognostic and predictive impact on treatment response, along with the role of transcriptomic predictors of RAS pathway activation. Our analysis shows that the driver alterations in RAS/RAF/MEK/ERK pathway-related genes are detected in 11% of primary breast cancers. The most frequently mutated genes are NF1 and KRAS, while copy number alterations mainly affect KRAS and BRAF, especially in basal-like tumors. The subgroup of patients carrying these alterations shows a worse prognosis; alterations in NF1 and RAF1 are associated with significantly reduced breast-cancer-specific survival in multivariate analysis. The literature review shows that the pathway is implicated, either by genetic or epigenetic alterations or by signaling network adaptations, in the mechanisms of sensitivity and resistance to a wide range of drugs used in the treatment of breast cancer. A thorough understanding of these alterations is critical for developing combination therapies that can delay or overcome drug resistance.
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Affiliation(s)
- Andrea Rocca
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy
- Correspondence:
| | - Luca Braga
- Functional Cell Biology Group, International Centre for Genetic Engineering and Biotechnology (ICGEB), 34149 Trieste, Italy
| | - Maria Concetta Volpe
- Functional Cell Biology Group, International Centre for Genetic Engineering and Biotechnology (ICGEB), 34149 Trieste, Italy
| | - Serena Maiocchi
- Functional Cell Biology Group, International Centre for Genetic Engineering and Biotechnology (ICGEB), 34149 Trieste, Italy
| | - Daniele Generali
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy
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10
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Palleschi M, Prochowski Iamurri A, Scarpi E, Mariotti M, Maltoni R, Mannozzi F, Barone D, Paganelli G, Casi M, Giampalma E, De Giorgi U, Rocca A. Computed tomography based analyses of body mass composition in HER2 positive metastatic breast cancer patients undergoing first line treatment with pertuzumab and trastuzumab. Sci Rep 2022; 12:3385. [PMID: 35233007 PMCID: PMC8888586 DOI: 10.1038/s41598-022-07143-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 02/08/2022] [Indexed: 11/09/2022] Open
Abstract
Body composition parameters (BCp) have been associated with outcome in different tumor types. However, their prognostic value in patients with HER2-positive metastatic breast cancer (BC) receiving first line treatment with dual anti-HER2 antibody blockade is unknown. Preclinical evidences suggest that adipocytes adjacent to BC cells can influence response to anti-HER2 treatments. We retrospectively analyzed Computed Tomography (CT)-based BCp from 43 patients with HER2-positive metastatic BC who received first line pertuzumab/trastuzumab-based treatment between May 2009 and March 2020. The impact of baseline CT-based BCp on progression-free survival (PFS) was tested using Kaplan–Meier estimates and univariate and multivariate Cox regression models. We found a significantly worse PFS for patients with high baseline subcutaneous fat index (median 7.9 vs 16.1 months, p = 0.047, HR = 2.04, 95%CI 1–4.17) and for those with high total abdominal fat index (8.1 vs 18.8 months, p = 0.030, HR = 2.17, 95%CI 1.06–4.46). Patients with baseline sarcopenia did not show shorter PFS compared to those without sarcopenia (10.4 vs 9.2 months, p = 0.960, HR = 0.98, 95%CI 0.47–2.03). Total abdominal fat index remained a significant predictor of PFS at multivariate analysis. Our findings suggest that a high quantity of total abdominal fat tissue is a poor prognostic factor in patients receiving trastuzumab/pertuzumab-based first-line treatment for HER2-positive metastatic BC.
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Affiliation(s)
- Michela Palleschi
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Andrea Prochowski Iamurri
- Radiology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy.
| | - Emanuela Scarpi
- Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Marita Mariotti
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Roberta Maltoni
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Francesca Mannozzi
- Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Domenico Barone
- Radiology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Giovanni Paganelli
- Nuclear Medicine Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Michela Casi
- Nuclear Medicine Unit, Bufalini Hospital, AUSL Della Romagna, Cesena, Italy
| | - Emanuela Giampalma
- Radiology Department, Bufalini Hospital, AUSL Della Romagna, Cesena, Italy
| | - Ugo De Giorgi
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Andrea Rocca
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
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11
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Ravaioli S, Maltoni R, Petracci E, Palleschi M, Balzi W, Pirini F, Tumedei MM, Zanoni M, Cortesi M, Martinelli G, Rocca A, Bravaccini S. Abstract P2-13-44: HDAC6 is an unfavorable prognostic factor in HER2-positive breast cancer patients treated with adjuvant trastuzumab. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p2-13-44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background Trastuzumab is the cornerstone of adjuvant therapy for HER2-positive breast cancer (BC), but due to de novo or primary resistance, >20% of early-stage patients become resistant. Thus, predicting the mechanisms of trastuzumab resistance would facilitate the planning of specific therapeutic strategies. We performed a case-control study of 26 HER2-positive BC patients who relapsed within 5 years of starting adjuvant treatment and 26 controls, no relapsed, analyzing an extensive gene expression profile. Methods Total RNA was isolated from formalin-fixed paraffin-embedded primary tumors with AllPrep DNA/RNA FFPE Kit (Qiagen) and quantified by Nanodrop, before performing Nanostring gene expression profiling. nCounter Breast Cancer 360 Panel (Nanostring Technologies) was used according to the manufacturer’s instructions to analyze the expression of 770 genes and important signatures for BC (e.g. PAM50). For the statistical analyses, genes were normalized using a ratio of the expression value to the geometric mean of all housekeeping genes on the panel. Housekeeper-normalized data were then log(2) transformed. These data were evaluated by unsupervised selection of genes using consensus clustering with the Partitioning Around Medoids algorithm followed by the association of cluster “representative” genes (i.e. the medoids) with respect to the presence of relapse. The optimal number of clusters was determined by inspecting the consensus matrix cumulative distribution. Given the small sample size, the association between the "representative" genes, demographic and clinical covariates and the risk of relapse was evaluated using a logistic regression model with ELASTIC-NET regularization with α and λ tuned by 5-fold cross-validation. Penalized regression coefficients β are reported. The analyses were performed using R version 4.0.4 and package “ConsensusClusterPlus” and “glmnet”. Results Patient clinical characteristics are reported in Table 1. Relapsed patients showed a higher tumor stage, larger tumor size and greater lymph node involvement than controls (Table 1). Six samples failed the quality control check and so the analyses on gene expression data were performed on 46 subjects who had a distribution of clinical covariates similar to that reported in Table 1. The PAM50 intrinsic subtype, Risk Of Recurrence (ROR) score and ROR category were not associated with relapse status (P = 0.5, 0.5 and 0.1, respectively). The consensus clustering analysis revealed that the optimal number of clusters was 5, and the corresponding medoids were: HDAC6 for cluster 1 (n1=192 genes), WNT4 for cluster 2 (n2=102 genes), BMPR2 for cluster 3 (n3=162 genes), PALB2 for cluster 4 (n4=191 genes), and PARP1 for cluster 5 (n5=84 genes). HDAC6 and BMPR2 showed the highest correlation (r = 0.53, P<0.001) among the 5 genes. HDAC6 showed prognostic potential in the penalized logistic regression analysis, independently of tumor stage and Body Mass Index (β: 0.57, 1.49, and 0.11, respectively). Higher HDAC6 expression was associated with a higher risk of relapse, all other conditions being equal. Conclusions We are now planning to validate these results in a larger case series and in in vitro models to verify whether HDAC6, in addition to being an unfavorable prognostic factor, could also be a new therapeutic target for trastuzumab resistance.
Table 1.Patient characteristics in relation to Trastuzumab outcome.VariableAllCasesControlsP(n=52)(n=26)(n=26)n(%)n(%)n(%)Age at start adiuvant therapyMean ± sd53.4 ± 11.953.1 ± 12.653.7 ± 11.40.854Menopausal StatusPre-menopause21(40.4)10(38.5)11(42.3)0.777Post-menopause31(59.6)16(61.5)15(57.7)Stage of DiseaseI9(18.8)2(8.0)7(30.4)0.001II20(41.7)7(28.0)13(56.5)III19(39.6)16(64.0)3(13.0)Unknown413Lymph Node StatusNegative18(36.0)4(16.7)14(53.9)0.008Positive32(64.0)20(83.3)12(46.2)Unknown220Tumor SizeT128(53.9)7(26.9)21(80.8)<0.001T213(25.0)8(30.8)5(19.2)T36(11.5)6(23.1)0(0.0)T45(9.6)5(19.2)0(0.0)Histologic Grade12(4.1)1(4.2)1(4.0)0.889218(36.7)8(33.3)10(40.0)329(59.2)15(62.5)14(56.0)Unknown321Ki-67<20%17(32.7)8(30.8)9(34.6)0.768≥20%35(67.3)18(69.2)17(65.4)ERNegative14(26.9)7(26.9)7(26.9)1.000Positive38(73.1)19(73.1)19(73.1)PRNegative22(43.1)11(44.0)11(42.3)0.903Positive29(56.9)14(56.0)15(57.7)Unknown110Vascular invasionNo13(56.5)3(37.5)10(66.7)0.221Yes10(43.5)5(62.5)5(33.3)Unknown291811Adjuvant ChemotherapyAnthracyclines and taxanes24(46.2)7(26.9)17(65.4)<0.001Taxanes only6(11.5)4(15.4)2(7.7)Anthracyclines only10(19.2)3(11.5)7(26.9)Other12(23.1)12(46.2)0(0.0)BMI at start of Adjuvant ChemotherapyMean ± sd24.8 ± 4.025.9 ± 3.223.6 ± 4.40.039sd: standard deviation BMI: Body Mass Index
Citation Format: Sara Ravaioli, Roberta Maltoni, Elisabetta Petracci, Michela Palleschi, William Balzi, Francesca Pirini, Maria Maddalena Tumedei, Michele Zanoni, Michela Cortesi, Giovanni Martinelli, Andrea Rocca, Sara Bravaccini. HDAC6 is an unfavorable prognostic factor in HER2-positive breast cancer patients treated with adjuvant trastuzumab [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P2-13-44.
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Affiliation(s)
- Sara Ravaioli
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Roberta Maltoni
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Elisabetta Petracci
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Michela Palleschi
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - William Balzi
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Francesca Pirini
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | | | - Michele Zanoni
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Michela Cortesi
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Giovanni Martinelli
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Andrea Rocca
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Sara Bravaccini
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
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Abstract
Precision oncology is perceived as a way forward to treat individual cancer patients. However, knowing particular cancer mutations is not enough for optimal therapeutic treatment, because cancer genotype-phenotype relationships are nonlinear and dynamic. Systems biology studies the biological processes at the systems' level, using an array of techniques, ranging from statistical methods to network reconstruction and analysis, to mathematical modeling. Its goal is to reconstruct the complex and often counterintuitive dynamic behavior of biological systems and quantitatively predict their responses to environmental perturbations. In this paper, we review the impact of systems biology on precision oncology. We show examples of how the analysis of signal transduction networks allows to dissect resistance to targeted therapies and inform the choice of combinations of targeted drugs based on tumor molecular alterations. Patient-specific biomarkers based on dynamical models of signaling networks can have a greater prognostic value than conventional biomarkers. These examples support systems biology models as valuable tools to advance clinical and translational oncological research.
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Affiliation(s)
- Andrea Rocca
- Hygiene and Public Health, Local Health Unit of Romagna, 47121 Forlì, Italy
| | - Boris N. Kholodenko
- Systems Biology Ireland, School of Medicine, University College Dublin, Belfield, D04 V1W8 Dublin, Ireland
- Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Belfield, D04 V1W8 Dublin, Ireland
- Department of Pharmacology, Yale University School of Medicine, New Haven, CT 06520, USA
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13
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Vernieri C, Nichetti F, Lalli L, Moscetti L, Giorgi CA, Griguolo G, Marra A, Randon G, Rea CG, Ligorio F, Scagnoli S, De Angelis C, Molinelli C, Fabbri A, Ferraro E, Trapani D, Milani A, Agostinetto E, Bernocchi O, Catania G, Vantaggiato A, Palleschi M, Moretti A, Basile D, Cinausero M, Ajazi A, Castagnoli L, Lo Vullo S, Gerratana L, Puglisi F, La Verde N, Arpino G, Rocca A, Ciccarese M, Pedersini R, Fabi A, Generali D, Losurdo A, Montemurro F, Curigliano G, Del Mastro L, Michelotti A, Cortesi E, Guarneri V, Pruneri G, Mariani L, de Braud F. Impact of Baseline and On-Treatment Glycemia on Everolimus-Exemestane Efficacy in Patients with Hormone Receptor-Positive Advanced Breast Cancer (EVERMET). Clin Cancer Res 2021; 27:3443-3455. [PMID: 33785482 DOI: 10.1158/1078-0432.ccr-20-4928] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/24/2021] [Accepted: 03/26/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE The mTOR complex C1 (mTORC1) inhibitor everolimus in combination with the aromatase inhibitor exemestane is an effective treatment for patients with hormone receptor-positive (HR+), HER2-negative (HER2-), advanced breast cancer (HR+/HER2- aBC). However, everolimus can cause hyperglycemia and hyperinsulinemia, which could reactivate the PI3K/protein kinase B (AKT)/mTORC1 pathway and induce tumor resistance to everolimus. EXPERIMENTAL DESIGN We conducted a multicenter, retrospective, Italian study to investigate the impact of baseline and on-treatment (i.e., during first 3 months of therapy) blood glucose levels on progression-free survival (PFS) in patients with HR+/HER2- aBC treated with everolimus-exemestane. RESULTS We evaluated 809 patients with HR+/HER2- aBC treated with everolimus-exemestane as any line of therapy for advanced disease. When evaluated as dichotomous variables, baseline and on-treatment glycemia were not significantly associated with PFS. However, when blood glucose concentration was evaluated as a continuous variable, a multivariable model accounting for clinically relevant patient- and tumor-related variables revealed that both baseline and on-treatment glycemia are associated with PFS, and this association is largely attributable to their interaction. In particular, patients who are normoglycemic at baseline and experience on-treatment diabetes have lower PFS compared with patients who are already hyperglycemic at baseline and experience diabetes during everolimus-exemestane therapy (median PFS, 6.34 vs. 10.32 months; HR, 1.76; 95% confidence interval, 1.15-2.69; P = 0.008). CONCLUSIONS The impact of on-treatment glycemia on the efficacy of everolimus-exemestane therapy in patients with HR+/HER2- aBC depends on baseline glycemia. This study lays the foundations for investigating novel therapeutic approaches to target the glucose/insulin axis in combination with PI3K/AKT/mTORC1 inhibitors in patients with HR+/HER2- aBC.
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Affiliation(s)
- Claudio Vernieri
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. .,IFOM, the FIRC Institute of Molecular Oncology, Milan, Italy
| | - Federico Nichetti
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Luca Lalli
- Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Luca Moscetti
- Division of Medical Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | | | - Gaia Griguolo
- Medical Oncology 2, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy.,Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
| | - Antonio Marra
- Division of Early Drug Development for Innovative Therapies, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Giovanni Randon
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Carmen G Rea
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Francesca Ligorio
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Simone Scagnoli
- Department of Medico-Surgical Sciences and Translational Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Claudia De Angelis
- UO Oncologia Medica 2, Ospedale S. Chiara, Dipartimento di Oncologia, Dei Trapianti e Delle Nuove Tecnologie, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Chiara Molinelli
- IRCCS Ospedale Policlinico San Martino, U.O.S.D. Breast Unit, Genova, Italy
| | - Agnese Fabbri
- Medical Oncology Unit, Belcolle Hospital, Viterbo, Italy
| | - Emanuela Ferraro
- Division of Early Drug Development for Innovative Therapies, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Dario Trapani
- Division of Early Drug Development for Innovative Therapies, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Andrea Milani
- Multidisciplinary Oncology Outpatient Clinic, Candiolo Cancer Institute, FPO-IRCCS, Turin, Italy
| | - Elisa Agostinetto
- Medical Oncology and Hematology Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Ottavia Bernocchi
- Department of Medical, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Giovanna Catania
- Division of Medical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | - Michela Palleschi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori" - IRST, Meldola, Italy
| | - Anna Moretti
- Department of Oncology, ASST Fatebenefratelli Sacco - PO Fatebenefratelli, Milan, Italy
| | - Debora Basile
- Department of Medical Oncology, IRCCS Centro di Riferimento Oncologico di Aviano (CRO), Aviano, Italy
| | - Marika Cinausero
- Department of Oncology, ASUFC University Hospital of Udine, Udine, Italy
| | - Arta Ajazi
- IFOM, the FIRC Institute of Molecular Oncology, Milan, Italy
| | - Lorenzo Castagnoli
- Molecular Targeting Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Salvatore Lo Vullo
- Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Lorenzo Gerratana
- Department of Medical Oncology, IRCCS Centro di Riferimento Oncologico di Aviano (CRO), Aviano, Italy.,Department of Medicine, University of Udine, Udine, Italy
| | - Fabio Puglisi
- Department of Medical Oncology, IRCCS Centro di Riferimento Oncologico di Aviano (CRO), Aviano, Italy.,Department of Medicine, University of Udine, Udine, Italy
| | - Nicla La Verde
- Department of Oncology, ASST Fatebenefratelli Sacco - PO Luigi Sacco, Milan, Italy
| | - Grazia Arpino
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Andrea Rocca
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori" - IRST, Meldola, Italy
| | | | - Rebecca Pedersini
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Medical Oncology, University of Brescia at ASST Spedali Civili, Brescia, Italy
| | - Alessandra Fabi
- Division of Medical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Daniele Generali
- Department of Medical, Surgery and Health Sciences, University of Trieste, Trieste, Italy.,Breast Cancer Unit & Translational Research Unit, ASST Cremona, Cremona, Italy
| | - Agnese Losurdo
- Medical Oncology and Hematology Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Filippo Montemurro
- Multidisciplinary Oncology Outpatient Clinic, Candiolo Cancer Institute, FPO-IRCCS, Turin, Italy
| | - Giuseppe Curigliano
- Division of Early Drug Development for Innovative Therapies, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Lucia Del Mastro
- IRCCS Ospedale Policlinico San Martino, U.O.S.D. Breast Unit, Genova, Italy.,Dipartimento di Medicina Interna e Specialità Mediche (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - Andrea Michelotti
- UO Oncologia Medica 2, Ospedale S. Chiara, Dipartimento di Oncologia, Dei Trapianti e Delle Nuove Tecnologie, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Enrico Cortesi
- Department of Medico-Surgical Sciences and Translational Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Valentina Guarneri
- Medical Oncology 2, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy.,Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
| | - Giancarlo Pruneri
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Department of Diagnostic Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Luigi Mariani
- Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Filippo de Braud
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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14
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Bravaccini S, Ravaioli S, Tumedei MM, Rocca A, Palleschi M, Puccetti M, Parrella P, Altini M, Maltoni R. Atezolizumab Plus Nab-paclitaxel in PD-L1-Positive TNBC-Letter. Clin Cancer Res 2021; 26:3892-3893. [PMID: 32669274 DOI: 10.1158/1078-0432.ccr-20-0668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/26/2020] [Accepted: 04/03/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Sara Bravaccini
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Forlí-Cesena, Italy.
| | - Sara Ravaioli
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Forlí-Cesena, Italy
| | - Maria Maddalena Tumedei
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Forlí-Cesena, Italy
| | - Andrea Rocca
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Forlí-Cesena, Italy
| | - Michela Palleschi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Forlí-Cesena, Italy
| | - Maurizio Puccetti
- Pathology Unit, Azienda Unità Sanitaria Locale (AUSL) di Imola, Imola, Italy
| | - Paola Parrella
- Fondazione IRCCS Casa Sollievo della Sofferenza Laboratorio di Oncologia, San Giovanni Rotondo, Foggia, Italy
| | - Mattia Altini
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Forlí-Cesena, Italy
| | - Roberta Maltoni
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Forlí-Cesena, Italy
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Cortesi L, Venturelli M, Caggia F, Marcheselli L, Gozzi A, Zambelli A, Guarneri V, Musolino A, Fiorio E, Bisagni G, Rocca A, Arcangeli V, De Matteis E, Rizzo S, Michelotti A. Abstract OT-31-01: A phase II study to evaluate the efficacy and safety of pembrolizumab plus carboplatin in BRCA-related metastatic breast cancer: PEMBRACA trial. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ot-31-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Considering the high proportion of tumor-infiltrating lymphocytes (TILs) in BRCA-related breast cancer, we expect that PD-1 pathway is highly expressed and PD-1 antagonist pembrolizumab could provide clinical activity in this kind of tumor. Furthermore, BRCA-related breast cancers are known to be more sensitive to platinum-derived drugs. Thus the association between Pembrolizumab and Carboplatin in metastatic BRCA-related breast cancer seems to be active in this setting of patients. This study will evaluate the safety and the efficacy of Pembrolizumab associated with Carboplatin in BRCA mutated or with unknown mutations metastatic breast cancer patients.
Study and Statistical DesignThis is a national multicenter two-stage single arm phase II study, enrolling BRCA mutated or with unknown mutations metastatic breast cancer patients. The sample size has been estimated by using the two-stage Simon’s design. In the first stage, 20 subjects will be enrolled. If, after first stage ≤11 responses (r1) will be observed, accrual will terminate and the experimental regimen will be rejected. Otherwise if 12 or more responses will be seen then the accrual will continue to the second stage of an additional 33 subjects (total, 53 subjects). At the second stage if 33 or less responses out of 53 subjects will be observed the treatment will be rejected. With the null hypothesis (p0) being equal 0.55 with a type I (alfa) error of 0.10 (10%) and a type II (beta) error of 0.20 (power=80%) and the alternative hypothesis (p1) is 0.70, (response rate 70%), we expect to reach an overall response rate (ORR) ≥ 70% by the combination of Pembrolizumab plus Carboplatin. We also expect to reach a median Time to Progression (TTP) and Overall Survival (OS) of five and fifteen months respectively. The Disease Control Rate (DCR) will be expected as ≥ 80% by the combination of Pembrolizumab plus Carboplatin
Study TreatmentCarboplatin at area under the time-concentration curve 6 (AUC 6) intravenously once every 3 weeks in combination with Pembrolizumab 200 mg intravenously every 3 weeks will be administered for six courses and then only Pembrolizumab alone will continue until occurrence of unacceptable toxicities or disease progression.
Eligibility CriteriaIn order to be eligible for participation in this trial, the subject, aged ≥ 18 years, must have metastatic confirmed breast cancer, with a disease progression by radiological techniques within 12 months prior to signing informed consent, and a documented mutation in BRCA1 or BRCA2 genes that is predicted to be deleterious or suspected deleterious or with unknown significance. The subject must have measurable disease based on RECIST 1.1 and have a performance status of 0 or 1 on the Eastern Cooperative Oncology Group (ECOG) Performance Scale. Prior chemotherapy with anthracyclines and taxanes has to be administered in neoadjuvant or adjuvant setting. In case of luminal tumors hormonal treatments for advanced disease can be administered before. The life expectancy must be greater than 3 months and the subject must demonstrate adequate organ function by screening labs performed within 10 days of treatment initiation.
Objectives and HypothesisThe primary end-point will be the ORR, evaluated according to RECIST criteria. Secondary objectives will be the TTP, the duration of response (DOR ), the DCR, and the OS. The safety of the combination will be evaluated according to the worst toxicity grade reported throughout the whole treatment period.The Exploratory Objective will be the evaluation of ORR, TTP, DOR, and DCR based on irRECIST. Biological parameters of CD8/TILs and PD-L1 will be considered in the metastatic biopsy.
Target AccrualThe first subject was enrolled in January 2019 and recruitment is ongoing. Enrollment of the first 20 subjects is expected to complete in Q2 2021.
Citation Format: Laura Cortesi, Marta Venturelli, Federica Caggia, Luigi Marcheselli, Annita Gozzi, Alberto Zambelli, Valentina Guarneri, Antonino Musolino, Elena Fiorio, Giancarlo Bisagni, Andrea Rocca, Valentina Arcangeli, Elisabetta De Matteis, Sergio Rizzo, Andrea Michelotti. A phase II study to evaluate the efficacy and safety of pembrolizumab plus carboplatin in BRCA-related metastatic breast cancer: PEMBRACA trial [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr OT-31-01.
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Affiliation(s)
- Laura Cortesi
- 1Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Marta Venturelli
- 1Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Federica Caggia
- 1Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Luigi Marcheselli
- 1Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Annita Gozzi
- 1Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Alberto Zambelli
- 2Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | | | | | - Elena Fiorio
- 5Azienda Ospedaliero Universitaria Integrata, Verona, Italy
| | | | - Andrea Rocca
- 7Scientific Institute Romagnolo for the Study and Treatment of Cancer (IRST) IRCCS, Meldola, Italy
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Bravaccini S, Ravaioli S, Maltoni R, Petracci E, Palleschi M, Balzi W, Pirini F, Martinelli G, Rocca A. Abstract PS10-19: Gene expression profile in HER2-positive breast cancer to predict outcome in patients treated with adjuvant trastuzumab. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps10-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background Trastuzumab is the cornerstone of adjuvant therapy for HER2-positive breast cancer (BC), but up to 20% of patients relapse. We performed a nested case-control study comparing the gene expression profile of relapsed cases within 5 years from the start of adjuvant trastuzumab and a group of controls not relapsed, in order to understand potential resistance mechanisms and to allow developing alternative strategies.MethodsRNA was isolated from formalin-fixed paraffin-embedded primary tumors with AllPrep DNA/RNA FFPE Kit (Qiagen) and analyzed with nCounter Breast Cancer 360 Panel (Nanostring Technologies), according to manufacturer’s instructions. The analysis of differential expression was performed by DESeq2 R package, on raw counts assuming a negative binomial distribution and using the Benjamini-Hochberg procedure to control the False Discovery Rate (FDR). Pathway enrichment analysis on Differentially Expressed Genes (DEGs) was performed by STRING database v. 11.0. Fisher’s Exact test was used for categorical variables and Wilcoxon-Mann-Whitney test for the continuous ones to analyze the comparison between cases and controls for the clinical and genetic variables. ResultsConsidering a median of > 20 counts per gene as threshold, 653 genes were analyzed. Eight significant DEGs were found between cases and controls, with a FDR < 0,10: AGTR1, Receptor for angiotensin 2 (log2foldchange [log2FC]=-1.83; FDR=0.0017), PGR (log2FC=-2.41, FDR=0.016), ROCK1, Rho-associated protein kinase 1 (log2FC=1.26, FDR=0.042), ITPR1, Inositol 1,4,5-trisphosphate receptor type 1 (log2FC=-0.98, FDR=0.052), MMP3, Stromelysin-1 (log2FC=-0.58, FDR=0.097), MMP9, Matrix Metalloproteinase-9 (log2FC=1.15, FDR=0.097), TIE1, Tyrosine-protein kinase receptor-1 (log2FC= 1.0047, FDR=0.097) and GDF15, Growth Differentiation Factor 15 (log2FC= 1.30, FDR=0.099). After adjustment for multiplicity of the tests, no statistically significant associations were found between gene expression and clinical variables (e.g. tumor size, stage…). The most enriched KEGG pathways were: Estrogen signaling (3 genes out of 133, FDR=0.00088), Vascular smooth muscle contraction (3/119, FDR= 0.00088), cGMP-PKG signaling (3/160, FDR=0.00088), Proteoglycans in cancer (3/195, FDR= 0.00093), Cortisol synthesis and secretion (2/63, FDR=0.0041), Leukocyte transendothelial migration (2/112, FDR= 0.0061), TNF signaling (2/108, FDR=0.0061), IL-17 signaling (2/92, FDR=0.0061) and Calcium signaling (2/179, FDR=0.0078).
Conclusions Our preliminary results indicate that altered expression of genes related to inflammation and antigen presentation, adhesion and migration are involved in trastuzumab resistance, highlighting the role of the immune system and of the tumor microenvironment in this particular subtype of BC. For HER2+ BC with extremely poor prognosis, we aim to validate these results, reproducing the genetic landscape of unfavorable prognostic factors, in order to identify new therapeutic targets and gene signatures, able to identify Trastuzumab resistance mechanisms.
Table 1. Patient characteristicsGlobalCasesControlsP(42)(18)(24)N %Tumor SizeT1-T24379.631659.2627100.00<0.001T3-T41140.741140.7400.00Stage1821.0515.88733.330.00421642.11529.411152.3831436.841164.71314.29Unknown413Lymph Node StatuspN negative1741.46317.651458.330.012pN positive2458.541482.351041.67Unknown110ER<1%1126.19527.78625.000.839≥1%3173.811372.221875.00PR<1%1741.46847.06937.500.54≥1%2458.54952.941562.50Unknown1-1Ki67<20%1433.33527.78937.500.508≥20%2866.671372.221562.50Adjuvant ChemotherapyAnthracyclines + taxanes2252.38738.891562.500.025Taxanes511.90316.6728.33Anthracyclines1023.81316.67729.17Other511.90527.7800.002
Citation Format: Sara Bravaccini, Sara Ravaioli, Roberta Maltoni, Elisabetta Petracci, Michela Palleschi, William Balzi, Francesca Pirini, Giovanni Martinelli, Andrea Rocca. Gene expression profile in HER2-positive breast cancer to predict outcome in patients treated with adjuvant trastuzumab [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS10-19.
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Rocca A, Cortesi P, Cortesi L, Gianni L, Matteucci F, Fantini L, Maestri A, Giunchi DC, Cavanna L, Ciani R, Falcini F, Bagni A, Meldoli E, Dall’Agata M, Volpi R, Andreis D, Nanni O, Curcio A, Lucchi L, Amadori D, Fedeli A. Phase II study of liposomal doxorubicin, docetaxel and trastuzumab in combination with metformin as neoadjuvant therapy for HER2-positive breast cancer. Ther Adv Med Oncol 2021; 13:1758835920985632. [PMID: 33613693 PMCID: PMC7876584 DOI: 10.1177/1758835920985632] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/11/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The aim of this study was to improve activity over single human epidermal growth factor receptor 2 (HER2)-blockade sequential neaodjuvant regimens for HER2-positive breast cancer, by exploiting the concomitant administration of trastuzumab, taxane and anthracycline, while restraining cardiac toxicity with use of liposomal doxorubicin, and by adding metformin, based on preliminary evidence of antitumor activity. PATIENTS AND METHODS This multi-center, single-arm, two-stage phase II trial, assessed the safety and the activity of a new treatment regimen for HER2-positive, early or locally advanced breast cancer. Patients received six 21-day cycles of non-pegylated liposomal doxorubicin, 50 mg/m2 intravenously (i.v.) on day 1, docetaxel, 30 mg/m2 i.v. on days 2 and 9, trastuzumab, 2 mg/kg/week i.v. on days 2, 9, and 16 (with 4 mg/kg loading dose), in association with metformin 1000 mg orally twice daily. The primary endpoint was the rate of pathological complete response (pCR) in the breast and axilla (ypT0/is ypN0). A subgroup of patients performed a 3-deoxy-3-18F-fluorothymidine positron emission tomography (FLT-PET) at baseline and after one cycle. RESULTS Among 47 evaluable patients, there were 18 pCR [38.3%, 95% confidence interval (CI) 24.5-53.6%]. A negative estrogen-receptor status, high Ki67, and histological grade 3 were related with pCR, although only grade reached statistical significance. FLT-PET maximum standardized uptake value after one cycle was inversely related to pCR in the breast (odds ratio 0.29, 95% CI 0.06-1.30, p = 0.11). Toxicity included grade 3-4 neutropenia in 70% and febrile neutropenia in 4% of patients, grade 1-2 nausea/vomiting in 60%/38%, and grade 3 in 4%/2%, respectively, grade 1-2 diarrhea in 72%, and grade 3 in 6%. There were two cases of reversible grade 2 left-ventricular ejection-fraction decrease, and one case of sharp troponin-T increase. CONCLUSIONS The concomitant administration of trastuzumab, liposomal doxorubicin, docetaxel, and metformin is safe and shows good activity, but does not appear to improve activity over conventional sequential regimens.
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Affiliation(s)
- Andrea Rocca
- Department of Clinical and Experimental Oncology and Hematology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Via Maroncelli 40, Meldola 47014, Italy
| | - Pietro Cortesi
- Department of Clinical and Experimental Oncology and Hematology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Laura Cortesi
- Department of Oncology and Hematology, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Lorenzo Gianni
- Department of Medical Oncology, Infermi Hospital, Rimini, Italy
| | - Federica Matteucci
- Nuclear Medicine Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Lorenzo Fantini
- Nuclear Medicine Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Antonio Maestri
- Department of Medical Oncology, Santa Maria della Scaletta Hospital, Imola, Italy
| | - Donata Casadei Giunchi
- Department of Clinical and Experimental Oncology and Hematology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Luigi Cavanna
- Department of Onco-Hematology, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Rosa Ciani
- Cancer Prevention Unit, Azienda Usl della Romagna, Forlì, Italy
| | - Fabio Falcini
- Cancer Prevention Unit, Azienda Usl della Romagna, Forlì, Italy Romagna Cancer Registry, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Antonella Bagni
- Breast Diagnostic Unit, Maurizio Bufalini Hospital, Cesena, Italy
| | - Elena Meldoli
- Breast Diagnostic Unit, Maurizio Bufalini Hospital, Cesena, Italy
| | - Monia Dall’Agata
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Roberta Volpi
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Daniele Andreis
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Oriana Nanni
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Annalisa Curcio
- Breast Surgery Unit, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Leonardo Lucchi
- Breast Surgery Unit, Maurizio Bufalini Hospital, Forlì, Italy
| | - Dino Amadori
- Department of Clinical and Experimental Oncology and Hematology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Anna Fedeli
- Department of Clinical and Experimental Oncology and Hematology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
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Pellegrino B, Cavanna L, Boggiani D, Zamagni C, Frassoldati A, Schirone A, Caldara A, Rocca A, Gori S, Piacentini F, Berardi R, Brandes AA, Foglietta J, Villa F, Todeschini R, Tognetto M, Naldi N, Bortesi B, Montemurro F, Ardizzoni A, Boni L, Musolino A. Phase II study of eribulin in combination with gemcitabine for the treatment of patients with locally advanced or metastatic triple negative breast cancer (ERIGE trial). Clinical and pharmacogenetic results on behalf of the Gruppo Oncologico Italiano di Ricerca Clinica (GOIRC). ESMO Open 2020; 6:100019. [PMID: 33399082 PMCID: PMC7808100 DOI: 10.1016/j.esmoop.2020.100019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 11/07/2020] [Accepted: 11/17/2020] [Indexed: 12/21/2022] Open
Abstract
Background The combination of a microtubule inhibitor (eribulin) with a nucleoside analog (gemcitabine) may synergistically induce tumor cell death, particularly in triple negative breast cancer (TNBC) characterized by high cell proliferation, aggressive behavior, and chemo-resistance. Patients and methods This is an open-label, multicenter phase II study evaluating the combination of eribulin (0.88 mg/m2) plus gemcitabine (1000 mg/m2) on days 1 and 8 of a 21-day cycle as either first- or second-line treatment of locally advanced or metastatic TNBC. The primary endpoint was the objective response for evaluable patients. A prospective, molecular correlative study was carried out to assess the role of germinal BRCA pathogenic variants and single nucleotide polymorphisms (SNPs) in predicting efficacy and toxicity of the combination regimen. Results From July 2013 to September 2016, 83 evaluable patients were enrolled. They received a median number of six cycles of treatment. An overall response rate (ORR) of 37.3% (31 patients) was observed, with a complete response rate of 2.4% and a partial response rate of 34.9%; the clinical benefit rate was 48.8%. With a median follow-up of 28.8 months, the median response duration was 6.6 months, the median progression-free survival (PFS) was 5.1 months, and the median overall survival (OS) was 14.5 months. The most common grade 3-4 adverse events were aminotransferase elevation (in 25% of the patients) and neutropenia (in 23.8%). Women with BRCA1/2 pathogenic variants were associated with worse ORR, PFS, and OS than BRCA1/2 wild-type carriers. CYP3A4 and FGD4 SNPs were associated with increased risk of liver toxicity. Three different SNPs in CDA∗2, RRM1, and CYP2C8 genes were significantly associated with poorer OS. Conclusions The combination of eribulin and gemcitabine showed promising activity and a moderate toxicity profile in metastatic TNBC. BRCA status and pharmacogenetics tests may help identify patients with high probability of response with negligible toxicity. EudraCT number 2012-003505-10. Eribulin plus gemcitabine showed a remarkable best ORR of 37.3% and a clinical benefit rate of 48.8%. The most common grade 3/4 toxicities were liver toxicity and neutropenia without febrile neutropenia. The study regimen partially lost its efficacy in patients harboring BRCA1/2 pathogenic variants. SNPs in CYP3A4 and FGD4 genes were associated with increased risk of liver toxicity. Three different SNPs in CDA∗2, RRM1, and CYP2C8 genes were significantly associated with poorer OS.
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Affiliation(s)
- B Pellegrino
- Medical Oncology and Breast Unit, University Hospital of Parma, Parma, Italy; Italian Oncology Group for Clinical Research (GOIRC), Parma, Italy; Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - L Cavanna
- Hospital of Piacenza, Piacenza, Italy
| | - D Boggiani
- Medical Oncology and Breast Unit, University Hospital of Parma, Parma, Italy; Italian Oncology Group for Clinical Research (GOIRC), Parma, Italy
| | - C Zamagni
- SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - A Frassoldati
- Italian Oncology Group for Clinical Research (GOIRC), Parma, Italy; Medical Oncology Unit, University Hospital of Ferrara, Ferrara, Italy
| | - A Schirone
- Medical Oncology Unit, University Hospital of Ferrara, Ferrara, Italy
| | - A Caldara
- Medical Oncology Unit, Ospedale Santa Chiara, Trento, Italy
| | - A Rocca
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola (FC), Italy
| | - S Gori
- Sacro Cuore-Don Calabria Hospital, Negrar (VR), Italy
| | - F Piacentini
- Medical Oncology Unit, University Hospital of Modena, Modena, Italy
| | - R Berardi
- Ancona University Hospital, Ancona, Italy
| | - A A Brandes
- Department of Medical Oncology, Azienda USL, Bologna, Italy
| | | | - F Villa
- Hospital of Lecco, Lecco, Italy
| | - R Todeschini
- Italian Oncology Group for Clinical Research (GOIRC), Parma, Italy
| | - M Tognetto
- Oncologia Medica, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - N Naldi
- Medical Oncology and Breast Unit, University Hospital of Parma, Parma, Italy
| | - B Bortesi
- Medical Oncology and Breast Unit, University Hospital of Parma, Parma, Italy
| | - F Montemurro
- Multidisciplinary Oncology Outpatient Clinic, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | - A Ardizzoni
- Oncologia Medica, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - L Boni
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - A Musolino
- Medical Oncology and Breast Unit, University Hospital of Parma, Parma, Italy; Italian Oncology Group for Clinical Research (GOIRC), Parma, Italy; Department of Medicine and Surgery, University of Parma, Parma, Italy.
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Palleschi M, Barzotti E, Melegari E, Manunta S, Mannozzi F, Vagheggini A, Maltoni R, Fedeli A, Sarti S, Cecconetto L, Possanzini P, Ravaioli S, Tumedei M, Amadori D, Bravaccini S, Rocca A. Impact of Ki67 and progesterone receptor on PFS with cyclin-dependent kinase 4/6 inhibitors in HER2-negative advanced breast cancer: A real world mono-institutional experience. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30705-x] [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: 10/23/2022]
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Rossi T, Gallerani G, Angeli D, Cocchi C, Bandini E, Fici P, Gaudio M, Martinelli G, Rocca A, Maltoni R, Fabbri F. Single-Cell NGS-Based Analysis of Copy Number Alterations Reveals New Insights in Circulating Tumor Cells Persistence in Early-Stage Breast Cancer. Cancers (Basel) 2020; 12:cancers12092490. [PMID: 32887501 PMCID: PMC7565733 DOI: 10.3390/cancers12092490] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/28/2020] [Accepted: 08/31/2020] [Indexed: 12/18/2022] Open
Abstract
Simple Summary Circulating tumor cells (CTCs) are crucial for the identification of patients with a higher risk of relapse, including those diagnosed with breast cancer (BC). The aim of this study was to explore their molecular aspects in 11 early-stage BC patients during patient management, focusing on copy number alterations (CNAs) and exploiting a single-CTC next-generation sequencing approach. CTCs showed different degrees of aberration based on access time. Moreover, CTCs, in particular those persisting even months after tumor resection, shared CNAs with matched tumor tissue. Enrichment analyses of CNAs on CTCs highlighted peculiar aberrations, especially associated with interferon (IFN)-associated terms. The study of CTCs CNAs can provide information about the molecular mechanisms involving CTC-related processes and their survival ability in occult niches, supporting the goal of exploiting their application in patients’ surveillance and follow-up. Abstract Circulating tumor cells (CTCs) are a rare population of cells representing a key player in the metastatic cascade. They are recognized as a validated tool for the identification of patients with a higher risk of relapse, including those diagnosed with breast cancer (BC). However, CTCs are characterized by high levels of heterogeneity that also involve copy number alterations (CNAs), structural variations associated with gene dosage changes. In this study, single CTCs were isolated from the peripheral blood of 11 early-stage BC patients at different time points. A label-free enrichment of CTCs was performed using OncoQuick, and single CTCs were isolated using DEPArray. Libraries were prepared from single CTCs and DNA extracted from matched tumor tissues for a whole-genome low-coverage next-generation sequencing (NGS) analysis using the Ion Torrent S5 System. The analysis of the CNA burden highlighted that CTCs had different degrees of aberration based on the time point and subtype. CTCs were found even six months after surgery and shared CNAs with matched tumor tissue. Tumor-associated CNAs that were recurrent in CTCs were patient-specific, and some alterations involved regions associated with BC and survival (i.e., gains at 1q21-23 and 5p15.33). The enrichment analysis emphasized the involvement of aberrations of terms, associated in particular with interferon (IFN) signaling. Collectively, our findings reveal that these aberrations may contribute to understanding the molecular mechanisms involving CTC-related processes and their survival ability in occult niches, supporting the goal of exploiting their application in patients’ surveillance and follow-up.
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Affiliation(s)
- Tania Rossi
- Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (G.G.); (C.C.); (E.B.); (P.F.); (F.F.)
- Correspondence: ; Tel.: +39-05-4373-9982
| | - Giulia Gallerani
- Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (G.G.); (C.C.); (E.B.); (P.F.); (F.F.)
| | - Davide Angeli
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy;
| | - Claudia Cocchi
- Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (G.G.); (C.C.); (E.B.); (P.F.); (F.F.)
| | - Erika Bandini
- Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (G.G.); (C.C.); (E.B.); (P.F.); (F.F.)
| | - Pietro Fici
- Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (G.G.); (C.C.); (E.B.); (P.F.); (F.F.)
| | - Michele Gaudio
- Pathology Unit, AUSL Romagna, Morgagni-Pierantoni Hospital, 47121 Forlì, Italy;
| | - Giovanni Martinelli
- Scientific Directorate, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy;
| | - Andrea Rocca
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (A.R.); (R.M.)
| | - Roberta Maltoni
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (A.R.); (R.M.)
| | - Francesco Fabbri
- Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (G.G.); (C.C.); (E.B.); (P.F.); (F.F.)
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Farolfi A, Petracci E, Serra L, Ravaioli A, Bravaccini S, Ravaioli S, Tumedei MM, Ulivi P, Canale M, Puccetti M, Falcini F, Folli S, Curcio A, Rocca A. Tumor-Infiltrating Lymphocytes (TILs) and Risk of a Second Breast Event After a Ductal Carcinoma in situ. Front Oncol 2020; 10:1486. [PMID: 32974178 PMCID: PMC7466557 DOI: 10.3389/fonc.2020.01486] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 07/13/2020] [Indexed: 01/21/2023] Open
Abstract
Women with a diagnosis of ductal carcinoma in situ (DCIS) have a high risk of developing a second breast event (SBE). The immune system might play a role in trying to prevent a SBE. Patients diagnosed with DCIS were identified in the population-based cancer registry of Area Vasta Romagna from 1997 to 2010. Median follow-up is 8.5 years. Tumor-infiltrating lymphocytes (TILs) were evaluated both in index DCIS and in SBE. The main endpoint was to assess the association between TILs' levels in index DCIS and risk of a SBE. Out of 496 DCIS patients, 100 SBEs (20.2%) were identified: 55 ipsilateral (11.1%) and 43 contralateral (8.7%). The distribution of TILs was heterogeneous, but significantly associated with grade, necrosis, screen detection and type of surgery. Patients stratified according to TILs percentage (≤5% and >5%) did not show a statistically significant difference in the 5-year cumulative incidence of SBEs: 14.9% (95% CI 11.3–19.1) and 11.0% (95% CI, 6.9–16.2), respectively (p = 0.147). In the subgroup of patients who did not receive radiotherapy, TILs >5% were associated with a reduced risk of SBE (HR 0.34, 95% CI 0.14–0.82, p = 0.016). Although we did not find any significant association between TILs and SBE, further studies evaluating their role according to radiotherapy are warranted.
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Affiliation(s)
- Alberto Farolfi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Elisabetta Petracci
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Luigi Serra
- Pathology Unit, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Alessandra Ravaioli
- Romagna Cancer Registry, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Sara Bravaccini
- Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Sara Ravaioli
- Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Maria Maddalena Tumedei
- Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Paola Ulivi
- Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Matteo Canale
- Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | | | - Fabio Falcini
- Romagna Cancer Registry, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Secondo Folli
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Andrea Rocca
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
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Ravaioli S, Maltoni R, Pirini F, Palleschi M, Balzi W, Petracci E, Martinelli G, Rocca A, Bravaccini S. Abstract 5295: Impact of a multi-gene expression profile in predicting adjuvant trastuzumab outcome in HER2-positive breast cancer. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-5295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Trastuzumab is the cornerstone of adjuvant therapy for HER2-positive breast cancer (BC), but up to 20% of patients relapse. Understanding resistance mechanisms could allow developing strategies to overcome this issue. We performed a case-control, retrospective study to compare the gene expression profiles (GEPs) of 27 patients who experienced disease relapse within 2 years from the start of adjuvant trastuzumab therapy, with those of 27 patients who were disease-free after at least 5 years. Here, we present the preliminary results on 12 cases and 12 controls, matched by age and hormone receptor status.
Methods
RNA was isolated from formalin-fixed paraffin-embedded primary tumors (FFPE) with AllPrep DNA/RNA FFPE Kit (Qiagen) and quantified by Nanodrop, before performing Nanostring gene expression profile. nCounter Breast Cancer 360 Panel (Nanostring Technologies) was used according to manufacturer's instructions. nSolver analysis software (Nanostring Technologies) was used to obtain normalized counts and to compare GEPs between cases and controls, considering as significant a Benjamini Yekutieli (BY) corrected p-value ≤0.05. Mann-Whitney median test was used to compare Ki67 score and Body Mass Index (BMI) between cases and controls.
Results
Out of 770 analyzed genes, none was significantly differentially expressed at BY p-value <0.05, probably due to the low number of cases. Five genes were differentially expressed with a BY p-value <0.1: CDKN1A (Log2 fold change -0.733, 95% CI: -1.06 − -0.409), GDF15 (Log2 fold change -1.92, 95% CI: -2.78 − -1.05), TFDP1 (Log2 fold change -0.567, 95% CI: -0.826 − -0.309) and ELF3 (Log2 fold change -1.52, 95%CI: -2.22 − -0.813) were downregulated in control patients, whereas TNFSF10 (Log2 fold change 1.27, 95% CI: 0.669 − 1.88) was upregulated. CDKN1A and TFDP1 are cell cycle regulators: the former encodes for p21, which inhibits cell cycle progression and is involved in DNA damage repair; the latter encodes a transcription factors that dimerizes with E2F, promoting cell cycle genes' transcription. GDF15 codes for a secreted ligand of the TGF-beta superfamily and acts as a pleiotropic cytokine involved in response to hypoxia, inflammation, acute injury and oxidative stress. ELF3 is a transcriptional activator involved in vascular inflammation and a critical downstream effector of HER2 pathway. TNFSF10 encodes a cytokine belonging to the TNF ligand family, inducing apoptosis in tumor cells. No differences were found between cases and controls considering Ki67 proliferation index and BMI.
Conclusions
Our preliminary results indicate that altered expression of genes involved in cell cycle, apoptosis, inflammation and stress response are involved in trastuzumab resistance. The validation of these results overall series is ongoing. The relations between GEPs and clinico-pathological features will be assessed.
Citation Format: Sara Ravaioli, Roberta Maltoni, Francesca Pirini, Michela Palleschi, William Balzi, Elisabetta Petracci, Giovanni Martinelli, Andrea Rocca, Sara Bravaccini. Impact of a multi-gene expression profile in predicting adjuvant trastuzumab outcome in HER2-positive breast cancer [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5295.
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Palleschi M, Maltoni R, Ravaioli S, Vagheggini A, Mannozzi F, Fanini F, Pirini F, Tumedei MM, Barzotti E, Cecconetto L, Sarti S, Manunta S, Possanzini P, Fedeli A, Curcio A, Altini M, De Giorgi U, Rocca A, Bravaccini S. Ki67 and PR in Patients Treated with CDK4/6 Inhibitors: A Real-World Experience. Diagnostics (Basel) 2020; 10:diagnostics10080573. [PMID: 32784518 PMCID: PMC7460222 DOI: 10.3390/diagnostics10080573] [Citation(s) in RCA: 8] [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: 07/03/2020] [Revised: 08/06/2020] [Accepted: 08/08/2020] [Indexed: 01/20/2023] Open
Abstract
CDK4/6 inhibitors (CDK4/6i) are recommended in patients with estrogen receptor (ER)-positive, HER2-negative advanced breast cancer (ABC). Up to now, no prognostic biomarkers have been identified in this setting. We retrospectively analyzed the expression of progesterone receptor (PR) and Ki67, assessed by immunohistochemistry, in 71 ABC patients treated with CDK4/6i and analyzed the impact of these markers on progression-free survival (PFS). The majority of patients 63/71 (88.7%) received palbociclib, 4 (5.6%) received ribociclib, and 4 (5.6%) received abemaciclib. A higher median value of Ki67 was observed in cases undergoing second-line treatment (p = 0.047), whereas the luminal B subtype was more prevalent (p = 0.005). In the univariate analysis of the first-line setting, luminal A subtype showed a trend towards a correlation with a longer PFS (p = 0.053). A higher continuous Ki67 value led to a significantly shorter PFS. When the interaction between pathological characteristics and line of treatment was considered, luminal B subtype showed a significantly (p = 0.043) worse outcome (Hazard Ratio (HR) 2.84; 1.03–7.82 95% Confidence Interval (CI)). PFS in patients undergoing endocrine therapy plus CDK4/6i was inversely correlated with Ki67 expression but not with PR, suggesting that tumor proliferation has a greater impact on cell cycle inhibitors combined with endocrine therapy than PR expression.
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Affiliation(s)
- Michela Palleschi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (M.P.); (R.M.); (A.V.); (F.M.); (F.F.); (F.P.); (M.M.T.); (E.B.); (L.C.); (S.S.); (S.M.); (A.F.); (M.A.); (U.D.G.); (A.R.); (S.B.)
| | - Roberta Maltoni
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (M.P.); (R.M.); (A.V.); (F.M.); (F.F.); (F.P.); (M.M.T.); (E.B.); (L.C.); (S.S.); (S.M.); (A.F.); (M.A.); (U.D.G.); (A.R.); (S.B.)
| | - Sara Ravaioli
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (M.P.); (R.M.); (A.V.); (F.M.); (F.F.); (F.P.); (M.M.T.); (E.B.); (L.C.); (S.S.); (S.M.); (A.F.); (M.A.); (U.D.G.); (A.R.); (S.B.)
- Correspondence: ; Tel.: +39-054-373-9978; Fax: +39-054-373-9221
| | - Alessandro Vagheggini
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (M.P.); (R.M.); (A.V.); (F.M.); (F.F.); (F.P.); (M.M.T.); (E.B.); (L.C.); (S.S.); (S.M.); (A.F.); (M.A.); (U.D.G.); (A.R.); (S.B.)
| | - Francesca Mannozzi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (M.P.); (R.M.); (A.V.); (F.M.); (F.F.); (F.P.); (M.M.T.); (E.B.); (L.C.); (S.S.); (S.M.); (A.F.); (M.A.); (U.D.G.); (A.R.); (S.B.)
| | - Francesca Fanini
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (M.P.); (R.M.); (A.V.); (F.M.); (F.F.); (F.P.); (M.M.T.); (E.B.); (L.C.); (S.S.); (S.M.); (A.F.); (M.A.); (U.D.G.); (A.R.); (S.B.)
| | - Francesca Pirini
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (M.P.); (R.M.); (A.V.); (F.M.); (F.F.); (F.P.); (M.M.T.); (E.B.); (L.C.); (S.S.); (S.M.); (A.F.); (M.A.); (U.D.G.); (A.R.); (S.B.)
| | - Maria Maddalena Tumedei
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (M.P.); (R.M.); (A.V.); (F.M.); (F.F.); (F.P.); (M.M.T.); (E.B.); (L.C.); (S.S.); (S.M.); (A.F.); (M.A.); (U.D.G.); (A.R.); (S.B.)
| | - Eleonora Barzotti
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (M.P.); (R.M.); (A.V.); (F.M.); (F.F.); (F.P.); (M.M.T.); (E.B.); (L.C.); (S.S.); (S.M.); (A.F.); (M.A.); (U.D.G.); (A.R.); (S.B.)
| | - Lorenzo Cecconetto
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (M.P.); (R.M.); (A.V.); (F.M.); (F.F.); (F.P.); (M.M.T.); (E.B.); (L.C.); (S.S.); (S.M.); (A.F.); (M.A.); (U.D.G.); (A.R.); (S.B.)
| | - Samanta Sarti
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (M.P.); (R.M.); (A.V.); (F.M.); (F.F.); (F.P.); (M.M.T.); (E.B.); (L.C.); (S.S.); (S.M.); (A.F.); (M.A.); (U.D.G.); (A.R.); (S.B.)
| | - Silvia Manunta
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (M.P.); (R.M.); (A.V.); (F.M.); (F.F.); (F.P.); (M.M.T.); (E.B.); (L.C.); (S.S.); (S.M.); (A.F.); (M.A.); (U.D.G.); (A.R.); (S.B.)
| | - Paola Possanzini
- Pathology Unit, Morgagni-Pierantoni Hospital, 47121 Forlì, Italy;
| | - Anna Fedeli
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (M.P.); (R.M.); (A.V.); (F.M.); (F.F.); (F.P.); (M.M.T.); (E.B.); (L.C.); (S.S.); (S.M.); (A.F.); (M.A.); (U.D.G.); (A.R.); (S.B.)
| | - Annalisa Curcio
- Breast Surgery Unit, Morgagni-Pierantoni Hospital, 47121 Forlì, Italy;
| | - Mattia Altini
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (M.P.); (R.M.); (A.V.); (F.M.); (F.F.); (F.P.); (M.M.T.); (E.B.); (L.C.); (S.S.); (S.M.); (A.F.); (M.A.); (U.D.G.); (A.R.); (S.B.)
| | - Ugo De Giorgi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (M.P.); (R.M.); (A.V.); (F.M.); (F.F.); (F.P.); (M.M.T.); (E.B.); (L.C.); (S.S.); (S.M.); (A.F.); (M.A.); (U.D.G.); (A.R.); (S.B.)
| | - Andrea Rocca
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (M.P.); (R.M.); (A.V.); (F.M.); (F.F.); (F.P.); (M.M.T.); (E.B.); (L.C.); (S.S.); (S.M.); (A.F.); (M.A.); (U.D.G.); (A.R.); (S.B.)
| | - Sara Bravaccini
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (M.P.); (R.M.); (A.V.); (F.M.); (F.F.); (F.P.); (M.M.T.); (E.B.); (L.C.); (S.S.); (S.M.); (A.F.); (M.A.); (U.D.G.); (A.R.); (S.B.)
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Maltoni R, Palleschi M, Ravaioli S, Tumedei MM, Rocca A, Melegari E, Altini M, Puccetti M, Manunta S, Bravaccini S. Cell-Free DNA Variant Sequencing Using CTC-Depleted Blood for Comprehensive Liquid Biopsy Testing in Metastatic Breast Cancer. Cell Transplant 2020; 29:963689720925057. [PMID: 32584148 PMCID: PMC7586254 DOI: 10.1177/0963689720925057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Keup and colleagues provide liquid biopsy preliminary results by sequencing variants in circulating tumor cells (CTCs) and cell-free deoxyribonucleic acid (cfDNA) “all from one tube” format, in order to use the same blood sample under the same isolation conditions of both analytes to reach an unbiased comparability and consistency. We appreciated the attempt of the authors to improve technical procedures in liquid biopsy research area, but we wanted to raise several issues related to cfDNA detection, reporting our research experience. This is a feasibility study as the authors analyzed only one sample from a small case series at an advanced line of treatment. In the clinical practice to monitor the disease and predict the treatment response, the analysis should be done at multiple time points. We have previously demonstrated that the quantity and the integrity of the cfDNA are not useful to determine the evolution of early breast cancer (bc), maybe due to the fact that cfDNA is not strictly related to cancer but also to an inflammatory status. Given that a high content of cfDNA could reflect inflammatory processes, we decided to investigate the role of stimulator of interferon gene (STING), an important regulator of cancer cell growth and senescence, in bc tissue in relation to cfDNA. STING biomarker analyzed by immunohistochemistry on tumor tissue could reflect a circulating inflammatory status and needs to be further investigated, not only on CTCs but also on cfDNA. One of the major issues of cfDNA is to decide what to analyze on it, in terms of type of cells and genetic alterations. Considering that multiple tests could be done to study gene copy number alterations, mutations, and variant fusions, the proper molecular test should be chosen, on the basis of the clinical need, starting from the treatment choice to disease monitoring.
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Affiliation(s)
- Roberta Maltoni
- Istituto Scientifico Romagnolo per Lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Michela Palleschi
- Istituto Scientifico Romagnolo per Lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Sara Ravaioli
- Istituto Scientifico Romagnolo per Lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Maria Maddalena Tumedei
- Istituto Scientifico Romagnolo per Lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Andrea Rocca
- Istituto Scientifico Romagnolo per Lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Elisabetta Melegari
- Istituto Scientifico Romagnolo per Lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Mattia Altini
- Istituto Scientifico Romagnolo per Lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | | | - Silvia Manunta
- Istituto Scientifico Romagnolo per Lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Sara Bravaccini
- Istituto Scientifico Romagnolo per Lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
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Maltoni R, Palleschi M, Gallerani G, Bravaccini S, Cecconetto L, Melegari E, Altini M, Rocca A. Impressive long-term response with chemo-endocrine therapy in a premenopausal patient with metastatic breast cancer: A case report. Medicine (Baltimore) 2020; 99:e20396. [PMID: 32541460 PMCID: PMC7302633 DOI: 10.1097/md.0000000000020396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Patients with, or who develop, metastatic breast cancer have a 5-year relative survival of about 25%. Endocrine therapy clearly improves outcomes in patients with estrogen receptor-positive breast cancer. In the metastatic setting, the primary goal of treatment is to maintain long-term disease control with good quality of life. Rarely, exceptional responders achieve durable disease control, and potential cures cannot be ruled out. PATIENT CONCERNS We report the case of a 39-year-old woman with primary breast cancer and associated synchronous bone metastases, who experienced a disease response of 12 years with hormonal therapy as maintenance after first line chemotherapy, with a good toxicity profile. DIAGNOSIS The patient was diagnosed with estrogen receptor + human epidermal growth factor receptor 2 (HER2)- metastatic breast cancer with synchronous bone metastases. INTERVENTIONS This patient was treated with chemotherapy for 6 cycles as a first-line therapy following by endocrine treatment given as a maintenance therapy. OUTCOMES Our patient experienced a progression-free survival >12 years with an exceptionally good quality of life. LESSONS Our anecdotal experience highlights the existence of exceptional responders among patients with hormone receptor-positive metastatic breast cancer, who achieve clinical remission and durable disease control with endocrine therapy. Being able to identify these patients could help in the selection of the best treatment option among the many available.
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Ravaioli S, Rocca A, Pirini F, De Matteis S, Fanini F, Tumedei MM, Maltoni R, Michela P, Martinelli G, Bravaccini S. Presence of human papillomavirus DNA in breast cancer patients: SERUM and tissue analysis. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e12582] [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
e12582 Background: It has been demonstrated an increased risk of breast cancer (BC) incidence in patients with previous cervical dysplasia, suggesting a role of human papillomavirus (HPV) of cervical lesions in the development of BC. Although, the origin of HPV spreading to the mammary gland and its mechanism of dissemination is not clear. Methods: Seven serum samples from healthy donors and 58 from early BC patients collected pre-surgery were analyzed for the presence of HPV DNA. For 49/58 patients HPV DNA was analyzed also on the primary tumor tissue. 17 patients had luminal A BC (4 relapsed, 13 non relapsed), 16 had luminal B BC (5 relapsed, 11 non relapsed), 13 had triple-negative BC (6 relapsed, 7 non relapsed), 12 had HER2-positive BC (4 relapsed, 8 non relapsed). Circulating DNA was extracted from 500 μl of serum by Qiamp DNA Mini kit (Qiagen, Milan, Italy) and tumor DNA was extracted from at least four 10-micron sections by QIAamp DNA FFPE Tissue Kit (Qiagen, Milan, Italy). Circulating HPV DNA was amplified by a multiplex PCR with HPV E6 or E7 gene-specific primers and the sequence was assessed by a high-throughput MALDI-TOF mass spectrometry-based method. Results: HPV DNA was detected in only 5 serum of BC patients and in none of the healthy controls. 4/5 BC cases had high-risk HPV DNA (type 39,45,52,59) and 1 had type 73 low-risk HPV DNA. 4/5 HPV DNA-positive patients had previously low-grade cervical intraepithelial neoplasia (CIN I) detected by Pap smear. These 5 patients with circulating HPV DNA did not show HPV positivity in the BC tissue. 2 out of 49 cases were positive for universal HPV DNA sequence in tissue and only 1 case showed HPV type 51. No relation was found between HPV infection and tumor subtype or prognosis, neither for HPV DNA positivity between serum and tissue. Conclusions: Our data support the feasibility of HPV DNA detection by liquid biopsy in BC. The presence of circulating HPV could be due to a viral spread from other organs. More data are needed to establish the role of circulating HPV DNA and its potential association with HPV infection of the breast and/or of the cervix. [Table: see text]
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Affiliation(s)
- Sara Ravaioli
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Andrea Rocca
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Francesca Pirini
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Serena De Matteis
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Francesca Fanini
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Maria Maddalena Tumedei
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Roberta Maltoni
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Palleschi Michela
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Giovanni Martinelli
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Sara Bravaccini
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
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Maltoni R, Palleschi M, Altini M, Massa I, Balzi W, Ravaioli S, Tumedei MM, Rocca A, Bravaccini S. Are BMI and Negative Hormone Receptors Prognostic Factors in HER2 + Early-stage Breast Cancer? Clin Breast Cancer 2020; 20:359-360. [PMID: 32201162 DOI: 10.1016/j.clbc.2020.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/09/2020] [Accepted: 01/21/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Roberta Maltoni
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola, Italy.
| | - Michela Palleschi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola, Italy
| | - Mattia Altini
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola, Italy
| | - Ilaria Massa
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola, Italy
| | - William Balzi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola, Italy
| | - Sara Ravaioli
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola, Italy
| | - Maria Maddalena Tumedei
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola, Italy
| | - Andrea Rocca
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola, Italy
| | - Sara Bravaccini
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola, Italy
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Gennari A, Foca F, Zamarchi R, Rocca A, Amadori D, De Censi A, Bologna A, Cavanna L, Gianni L, Scaltriti L, Rossi E, Facchinetti A, Martini V, Bruzzi P, Nanni O. Insulin-like growth factor-1 receptor (IGF-1R) expression on circulating tumor cells (CTCs) and metastatic breast cancer outcome: results from the TransMYME trial. Breast Cancer Res Treat 2020; 181:61-68. [PMID: 32200486 DOI: 10.1007/s10549-020-05596-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 03/12/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate the prognostic value of IGF-1R expression on circulating tumor cells (CTCs) in a prospective randomized clinical trial comparing chemotherapy plus metformin with chemotherapy alone in metastatic breast cancer (MBC) patients. METHODS CTCs were collected at baseline and at the end of chemotherapy. An automated sample preparation and analysis system (CellSearch) were customized for detecting IGF-1R expression. The prognostic role of CTC count and IGF-1R was assessed for PFS and OS by univariate and multivariate analyses. RESULTS Seventy-two out of 126 randomized patients were evaluated: 57% had ≥ 1 IGF-1R positive CTC and 37.5% ≥ 4 IGF-1R negative cells; 42% had CTC count ≥ 5/7.5 ml. At univariate analysis, the number of IGF-1R negative CTCs was strongly associated with risk of progression and death: HR 1.93 (P = 0.013) and 3.65 (P = 0.001), respectively; no association was detected between number of IGF-1R positive CTCs and PFS or OS (P = 0.322 and P = 0.840). The prognostic role of CTC count was confirmed: HR 1.69, P = 0.042 for PFS and HR 2.80 for OS, P = 0.002. By multivariate analysis, the prognostic role of the number of IGF-1R negative CTCs was maintained, while no residual prognostic role of CTC count or number of IGF-1R positive cells was found. CONCLUSION Loss of IGF-1R in CTCs is associated with a significantly worse outcome in MBC patients. This finding supports further evaluation for the role of IGF-1R on CTCs to improve patient stratification and to implement new targeted strategies. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov (NCT01885013); European Clinical Trials Database (EudraCT No.2009-014,662-26).
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Affiliation(s)
- Alessandra Gennari
- Medical Oncology, Department of Translational Medicine, University of Eastern Piedmont, Via Solaroli 17, 28100, Novara, Italy.
| | - Flavia Foca
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Rita Zamarchi
- Department of Immunology and Oncological Molecular Diagnostics, Veneto Institute of Oncology (IOV) IRCCS, Padua, Italy
| | - Andrea Rocca
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Dino Amadori
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Andrea De Censi
- Division of Medical Oncology, EO Ospedali Galliera, Genoa, Italy
| | - Alessandra Bologna
- Department of Oncology, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy
| | - Luigi Cavanna
- Oncology-Hematology Department, Hospital of Piacenza, Piacenza, Italy
| | - Lorenzo Gianni
- Department of Medical Oncology, Ospedale Infermi, Rimini, Italy
| | - Laura Scaltriti
- Oncology Day Hospital Unit, Ospedale Civile Di Guastalla, Guastalla, Italy
| | - Elisabetta Rossi
- Department of Immunology and Oncological Molecular Diagnostics, Veneto Institute of Oncology (IOV) IRCCS, Padua, Italy.,Department of Surgery, Oncology and Gastroenterology, University of Paduva, Paduva, Italy
| | - Antonella Facchinetti
- Department of Immunology and Oncological Molecular Diagnostics, Veneto Institute of Oncology (IOV) IRCCS, Padua, Italy.,Department of Surgery, Oncology and Gastroenterology, University of Paduva, Paduva, Italy
| | - Veronica Martini
- Medical Oncology, Department of Translational Medicine, University of Eastern Piedmont, Via Solaroli 17, 28100, Novara, Italy
| | - Paolo Bruzzi
- Department of Clinical Epidemiology, IRCCS San Martino - IST, Genoa, Italy
| | - Oriana Nanni
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
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Bravaccini S, Bronte G, Scarpi E, Ravaioli S, Maltoni R, Mangia A, Tumedei MM, Puccetti M, Serra P, Gianni L, Amaducci L, Biglia N, Bounous V, Paradiso AV, Silvestrini R, Amadori D, Rocca A. The impact of progesterone receptor expression on prognosis of patients with rapidly proliferating, hormone receptor-positive early breast cancer: a post hoc analysis of the IBIS 3 trial. Ther Adv Med Oncol 2020; 12:1758835919888999. [PMID: 32158505 PMCID: PMC7047424 DOI: 10.1177/1758835919888999] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 10/17/2019] [Indexed: 12/29/2022] Open
Abstract
Background In the Italian Breast Cancer Intergroup Studies (IBIS) 3 phase III trial, we compared cyclophosphamide, methotrexate, 5-fluorouracil (CMF) alone to sequential epirubicin/CMF regimens in patients with rapidly proliferating early breast cancer (RPEBC). We performed a post hoc analysis in the subgroup of patients with hormone-receptor-positive RPEBC on the prognostic role of progesterone receptor (PgR) status. Methods RPEBC was defined by thymidine labeling index (TLI) >3% or grade 3 or S-phase >10% or Ki67 >20%. We analyzed 466 patients with hormone-receptor-positive RPEBC receiving sequential epirubicin/CMF regimens followed by tamoxifen, and for whom the status of ER and PgR was available. Results Considering both cut-off values of 10% and 20%, PgR expression was significantly associated with age, menopausal status, and ER expression; HER2 status was associated with PgR status only at a cutoff value of 20% PgR. Upon univariate analysis, tumor size, nodal status, and PgR were significantly associated with disease-free survival (DFS) and overall survival (OS), while age class and local treatment type were associated only with DFS. Patients with PgR <20% showed lower 5- and 10-year DFS [hazard ratio (HR) = 1.48; 95%CI: 1.01-2.18; p = 0.044] and OS (HR = 1.85; 95%CI: 1.08-3.19, p = 0.025) rates compared with patients with PgR ⩾20%. Upon multivariate analysis, only tumor size, nodal status, and PgR were independent prognostic factors. Conclusions Our results highlight the independent prognostic relevance of PgR expression in patients with hormone-receptor-positive RPEBC treated with adjuvant chemotherapy and endocrine therapy, where the definition of prognostic subgroups is still a major need.
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Affiliation(s)
- Sara Bravaccini
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy
| | - Giuseppe Bronte
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy
| | - Emanuela Scarpi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, 47014, Italy
| | - Sara Ravaioli
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy
| | - Roberta Maltoni
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy
| | - Anita Mangia
- Functional Biomorphology Laboratory, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Maria Maddalena Tumedei
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy
| | | | - Patrizia Serra
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy
| | - Lorenzo Gianni
- Department of Medical Oncology, Infermi Hospital, Rimini, Italy
| | - Laura Amaducci
- Department of Onco-hematology, Faenza Hospital, Faenza (RA), Italy
| | - Nicoletta Biglia
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, Umberto I Hospital, School of Medicine, University of Torino, Torino, Italy
| | - Valentina Bounous
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, Umberto I Hospital, School of Medicine, University of Torino, Torino, Italy
| | - Angelo Virgilio Paradiso
- Institutional BioBank, Experimental Oncology and Biobank Management Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | | | - Dino Amadori
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy
| | - Andrea Rocca
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy
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Rocca A, Ravaioli S, Fonzi E, Barozzi I, Perone Y, Magnani L, Pirini F, Martinelli G, Bravaccini S. Abstract P4-07-06: Breast cancer subtype classification using NanoString and RNAseq technologies. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p4-07-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Immunohistochemistry (IHC) is conventionally used in clinical practice to define Breast Cancer (BC) subtypes, while PAM50 is useful in specific cases. The former is partly subjective and semi-quantitative, the latter is based on gene expression profile. We compared gene expression data obtained by NanoString BC 360™ panel with those obtained by RNAseq on 12 Formalin-Fixed Paraffin-Embedded (FFPE) BC samples.
Methods: RNA was isolated from FFPE tumors and the quality was checked before performing NanoString BC 360™ assay and preparing RNAseq library (NEBNext Ultra II RNA Library Prep Kit, Illumina) following the manufacturers’ instructions. Libraries were sequenced on NextSeq500 (Illumina). Reads were aligned using Kallisto and raw read counts were normalized as Transcripts Per Million (TPM). PAM50 and Tumor Inflammation Signature (TIS) were determined on NanoString data. Two-sided t-test on TPM and on normalized NanoString counts was used to compare luminal and Triple Negative (TN) BCs (p <0.05 statistically significant), considering the 734 genes shared by the 2 assays. Deseq2 (1.22.1) was used to perform a differential gene expression analysis on raw RNAseq counts. Enrichment tests were performed on KEGG pathways (FDR < 0.05). Python and R softwares were used for statistical analyses.
Results: Of the 12 BC samples, 3 were luminal A-like, 3 luminal B (HER2+)-like and 6 TN by IHC (Table 1). Pearson’s correlation coefficient between NanoString counts and RNAseq TPM was 0.72.
Out of the 734 genes shared by both methods, those differentially expressed between luminal and TN BCs, defined based on IHC, were 135 according to RNAseq TPM, 155 according to NanoString counts and 88 according to both methods. These 88 genes belonged to “cell cycle”, “pathways in cancer”, “HIF-1 signaling”, “progesterone-mediated oocyte maturation”, “prostate cancer” and “basal cell carcinoma” KEGG pathways.
When considering the whole transcriptome analyzed by RNAseq, the differential gene expression analysis between luminal and TN/basal BCs was performed according to both IHC and PAM50 classifications. Considering the former, there were 1143 differentially expressed genes out of a total of 20936 (5.5%) and the pathways involved were “fatty acid elongation”, “cell cycle”, “oocyte meiosis”, “p53 signaling” and “alcoholism”. The analysis on the latter classification showed 1608 differentially expressed genes out of 21048 (7.6%), and the enriched pathways were “cell cycle”, “p53 signaling”, “DNA replication”, “alcoholism” and “systemic lupus erythematosus”.
Regarding the TIS, no significant differences were found between TN/basal and luminal BCs, comparing both IHC and the PAM50 subtypes. An expected heterogeneity was found among TNBCs, that showed 3 distinct signatures: basal-like immune activated, basal-like immune-suppressed and luminal androgen receptor.
Conclusions: This preliminary analysis shows a good concordance between NanoString and RNAseq data. The choice of the method must take into account important factors such as the costs, the number of genes analyzed, the requirement of bioinformatic support, the working time. Further analyses on pathway enrichment will be presented.
Table 1. Breast cancer samples characteristics.Sample ID Age Grade T N IHC subtype PAM50 Subtype TIS scoreTNBC signature 0172222aLumALumB7,0NA026031c2aTNBasal7,2BLIA037221cxTNLumA7,4LAR045231c0LumALumA7,5NA053531c1aTNBasal5,5BLIS0675320TNBasal6,2BLIS077931cxLumB HER2+LumB6,7NA0878220LumALumB7,7NA097431a2aTNBasal8,5BLIA106031c1LumB HER2+LumA8,2NA116621b0LumB HER2+LumA6,1NA1241321aTNBasal7,5BLIATIS: Tumor Inflammation Signature; BLIA: Basal-like Immune Activated; BLIS: Basal-like Immune-Suppressed; LAR: Luminal Androgen Receptor.
Citation Format: Andrea Rocca, Sara Ravaioli, Eugenio Fonzi, Iros Barozzi, Ylenia Perone, Luca Magnani, Francesca Pirini, Giovanni Martinelli, Sara Bravaccini. Breast cancer subtype classification using NanoString and RNAseq technologies [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P4-07-06.
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Affiliation(s)
- Andrea Rocca
- 1Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Sara Ravaioli
- 1Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Eugenio Fonzi
- 1Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Iros Barozzi
- 2Department of Surgery and Cancer, The Imperial Centre for Translational and Experimental Medicine, Imperial College London, London, United Kingdom
| | - Ylenia Perone
- 2Department of Surgery and Cancer, The Imperial Centre for Translational and Experimental Medicine, Imperial College London, London, United Kingdom
| | - Luca Magnani
- 2Department of Surgery and Cancer, The Imperial Centre for Translational and Experimental Medicine, Imperial College London, London, United Kingdom
| | - Francesca Pirini
- 1Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Giovanni Martinelli
- 1Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Sara Bravaccini
- 1Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
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Palleschi M, Maltoni R, Barzotti E, Melegari E, Curcio A, Cecconetto L, Sarti S, Manunta S, Rocca A. Can cyclin-dependent kinase 4/6 inhibitors convert inoperable breast cancer relapse to operability? A case report. World J Clin Cases 2020; 8:517-521. [PMID: 32110660 PMCID: PMC7031833 DOI: 10.12998/wjcc.v8.i3.517] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 01/09/2020] [Accepted: 01/14/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pathological complete response (pCR) is rare in hormone receptor-positive (HR+) HER2-negative breast cancer (BC) treated with either endocrine therapy (ET) or chemotherapy. Radical resection of locoregional relapse, although potentially curative in some cases, is challenging when the tumor invades critical structures. The oral cyclin-dependent kinase 4/6 inhibitor palbociclib in combination with ET has obtained a significant increase in objective response rates and progression-free survival in patients with advanced BC and is now being evaluated in the neoadjuvant setting. We present a clinical case of a patient with an inoperable locoregional relapse of HR+ HER2-negative BC who experienced pCR after treatment with palbociclib.
CASE SUMMARY We report the clinical case of a 60-year-old patient who presented with an inoperable locoregional relapse of HR+, HER2-negative BC 10 years after the diagnosis of the primary tumor. During a routine follow-up visit, breast magnetic resonance imaging and positron emission tomography/computed tomography revealed a 4-cm lesion in the right subclavicular region, infiltrating the chest wall and extending to the subclavian vessels, but without bone or visceral involvement. Treatment was begun with palbociclib plus letrozole, converting the disease to operability over a period of 6 mo. Surgery was performed and a pCR achieved. Of note, during treatment the patient experienced a very uncommon toxicity characterized by burning tongue and glossodynia associated with dysgeusia, paresthesia, dysesthesia, and xerostomia. A reduction in the dose of palbociclib did not provide relief and treatment with the inhibitor was thus discontinued, resolving the tongue symptoms. Laboratory exams were unremarkable. Given that this was a late relapse, the tumor was classified as endocrine-sensitive, a condition associated with high sensitivity to palbociclib.
CONCLUSION This case highlights the potential of the cyclin-dependent kinase 4/6 inhibitor plus ET combination to achieve pCR in locoregional relapse of BC, enabling surgical resection of a lesion initially considered inoperable.
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Affiliation(s)
- Michela Palleschi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola 47014, Italy
| | - Roberta Maltoni
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola 47014, Italy
| | - Eleonora Barzotti
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola 47014, Italy
| | - Elisabetta Melegari
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola 47014, Italy
| | - Annalisa Curcio
- Breast Surgery Unit, Ospedale Morgagni-Pierantoni, Forlì 47121, Italy
| | - Lorenzo Cecconetto
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola 47014, Italy
| | - Samanta Sarti
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola 47014, Italy
| | - Silvia Manunta
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola 47014, Italy
| | - Andrea Rocca
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola 47014, Italy
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Affiliation(s)
- Andrea Rocca
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Elisabetta Melegari
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Michela Palleschi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
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Palleschi M, Maltoni R, Sarti S, Melegari E, Bravaccini S, Rocca A. Immunotherapy: The end of the "dark age" for metastatic triple-negative breast cancer? Breast J 2019; 26:739-742. [PMID: 31612573 DOI: 10.1111/tbj.13662] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 08/16/2019] [Revised: 09/20/2019] [Accepted: 09/24/2019] [Indexed: 01/10/2023]
Abstract
The lack of effective therapies for metastatic triple-negative breast cancer (mTNBC) highlights the need for the development of novel treatment strategies. The cornerstone of treatment has long been represented by chemotherapy. Relevant evidence has recently emerged regarding the efficacy of immune checkpoint inhibitors, with the demonstration of a statistically significant improvement of progression-free survival with the addition of atezolizumab to nab-paclitaxel in the first-line treatment of mTNBC, accompanied by a substantial overall survival benefit in the PD-L1-positive subgroup. Despite this, it is necessary to identify the biomarkers that could allow a better selection of patients and combination regimens.
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Affiliation(s)
- Michela Palleschi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Roberta Maltoni
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Samanta Sarti
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Elisabetta Melegari
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Sara Bravaccini
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Andrea Rocca
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
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Hong SP, Chan TE, Lombardo Y, Corleone G, Rotmensz N, Bravaccini S, Rocca A, Pruneri G, McEwen KR, Coombes RC, Barozzi I, Magnani L. Single-cell transcriptomics reveals multi-step adaptations to endocrine therapy. Nat Commun 2019; 10:3840. [PMID: 31477698 PMCID: PMC6718416 DOI: 10.1038/s41467-019-11721-9] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 07/30/2019] [Indexed: 02/07/2023] Open
Abstract
Resistant tumours are thought to arise from the action of Darwinian selection on genetically heterogenous cancer cell populations. However, simple clonal selection is inadequate to describe the late relapses often characterising luminal breast cancers treated with endocrine therapy (ET), suggesting a more complex interplay between genetic and non-genetic factors. Here, we dissect the contributions of clonal genetic diversity and transcriptional plasticity during the early and late phases of ET at single-cell resolution. Using single-cell RNA-sequencing and imaging we disentangle the transcriptional variability of plastic cells and define a rare subpopulation of pre-adapted (PA) cells which undergoes further transcriptomic reprogramming and copy number changes to acquire full resistance. We find evidence for sub-clonal expression of a PA signature in primary tumours and for dominant expression in clustered circulating tumour cells. We propose a multi-step model for ET resistance development and advocate the use of stage-specific biomarkers.
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Affiliation(s)
- Sung Pil Hong
- Department of Surgery and Cancer, Imperial College London, London, UK.
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
| | - Thalia E Chan
- Centre for Integrative Systems Biology and Bioinformatics, Department of Life Sciences, Imperial College London, London, UK
| | - Ylenia Lombardo
- Department of Surgery and Cancer, Imperial College London, London, UK
- Nature Communications, The Macmillan Campus, 4 Crinan Street, London, N1 9XW, UK
| | - Giacomo Corleone
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Nicole Rotmensz
- Division of Pathology, European Institute of Oncology and University of Milan, School of Medicine, Milan, Italy
| | - Sara Bravaccini
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Andrea Rocca
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Giancarlo Pruneri
- Division of Pathology, European Institute of Oncology and University of Milan, School of Medicine, Milan, Italy
| | - Kirsten R McEwen
- Centre for Integrative Systems Biology and Bioinformatics, Department of Life Sciences, Imperial College London, London, UK
| | - R Charles Coombes
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Iros Barozzi
- Department of Surgery and Cancer, Imperial College London, London, UK.
| | - Luca Magnani
- Department of Surgery and Cancer, Imperial College London, London, UK.
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Rocca A, Melegari E, Palleschi M. Precision medicine: PI3K targeting in advanced breast cancer. Breast Cancer Res Treat 2019; 178:479. [PMID: 31428907 DOI: 10.1007/s10549-019-05409-3] [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] [Received: 08/06/2019] [Accepted: 08/12/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Andrea Rocca
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy.
| | - Elisabetta Melegari
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Michela Palleschi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
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Ravaioli S, Pirini F, Rocca A, Puccetti M, Bonafè M, Martinelli G, Bravaccini S. Abstract 5255: Breast cancer subtype classification using a multi-gene expression profile. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-5255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Immunohistochemistry (IHC) is the method conventionally used in clinical practice to define breast cancer (BC) subtypes. This technique is subjective and semi-quantitative. Molecular approaches like multigene panels are increasingly used in clinical practice for their reliability and accuracy. This preliminary study was performed to assess the applicability of the NanoString Breast Cancer 360™ panel, which analyze 770 transcripts of genes involved in a number of signatures useful to define the molecular subtype. We evaluated the correlation between the gene expression levels with the IHC values of conventional biomarkers on 12 BC formalin-fixed paraffin-embedded (FFPE) samples.
Methods: Immunostaining was performed by using Ventana Benchmark Ultra system. Anti-ER, -PR, -Ki67 and -HER2 Ventana antibodies were used. Tumors were classified according to the most recent St. Gallen classification. RNA was isolated from FFPE tumor with AllPrep DNA/RNA FFPE Kit and quantified by Nanodrop. The Breast Cancer 360™ panel assay was performed according to manufacturer’s instructions. The normalized count for each gene analyzed using nSolver analysis software was compared with the respective IHC biomarker status by Mann-Whitney test to assess the correlation between the two methods. The mean mRNA count was compared between luminal and triple negative BC by unpaired T test. All statistical analyses were performed by Graphpad Prism software 5.
Results: The 12 BC samples were classified in 3 luminal A, 3 luminal B (HER2+) and 6 triple negative tumors by IHC. The expression level of ESR1, PGR, MKI67 and ERBB2 genes showed a statistically significant correlation with the corresponding protein expression (p=0.0022, p=0.0054, p=0.0025 and p=0.0091, respectively).
A significant difference in the expression levels of ERBB2 gene between HER2+ and HER2- BC was observed (mean mRNA counts 16848 vs 1307, p=0,035). Furthermore, ESR1 expression was significantly higher in ER+ than in ER- BC (mean mRNA counts 9105 vs 195, p=0,021). We also evaluated the differential expression between luminal and triple negative BC for AR, EGFR, HIF1A, MKI67, MYC, NOTCH1, RAD51 genes. The expression levels for all these genes were significantly higher in triple negative cases than luminal BC, except for AR that was higher in luminal tumors (p<0.05).
Conclusions: In this study Breast Cancer 360™ panel showed high concordance with IHC data. We are aware that our preliminary results require validation in a larger case series to establish the real value of this multi-gene expression profile in BC. However, our results highlight the potential of this molecular approach to properly identify tumor subtypes, allowing a better management of BC patients.
Citation Format: Sara Ravaioli, Francesca Pirini, Andrea Rocca, Maurizio Puccetti, Massimiliano Bonafè, Giovanni Martinelli, Sara Bravaccini. Breast cancer subtype classification using a multi-gene expression profile [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 5255.
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Affiliation(s)
- Sara Ravaioli
- 1Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Francesca Pirini
- 1Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Andrea Rocca
- 1Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | | | - Massimiliano Bonafè
- 1Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Giovanni Martinelli
- 1Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Sara Bravaccini
- 1Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
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Pietri E, Massa I, Bravaccini S, Ravaioli S, Tumedei MM, Petracci E, Donati C, Schirone A, Piacentini F, Gianni L, Nicolini M, Campadelli E, Gennari A, Saba A, Campi B, Valmorri L, Andreis D, Fabbri F, Amadori D, Rocca A. Phase II Study of Dehydroepiandrosterone in Androgen Receptor-Positive Metastatic Breast Cancer. Oncologist 2019; 24:743-e205. [PMID: 30591548 PMCID: PMC6656524 DOI: 10.1634/theoncologist.2018-0243] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 10/28/2018] [Indexed: 12/02/2022] Open
Abstract
LESSONS LEARNED The androgen receptor (AR) is present in most breast cancers (BC), but its exploitation as a therapeutic target has been limited.This study explored the activity of dehydroepiandrosterone (DHEA), a precursor being transformed into androgens within BC cells, in combination with an aromatase inhibitor (to block DHEA conversion into estrogens), in a two-stage phase II study in patients with AR-positive/estrogen receptor-positive/human epidermal growth receptor 2-negative metastatic BC.Although well tolerated, only 1 of 12 patients obtained a prolonged clinical benefit, and the study was closed after its first stage for poor activity. BACKGROUND Androgen receptors (AR) are expressed in most breast cancers, and AR-agonists have some activity in these neoplasms. We investigated the safety and activity of the androgen precursor dehydroepiandrosterone (DHEA) in combination with an aromatase inhibitor (AI) in patients with AR-positive metastatic breast cancer (MBC). METHODS A two-stage phase II study was conducted in two patient cohorts, one with estrogen receptor (ER)-positive (resistant to AIs) and the other with triple-negative MBC. DHEA 100 mg/day was administered orally. The combination with an AI aimed to prevent the conversion of DHEA into estrogens. The main endpoint was the clinical benefit rate. The triple-negative cohort was closed early. RESULTS Twelve patients with ER-positive MBC were enrolled. DHEA-related adverse events, reported in four patients, included grade 2 fatigue, erythema, and transaminitis, and grade 1 drowsiness and musculoskeletal pain. Clinical benefit was observed in one patient with ER-positive disease whose tumor had AR gene amplification. There was wide inter- and intra-patient variation in serum levels of DHEA and its metabolites. CONCLUSION DHEA showed excellent safety but poor activity in MBC. Although dose and patient selection could be improved, high serum level variability may hamper further DHEA development in this setting.
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Affiliation(s)
- Elisabetta Pietri
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Ilaria Massa
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Sara Bravaccini
- Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Sara Ravaioli
- Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Maria Maddalena Tumedei
- Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Elisabetta Petracci
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Caterina Donati
- Oncology Pharmacy Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Alessio Schirone
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Federico Piacentini
- Division of Medical Oncology, Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena, Modena, Italy
| | | | - Mario Nicolini
- Oncology Day Hospital Unit, Cervesi Hospital, Cattolica, Italy
| | | | - Alessandra Gennari
- Medical Oncology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Alessandro Saba
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Beatrice Campi
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Linda Valmorri
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Daniele Andreis
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Francesco Fabbri
- Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Dino Amadori
- Department of Medical Oncology, 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
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Bravaccini S, Bronte G, Scarpi E, Ravaioli S, Tumedei MM, Maltoni R, Puccetti M, Mangia A, Amadori D, Rocca A. The prognostic role of progesterone receptor in patients with rapidly proliferating, hormone receptor-positive early breast cancer. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.545] [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
545 Background: The prognostic role of progesterone receptor (PgR) in highly proliferating early breast cancer (BC) is not well established. We retrospectively explored this biomarker in a cohort of patients with highly proliferating tumors enrolled in a phase III trial of adjuvant therapy. Methods: 1066 patients with N- or 1-3 N+ BC were randomized to receive: epirubicin followed by CMF, CMF followed by epirubicin, or CMF alone. Rapidly proliferating tumors were defined by thymidine labeling index (TLI) > 3% or histological grade 3 or S-phase > 10% or Ki67 > 20%. We analyze the subgroup of 466 patients with hormone receptor (HR)-positive tumors treated with sequential epirubicin/CMF regimens followed by tamoxifen and for whom immunohistochemical assessments of estrogen receptor (ER), PgR, HER2 and Ki67 were available. Disease-free (DFS) and overall survival (OS) curves were built with the Kaplan–Meier estimator and compared by logrank test and Cox regression models. Results: PgR expression was significantly associated with ER expression, HER2 status, age and menopausal status, but not with Ki67, tumor size and nodal status. PgR cutoff values of 10% and 20% were chosen based on a Receiver Operating Characteristics analysis and the literature data. DFS and OS figures at 5 and 10 years, as well as the relative hazard ratios, according to the different PgR cutoff values, are reported in the table. Conclusions: Our results confirm the prognostic relevance of PgR expression in a cohort of patients with highly proliferating, HR-positive early BC treated with adjuvant chemotherapy and endocrine therapy. [Table: see text]
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Affiliation(s)
- Sara Bravaccini
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Giuseppe Bronte
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Emanuela Scarpi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Sara Ravaioli
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Maria Maddalena Tumedei
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Roberta Maltoni
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | | | - Anita Mangia
- IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Dino Amadori
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Andrea Rocca
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
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Bravaccini S, Ravaioli S, Rocca A, Tumedei MM, Bucchi E, Malmesi M, Medri L, Bonafè M, Puccetti M. Abstract P4-02-10: Are fine-needle aspiration (FNA)-derived cell blocks a useful tissue sample surrogate for testing conventional biomarkers and PD-L1 in breast cancer? Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p4-02-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background The diagnosis of breast cancer (BC) is based on clinical examination in combination with imaging and confirmed by pathological assessment of core needle biopsy (CNB) or fine needle aspiration (FNA). The biological profile of the lesion is needed to define prognosis and guide therapy. Given the importance of an early and minimally invasive diagnosis, we aimed to verify whether the biological features detected in FNA-derived cytological material reflect the biological characteristics of surgical specimens.
Methods We used immunohistochemistry and fluorescence in situ hybridization (FISH) to study a panel of biomarkers (ER, PgR, Ki67 and HER2 in 93 patients, programmed death-ligand 1 (PD-L1) in 20 patients) in FNA-derived cell blocks of BC, comparing the results with those obtained on the histological specimens.Immunostaining was performed with the Ventana Benchmark XT system and the Ultraview DAB Detection Kit (Ventana Medical Systems). Confirm anti-ER (clone SP1, Ventana), Confirm Anti-PgR (clone 1E2, Ventana) and Ki67 (clone Mib-1, Dako, Carpinteria, CA, US) antibodies were used. Ventana PD-L1 (SP263) assay (Ventana Medical Systems) was used for PD-L1 immunostaining. HER2 status was analyzed by FISH using PathVysion kit (Abbott Molecular, Abbott Park, Illinois, IL, USA).
Results Median immunopositive values of ER, PgR Ki67, and PD-L1 were similar in cell blocks and surgical samples. Concordance for ER and PgR between FNA and histological samples was 98% and 84%, respectively. With regard to Ki67 and HER2 status, concordance between the two specimen types was 90% and 96%, respectively. PD-L1 expression analyzed in FNA-derived samples was 100% concordant with that of surgical specimens. Tumor subtype classification for triple-negative and HER2-positive tumors in FNA samples was always concordant with the subtype determined in surgical material.
Table 1.Concordance of tumor subtype classification between FNAB-derived and histological samples.Overall series (n=93)87%Luminal A (n=26)81%Luminal B (n=47)86%HER2-positive (n=6)100%Triple-negative (n=14)100%
Conclusions We showed that biological marker determination in FNA-derived cell blocks is feasible and provides useful information and comparable results with those obtained by histological evaluation. Given the low cost of the procedure and its minimal impact on patients, that cytological samples could be used as an alternative to tissue samples for early BC biomarker evaluation to facilitate the planning of tailored neoadjuvant therapy.
Citation Format: Bravaccini S, Ravaioli S, Rocca A, Tumedei MM, Bucchi E, Malmesi M, Medri L, Bonafè M, Puccetti M. Are fine-needle aspiration (FNA)-derived cell blocks a useful tissue sample surrogate for testing conventional biomarkers and PD-L1 in breast cancer? [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-02-10.
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Affiliation(s)
- S Bravaccini
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy; Santa Maria delle Croci Hospital, Ravenna, Italy; Morgagni-Pierantoni Hospital, Forlì, FC, Italy; Alma Mater Studiorum, University of Bologna, Bologna, Italy; Imola Hospital, Imola, Italy
| | - S Ravaioli
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy; Santa Maria delle Croci Hospital, Ravenna, Italy; Morgagni-Pierantoni Hospital, Forlì, FC, Italy; Alma Mater Studiorum, University of Bologna, Bologna, Italy; Imola Hospital, Imola, Italy
| | - A Rocca
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy; Santa Maria delle Croci Hospital, Ravenna, Italy; Morgagni-Pierantoni Hospital, Forlì, FC, Italy; Alma Mater Studiorum, University of Bologna, Bologna, Italy; Imola Hospital, Imola, Italy
| | - MM Tumedei
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy; Santa Maria delle Croci Hospital, Ravenna, Italy; Morgagni-Pierantoni Hospital, Forlì, FC, Italy; Alma Mater Studiorum, University of Bologna, Bologna, Italy; Imola Hospital, Imola, Italy
| | - E Bucchi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy; Santa Maria delle Croci Hospital, Ravenna, Italy; Morgagni-Pierantoni Hospital, Forlì, FC, Italy; Alma Mater Studiorum, University of Bologna, Bologna, Italy; Imola Hospital, Imola, Italy
| | - M Malmesi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy; Santa Maria delle Croci Hospital, Ravenna, Italy; Morgagni-Pierantoni Hospital, Forlì, FC, Italy; Alma Mater Studiorum, University of Bologna, Bologna, Italy; Imola Hospital, Imola, Italy
| | - L Medri
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy; Santa Maria delle Croci Hospital, Ravenna, Italy; Morgagni-Pierantoni Hospital, Forlì, FC, Italy; Alma Mater Studiorum, University of Bologna, Bologna, Italy; Imola Hospital, Imola, Italy
| | - M Bonafè
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy; Santa Maria delle Croci Hospital, Ravenna, Italy; Morgagni-Pierantoni Hospital, Forlì, FC, Italy; Alma Mater Studiorum, University of Bologna, Bologna, Italy; Imola Hospital, Imola, Italy
| | - M Puccetti
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy; Santa Maria delle Croci Hospital, Ravenna, Italy; Morgagni-Pierantoni Hospital, Forlì, FC, Italy; Alma Mater Studiorum, University of Bologna, Bologna, Italy; Imola Hospital, Imola, Italy
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Bravaccini S, Ravaioli S, Rocca A, Maltoni R, Cristalli C, Marasco E, De Carolis S, Cricca M, Bonafè M. Abstract P2-04-01: Human papillomavirus (HPV) DNA detection in breast cancer by liquid biopsy: Something new on the horizon? Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p2-04-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background The presence of human papillomavirus (HPV) DNA in breast cancer (BC) tissues has been widely investigated in recent years. HPV DNA has been detected in ductal lavage fluids and in serum-derived extracellular vesicles of patients with benign or in situ breast lesions. However, there are no data attesting to its presence in liquid biopsies of different BC subtypes or to its impact on prognosis.
Methods We analyzed a total of 72 serum samples for the presence of circulating HPV DNA, of which 20 were from luminal A BC (5 relapsed, 15 non relapsed), 17 from luminal B BC (5 relapsed, 12 non relapsed), 15 from triple-negative BC (6 relapsed and 9 non relapsed), 12 from HER2-positive BC (3 relapsed, 9 non relapsed) and 8 from healthy subjects. Circulating DNA was extracted and purified from 500 μl of serum by Qiamp DNA minikit (Qiagen, Milan, Italy) according to the manufacturer's instructions. HPV DNA was assessed by a high-throughput MALDI-TOF mass spectrometry-based method (Mass Array Platform, Agena Bioscience, Hamburg, Germany). The DNA target sequence was amplified by a multiplex PCR with HPV E6 or E7 gene-specific primers. A primer for primer extension annealing to the amplified product was extended at its 3′ terminal base for each HPV type.
Results HPV DNA was detected in 5 BC patients but in none of the healthy controls. None of the serum samples analyzed showed HPV DNA types 16 or 18. Four of the 5 BC cases had high-risk HPV DNA (type 39,45,52,59) and one had low-risk HPV DNA (type 73). The 4 patients with high risk HPV DNA had low-grade cervical intraepithelial neoplasia (CIN 1) detected by Pap smear prior to the diagnosis of BC. No relation was found between HPV infection and tumor subtype or prognosis. Our in vitro studies also revealed the active release of HPV DNA into the extracellular vesicle compartment of cervical cancer cells.
Table 1.Features of BC patients positive for circulating HPV DNA.Sample IDAge (years)GradingSubtypeDeathRelapseHPV type, riskCervical lesion17471Luminal A-No59, highCIN 139783Luminal B20/03/2015No45, highCIN 145462Luminal B-No39, highCIN 160583TN03/01/2011Yes73, lowHyperplasia63523HER2-positive-Yes52, highCIN 1TN, triple negative; CIN 1:low-grade cervical intraepithelial neoplasia
Conclusions Our findings support the feasibility of HPV DNA evaluation by liquid biopsy in BC. They also suggest that circulating HPV DNA in BC patients might be of cervical tissue origin and that the presence of HPV DNA in BC may be a consequence of its spreading from virus-infected tissue such as that of the uterine cervix.
Citation Format: Bravaccini S, Ravaioli S, Rocca A, Maltoni R, Cristalli C, Marasco E, De Carolis S, Cricca M, Bonafè M. Human papillomavirus (HPV) DNA detection in breast cancer by liquid biopsy: Something new on the horizon? [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-04-01.
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Affiliation(s)
- S Bravaccini
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy; Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - S Ravaioli
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy; Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - A Rocca
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy; Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - R Maltoni
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy; Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - C Cristalli
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy; Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - E Marasco
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy; Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - S De Carolis
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy; Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - M Cricca
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy; Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - M Bonafè
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy; Alma Mater Studiorum, University of Bologna, Bologna, Italy
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Musolino A, Cavanna L, Boggiani D, Zamagni C, Frassoldati A, Caldara A, Rocca A, Gori S, Piacentini F, Berardi R, Brandes AA, Foglietta J, Villa F, Pellegrino B, Todeschini R, Tognetto M, Naldi N, Bortesi B, Boni L, Montemurro F, Ardizzoni A. Abstract P1-14-05: Phase II study of eribulin in combination with gemcitabine for the treatment of patients with locally advanced or metastatic triple negative breast cancer (ERIGE Trial). Clinical and pharmacogenetic results on behalf of the Gruppo Oncologico Italiano di Ricerca Clinica (GOIRC). Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p1-14-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: There are no well-established chemotherapy regimens for metastatic triple negative breast cancer. The combination of a microtubule inhibitor (eribulin) with a nucleoside analog (gemcitabine) may synergistically induce tumor cell death, especially in tumors like triple negative breast cancers (TNBC) characterized by high cell proliferation, aggressive tumor behavior, and chemo-resistance.
Materials and Methods:This is an open-label, national multicenter phase II study evaluating the combination of eribulin (0.88 mg/m2) plus gemcitabine (1000 mg/m2) on day 1 and 8, q21 as either first- or second-line treatment of locally advanced or metastatic TNBC.The primary endpoint was the objective response rate (ORR) for evaluable patients (pts). The study was designed according to the Simon's two stage optimal design. We chose the lower activity (p0) of 0.20 and target activity level (p1) of 0.35. A prospective, molecular correlative study has been being carried out on germinal DNA of study population to assess the role of BRCA mutations and single nucleotide polymorphisms (SNPs) in predicting efficacy and toxicity of the combination regimen.
Results: From July 2013 to September 2016, 83 evaluable pts (37 in the first stage, 46 in the second one) were enrolled. They received a median number of 6 cycles of treatment (range 1-24). The ORR (CR+PR) was 37.35% (90% CI: 28.47-46.93) and the clinical benefit rate (CR+PR+SD ≥ 24wks) was 48.78% (90% CI: 39.24%-58.39%). The most common grade 3-4 adverse events (> 10% of patients) were neutropenia and liver toxicity. With a median follow-up of 28.8 months, the median progression-free survival (PFS) and overall survival (OS) were 5.1 months (95% CI: 4.2-7.0) and 14.7 months (95% CI: 10.2-20.0), respectively. BRCA1/2 deleterious mutations were observed in 15 (22%) out of 68 genotyped pts. Women with BRCA1/2 mutations were associated with worse ORR, PFS and OS than those with BRCA1/2 wild-type. A panel of SNPs in genes of study drug metabolism pathways was evaluated. Among these, CYP3A4 392A >G and FGD4 2044236G>A SNPs were associated with greater liver toxicity by logistic regression analysis. Furthermore, CDA*2 79A>C, RRM1 2455 A>G, and CYP2C8 416G>A SNPs were associated with poorer overall survival by Cox proportional hazards model.
Conclusions:The combination of eribulin and gemcitabine shows promising activity and a moderate toxicity profile in metastatic TNBC. BRCA status and pharmacogenetics tests may help identify pts with high probability of response with negligible toxicity.
Citation Format: Musolino A, Cavanna L, Boggiani D, Zamagni C, Frassoldati A, Caldara A, Rocca A, Gori S, Piacentini F, Berardi R, Brandes AA, Foglietta J, Villa F, Pellegrino B, Todeschini R, Tognetto M, Naldi N, Bortesi B, Boni L, Montemurro F, Ardizzoni A. Phase II study of eribulin in combination with gemcitabine for the treatment of patients with locally advanced or metastatic triple negative breast cancer (ERIGE Trial). Clinical and pharmacogenetic results on behalf of the Gruppo Oncologico Italiano di Ricerca Clinica (GOIRC) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-14-05.
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Affiliation(s)
- A Musolino
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - L Cavanna
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - D Boggiani
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - C Zamagni
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - A Frassoldati
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - A Caldara
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - A Rocca
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - S Gori
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - F Piacentini
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - R Berardi
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - AA Brandes
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - J Foglietta
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - F Villa
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - B Pellegrino
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - R Todeschini
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - M Tognetto
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - N Naldi
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - B Bortesi
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - L Boni
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - F Montemurro
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - A Ardizzoni
- Medical Oncology Unit and Gruppo Oncologico di Ricerca Clinica (GOIRC), University Hospital of Parma, Parma, Italy; Hospital of Piacenza, Piacenza, Italy; SSD Oncologia Medica Addarii, Bologna, Italy; Oncologia Clinica, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy; Oncologia Medica, Ospedale Santa Chiara, Trento, Italy; IRST-IRCCS, Meldola, Italy; Sacro Cuore-Don Calabria Hospital, Negrar, Italy; University Hospital of Modena, Modena, Italy; Ancona University Hospital, Ancona, Italy; Azienda USL-IRCCS, Bologna, Italy; Hospital of Perugia, Perugia, Italy; Lecco Hospital, Lecco, Italy; GOIRC, Parma, Italy; Careggi University Hospital, ITT, Firenze, Italy; Istituto per la Ricerca e la Cura del Cancro, IRCCS, Candiolo, Italy; Medical Oncology Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy
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Rega D, Scala D, Pace U, Bucci AF, Patrone R, Rocca A, Delrio P. Closure of the defect after TAMIS for rectal tumor: which methods. Eur J Surg Oncol 2019. [DOI: 10.1016/j.ejso.2018.10.269] [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: 11/26/2022] Open
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Salzano E, Raible SE, Kaur M, Wilkens A, Sperti G, Tilton RK, Bettini LR, Rocca A, Cocchi G, Selicorni A, Conlin LK, McEldrew D, Gupta R, Thakur S, Izumi K, Krantz ID. Prenatal profile of Pallister-Killian syndrome: Retrospective analysis of 114 pregnancies, literature review and approach to prenatal diagnosis. Am J Med Genet A 2018; 176:2575-2586. [PMID: 30289601 DOI: 10.1002/ajmg.a.40499] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 06/23/2018] [Accepted: 07/14/2018] [Indexed: 01/10/2023]
Abstract
Pallister-Killian syndrome (PKS) is a tissue limited mosaic disorder, characterized by variable degrees of neurodevelopmental delay and intellectual disability, typical craniofacial findings, skin pigmentation anomalies and multiple congenital malformations. The wide phenotypic spectrum of PKS in conjunction with the mosaic distribution of the i(12p) makes PKS an underdiagnosed disorder. Recognition of prenatal findings that should raise a suspicion of PKS is complicated by the fragmentation of data currently available in the literature and challenges in diagnosing a mosaic diagnosis on prenatal testing. Ultrasound anomalies, especially congenital diaphragmatic hernia, congenital heart defects, and rhizomelic limb shortening, have been related to PKS, but they are singularly not specific and are not present in all affected fetuses. We have combined prenatal data from 86 previously published reports and from our cohort of 114 PKS probands (retrospectively reviewed). Summarizing this data we have defined a prenatal growth profile and identified markers of perinatal outcome which collectively provide guidelines for early recognition of the distinctive prenatal profile and consideration of a diagnosis of PKS as well as for management and genetic counseling.
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Affiliation(s)
- E Salzano
- Division of Human Genetics, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - S E Raible
- Division of Human Genetics, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - M Kaur
- Division of Human Genetics, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - A Wilkens
- Division of Genomic Diagnostics, Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - G Sperti
- Neonatology Unit, St. Orsola-Malpighi Polyclinic, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - R K Tilton
- Division of Human Genetics, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - L R Bettini
- Dipartimento di Scienze Della Salute, San Paolo Hospital Medical School, Università degli Studi di Milano, Milan, Italy
| | - A Rocca
- Neonatology Unit, St. Orsola-Malpighi Polyclinic, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - G Cocchi
- Neonatology Unit, St. Orsola-Malpighi Polyclinic, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | | | - L K Conlin
- Division of Genomic Diagnostics, Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pathology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - D McEldrew
- Division of Genomic Diagnostics, Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - R Gupta
- Department of Fetal Medicine, Maharaja Agrasen Hospital, Delhi & Sonepat Genetic and Fetal Medicine Centre, Sonepat, Haryana
| | - S Thakur
- Department of Genetic & Fetal Medicine, Fortis Hospital, Delhi-NCR & Apollo Hospital, Delhi, India
| | - K Izumi
- Division of Human Genetics, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Division of Genomic Diagnostics, Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - I D Krantz
- Division of Human Genetics, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Stefanovska B, Vicier C, Scott V, Bouakka I, Rocca A, André F, Fromigué O. TRIB3: A new transcriptional target gene of rapalogs, modulating their effects on splicing. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy314.001] [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
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Rocca A, Maltoni R, Bravaccini S, Donati C, Andreis D. Clinical utility of fulvestrant in the treatment of breast cancer: a report on the emerging clinical evidence. Cancer Manag Res 2018; 10:3083-3099. [PMID: 30214302 PMCID: PMC6124791 DOI: 10.2147/cmar.s137772] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Fulvestrant is the first selective estrogen receptor (ER) downregulator available in clinical practice. It is a pure antiestrogen with no agonistic effects, leading to degradation of ER alpha, with activity in tamoxifen-resistant breast cancer (BC) models. Pharmacokinetic and pharmacodynamic studies and several postmarketing clinical trials led to the definition of the optimal dose at 500 mg intramuscularly on days 1, 15, and 29 and then every 28 days. Targeting ER alpha, fulvestrant is a cornerstone of treatment in luminal BCs, whose growth is largely driven by the ER pathway. In endocrine therapy-naïve patients with hormone receptor-positive, HER2− advanced BC (ABC), fulvestrant yielded significantly longer progression-free survival compared to anastrozole in the Phase III FALCON study. Due to its mechanism of action and pharmacokinetic properties, fulvestrant is an ideal backbone for combination therapies. Preclinical studies have shown synergism with drugs acting on signaling pathways involved in the development of endocrine resistance, among which the cyclin D/cyclin-dependent kinase 4-6/retinoblastoma pathway and the phosphatidylinositol 3-kinase (PI3K)/Akt/mammalian target of rapamycin pathway, contributing to overcoming or delaying endocrine resistance. In the Phase III PALOMA-3 trial, a combination of the cyclin-dependent kinase 4/6 inhibitor palbociclib with fulvestrant significantly improved progression-free survival over fulvestrant alone in women with hormone receptor positive, HER2− ABC progressing during prior endocrine therapy. This led to approval of the combination in this clinical setting. Similar results were obtained with abemaciclib and ribociclib. Combination with pan-PI3K inhibitors, though showing some efficacy, was hampered by the toxicity of these agents, and studies in combinations with more selective inhibitors of the α-catalytic subunit of PI3K are ongoing. Fulvestrant has shown partial activity also in patients with tumors harboring mutations of the ESR1 gene. It is thus a key drug in the treatment of ABC, whose role in combination with new targeted agents is still evolving.
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Affiliation(s)
- Andrea Rocca
- Breast Cancer Unit, Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS,
| | - Roberta Maltoni
- Breast Cancer Unit, Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS,
| | - Sara Bravaccini
- Cyto-Histo-Molecular Pathology, Bioscience Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS
| | - Caterina Donati
- Pharmacy, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS
| | - Daniele Andreis
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
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Gallerani G, Delmonte A, Cocchi C, Bocchini M, Piccinini F, Burgio MA, Casadei C, Rocca A, Fabbri F. Abstract 5196: Feasibility investigation of EML4-ALK rearrangements in mNSCLC CTCs using a new in vivo procedure. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-5196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background - Circulating tumor cells (CTCs) are the liquid phase of a solid tumor. An advanced CTC phenotyping and genotyping procedure could allow a superior understanding of tumor heterogeneity aimed at improving personalized treatment selection. However, these investigations are hampered by the difficulty to catch and analyze CTCs. EML4-ALK chromosomal rearrangement is a fundamental marker of sensitivity in metastatic non-small cell lung cancer (mNSCLC), but conventional tissue-based ALK scrutiny is not always possible. A CTC-based ALK evaluation may be an easy and not invasive method for identifying rearrangements and hence patients eligible for specific treatments.
Methods - Analyses were performed via the Gilupi CellCollector CANCER01 (DC01), a device that allows the in vivo isolation of CTCs from a high volume of peripheral blood. The DC01 is a CE-approved functionalized 16 cm long medical wire that includes a functionalized 2 cm long gold-coated tip covalently coupled with antibodies against EpCAM. The DC01 can be inserted through a standard venous cannula into the cubital vein of cancer patients for 30 minutes where it captures CTCs directly from the bloodstream of cancer patients. CTC presence was investigated in 18 mNSCLC patients and CTC-ALK-chromosomal status was studied by an innovative method, the 3D-immuno-FISH, that combined immuno-fluorescence and FISH approaches on a 3D structure (the DC01). Two DC01 per patients were utilized. After removal, on one wire, CTCs were identified and counted by nuclei, EpCAM and cytokeratins staining. On the second wire, CTCs were recognized by EpCAM staining and analyzed for ALK alterations by FISH. Formalin-fixed paraffin-embedded primary tumor tissues from the same patients were analyzed for comparison. Immortalized cell lines attached to DC01 devices were exploited as positive controls.
Results - Using the DC01 it was feasible to isolate and detect CTCs. Among the 18 enrolled patients, 7 presented tumor-tissue ALK-translocation, whereas 11 were wild type. Overall, 61.1% patients were CTC positive (median CTC number, 3.0 per patient). Amid those that owned ALK-translocation, 28.6% were CTC-positive, whereas 81.8 % patient without ALK-translocation were CTC positive. ALK rearrangements were detectable directly on cells attached to the wires. However, the 3D-immuno-FISH analysis in patients was hampered by the low median number of detected CTCs.
Conclusions - The detection of ALK-chromosomal rearrangements with the 3D-immuno-FISH analysis in cells recovered by DC01 was feasible. This method is valid for tracking positive CTC patients, but the few cells retrieved per patients still limit CTC full exploitation. Although further studies are needed to validate our data and to improve DC01 capture efficiency, our results pave the way to CTC-based chromosomal rearrangement identification and therapy personalization.
Citation Format: Giulia Gallerani, Angelo Delmonte, Claudia Cocchi, Martine Bocchini, Filippo Piccinini, Marco Angelo Burgio, Carla Casadei, Andrea Rocca, Francesco Fabbri. Feasibility investigation of EML4-ALK rearrangements in mNSCLC CTCs using a new in vivo procedure [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 5196.
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Bronte G, Bravaccini S, Ravaioli S, Puccetti M, Scarpi E, Andreis D, Tumedei MM, Sarti S, Cecconetto L, Pietri E, De Simone V, Maltoni R, Bonafè M, Amadori D, Rocca A. Androgen Receptor Expression in Breast Cancer: What Differences Between Primary Tumor and Metastases? Transl Oncol 2018; 11:950-956. [PMID: 29890379 PMCID: PMC6036224 DOI: 10.1016/j.tranon.2018.05.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 02/22/2018] [Revised: 05/14/2018] [Accepted: 05/23/2018] [Indexed: 01/13/2023] Open
Abstract
Genomic studies have shown that the androgen receptor (AR) pathway plays an important role in some breast cancer subtypes. However few data are present on the concordance between AR expression in primary tumors and metastases. We investigated AR expression by using immunohistochemistry (IHC) in 164 primary tumors and 83 metastases, to explore its distribution in the different tumor subtypes and its concordance between the two sample types and according to sampling time. AR was more highly expressed in luminal A and B than HER2-positive and triple negative primary tumors. A similar distribution was found in metastases, and the concordance of AR expression between primary tumors and metastases was greater than 60%. No association between sampling time and AR expression was observed. We found a good concordance of AR expression between primary tumor and metastasis, but the variability remains high between the two types of specimens, regardless of the variation in sampling time. For this reason, if used for treatment decisions, AR evaluation should be repeated in each patient whenever a new biopsy is performed, as commonly done for the other breast cancer biomarkers.
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Affiliation(s)
- Giuseppe Bronte
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy
| | - Sara Bravaccini
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy.
| | - Sara Ravaioli
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy
| | | | - Emanuela Scarpi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy
| | - Daniele Andreis
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy
| | - Maria Maddalena Tumedei
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy
| | - Samanta Sarti
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy
| | - Lorenzo Cecconetto
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy
| | - Elisabetta Pietri
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy
| | - Valeria De Simone
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy
| | - Roberta Maltoni
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy
| | - Massimiliano Bonafè
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy; Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Dino Amadori
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy
| | - Andrea Rocca
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy
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Cecconetto L, Gardini AC, Tenti E, Maltoni R, Bravaccini S, Oboldi D, Zoli W, Serra P, Donati C, Sarti S, Amadori D, Rocca A. Long-term Complete Response in a Patient with Liver Metastases from Breast Cancer Treated with Metronomic Chemotherapy. Tumori Journal 2018. [DOI: 10.1177/1578.17238] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Lorenzo Cecconetto
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Andrea Casadei Gardini
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Elena Tenti
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Roberta Maltoni
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Sara Bravaccini
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Devil Oboldi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Wainer Zoli
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Patrizia Serra
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Caterina Donati
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Samanta Sarti
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Dino Amadori
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Andrea Rocca
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
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Lepore G, Bonfanti R, Bozzetto L, Di Blasi V, Girelli A, Grassi G, Iafusco D, Laviola L, Rabbone I, Schiaffini R, Bruttomesso D, Mammì F, Bruzzese M, Schettino M, Nuzzo M, Di Blasi V, Fresa R, Lambiase C, Iafusco D, Zanfardino A, Confetto S, Bozzetto L, Annuzzi G, Alderisio A, Riccardi G, Gentile S, Marino G, Guarino G, Zucchini S, Maltoni G, Suprani T, Graziani V, Nizzoli M, Acquati S, Cavani R, Romano S, Michelini M, Manicardi E, Bonadonna R, Dei Cas A, Dall'aglio E, Papi M, Riboni S, Manicardi V, Manicardi E, Manicardi E, Pugni V, Lasagni A, Street M, Pagliani U, Rossi C, Assaloni R, Brunato B, Tortul C, Zanette G, Li Volsi P, Zanatta M, Tonutti L, Agus S, Pellegrini M, Ceccano P, Pozzilli G, Anguissola B, Buzzetti R, Moretti C C, Leto G, Pozzilli P, Manfrini S, Maurizi A, Leotta S, Altomare M, Abbruzzese S, Carletti S, Suraci C, Filetti S, Manca Bitti M, Arcano S, Cavallo M, De Bernardinis M, Pitocco D, Caputo S, Rizzi A, Manto A, Schiaffini R, Cappa M, Benevento D, Frontoni S, Malandrucco I, Morano S, Filardi T, Lauro D, Marini M, Castaldo E, Sabato D, Tuccinardi F, Forte E, Viterbori P, Arnaldi C, Minuto N, d'Annunzio G, Corsi A, Rota R, Scaranna C, Trevisan R, Valentini U, Girelli A, Bonfadini S, Zarra E, Plebani A, Prandi E, Felappi B, Rocca A, Meneghini E, Galli P, Ruggeri P, Carrai E, Fugazza L, Baggi V, Conti D, Bosi E, Laurenzi A, Caretto A, Molinari C, Orsi E, Grancini V, Resi V, Bonfanti R, Favalli V, Bonura C, Rigamonti A, Bonomo M, Bertuzzi F, Pintaudi B, Disoteo O, Perseghin G, Perra S, Chiovato L, De Cata P, Zerbini F, Lovati E, Laneri M, Guerraggio L, Bossi A, De Mori V, Galetta M, Meloncelli I, Aiello A A, Di Vincenzo S, Nuzzi A, Fraticelli E, Ansaldi E, Battezzati M, Lombardi M, Balbo M, Lera R, Secco A, De Donno V, Cadario F, Savastio S, Ponzani C, Aimaretti G, Rabbone I, Ignaccolo G, Tinti D, Cerutti F, Bari F, Giorgino F, Piccinno E, Zecchino O, Cignarelli M, Lamacchia O, Picca G, De Cosmo S, Rauseo A, Tomaselli L, Tumminia A, Egiziano C, Scarpitta A, Maggio F, Cardella F, Roppolo R, Provenzano V, Fleres M, Scorsone A, Scatena A, Gregori G, Lucchesi S, Gadducci F, Di Cianni S, Pancani S, Del Prato S, Aragona M, Crisci I, Calianno A, Fattor B, Crazzolara D, Reinstadler P, Longhi S, Incelli G, Rauch S, Romanelli T, Orrasch M, Cauvin V, Franceschi R, Lalli C, Pianta A, Marangoni A, Aricò C, Marin N, Nogara N, Simioni N, Filippi A, Gidoni Guarneri G, Contin M.L M, Decata A, Bondesan L, Confortin L, Coracina A, Lombardi S, Costa Padova S, Cipponeri E, Scotton R, Galasso S, Boscari F, Zanon M, Vinci C, Lisato G, Gottardo L, Bonora E, Trombetta M, Negri C, Brangani C, Maffeis C, Sabbion A, Marigliano M. Metabolic control and complications in Italian people with diabetes treated with continuous subcutaneous insulin infusion. Nutr Metab Cardiovasc Dis 2018; 28:335-342. [PMID: 29428572 DOI: 10.1016/j.numecd.2017.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 10/31/2017] [Accepted: 12/02/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND AIM The objective of this cross-sectional study was to evaluate the degree of glycaemic control and the frequency of diabetic complications in Italian people with diabetes who were treated with continuous subcutaneous insulin infusion (CSII). METHODS AND RESULTS Questionnaires investigating the organisation of diabetes care centres, individuals' clinical and metabolic features and pump technology and its management were sent to adult and paediatric diabetes centres that use CSII for treatment in Italy. Information on standard clinical variables, demographic data and acute and chronic diabetic complications was derived from local clinical management systems. The sample consisted of 6623 people with diabetes, which was obtained from 93 centres. Of them, 98.8% had type 1 diabetes mellitus, 57.2% were female, 64% used a conventional insulin pump and 36% used a sensor-augmented insulin pump. The median glycated haemoglobin (HbA1c) level was 60 mmol/mol (7.6%). The HbA1c target (i.e. <58 mmol/mol for age <18 years and <53 mmol/mol for age >18 years) was achieved in 43.4% of paediatric and 23% of adult participants. Factors such as advanced pump functions, higher rate of sensor use, pregnancy in the year before the study and longer duration of diabetes were associated with lower HbA1c levels. The most common chronic complications occurring in diabetes were retinopathy, microalbuminuria and hypertension. In the year before the study, 5% of participants reported ≥1 episode of severe hypoglycaemic (SH) episodes (SH) and 2.6% reported ≥1 episode of ketoacidosis. CONCLUSIONS Advanced personal skills and use of sensor-based pump are associated with better metabolic control outcomes in Italian people with diabetes who were treated with CSII. The reduction in SH episodes confirms the positive effect of CSII on hypoglycaemia. CLINICAL TRIAL REGISTRATION NUMBER NCT 02620917 (ClinicalTrials.gov).
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Rinaldi A, Dell'Amore A, Pastore S, Rocca A, Giunta D, Palazzini M, Manes A, Dardi F, Gotti E, Galiè N. Double Lungtransplantation In Patients with End-Stage Pulmonary Arterial Hypertension or End-Stage Inoperable Chronic Thromboembolic Pulmonary Hypertension. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.1304] [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: 11/24/2022] Open
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