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Modica R, La Salvia A, Liccardi A, Cozzolino A, Di Sarno A, Russo F, Colao A, Faggiano A. Dyslipidemia, lipid-lowering agents and neuroendocrine neoplasms: new horizons. Endocrine 2024:10.1007/s12020-024-03767-7. [PMID: 38509261 DOI: 10.1007/s12020-024-03767-7] [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: 01/31/2024] [Accepted: 02/29/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE Neuroendocrine neoplasms (NENs) are a heterogeneous group of malignancies originating from cells with a neuroendocrine phenotype. The complex relationship between lipid metabolism and cancer is gaining interest and a potential anti-cancer effect of lipid lowering agents is being considered. This review aims to discuss the current understanding and treatment of dyslipidaemia in NENs, focusing on the role of lipid lowering agents, including new therapeutic approaches, and future perspectives as possible tool in cancer prevention and tumor-growth control. METHODS We performed an electronic-based search using PubMed updated until December 2023, summarizing the available evidence both in basic and clinical research about lipid lowering agents in NENs. RESULTS Dyslipidemia is an important aspect to be considered in NENs management, although randomized studies specifically addressing this topic are lacking, unlike other cancer types. Available data mainly regard statins, and in vitro studies have demonstrated direct antitumor effects, including antiproliferative effects in some cancers, supporting possible pleiotropic effects also in NENs, but data remain conflicting. Ezetimibe, omega 3-fatty acids, fibrates and inhibitors of proprotein convertase subtilisin/kexin type 9 (PCSK9) may enhance the regulation of lipid homeostasis, as demonstrated in other cancers. CONCLUSIONS Targeting dyslipidemia in NENs should be part of the multidisciplinary management and an integrated approach may be the best option for both metabolic and tumor control. Whether lipid lowering agents may directly contribute to tumor control remains to be confirmed with specific studies, focusing on association with other metabolic risk, disease stage and primary site.
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Affiliation(s)
- Roberta Modica
- Endocrinology, Diabetology and Andrology Unit, Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131, Naples, Italy.
| | - Anna La Salvia
- National Center for Drug Research and Evaluation, National Institute of Health (ISS), 00161, Rome, Italy
| | - Alessia Liccardi
- Endocrinology, Diabetology and Andrology Unit, Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131, Naples, Italy
| | - Alessia Cozzolino
- Department of Experimental Medicine, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Antonella Di Sarno
- Endocrinology, Diabetology and Andrology Unit, Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131, Naples, Italy
| | - Flaminia Russo
- Endocrinology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, ENETS Center of Excellence, Sapienza University of Rome, 00189, Rome, Italy
| | - Annamaria Colao
- Endocrinology, Diabetology and Andrology Unit, Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131, Naples, Italy
- UNESCO Chair, Education for Health and Sustainable Development, Federico II University, 80131, Naples, Italy
| | - Antongiulio Faggiano
- Endocrinology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, ENETS Center of Excellence, Sapienza University of Rome, 00189, Rome, Italy
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La Salvia A, Siciliani A, Rinzivillo M, Verrico M, Baldelli R, Puliani G, Modica R, Zanata I, Persano I, Fanciulli G, Bassi M, Mancini M, Bellino S, Giannetta E, Ibrahim M, Panzuto F, Brizzi MP, Faggiano A. Thyroid transcription factor-1 expression in lung neuroendocrine tumours: a gender-related biomarker? Endocrine 2024; 83:519-526. [PMID: 37775725 PMCID: PMC10850191 DOI: 10.1007/s12020-023-03542-0] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/15/2023] [Indexed: 10/01/2023]
Abstract
PURPOSE Thyroid transcription factor-1 (TTF-1) assessed by immunohistochemistry (IHC) is a specific biomarker for lung adenocarcinoma, and is commonly used to confirm the pulmonary origin of neuroendocrine tumours (NET). The majority of the available data suggest that TTF-1 is favourable prognostic biomarker for lung adenocarcinomas, whereas its role is more conflicting for lung NET. The main aim of this multicenter retrospective study was to investigate the potentially relevant associations between TTF-1 biomarker and clinical and pathological features of the study population, as well as determine TTF-1 prognostic effect on the clinical outcome of the patients. METHODS A multicentre retrospective study was conducted on 155 surgically-removed lung NET, with available IHC TTF-1 assessment. RESULTS Median age was 59.5 years (range 13-86), 97 patients (62.6%) were females, 31 cases (20%) were atypical carcinoids, 4 (2.6%) had TNM stage IV. Mitotic count ≥2 per 10 high-power field was found in 35 (22.6%) subjects, whereas necrosis was detected in 20 patients (12.9%). TTF-1 was positive in 78 cases (50.3%). The median overall survival was 46.9 months (range 0.6-323) and the median progression-free survival was 39.1 months (range 0.6-323). Statistically significant associations were found between (1) TTF-1 positivity and female sex (p = 0.007); and among (2) TTF-1 positivity and the absence of necrosis (p = 0.018). CONCLUSIONS This study highlights that TTF-1 positivity differs according to sex in lung NET, with a more common TTF-1 positive staining in female. Moreover, TTF-1 positivity correlated with the absence of necrosis. These data suggest that TTF-1 could potentially represent a gender-related biomarker for lung NET.
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Affiliation(s)
- Anna La Salvia
- National Center for Drug Research and Evaluation, National Institute of Health (ISS), Rome, Italy
| | | | - Maria Rinzivillo
- Digestive Disease Unit, ENETS Center of Excellence, Sant'Andrea University Hospital, Rome, Italy
| | - Monica Verrico
- Department of Radiological, Oncological, and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Roberto Baldelli
- Endocrinology Unit, Department of Oncology and Medical Specialities, A.O. San Camillo-Forlanini, Rome, Italy
| | - Giulia Puliani
- Oncological Endocrinology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Roberta Modica
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Isabella Zanata
- Department of Medical Sciences, Section of Endocrinology and Internal Medicine, University of Ferrara, Ferrara, Italy
| | - Irene Persano
- Department of Oncology, A.O.U. San Luigi Gonzaga Hospital, Orbassano, TO, Italy
| | - Giuseppe Fanciulli
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
- Endocrine Oncology Program, Endocrine Unit, Azienda Ospedaliero-Universitaria (AOU) Sassari, Sassari, Italy
| | - Massimiliano Bassi
- Department of Thoracic Surgery, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Massimiliano Mancini
- Division of Morphologic and Molecular Pathology Unit, S. Andrea Hospital, Rome, Italy
| | - Stefania Bellino
- National Center for Drug Research and Evaluation, National Institute of Health (ISS), Rome, Italy
| | - Elisa Giannetta
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Mohsen Ibrahim
- Department of Thoracic Surgery, Sant'Andrea University Hospital, Rome, Italy
| | - Francesco Panzuto
- Digestive Disease Unit, ENETS Center of Excellence, Sant'Andrea University Hospital, Rome, Italy
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy
| | - Maria Pia Brizzi
- Department of Oncology, A.O.U. San Luigi Gonzaga Hospital, Orbassano, TO, Italy
| | - Antongiulio Faggiano
- Endocrinology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza University of Rome, ENETS Center of Excellence, Rome, Italy.
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La Salvia A, Lens-Pardo A, López-López A, Carretero-Puche C, Capdevila J, Benavent M, Jiménez-Fonseca P, Castellano D, Alonso T, Teule A, Custodio A, Tafuto S, La Casta A, Spada F, Lopez-Gonzalvez A, Gil-Calderon B, Espinosa-Olarte P, Barbas C, Garcia-Carbonero R, Soldevilla B. Metabolomic profile of neuroendocrine tumors identifies methionine, porphyrin, and tryptophan metabolisms as key dysregulated pathways associated with patient survival. Eur J Endocrinol 2024; 190:62-74. [PMID: 38033321 DOI: 10.1093/ejendo/lvad160] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 10/17/2023] [Accepted: 11/06/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVE Metabolic profiling is a valuable tool to characterize tumor biology but remains largely unexplored in neuroendocrine tumors (NETs). Our aim was to comprehensively assess the metabolomic profile of NETs and identify novel prognostic biomarkers and dysregulated molecular pathways. DESIGN AND METHODS Multiplatform untargeted metabolomic profiling (GC-MS, CE-MS, and LC-MS) was performed in plasma from 77 patients with G1-2 extra-pancreatic NETs enrolled in the AXINET trial (NCT01744249) (study cohort) and from 68 non-cancer individuals (control). The prognostic value of each differential metabolite (n = 155) in NET patients (P < .05) was analyzed by univariate and multivariate analyses adjusted for multiple testing and other confounding factors. Related pathways were explored by Metabolite Set Enrichment Analysis (MSEA) and Metabolite Pathway Analysis (MPA). RESULTS Thirty-four metabolites were significantly associated with progression-free survival (PFS) (n = 16) and/or overall survival (OS) (n = 27). Thirteen metabolites remained significant independent prognostic factors in multivariate analysis, 3 of them with a significant impact on both PFS and OS. Unsupervised clustering of these 3 metabolites stratified patients in 3 distinct prognostic groups (1-year PFS of 71.1%, 47.7%, and 15.4% (P = .012); 5-year OS of 69.7%, 32.5%, and 27.7% (P = .003), respectively). The MSEA and MPA of the 13-metablolite signature identified methionine, porphyrin, and tryptophan metabolisms as the 3 most relevant dysregulated pathways associated with the prognosis of NETs. CONCLUSIONS We identified a metabolomic signature that improves prognostic stratification of NET patients beyond classical prognostic factors for clinical decisions. The enriched metabolic pathways identified reveal novel tumor vulnerabilities that may foster the development of new therapeutic strategies for these patients.
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Affiliation(s)
- Anna La Salvia
- Center of Experimental Oncology, Gastrointestinal and Neuroendrocrine Tumors Research Group, Research Institute Hospital 12 de Octubre (imas12), 28041 Madrid, Spain
- Oncology Department, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
- National Center for Drug Research and Evaluation, National Institute of Health (ISS), 00161 Rome, Italy
| | - Alberto Lens-Pardo
- Center of Experimental Oncology, Gastrointestinal and Neuroendrocrine Tumors Research Group, Research Institute Hospital 12 de Octubre (imas12), 28041 Madrid, Spain
- Spanish National Cancer Research Center (CNIO), 28029 Madrid, Spain
| | - Angel López-López
- Department of Chemistry and Biochemistry, Facultad de Farmacia, Centre for Metabolomics and Bioanalysis (CEMBIO), Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, Boadilla del Monte, 28925 Madrid, Spain
| | - Carlos Carretero-Puche
- Center of Experimental Oncology, Gastrointestinal and Neuroendrocrine Tumors Research Group, Research Institute Hospital 12 de Octubre (imas12), 28041 Madrid, Spain
- Spanish National Cancer Research Center (CNIO), 28029 Madrid, Spain
| | - Jaume Capdevila
- Vall Hebron University Hospital and Vall Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain
| | - Marta Benavent
- Medical Oncology Department, Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS), 41013 Seville, Spain
| | - Paula Jiménez-Fonseca
- Medical Oncology Department, Hospital Universitario Central de Asturias, ISPA, 33011 Oviedo, Spain
| | - Daniel Castellano
- Oncology Department, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
| | - Teresa Alonso
- Medical Oncology, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
| | - Alexandre Teule
- Institut Català d'Oncologia (ICO)-Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), 08908 L'Hospitalet del Llobregat, Barcelona, Spain
| | - Ana Custodio
- Department of Medical Oncology, Hospital Universitario La Paz, CIBERONC CB16/12/00398, 28046 Madrid, Spain
| | - Salvatore Tafuto
- Sarcomas and Rare Tumours Unit, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, 80131 Naples, Italy
| | - Adelaida La Casta
- Department of Medical Oncology, Biodonostia Health Research Institute, Donostia University Hospital, University of the Basque Country (UPV/EHU), 20014 San Sebastián, Spain
| | - Francesca Spada
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, IEO, European Institute of Oncology, IRCCS, 20141 Milan, Italy
| | - Angeles Lopez-Gonzalvez
- Department of Chemistry and Biochemistry, Facultad de Farmacia, Centre for Metabolomics and Bioanalysis (CEMBIO), Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, Boadilla del Monte, 28925 Madrid, Spain
| | - Beatriz Gil-Calderon
- Center of Experimental Oncology, Gastrointestinal and Neuroendrocrine Tumors Research Group, Research Institute Hospital 12 de Octubre (imas12), 28041 Madrid, Spain
- Spanish National Cancer Research Center (CNIO), 28029 Madrid, Spain
| | - Paula Espinosa-Olarte
- Center of Experimental Oncology, Gastrointestinal and Neuroendrocrine Tumors Research Group, Research Institute Hospital 12 de Octubre (imas12), 28041 Madrid, Spain
- Oncology Department, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
| | - Coral Barbas
- Department of Chemistry and Biochemistry, Facultad de Farmacia, Centre for Metabolomics and Bioanalysis (CEMBIO), Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, Boadilla del Monte, 28925 Madrid, Spain
| | - Rocio Garcia-Carbonero
- Center of Experimental Oncology, Gastrointestinal and Neuroendrocrine Tumors Research Group, Research Institute Hospital 12 de Octubre (imas12), 28041 Madrid, Spain
- Oncology Department, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
- Spanish National Cancer Research Center (CNIO), 28029 Madrid, Spain
- Medicine Department, Complutense University of Madrid (UCM), 28040 Madrid, Spain
| | - Beatriz Soldevilla
- Center of Experimental Oncology, Gastrointestinal and Neuroendrocrine Tumors Research Group, Research Institute Hospital 12 de Octubre (imas12), 28041 Madrid, Spain
- Spanish National Cancer Research Center (CNIO), 28029 Madrid, Spain
- Genetics, Physiology and Microbiology Department, Complutense University of Madrid (UCM), 28040 Madrid, Spain
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Stumpo S, Formelli MG, Persano I, Parlagreco E, Lauricella E, Rodriquenz MG, Guerrera LP, Zurlo IV, Campana D, Brizzi MP, Cives M, La Salvia A, Lamberti G. Extrapulmonary Neuroendocrine Carcinomas: Current Management and Future Perspectives. J Clin Med 2023; 12:7715. [PMID: 38137784 PMCID: PMC10743506 DOI: 10.3390/jcm12247715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 12/07/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
Neuroendocrine carcinomas (NECs) are poorly differentiated and highly aggressive epithelial neuroendocrine neoplasms. The most common primary site is the lung, but they may arise in every organ. Approximately 37% of extrapulmonary NECs (EP-NECs) occur in the gastroenteropancreatic (GEP) tract, followed by the genitourinary (GU) system and gynecological tract. As a result of their rarity, there is scant evidence to guide treatment recommendations, and a multidisciplinary approach is essential for the management of such patients. Platinum-based chemotherapy currently represents the standard of care for EP-NECs of any site, mirroring the management of small-cell lung cancer (SCLC), but further approaches are still under investigation. Indeed, ongoing trials evaluating targeted therapies, immune checkpoint inhibitors (ICIs), and radionuclide therapy could provide potentially breakthrough therapeutic options. Given the relative dearth of evidence-based literature on these orphan diseases, the aim of this review is to provide an overview of the pathology and current treatment options, as well as to shed light on the most pressing unmet needs in the field.
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Affiliation(s)
- Sara Stumpo
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum–University of Bologna, Via Zamboni 33, 40126 Bologna, Italy; (S.S.); (M.G.F.); (D.C.); (G.L.)
| | - Maria Giovanna Formelli
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum–University of Bologna, Via Zamboni 33, 40126 Bologna, Italy; (S.S.); (M.G.F.); (D.C.); (G.L.)
| | - Irene Persano
- Medical Oncology, AO S. Croce e Carle, 12100 Cuneo, Italy; (I.P.); (E.P.)
| | - Elena Parlagreco
- Medical Oncology, AO S. Croce e Carle, 12100 Cuneo, Italy; (I.P.); (E.P.)
| | - Eleonora Lauricella
- Medical Oncology Unit, Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, 70124 Bari, Italy; (E.L.); (M.C.)
| | - Maria Grazia Rodriquenz
- Oncology Unit, Ospedale IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy;
| | - Luigi Pio Guerrera
- Division of Medical Oncology, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy;
- Sarcomas and Rare Tumors Unit, Istituto Nazionale Tumori, IRCCS-Fondazione “G. Pascale”, 80131 Naples, Italy
| | | | - Davide Campana
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum–University of Bologna, Via Zamboni 33, 40126 Bologna, Italy; (S.S.); (M.G.F.); (D.C.); (G.L.)
- Medical Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via P. Albertoni 15, 40138 Bologna, Italy
| | - Maria Pia Brizzi
- Department of Oncology, A.O.U. San Luigi Gonzaga Hospital, 10043 Orbassano, Italy;
| | - Mauro Cives
- Medical Oncology Unit, Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, 70124 Bari, Italy; (E.L.); (M.C.)
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70121 Bari, Italy
| | - Anna La Salvia
- National Center for Drug Research and Evaluation, National Institute of Health (ISS), 00161 Rome, Italy
| | - Giuseppe Lamberti
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum–University of Bologna, Via Zamboni 33, 40126 Bologna, Italy; (S.S.); (M.G.F.); (D.C.); (G.L.)
- Medical Oncology Unit, Vito Fazzi Hospital, 73100 Lecce, Italy;
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Fanciulli G, La Salvia A, Di Molfetta S, Cannavale G, Puliani G, Verrico M, Campolo F, Colao A, Faggiano A. Predictive Factors of Response to Streptozotocin in Neuroendocrine Pancreatic Neoplasms. J Clin Med 2023; 12:7557. [PMID: 38137624 PMCID: PMC10743702 DOI: 10.3390/jcm12247557] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/03/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
Pancreatic neuroendocrine neoplasms (Pan-NENs) may exhibit a heterogeneous clinical course, ranging from indolent to progressive/metastatic behavior. In the latter scenario, streptozocin (STZ) is considered the cornerstone of systemic treatment; however, response to STZ-based chemotherapy may vary among individuals. In this narrative review, we aimed to identify the predictive factors of response to STZ in advanced Pan-NENs. We performed an extensive search in international online databases for published studies and ongoing clinical trials evaluating STZ in Pan-NENs. We found 11 pertinent studies evaluating 17 patient-, tumor-, or treatment-related factors. Age, CgA blood levels, tumor grade, Ki-67% index, anatomical location of the primary tumor, tumor stage, site of metastasis origin, liver tumor burden, extrahepatic spread, functional status, O6-methylguanine-methyltransferase (MGMT) status, line of therapy, and response to previous treatments were all statistically associated with radiological response and/or survival. The identified predictors may help clinicians make appropriate treatment decisions, in this way improving clinical outcomes in patients with advanced Pan-NENs.
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Affiliation(s)
- Giuseppe Fanciulli
- Endocrine Oncology Program, Endocrine Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, University Hospital of Sassari, 07100 Sassari, Italy
| | - Anna La Salvia
- National Center for Drug Research and Evaluation, National Institute of Health (ISS), 00161 Rome, Italy;
| | - Sergio Di Molfetta
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, 70124 Bari, Italy;
| | - Giuseppe Cannavale
- Unit of Endocrinology, Andrology, Diabetology and Nutrition, Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy;
| | - Giulia Puliani
- Oncological Endocrinology Unit, Regina Elena National Cancer Institute IRCCS, 00144 Rome, Italy;
| | - Monica Verrico
- Department of Radiology, Oncology and Pathology, Sapienza University of Rome, 00161 Rome, Italy;
| | - Federica Campolo
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy;
| | - Annamaria Colao
- UNESCO Chair, Education for Health and Sustainable Development, Federico II University, 80131 Naples, Italy;
| | - Antongiulio Faggiano
- Endocrinology Unit, Department of Clinical and Molecular Medicine, The European Neuroendocrine Tumor Society (ENETS) Center of Excellence, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy;
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Fazio N, La Salvia A. Precision medicine in gastroenteropancreatic neuroendocrine neoplasms: Where are we in 2023? Best Pract Res Clin Endocrinol Metab 2023; 37:101794. [PMID: 37414651 DOI: 10.1016/j.beem.2023.101794] [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: 07/08/2023]
Abstract
Precision medicine describes a target-related approach to tailoring diagnosis and treatment of the individual patient. While this personalized approach is revoluzionizing many areas of oncology, it is quite late in the field of gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs), in which there are few molecular alterations to be therapeutically targeted. We critically reviewed the current evidence about precision medicine in GEP NENs, focusing on potential clinically relevant actionable targets for GEP NENs, such as the mTOR pathway, MGMT, hypoxia markers, RET, DLL-3, and some general agnostic targets. We analysed the main investigational approaches with solid and liquid biopsies. Furthermore, we reviewed a model of precision medicine more specific for NENs that is the theragnostic use of radionuclides. Overall, currently no true predictive factors for therapy have been validated so far in GEP NENs, and the personalized approach is based more on clinical thinking within a NEN-dedicated multidisciplinary team. However, there is a robust background to suppose that precision medicine, with the theragnostic model will yield new insights in this context soon.
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Affiliation(s)
- Nicola Fazio
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology (IEO) IRCCS, Milan, Italy.
| | - Anna La Salvia
- National Center for Drug Research and Evaluation, National Institute of Health (ISS), Rome, Italy
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Bellino S, La Salvia A, Cometa MF, Botta R. Cell-based medicinal products approved in the European Union: current evidence and perspectives. Front Pharmacol 2023; 14:1200808. [PMID: 37583902 PMCID: PMC10424920 DOI: 10.3389/fphar.2023.1200808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/18/2023] [Indexed: 08/17/2023] Open
Abstract
Advanced Therapy Medicinal Products (ATMPs) are innovative clinical treatments exploiting the pharmacological, immunological, or metabolic properties of cells and/or gene(s) with the aim to restore, correct, or modify a biological function in the recipient. ATMPs are heterogeneous medicinal products, developed mainly as individualized and patient-specific treatments, and represent new opportunities for diseases characterized by a high-unmet medical need, including rare, genetic and neurodegenerative disorders, haematological malignancies, cancer, autoimmune, inflammatory and orthopaedic conditions. Into the European Union (EU) market, the first ATMP has been launched in 2009 and, to date, a total of 24 ATMPs have been approved. This review aims at reporting on current evidence of cell-based therapies authorized in the EU, including Somatic Cell Therapies, Tissue Engineering Products, and Cell-based Gene Therapy Products as Chimeric Antigen Receptor (CAR) T-cells, focusing on the evaluation of efficacy and safety in clinical trials and real-world settings. Despite cell-based therapy representing a substantial promise for patients with very limited treatment options, some limitations for its widespread use in the clinical setting remain, including restricted indications, highly complex manufacturing processes, elevated production costs, the lability of cellular products over time, and the potential safety concerns related to the intrinsic characteristics of living cells, including the risk of severe or life-threatening toxicities, such as CAR-T induced neurotoxicity and cytokine release syndrome (CRS). Although encouraging findings support the clinical use of ATMPs, additional data, comparative studies with a long-term follow-up, and wider real-world evidences are needed to provide further insights into their efficacy and safety profiles.
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Affiliation(s)
- Stefania Bellino
- National Center for Drug Research and Evaluation, National Institute of Health (Istituto Superiore di Sanità), Rome, Italy
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La Salvia A, Giuffrida D, Modica R. Editorial: Neuroendocrine tumors: the road to precision medicine. Front Endocrinol (Lausanne) 2023; 14:1253319. [PMID: 37564989 PMCID: PMC10411878 DOI: 10.3389/fendo.2023.1253319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 07/17/2023] [Indexed: 08/12/2023] Open
Affiliation(s)
- Anna La Salvia
- National Center for Drug Research and Evaluation, National Institute of Health (ISS), Rome, Italy
| | - Dario Giuffrida
- Department of Oncology, Istituto Oncologico del Mediterraneo, Viagrande, Catania, Italy
| | - Roberta Modica
- Unit of Endocrinology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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de Mestier L, Resche-Rigon M, Dromain C, Lamarca A, La Salvia A, de Baker L, Fehrenbach U, Pusceddu S, Colao A, Borbath I, de Haas R, Rinzivillo M, Zerbi A, Funicelli L, de Herder WW, Selberherr A, Wagner AD, Manoharan P, De Cima A, Lybaert W, Jann H, Prinzi N, Faggiano A, Annet L, Walenkamp A, Panzuto F, Pedicini V, Pitoni MG, Siebenhuener A, Mayerhoefer ME, Ruszniewski P, Vullierme MP. Proposal of early CT morphological criteria for response of liver metastases to systemic treatments in gastroenteropancreatic neuroendocrine tumors: Alternatives to RECIST. J Neuroendocrinol 2023; 35:e13311. [PMID: 37345276 DOI: 10.1111/jne.13311] [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] [Received: 01/17/2023] [Revised: 04/10/2023] [Accepted: 04/28/2023] [Indexed: 06/23/2023]
Abstract
RECIST 1.1 criteria are commonly used with computed tomography (CT) to evaluate the efficacy of systemic treatments in patients with neuroendocrine tumors (NETs) and liver metastases (LMs), but their relevance is questioned in this setting. We aimed to explore alternative criteria using different numbers of measured LMs and thresholds of size and density variation. We retrospectively studied patients with advanced pancreatic or small intestine NETs with LMs, treated with systemic treatment in the first-and/or second-line, without early progression, in 14 European expert centers. We compared time to treatment failure (TTF) between responders and non-responders according to various criteria defined by 0%, 10%, 20% or 30% decrease in the sum of LM size, and/or by 10%, 15% or 20% decrease in LM density, measured on two, three or five LMs, on baseline (≤1 month before treatment initiation) and first revaluation (≤6 months) contrast-enhanced CT scans. Multivariable Cox proportional hazard models were performed to adjust the association between response criteria and TTF on prognostic factors. We included 129 systemic treatments (long-acting somatostatin analogs 41.9%, chemotherapy 26.4%, targeted therapies 31.8%), administered as first-line (53.5%) or second-line therapies (46.5%) in 91 patients. A decrease ≥10% in the size of three LMs was the response criterion that best predicted prolonged TTF, with significance at multivariable analysis (HR 1.90; 95% CI: 1.06-3.40; p = .03). Conversely, response defined by RECIST 1.1 did not predict prolonged TTF (p = .91), and neither did criteria based on changes in LM density. A ≥10% decrease in size of three LMs could be a more clinically relevant criterion than the current 30% threshold utilized by RECIST 1.1 for the evaluation of treatment efficacy in patients with advanced NETs. Its implementation in clinical trials is mandatory for prospective validation. Criteria based on changes in LM density were not predictive of treatment efficacy. CLINICAL TRIAL REGISTRATION: Registered at CNIL-CERB, Assistance publique hopitaux de Paris as "E-NETNET-L-E-CT" July 2018. No number was assigned. Approved by the Medical Ethics Review Board of University Medical Center Groningen.
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Affiliation(s)
- Louis de Mestier
- Department of Pancreatology and Digestive Oncology, Université Paris-Cité, INSERM U1149, Beaujon University Hospital, Clichy, France
| | - Matthieu Resche-Rigon
- Department of Epidemiology and Biostatistics, Université Paris-Cité, Saint-Louis Hospital, Paris, France
| | - Clarisse Dromain
- Department of Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Angela Lamarca
- Department of Medical Oncology, The Christie Hospital, Manchester, UK
| | - Anna La Salvia
- Department of Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Lesley de Baker
- Department of Radiology, Universitair Ziekenhuis Antwerpen, Edegem, Belgium
| | - Uli Fehrenbach
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sara Pusceddu
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Annamaria Colao
- Endocrinology Unit, Department of Clinical Medicine and Surgery, Università Federico II di Napoli, Naples, Italy
- Endocrinology Unit, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Sant'Andrea Hospital, ENETS Center of Excellence, Rome, Italy
| | - Ivan Borbath
- Department of Hepatology and Gastroenterology, University Hospital St Luc/UCLouvain, Woluwe, Belgium
| | - Robbert de Haas
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Maria Rinzivillo
- Digestive Disease Unit, Sant'Andrea University Hospital, ENETS Center of Excellence, Rome, Italy
| | - Alessandro Zerbi
- Pancreatic Surgery, Humanitas Clinical and Research Center, Rozzano-, Milano, Italy
| | - Luigi Funicelli
- Division of Radiology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Wouter W de Herder
- Department of Internal Medicine, Erasmus MC and Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Andreas Selberherr
- Division of General Surgery, Department of Surgery, Medical University, Vienna, Austria
- Department of General and Visceral Surgery, Evangelisches Krankenhaus Wien, Vienna, Austria
| | - Anna Dorothea Wagner
- Department of Medical Oncology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Prakash Manoharan
- Department of Radiology and Nuclear Medicine, The Christie, Manchester, UK
| | - Andrea De Cima
- Department of Radiology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Willem Lybaert
- Department of Medical Oncology, Universitair Ziekenhuis Antwerpen, Edegem, Belgium
| | - Henning Jann
- Department of Hepatology and Gastroenterology, Charité-University, Charité-Universitätsmedizin, Berlin, Germany
| | - Natalie Prinzi
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Antongiulio Faggiano
- Endocrinology Unit, Department of Clinical Medicine and Surgery, Università Federico II di Napoli, Naples, Italy
| | - Laurence Annet
- Department of Radiology, Cliniques Universitaires Saint-Luc/UCLouvain, Brussels, Belgium
| | - Annemiek Walenkamp
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Francesco Panzuto
- Digestive Disease Unit, Sant'Andrea University Hospital, ENETS Center of Excellence, Rome, Italy
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, ENETS Center of Excellence, Rome, Italy
| | - Vittorio Pedicini
- Department of Radiology, Humanitas Clinical and Research Center, Rozzano-Milano, Italy
| | | | - Alexander Siebenhuener
- Department of Gastroenterology and Hepatology, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Marius E Mayerhoefer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Philippe Ruszniewski
- Department of Pancreatology and Digestive Oncology, Université Paris-Cité, INSERM U1149, Beaujon University Hospital, Clichy, France
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10
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Fazio N, Gervaso L, Halfdanarson TR, Sonbol M, Eiring RA, Pusceddu S, Prinzi N, Lombardi Stocchetti B, Grozinsky-Glasberg S, Gross DJ, Walter T, Robelin P, Lombard-Bohas C, Frassoni S, Bagnardi V, Antonuzzo L, Sparano C, Massironi S, Gelsomino F, Bongiovanni A, Ranallo N, Tafuto S, Rossi M, Cives M, Rasul Kakil I, Hamid H, Chirco A, Squadroni M, La Salvia A, Hernando J, Hofland J, Koumarianou A, Boselli S, Tamayo D, Mazzon C, Rubino M, Spada F. COVID-19 in patients with neuroendocrine neoplasms: 2-year results of the INTENSIVE study. Endocr Relat Cancer 2023; 30:e220395. [PMID: 36930250 DOI: 10.1530/erc-22-0395] [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] [Received: 02/23/2023] [Accepted: 03/16/2023] [Indexed: 03/18/2023]
Abstract
We conducted a retrospective/prospective worldwide study on patients with neuroendocrine neoplasms (NENs) and a molecularly proven SARS-CoV-2 positivity. Preliminary results regarding 85 patients of the INTENSIVE study have been published in 2021. Now we are reporting the 2-year analysis.Here, we are reporting data from consecutive patients enrolled between 1 June 2020, and 31 May 2022. Among the 118 contacted centers, 25 were active to enroll and 19 actively recruiting at the time of data cut-off for a total of 280 patients enrolled. SARS-CoV-2 positivity occurred in 47.5% of patients in 2020, 35.1% in 2021, and 17.4% in 2022. The median age for COVID-19 diagnosis was 60 years. Well-differentiated tumors, non-functioning, metastatic stage, and gastroenteropancreatic (GEP) primary sites represented most of the NENs. COVID-19-related pneumonia occurred in 22.8% of the total, with 61.3% of them requiring hospitalization; 11 patients (3.9%) needed sub-intensive or intensive care unit therapies and 14 patients died (5%), in 11 cases (3.9%) directly related to COVID-19. Diabetes mellitus and age at COVID-19 diagnosis > 70 years were significantly associated with COVID-19 mortality, whereas thoracic primary site with COVID-19 morbidity. A significant decrease in both hospitalization and pneumonia occurred in 2022 vs 2020. In our largest series of NEN patients with COVID-19, the NEN population is similar to the general population of patients with NEN regardless of COVID-19. However, older age, non-GEP primary sites and diabetes mellitus should be carefully considered for increased COVID-19 morbidity and mortality. Relevant information could be derived by integrating our results with NENs patients included in other cancer patients with COVID-19 registries.
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Affiliation(s)
- Nicola Fazio
- Division of gastrointestinal medical oncology and neuroendocrine tumors, European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | - Lorenzo Gervaso
- Division of gastrointestinal medical oncology and neuroendocrine tumors, European Institute of Oncology (IEO) IRCCS, Milan, Italy
- Molecular Medicine Program, University of Pavia, Pavia, Italy
| | | | - Mohamad Sonbol
- Department of Hematology and Oncology, Mayo Clinic, Phoenix, Arizona, USA
| | - Rachel A Eiring
- Division of Medical Oncology Mayo Clinic, Rochester, Minnesota, USA
| | - Sara Pusceddu
- Division of Medical Oncology, National Cancer Institute, Milan, Italy
| | - Natalie Prinzi
- Division of Medical Oncology, National Cancer Institute, Milan, Italy
| | | | - Simona Grozinsky-Glasberg
- Neuroendocrine Tumor Unit, ENETS Center of Excellence, Department of Endocrinology and Metabolism, Hadassah Medical Center and Faculty of Medicine, The Hebrew University, Jerusalem, Israel
| | - David J Gross
- Neuroendocrine Tumor Unit, ENETS Center of Excellence, Department of Endocrinology and Metabolism, Hadassah Medical Center and Faculty of Medicine, The Hebrew University, Jerusalem, Israel
| | - Thomas Walter
- Medical Oncology Department, Hopital Edourad Herriot, Hospices civils de Lyon, Lyon, France
| | - Patrick Robelin
- Medical Oncology Department, Hopital Edourad Herriot, Hospices civils de Lyon, Lyon, France
| | | | - Samuele Frassoni
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Lorenzo Antonuzzo
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Clotilde Sparano
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence, Italy
| | - Sara Massironi
- Division of Gastroenterology, and Center for Autoimmune Liver Diseases, European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, University of Milano-Bicocca School of Medicine, Monza, Italy
| | - Fabio Gelsomino
- Division of Oncology. Department of Hematology and Oncology, University Hospital of Modena, Modena, Italy
| | - Alberto Bongiovanni
- Oncologia medica, IRCCS Istituto Romagnolo per lo Studio dei Tumori 'Dino Amadori', IRST S.r.l., Meldola, Italy
| | - Nicoletta Ranallo
- Oncologia medica, IRCCS Istituto Romagnolo per lo Studio dei Tumori 'Dino Amadori', IRST S.r.l., Meldola, Italy
| | - Salvatore Tafuto
- Oncologia Sarcomi e Tumori rari, I.R.C.C.S. Ist. Naz. Tumori di Napoli 'G. Pascale', Napoli, Italy
| | - Maura Rossi
- Oncology Unit and Centro Documentazione Osteonecrosi, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Mauro Cives
- Department of Interdisciplinary Medicine, University of Bari 'Aldo Moro', Bari, Italy
| | | | - Hytam Hamid
- Department of Surgery, Al-Moalem Medical City, Khartoum, Sudan
| | | | | | - Anna La Salvia
- Medical Oncology Department, Hospital Universitario Doce de Octubre, Imas12, UCM, Madrid, Spain
| | - Jorge Hernando
- Vall Hebron University Hospital and Vall Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Johannes Hofland
- Department of Internal Medicine, Sector Endocrinology, Rotterdam, the Netherlands
| | - Anna Koumarianou
- Hematology-Oncology Unit, Fourth Department of Internal Medicine, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Sabrina Boselli
- Data Management-Clinical Trial Office. Scientific Direction. European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | - Darina Tamayo
- Data Management-Clinical Trial Office. Scientific Direction. European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | - Cristina Mazzon
- Data Management-Clinical Trial Office. Scientific Direction. European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | - Manila Rubino
- Division of gastrointestinal medical oncology and neuroendocrine tumors, European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | - Francesca Spada
- Division of gastrointestinal medical oncology and neuroendocrine tumors, European Institute of Oncology (IEO) IRCCS, Milan, Italy
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11
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Soldevilla B, Lens-Pardo A, Espinosa-Olarte P, Carretero-Puche C, Molina-Pinelo S, Robles C, Benavent M, Gomez-Izquierdo L, Fierro-Fernández M, Morales-Burgo P, Jimenez-Fonseca P, Anton-Pascual B, Rodriguez-Gil Y, Teijo-Quintans A, La Salvia A, Rubio-Cuesta B, Riesco-Martínez MC, Garcia-Carbonero R. MicroRNA signature and integrative omics analyses define prognostic clusters and key pathways driving prognosis in patients with neuroendocrine neoplasms. Mol Oncol 2023; 17:582-597. [PMID: 36795001 PMCID: PMC10061291 DOI: 10.1002/1878-0261.13393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 01/16/2023] [Accepted: 02/07/2023] [Indexed: 02/17/2023] Open
Abstract
Neuroendocrine neoplasms (NENs) are mutationally quiet (low number of mutations/Mb), and epigenetic mechanisms drive their development and progression. We aimed at comprehensively characterising the microRNA (miRNA) profile of NENs, and exploring downstream targets and their epigenetic modulation. In total, 84 cancer-related miRNAs were analysed in 85 NEN samples from lung and gastroenteropancreatic (GEP) origin, and their prognostic value was evaluated by univariate and multivariate models. Transcriptomics (N = 63) and methylomics (N = 30) were performed to predict miRNA target genes, signalling pathways and regulatory CpG sites. Findings were validated in The Cancer Genome Atlas cohorts and in NEN cell lines. We identified a signature of eight miRNAs that stratified patients in three prognostic groups (5-year survival of 80%, 66% and 36%). Expression of the eight-miRNA gene signature correlated with 71 target genes involved in PI3K-Akt and TNFα-NF-kB signalling. Of these, 28 were associated with survival and validated in silico and in vitro. Finally, we identified five CpG sites involved in the epigenetic regulation of these eight miRNAs. In brief, we identified an 8-miRNA signature able to predict survival of patients with GEP and lung NENs, and identified genes and regulatory mechanisms driving prognosis in NEN patients.
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Affiliation(s)
- Beatriz Soldevilla
- Centro de Oncología Experimental, Grupo de Investigación en Tumores Gastrointestinales y Neuroendocrinos, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Centro Nacional de Investigaciones Oncológicas (CNIO), Madrid, Spain.,Universidad Complutense de Madrid (UCM), Spain
| | - Alberto Lens-Pardo
- Centro de Oncología Experimental, Grupo de Investigación en Tumores Gastrointestinales y Neuroendocrinos, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Centro Nacional de Investigaciones Oncológicas (CNIO), Madrid, Spain
| | - Paula Espinosa-Olarte
- Centro de Oncología Experimental, Grupo de Investigación en Tumores Gastrointestinales y Neuroendocrinos, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Oncology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Carlos Carretero-Puche
- Centro de Oncología Experimental, Grupo de Investigación en Tumores Gastrointestinales y Neuroendocrinos, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Centro Nacional de Investigaciones Oncológicas (CNIO), Madrid, Spain
| | - Sonia Molina-Pinelo
- Hospital Universitario Virgen del Rocío, IBIS, Sevilla, Spain.,Instituto de Biomedicina de Sevilla (IBiS) (HUVR, CSIC, Universidad de Sevilla), Spain
| | - Carlos Robles
- Hospital Universitario Virgen del Rocío, IBIS, Sevilla, Spain
| | - Marta Benavent
- Hospital Universitario Virgen del Rocío, IBIS, Sevilla, Spain
| | | | | | | | | | - Beatriz Anton-Pascual
- Centro de Oncología Experimental, Grupo de Investigación en Tumores Gastrointestinales y Neuroendocrinos, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Oncology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | - Anna La Salvia
- Centro de Oncología Experimental, Grupo de Investigación en Tumores Gastrointestinales y Neuroendocrinos, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Oncology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Beatriz Rubio-Cuesta
- Centro de Oncología Experimental, Grupo de Investigación en Tumores Gastrointestinales y Neuroendocrinos, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Centro Nacional de Investigaciones Oncológicas (CNIO), Madrid, Spain
| | - Maria C Riesco-Martínez
- Centro de Oncología Experimental, Grupo de Investigación en Tumores Gastrointestinales y Neuroendocrinos, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Centro Nacional de Investigaciones Oncológicas (CNIO), Madrid, Spain.,Oncology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Rocio Garcia-Carbonero
- Centro de Oncología Experimental, Grupo de Investigación en Tumores Gastrointestinales y Neuroendocrinos, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Centro Nacional de Investigaciones Oncológicas (CNIO), Madrid, Spain.,Oncology Department, Hospital Universitario 12 de Octubre, Madrid, Spain.,Universidad Complutense de Madrid (UCM), Spain
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12
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Altieri B, La Salvia A, Modica R, Marciello F, Mercier O, Filosso PL, de Latour BR, Giuffrida D, Campione S, Guggino G, Fadel E, Papotti M, Colao A, Scoazec JY, Baudin E, Faggiano A. Recurrence-Free Survival in Early and Locally Advanced Large Cell Neuroendocrine Carcinoma of the Lung after Complete Tumor Resection. J Pers Med 2023; 13:jpm13020330. [PMID: 36836564 PMCID: PMC9965978 DOI: 10.3390/jpm13020330] [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: 01/14/2023] [Revised: 02/09/2023] [Accepted: 02/13/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Large Cell Neuroendocrine Carcinoma (LCNEC) is a rare subtype of lung cancer with poor clinical outcomes. Data on recurrence-free survival (RFS) in early and locally advanced pure LCNEC after complete resection (R0) are lacking. This study aims to evaluate clinical outcomes in this subgroup of patients and to identify potential prognostic markers. METHODS Retrospective multicenter study including patients with pure LCNEC stage I-III and R0 resection. Clinicopathological characteristics, RFS, and disease-specific survival (DSS) were evaluated. Univariate and multivariate analyses were performed. RESULTS 39 patients (M:F = 26:13), with a median age of 64 years (44-83), were included. Lobectomy (69.2%), bilobectomy (5.1%), pneumonectomy (18%), and wedge resection (7.7%) were performed mostly associated with lymphadenectomy. Adjuvant therapy included platinum-based chemotherapy and/or radiotherapy in 58.9% of cases. After a median follow-up of 44 (4-169) months, the median RFS was 39 months with 1-, 2- and 5-year RFS rates of 60.0%, 54.6%, and 44.9%, respectively. Median DSS was 72 months with a 1-, 2- and 5-year rate of 86.8, 75.9, and 57.4%, respectively. At multivariate analysis, age (cut-off 65 years old) and pN status were independent prognostic factors for both RFS (HR = 4.19, 95%CI = 1.46-12.07, p = 0.008 and HR = 13.56, 95%CI 2.45-74.89, p = 0.003, respectively) and DSS (HR = 9.30, 95%CI 2.23-38.83, p = 0.002 and HR = 11.88, 95%CI 2.28-61.84, p = 0.003, respectively). CONCLUSION After R0 resection of LCNEC, half of the patients recurred mostly within the first two years of follow-up. Age and lymph node metastasis could help to stratify patients for adjuvant therapy.
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Affiliation(s)
- Barbara Altieri
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg, 97080 Würzburg, Germany
- Correspondence:
| | - Anna La Salvia
- National Center for Drug Research and Evaluation, National Institute of Health (ISS), 00161 Rome, Italy
| | - Roberta Modica
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy
| | - Francesca Marciello
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy
| | - Olaf Mercier
- Department of Thoracic Surgery and Heart and Lung Transplantation, Université Paris-Saclay, Marie Lannelongue Hospital, GHPSJ, 92350 Le Plessis Robinson, France
| | - Pier Luigi Filosso
- Department of Thoracic Surgery, University of Turin, San Giovanni Battista Hospital, 10126 Turin, Italy
| | - Bertrand Richard de Latour
- Department of Thoracic and Cardiovascular Surgery, University Hospital Rennes Pontchaillou, University of Rennes, 422931 Rennes, France
| | - Dario Giuffrida
- Clinical Oncology Unit, Department of Experimental Oncology, Mediterranean Institute of Oncology, 95029 Catania, Italy
| | - Severo Campione
- Department of Advanced Technology, Pathology Unit, Cardarelli Hospital, 80131 Naples, Italy
| | - Gianluca Guggino
- Department of Thoracic Surgery, Cardarelli Hospital, 80131 Naples, Italy
| | - Elie Fadel
- Department of Thoracic Surgery and Heart and Lung Transplantation, Université Paris-Saclay, Marie Lannelongue Hospital, GHPSJ, 92350 Le Plessis Robinson, France
| | - Mauro Papotti
- Department of Oncology, Pathology Unit, University of Turin, 10126 Turin, Italy
| | - Annamaria Colao
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy
| | - Jean-Yves Scoazec
- Department of Pathology, Institute Gustave Roussy, Université Paris Saclay, 94805 Villejuif, France
| | - Eric Baudin
- Endocrine Oncology and Nuclear Medicine Department, Institute Gustave Roussy, Paris-Saclay University, 94805 Villejuif, France
| | - Antongiulio Faggiano
- Endocrinology Unit, Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy
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13
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Fanciulli G, Modica R, La Salvia A, Grossrubatscher EM, Florio T, Ferraù F, Veresani A, Russo F, Colao A, Faggiano A. Proteasome inhibitors in medullary thyroid carcinoma: time to restart with clinical trials? Front Endocrinol (Lausanne) 2023; 14:1145926. [PMID: 37152939 PMCID: PMC10157225 DOI: 10.3389/fendo.2023.1145926] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 04/05/2023] [Indexed: 05/09/2023] Open
Abstract
Introduction Medullary thyroid cancer (MTC) is a rare thyroid tumour whose management in advanced stages is challenging, despite effective therapeutic options having expanded in recent years. Proteasome inhibitors (PrIn) have shown the ability to improve patient outcomes, including survival and quality of life, in several malignancies, due to their ability to impair cell proliferation and cause apoptosis through the inhibition of the proteasome activity. Consequently, these drugs could represent a useful tool, alone or in combination with other treatments, in MTC patients. Aim of the study This review aims to summarize the available in vitro and in vivo data about the role of PrIn in MTC. Materials and methods We performed an extensive search for relevant data sources, including full-published articles in international online databases (PubMed, Web of Science, Scopus), preliminary reports in selected international meeting abstract repositories, and short articles published as supplements of international meetings, by using the following terms: medullary thyroid carcinoma, proteasome inhibitors, bortezomib, carfilzomib, ixazomib, delanzomib, marizomib, oprozomib, and MG132. Additionally, we conducted with the same keywords, an in-depth search in registered clinical trials repositories. Results Our search revealed in vitro studies in human and murine MTC cell lines, based on the use of PrIns, both alone and in combination with other anticancer drugs, and two pertinent clinical trials. Conclusion We found a strong discrepancy between the evidence of PrIns effects in preclinical studies, and the scarcity or early interruption of clinical trials. We might speculate that difficulties in enrolling patients, as happens in other rare diseases, may have discouraged trials' implementation in favor of drugs already approved for MTC. However, given the concrete improvement in the comprehension of the molecular basis of PrIn effects in MTC, new clinical trials with accurate inclusion criteria of enrollment might be warranted, in order to ascertain whether this treatment, alone or in combination with other drugs, could indeed represent an option to enhance the therapeutic response, and to ultimately improve patients' outcome and survival.
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Affiliation(s)
- Giuseppe Fanciulli
- Neuroendocrine Tumor Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
- Endocrine Unit, Azienda Ospedaliero-Universitaria (AOU) Sassari, Sassari, Italy
- *Correspondence: Giuseppe Fanciulli,
| | - Roberta Modica
- Endocrinology, Diabetology and Andrology Unit, Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Anna La Salvia
- National Center for Drug Research and Evaluation, National Institute of Health (ISS), Rome, Italy
| | - Erika Maria Grossrubatscher
- Endocrine Unit, Azienda Socio Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Tullio Florio
- Department of Internal Medicine, University of Genoa, Genoa, Italy
- Scientific Institute for Research, Hospitalisation and Healthcare Ospedale Policlinico San Martino, Genoa, Italy
| | - Francesco Ferraù
- Department of Human Pathology of Adulthood and Childhood “G. Barresi” (DETEV), University of Messina, Messina, Italy
| | - Alessandro Veresani
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DiMI), University of Genoa, Genoa, Italy
| | - Flaminia Russo
- Endocrinology Unit, Department of Clinical and Molecular Medicine, The European Neuroendocrine Tumor Society (ENETS) Center of Excellence, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Annamaria Colao
- Endocrinology, Diabetology and Andrology Unit, Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
- UNESCO Chair, Education for Health and Sustainable Development, Federico II University, Naples, Italy
| | - Antongiulio Faggiano
- Endocrinology Unit, Department of Clinical and Molecular Medicine, The European Neuroendocrine Tumor Society (ENETS) Center of Excellence, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
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Ferolla P, Berruti A, Spada F, Brizzi MP, Ibrahim T, Marconcini R, Giuffrida D, Amoroso V, La Salvia A, Vaccaro V, Faggiano A, Colao A, Volante M, Ghizzoni S, Mazzanti P, Houchard A, Fazio N. Efficacy and Safety of Lanreotide Autogel and Temozolomide Combination Therapy in Progressive Thoracic Neuroendocrine Tumors (Carcinoid): Results from the Phase 2 ATLANT Study. Neuroendocrinology 2023; 113:332-342. [PMID: 36044870 DOI: 10.1159/000526811] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 08/22/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Lanreotide autogel (LAN) and temozolomide (TMZ) are guidelines-recommended monotherapies for thoracic neuroendocrine tumors (carcinoids; T-NETs), but prospective data for both combined and monotherapies are lacking. ATLANT (NCT02698410) evaluated efficacy and safety of LAN/TMZ in progressive T-NETs. METHODS ATLANT was a 12-month, Italian, phase 2, single-arm, open-label, multicenter pilot study. Eligible patients had unresectable, locally advanced/metastatic, well-/moderately differentiated T-NETs with radiological progression. Patients received subcutaneous LAN 120 mg every 28 days and oral TMZ 250 mg/day for 5 consecutive days every 28-day cycle. Main endpoints are disease control rate (DCR) at 9 months (primary; investigator-assessed), median progression-free survival (PFS), biomarkers, and safety. RESULTS The number of patients was 40; 60% were male. Primary tumor site was lung (90%) and thymus (10%). Carcinoid type was typical (20.0%) and atypical (52.5%). DCR at 9 months was 35.0% (95% confidence interval (CI) 20.63-51.68; nonacceptability threshold ≤10%, p < 0.0001; not significantly above clinically relevant threshold ≥30%, p = 0.2968). DCR between 7.5 and 10.5 months (sensitivity analysis) was 45.0% (95% CI: 29.26-61.51) and clinically relevant (p = 0.0320 at ≥30% threshold). Median PFS was 37.1 (95% CI: 24.1-52.9) weeks. No association was observed between biomarker variations (chromogranin A, neuron-specific enolase, somatostatin receptor type-2, Ki-67, 6-O-methylguanine-DNA-methyl-transferase) and DCR or PFS. Most patients (97.5%) had treatment-emergent adverse events (TEAEs); 72.5% had treatment-related TEAEs. TEAEs were mainly grade 1/2. No unanticipated TEAEs were reported. CONCLUSIONS This study showed that the LAN/TMZ combination has promising efficacy in progressive T-NETs, and was well tolerated. Larger studies are warranted to support the clinical benefits of LAN/TMZ in patients with T-NETs.
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Affiliation(s)
- Piero Ferolla
- Multidisciplinary NET Center, Umbria Regional Cancer Network, Perugia, Italy
| | - Alfredo Berruti
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Medical Oncology, University of Brescia at ASST-Spedali Civili, Brescia, Italy
| | - Francesca Spada
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, IRCCS, IEO, Milan, Italy
| | - Maria Pia Brizzi
- Department of Oncology, Medical Oncology, A.O.U. San Luigi Gonzaga, Turin, Italy
| | - Toni Ibrahim
- Osteoncology and Rare Tumors Center, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST), "Dino Amadori", Meldola, Italy
| | | | - Dario Giuffrida
- Department of Oncology, Istituto Oncologico del Mediterraneo, Viagrande (Catania), Italy
| | - Vito Amoroso
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Medical Oncology, University of Brescia at ASST-Spedali Civili, Brescia, Italy
| | - Anna La Salvia
- Department of Oncology, Medical Oncology, A.O.U. San Luigi Gonzaga, Turin, Italy
| | - Vanja Vaccaro
- Medical Oncology 1, Regina Elena National Cancer Institute, IRCCS, Rome, Italy
| | - Antongiulio Faggiano
- Endocrinology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Università Sapienza di Roma, Rome, Italy
| | - Annamaria Colao
- Department of Clinical Medicine and Surgery and UNESCO Chair for Health Education and Sustainable Development, Università Federico II di Napoli, Naples, Italy
| | - Marco Volante
- Department of Oncology, University of Turin, Turin, Italy
| | | | | | | | - Nicola Fazio
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, IRCCS, IEO, Milan, Italy
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15
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Persano I, Parlagreco E, La Salvia A, Audisio M, Volante M, Buttigliero C, Scagliotti GV, Brizzi MP. Synchronous or metachronous presentation of pancreatic neuroendocrine tumor versus secondary lesion to pancreas in patients affected by renal cell carcinoma. Systematic review. Semin Oncol 2022; 49:476-481. [PMID: 36759234 DOI: 10.1053/j.seminoncol.2023.01.007] [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] [Received: 06/19/2021] [Revised: 01/17/2023] [Accepted: 01/17/2023] [Indexed: 02/05/2023]
Abstract
The simultaneous or metachronous occurrence of pancreatic neuroendocrine tumor (panNET) and renal cell carcinoma (RCC) may represent a rare coincidence or a manifestation of von Hippel-Lindau disease (VHL). These two malignancies share both radiological and cytopathological features, making the differential diagnosis very challenging. In this review, we collected all cases of concurrent diagnosis of localized panNET and RCC, with or without VHL, as reported in the literature to date. We aimed to provide an insight into the differential diagnosis between panNET and RCC pancreatic metastasis with a focus on the optimal therapeutic algorithm depending on the diagnosis. We performed literature research in PubMed library databases for articles about coexisting panNET and RCC published from 2001 to 2018. We selected nine articles with a total of 13 patients, including one treated at our institution. Patients' median age was 49 years and eight out of 13 patients were women. VHL was diagnosed in nine cases. Most patients underwent radical nephrectomy for RCC (9/13) and a clear cell renal carcinoma variant was identified in six cases. The diagnosis of panNET was synchronous with RCC detection in nine cases and metachronous in four cases. The diameter of the pancreatic lesion was >2 cm in six cases. In two cases the panNET was misdiagnosed as metastatic RCC by radiological tests. Somatostatin receptor scanning was performed only in our patient (Octreoscan) showing intense uptake in the pancreatic mass. Endoscopic ultrasound fine needle aspiration of the pancreatic lesion was performed in four patients: in two cases the panNET was confused with metastatic RCC by cytological analysis. Most patients underwent pancreatic surgery (10/13) without histological confirmation. Clear cell panNET was recognized in six cases, while mixed neuroendocrine non-neuroendocrine neoplasm was diagnosed in one patient. Immunohistochemistry (IHC) staining showed positivity to typical neuroendocrine markers (chromogranin A and synaptophysin) in all reported tested cases (8/8). Three patients underwent systemic treatment: two patients received sunitinib and one patient interleukin-2 (IL-2). Other neoplasms were observed in seven patients, of whom six were affected by VHL syndrome. When neoplastic lesions are recognized in both the kidney and pancreas, panNET and RCC pancreatic metastasis are often misdiagnosed due to similar radiological and cytopathological features. An accurate differential diagnosis is crucial and IHC plays a central role in distinguishing the two entities. The therapeutic algorithm may change depending on the diagnosis: while pancreatic RCC metastases benefit from resection, in panNETs and VHL the indication for surgery must be carefully evaluated.
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Affiliation(s)
- Irene Persano
- Department of Oncology, University Hospital San Luigi Gonzaga, University of Turin, Orbassano, Italy.
| | - Elena Parlagreco
- Department of Oncology, University Hospital San Luigi Gonzaga, University of Turin, Orbassano, Italy
| | - Anna La Salvia
- National Center for Drug Research and Evaluation, National Institute of Health (ISS), Rome, Italy
| | - Marco Audisio
- Department of Oncology, University Hospital San Luigi Gonzaga, University of Turin, Orbassano, Italy
| | - Marco Volante
- Department of Oncology, University Hospital San Luigi Gonzaga, University of Turin, Orbassano, Italy
| | - Consuelo Buttigliero
- Department of Oncology, University Hospital San Luigi Gonzaga, University of Turin, Orbassano, Italy
| | | | - Maria Pia Brizzi
- Department of Oncology, University Hospital San Luigi Gonzaga, University of Turin, Orbassano, Italy
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Espinosa-Olarte P, La Salvia A, Riesco-Martinez MC, Anton-Pascual B, Garcia-Carbonero R. Correction to: Chemotherapy in NEN: still has a role? Rev Endocr Metab Disord 2022; 23:1103-1104. [PMID: 35776234 PMCID: PMC9515009 DOI: 10.1007/s11154-022-09741-w] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Paula Espinosa-Olarte
- Oncology Department, Hospital Universitario, 12 de Octubre, Imas12, UCM, Madrid, Spain
| | - Anna La Salvia
- Oncology Department, Hospital Universitario, 12 de Octubre, Imas12, UCM, Madrid, Spain
| | | | - Beatriz Anton-Pascual
- Oncology Department, Hospital Universitario, 12 de Octubre, Imas12, UCM, Madrid, Spain
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17
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Metovic J, La Salvia A, Rapa I, Napoli F, Birocco N, Pia Bizzi M, Garcia-Carbonero R, Ciuffreda L, Scagliotti G, Papotti M, Volante M. Molecular Subtypes of Extra-pulmonary Neuroendocrine Carcinomas Identified by the Expression of Neuroendocrine Lineage-Specific Transcription Factors. Endocr Pathol 2022; 33:388-399. [PMID: 35608806 PMCID: PMC9420091 DOI: 10.1007/s12022-022-09722-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 12/17/2022]
Abstract
Extra-pulmonary neuroendocrine carcinomas (EPNEC) represent a group of rare and heterogenous neoplasms with adverse clinical outcome. Their molecular profile is largely unexplored. Our aim was to investigate if the major transcriptional drivers recently described in high-grade pulmonary neuroendocrine carcinomas characterize distinct molecular and clinical subgroups of EPNEC. Gene expression of ASCL1, NEUROD1, DLL3, NOTCH1, INSM1, MYCL1, POU2F3, and YAP1 was investigated in a series of 54 EPNEC (including 10 cases with mixed components analyzed separately) and in a group of 48 pulmonary large cell neuroendocrine carcinomas (P-LCNEC). Unsupervised hierarchical cluster analysis classified the whole series into four major clusters. P-LCNEC were classified into two major clusters, the first ASCL1/DLL3/INSM1-high and the second (including four EPNEC) ASCL1/DLL3-low but INSM1-high. The remaining EPNEC cases were sub-classified into two other clusters. The first showed INSM1-high and alternative ASCL1/DLL3 or NEUROD1 high expression. The second was characterized mainly by MYCL1 and YAP1 overexpression. In the ten cases with mixed histology, ASCL1, DLL3, INSM1, and NEUROD1 genes were significantly upregulated in the neuroendocrine component. Higher gene-expression levels of NOTCH1 and INSM1 were associated with lower pT stage and negative nodal status. Low INSM1 gene expression was associated with shorter overall survival in the entire case series (p = 0.0017) and with a trend towards significance in EPNEC, only (p = 0.06). In conclusion, our results show that EPNEC possess distinct neuroendocrine-lineage-specific transcriptional profiles; moreover, low INSM1 gene expression represents a novel potential unfavorable prognostic marker in high-grade NECs including those in extra-pulmonary location.
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Affiliation(s)
- Jasna Metovic
- Department of Oncology, University of Turin; Pathology Unit at Città della Salute e della Scienza Hospital, via Santena 7, Turin, Italy
| | - Anna La Salvia
- Division of Medical Oncology, Hospital Universitario, 12 de Octubre, Madrid, Spain
| | - Ida Rapa
- Department of Oncology, University of Turin; Pathology Unit at San Luigi Hospital, Regione Gonzole 10, 10043, Orbassano, Turin, Italy
| | - Francesca Napoli
- Department of Oncology, University of Turin; Pathology Unit at San Luigi Hospital, Regione Gonzole 10, 10043, Orbassano, Turin, Italy
| | - Nadia Birocco
- Medical Oncology Unit, Città Della Salute e Della Scienza Hospital, Turin, Italy
| | - Maria Pia Bizzi
- Medical Oncology Unit, San Luigi Hospital, Orbassano, Turin, Italy
| | | | - Libero Ciuffreda
- Medical Oncology Unit, Città Della Salute e Della Scienza Hospital, Turin, Italy
| | - Giorgio Scagliotti
- Department of Oncology, University of Turin; Medical Oncology Unit at San Luigi Hospital, Orbassano, Turin, Italy
| | - Mauro Papotti
- Department of Oncology, University of Turin; Pathology Unit at Città della Salute e della Scienza Hospital, via Santena 7, Turin, Italy
| | - Marco Volante
- Department of Oncology, University of Turin; Pathology Unit at San Luigi Hospital, Regione Gonzole 10, 10043, Orbassano, Turin, Italy.
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18
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Fanciulli G, Modica R, La Salvia A, Campolo F, Florio T, Mikovic N, Plebani A, Di Vito V, Colao A, Faggiano A. Immunotherapy of Neuroendocrine Neoplasms: Any Role for the Chimeric Antigen Receptor T Cells? Cancers (Basel) 2022; 14:cancers14163991. [PMID: 36010987 PMCID: PMC9406675 DOI: 10.3390/cancers14163991] [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: 07/25/2022] [Revised: 08/14/2022] [Accepted: 08/17/2022] [Indexed: 12/14/2022] Open
Abstract
Simple Summary Neuroendocrine neoplasms (NENs) comprise a heterogeneous group of tumors arising in different organs whose clinical course is variable according to histological differentiation and metastatic spread. Therapeutic options have recently expanded, but there is a need for new effective therapies, especially in less differentiated forms. Chimeric antigen receptor T cells (CAR-T) have shown efficacy in several cancers, mainly hematological, but data on NENs are scattered. We aimed to analyze the available preclinical and clinical data about CAR-T in NENs, to highlight their potential role in clinical practice. A significant therapeutic effect of CAR-T cells in NENs emerges from preclinical studies. Results from clinical trials are expected in order to define their effective role in these cancers. Abstract Neuroendocrine neoplasms (NENs) are a heterogeneous group of tumors with variable clinical presentation and prognosis. Surgery, when feasible, is the most effective and often curative treatment. However, NENs are frequently locally advanced or already metastatic at diagnosis. Consequently, additional local or systemic therapeutic approaches are required. Immunotherapy, based on chimeric antigen receptor T cells (CAR-T), is showing impressive results in several cancer treatments. The aim of this narrative review is to analyze the available data about the use of CAR-T in NENs, including studies in both preclinical and clinical settings. We performed an extensive search for relevant data sources, comprising full-published articles, abstracts from international meetings, and worldwide registered clinical trials. Preclinical studies performed on both cell lines and animal models indicate a significant therapeutic effect of CAR-T cells in NENs. Ongoing and future clinical trials will clarify the possible role of these drugs in patients with highly aggressive NENs.
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Affiliation(s)
- Giuseppe Fanciulli
- Neuroendocrine Tumour Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari—Endocrine Unit, AOU Sassari, 07100 Sassari, Italy
- Correspondence:
| | - Roberta Modica
- Endocrinology, Diabetology and Andrology Unit, Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131 Naples, Italy
| | - Anna La Salvia
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Federica Campolo
- Department of Experimental Medicine, “Sapienza” University of Rome, 00161 Rome, Italy
| | - Tullio Florio
- Department of Internal Medicine, University of Genoa, 16132 Genoa, Italy
- Scientific Institute for Research, Hospitalisation and Healthcare Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Nevena Mikovic
- Endocrinology Unit, Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, ENETS Center of Excellence, Sapienza University of Rome, 00189 Rome, Italy
| | - Alice Plebani
- Laboratory of Geriatric and Oncologic Neuroendocrinology Research, Istituto Auxologico Italiano IRCCS, Cusano Milanino, 20095 Milan, Italy
| | - Valentina Di Vito
- Department of Experimental Medicine, “Sapienza” University of Rome, 00161 Rome, Italy
| | - Annamaria Colao
- Endocrinology, Diabetology and Andrology Unit, Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131 Naples, Italy
- UNESCO Chair, Education for Health and Sustainable Development, Federico II University, 80131 Naples, Italy
| | - Antongiulio Faggiano
- Endocrinology Unit, Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, ENETS Center of Excellence, Sapienza University of Rome, 00189 Rome, Italy
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Riesco-Martinez MC, Modrego A, Espinosa-Olarte P, La Salvia A, Garcia-Carbonero R. Perioperative Chemotherapy for Liver Metastasis of Colorectal Cancer: Lessons Learned and Future Perspectives. Curr Treat Options Oncol 2022; 23:1320-1337. [PMID: 35980520 DOI: 10.1007/s11864-022-01008-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2022] [Indexed: 11/27/2022]
Abstract
OPINION STATEMENT Colorectal cancer (CRC) is a major public health problem and the 2nd leading-cause of cancer-related death worldwide. Around 30% of patients present with metastatic disease and 50% of those with early disease will eventually relapse. The metastatic spread occurs mainly to the liver, which is the exclusive site in 30-40% of the cases. Surgery is the main curative option for liver recurrence, but only one out of five patients are eligible for resection. Moreover, even if surgery is feasible, recurrence rate is high, occurring in up to 75% of patients. Therefore, additional treatment to improve these disappointing outcomes has been sought. Adjuvant and perioperative chemotherapy aim to eradicate early micrometastatic disease, decreasing recurrence rates, and improving survival outcomes. Different chemotherapy regimens, mainly extrapolated from the adjuvant experience, have showed conflicting results, with improvements in disease free but not in overall survival. The addition of targeted therapies to chemotherapy has improved response rates and resectability when administered preoperatively, but did not have an impact on survival in the adjuvant setting. There is a need to critically synthetize the available evidence on perioperative and conversion therapy from the past years, and appraise areas of current research and potential future directions.
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Affiliation(s)
- Maria C Riesco-Martinez
- Medical Oncology Department, Hospital Universitario 12 de Octubre, imas 12, UCM, Avda Cordoba km 5.4, 28041, Madrid, Spain
| | - Andrea Modrego
- Medical Oncology Department, Hospital Universitario 12 de Octubre, imas 12, UCM, Avda Cordoba km 5.4, 28041, Madrid, Spain
| | - Paula Espinosa-Olarte
- Medical Oncology Department, Hospital Universitario 12 de Octubre, imas 12, UCM, Avda Cordoba km 5.4, 28041, Madrid, Spain
| | - Anna La Salvia
- Medical Oncology Department, Hospital Universitario 12 de Octubre, imas 12, UCM, Avda Cordoba km 5.4, 28041, Madrid, Spain
| | - Rocio Garcia-Carbonero
- Medical Oncology Department, Hospital Universitario 12 de Octubre, imas 12, UCM, Avda Cordoba km 5.4, 28041, Madrid, Spain.
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20
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La Salvia A, Persano I, Parlagreco E, Audisio A, Cani M, Brizzi MP. Pancreatic adenocarcinoma and pancreatic high-grade neuroendocrine carcinoma: two sides of the moon. Med Oncol 2022; 39:168. [PMID: 35972607 DOI: 10.1007/s12032-022-01764-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 06/09/2022] [Indexed: 06/15/2023]
Abstract
Pancreatic adenocarcinoma is the seventh leading cause of cancer death in the world and the most common type pf pancreatic cancer. Unfortunately, less than 20% of patients are surgically resectable and the great majority of cases are treated with palliative chemotherapy with unsatisfactory results. No targeted agents or personalized approaches have been validated in the last decades. On the other side, neuroendocrine neoplasms of the pancreas are generally considered indolent tumours. However, high-grade neuroendocrine carcinoma is a rare subtype of neuroendocrine neoplasm of the pancreas (accounting up to 10% of the neuroendocrine neoplasms of the pancreas), with particularly aggressive behaviour and poor prognosis. Even in this case, the treatment is represented by palliative chemotherapy with dismal results and no personalized therapies are available, so far. Notably, the quality of life of these patients is disappointingly low and the future perspectives of more personalized diagnostic and therapeutic strategies are scarce. In this review, we discuss relevant and current information on epidemiology, pathology, diagnosis, clinical presentation, treatment and ongoing clinical trials of these two entities, in order to illustrate the two sides of the moon.
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Affiliation(s)
- Anna La Salvia
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy.
| | - Irene Persano
- Department of Oncology, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Elena Parlagreco
- Department of Oncology, San Luigi Gonzaga Hospital, Orbassano, Italy
| | | | - Massimiliano Cani
- Department of Oncology, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Maria Pia Brizzi
- Department of Oncology, San Luigi Gonzaga Hospital, Orbassano, Italy
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21
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Zamponi V, La Salvia A, Tarsitano MG, Mikovic N, Rinzivillo M, Panzuto F, Giannetta E, Faggiano A, Mazzilli R. Effect of Neuroendocrine Neoplasm Treatment on Human Reproductive Health and Sexual Function. J Clin Med 2022; 11:jcm11143983. [PMID: 35887747 PMCID: PMC9324753 DOI: 10.3390/jcm11143983] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 07/06/2022] [Accepted: 07/07/2022] [Indexed: 02/02/2023] Open
Abstract
Neuroendocrine neoplasms (NEN) are characterized by a wide clinical heterogeneity and biological variability, with slow progression and long survival in most cases. Although these tumors can affect young adults, there are few studies that focus on the sexual and reproductive system. The aim of this review was to evaluate the effect of NEN treatment, including somatostatin analogues (SSA), targeted therapy (Everolimus and Sunitinib), radiolabeled-SSA and chemotherapy, on male and female reproductive systems and sexual function. This narrative review was performed for all available prospective and retrospective studies, case reports and review articles published up to March 2022 in PubMed. To date, few data are available on the impact of SSA on human fertility and most of studies come from acromegalic patients. However, SSAs seem to cross the blood–placental barrier; therefore, pregnancy planning is strongly recommended. Furthermore, the effect of targeted therapy on reproductive function is still undefined. Conversely, chemotherapy has a well-known negative impact on male and female fertility. The effect of temozolomide on reproductive function is still undefined, even if changes in semen parameters after the treatment have been described. Finally, very few data are available on the sexual function of NEN treatment.
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Affiliation(s)
- Virginia Zamponi
- Department of Clinical and Molecular Medicine, ENETS Center of Excellence, Sapienza University of Rome, 00185 Rome, Italy; (V.Z.); (N.M.); (A.F.); (R.M.)
| | - Anna La Salvia
- Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
- Correspondence: ; Tel.: +39-0652665698
| | - Maria Grazia Tarsitano
- Department of Medical and Surgical Science, University Magna Graecia, 88100 Catanzaro, Italy;
| | - Nevena Mikovic
- Department of Clinical and Molecular Medicine, ENETS Center of Excellence, Sapienza University of Rome, 00185 Rome, Italy; (V.Z.); (N.M.); (A.F.); (R.M.)
| | - Maria Rinzivillo
- Digestive Disease Unit, ENETS Center of Excellence, Sant’Andrea University Hospital, 00189 Rome, Italy; (M.R.); (F.P.)
| | - Francesco Panzuto
- Digestive Disease Unit, ENETS Center of Excellence, Sant’Andrea University Hospital, 00189 Rome, Italy; (M.R.); (F.P.)
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Elisa Giannetta
- Department of Experimental Medicine, Sapienza University of Rome, 00185 Rome, Italy;
| | - Antongiulio Faggiano
- Department of Clinical and Molecular Medicine, ENETS Center of Excellence, Sapienza University of Rome, 00185 Rome, Italy; (V.Z.); (N.M.); (A.F.); (R.M.)
| | - Rossella Mazzilli
- Department of Clinical and Molecular Medicine, ENETS Center of Excellence, Sapienza University of Rome, 00185 Rome, Italy; (V.Z.); (N.M.); (A.F.); (R.M.)
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22
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Puche CC, Soldevilla B, Gil B, La Salvia A, Lens-Pardo A, Espinosa P, Anton-Pascual B, Gómez-López G, Al-Shahrour F, García-Carbonero R. Abstract 2289: Comprehensive multiomic analysis reveals different subtypes in neuroendocrine tumors from multiple origins. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-2289] [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
Neuroendocrine neoplasms (NENs) are a heterogeneous group of tumors with a wide anatomical distribution and different clinical behaviors that share common “neuro” and “endocrine” properties. They are classified in well differentiated G1, G2 and G3 neuroendocrine tumors (NETs), or poorly differentiated neuroendocrine carcinomas (NECs) which are all G3. Some studies have assessed the NET molecular landscape of certain primary sites, but no cross-sites molecular assessment has been performed to date. Thus, we aimed to perform a comprehensive transcriptomic and methylomic characterization of large series of NENs of different anatomical origins in order to identify molecular subgroups, unravel genes and/or pathways involved, and explore their potential clinical relevance.
Transcriptomic and methylation data were obtained from tumor samples of 181 and 99 patients with NENs (37.02%G1; 54.7%G2 and 8.29%G3) using Clariom S Human microarrays and EPIC methylation arrays, respectively. Most common primary tumor site was the lung (43.1%), followed by the small intestine (35.4%), large intestine (8.8%), stomach (4.4%), pancreas (1.7%), other localizations (3.9%), and unknown primary (2.8%). Tumors were clustered using transcriptomic and methylation data by NMF and hierarchical clustering algorithms respectively, and differential expression (limma analysis) and gene set enrichment analysis (GSEA) was applied to transcriptomic data clusters
NENs were classified into three different clusters. Two of them (C1 and C3) showed an inverse transcriptomic profile, while C2 presented a mixed profile. We identified that C3 had the highest expression levels of neuroendocrine-related genes (somatostatin receptor SSTR5 LFC: 0.77 ; FDR: 1.52x10e-25 ; serotonin receptor HTR1A LFC: 0.79 ; FDR: 1.20X10e-20 ; VIP LFC: 0.64 ; FDR= 1.41x10e-10 etc), in lung primary tumor samples (50%) and methylation cluster 1 (82.14%). On the other hand, C1 was enriched in some important cancer-related pathways ( MYC targets NES -6.37 FDR < 10-3; MTORC1 NES -3.78 FDR < 10-3) and oxidative phosphorylation (NES -4.87 FDR < 10-3) ; and showed a higher proportion of small intestine primary tumors (46.34%), Grade 2 tumors (73.17%) and methylation cluster 2 (75%).
NENs of different primary sites can be stratified into two major transcriptomic clusters, with a third cluster having a mixed expression profile. The groups with extreme transcriptomic signatures were enriched in neuroendocrine-related genes or principal cancer pathways. These results suggest a dedifferentiation from a more indolent neuroendocrine phenotype to more aggressive proliferative tumor types that could be driven partially with the methylation profile.
Citation Format: Carlos Carretero Puche, Beatriz Soldevilla, Beatriz Gil, Anna La Salvia, Alberto Lens-Pardo, Paula Espinosa, Beatriz Anton-Pascual, Gonzalo Gómez-López, Fátima Al-Shahrour, Rocío García-Carbonero. Comprehensive multiomic analysis reveals different subtypes in neuroendocrine tumors from multiple origins [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 2289.
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Affiliation(s)
- Carlos Carretero Puche
- 1Fundación para la Investigación Biomédica del Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Beatriz Soldevilla
- 1Fundación para la Investigación Biomédica del Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Beatriz Gil
- 1Fundación para la Investigación Biomédica del Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Alberto Lens-Pardo
- 1Fundación para la Investigación Biomédica del Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Beatriz Anton-Pascual
- 1Fundación para la Investigación Biomédica del Hospital Universitario 12 de Octubre, Madrid, Spain
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La Salvia A, Persano I, Siciliani A, Verrico M, Bassi M, Modica R, Audisio A, Zanata I, Trabalza Marinucci B, Trevisi E, Puliani G, Rinzivillo M, Parlagreco E, Baldelli R, Feola T, Sesti F, Razzore P, Mazzilli R, Mancini M, Panzuto F, Volante M, Giannetta E, Romero C, Appetecchia M, Isidori A, Venuta F, Ambrosio MR, Zatelli MC, Ibrahim M, Colao A, Brizzi MP, García-Carbonero R, Faggiano A. Prognostic significance of laterality in lung neuroendocrine tumors. Endocrine 2022; 76:733-746. [PMID: 35301675 PMCID: PMC9156515 DOI: 10.1007/s12020-022-03015-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/06/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Well-differentiated lung neuroendocrine tumors (Lu-NET) are classified as typical (TC) and atypical (AC) carcinoids, based on mitotic counts and necrosis. However, prognostic factors, other than tumor node metastasis (TNM) stage and the histopathological diagnosis, are still lacking. The current study is aimed to identify potential prognostic factors to better stratify lung NET, thus, improving patients' treatment strategy and follow-up. METHODS A multicentric retrospective study, including 300 Lung NET, all surgically removed, from Italian and Spanish Institutions. RESULTS Median age 61 years (13-86), 37.7% were males, 25.0% were AC, 42.0% were located in the lung left parenchyma, 80.3% presented a TNM stage I-II. Mitotic count was ≥2 per 10 high-power field (HPF) in 24.7%, necrosis in 13.0%. Median overall survival (OS) was 46.1 months (0.6-323), median progression-free survival (PFS) was 36.0 months (0.3-323). Female sex correlated with a more indolent disease (T1; N0; lower Ki67; lower mitotic count and the absence of necrosis). Left-sided primary tumors were associated with higher mitotic count and necrosis. At Cox-multivariate regression model, age, left-sided tumors, nodal (N) positive status and the diagnosis of AC resulted independent negative prognostic factors for PFS and OS. CONCLUSIONS This study highlights that laterality is an independent prognostic factors in Lu-NETs, with left tumors being less frequent but showing a worse prognosis than right ones. A wider spectrum of clinical and pathological prognostic factors, including TNM stage, age and laterality is suggested. These parameters could help clinicians to personalize the management of Lu-NET.
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Affiliation(s)
- Anna La Salvia
- Department of Oncology, 12 de Octubre University Hospital, Madrid, Spain
| | - Irene Persano
- Department of Oncology, San Luigi Gonzaga Hospital, Orbassano, Italy
| | | | - Monica Verrico
- Department of Radiological, Oncological, and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Massimiliano Bassi
- Department of Thoracic Surgery, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Roberta Modica
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | | | - Isabella Zanata
- Department of Medical Sciences, Section of Endocrinology and Internal Medicine, University of Ferrara, Ferrara, Italy
| | | | - Elena Trevisi
- Department of Oncology, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Giulia Puliani
- Oncological Endocrinology Unit, Regina Elena National Cancer Institute, Rome, Italy
- Department of Experimental Medicine, "Sapienza" University of Roma, Rome, Italy
| | - Maria Rinzivillo
- Digestive Disease Unit, ENETS Center of Excellence, Sant'Andrea University Hospital, Rome, Italy
| | - Elena Parlagreco
- Department of Oncology, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Roberto Baldelli
- Endocrinology Unit, Department of Oncology and Medical Specialities, A.O. San Camillo-Forlanini, Rome, Italy
| | - Tiziana Feola
- Department of Experimental Medicine, "Sapienza" University of Roma, Rome, Italy
- Neuroendocrinology, Neuromed Institute, IRCCS, Pozzilli, Italy
| | - Franz Sesti
- Department of Experimental Medicine, "Sapienza" University of Roma, Rome, Italy
| | - Paola Razzore
- Endocrinology Unit, Mauriziano Hospital, Turin, Italy
| | - Rossella Mazzilli
- Endocrinology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza University of Rome, ENETS Center of Excellence, Rome, Italy
| | | | - Francesco Panzuto
- Digestive Disease Unit, ENETS Center of Excellence, Sant'Andrea University Hospital, Rome, Italy
| | - Marco Volante
- Department of Oncology, Pathology Unit of San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Elisa Giannetta
- Department of Experimental Medicine, "Sapienza" University of Roma, Rome, Italy
| | - Carmen Romero
- Scientific Support, 12 de Octubre University Hospital, Madrid, Spain
| | | | - Andrea Isidori
- Department of Experimental Medicine, "Sapienza" University of Roma, Rome, Italy
| | - Federico Venuta
- Department of Thoracic Surgery, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Maria Rosaria Ambrosio
- Department of Medical Sciences, Section of Endocrinology and Internal Medicine, University of Ferrara, Ferrara, Italy
| | - Maria Chiara Zatelli
- Department of Medical Sciences, Section of Endocrinology and Internal Medicine, University of Ferrara, Ferrara, Italy
| | - Mohsen Ibrahim
- Department of Thoracic Surgery, Sant'Andrea University Hospital, Rome, Italy
| | - Annamaria Colao
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Maria Pia Brizzi
- Department of Oncology, San Luigi Gonzaga Hospital, Orbassano, Italy
| | | | - Antongiulio Faggiano
- Endocrinology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza University of Rome, ENETS Center of Excellence, Rome, Italy.
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Abstract
Neuroendocrine neoplasms (NENs) comprise a broad spectrum of tumors with widely variable biological and clinical behavior. Primary tumor site, extent of disease, tumor differentiation and expression of so matostatin receptors, proliferation and growth rates are the major prognostic factors that determine the therapeutic strategy. Treatment options for advanced disease have considerably expanded in recent years, particularly for well differentiated tumors (NETs). Novel drugs approved over the past decade in this context include somatostatin analogues and 177Lu-oxodotreotide for somatostatin-receptor-positive gastroenteropancreatic (GEP) NETs, sunitinib for pancreatic NETs (P-NETs), and everolimus for P-NETs and non-functioning lung or gastrointestinal NETs. Nevertheless, chemotherapy remains an essential component of the treatment armamentarium of patients with NENs, particularly of patients with P-NETs or those with bulky, symptomatic or rapidly progressive tumors (generally G3 or high-G2 NENs). In this manuscript we will comprehensively review available evidence related to the use of chemotherapy in lung and GEP NENs and will critically discuss its role in the treatment algorithm of this family of neoplasms.
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Affiliation(s)
- Paula Espinosa-Olarte
- Oncology Department, Hospital Universitario, 12 de Octubre, Imas12, UCM, Madrid, Spain
| | - Anna La Salvia
- Oncology Department, Hospital Universitario, 12 de Octubre, Imas12, UCM, Madrid, Spain
| | | | - Beatriz Anton-Pascual
- Oncology Department, Hospital Universitario, 12 de Octubre, Imas12, UCM, Madrid, Spain
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Fazio N, Gervaso L, Halfdanarson TR, La Salvia A, Hofland J, Hernando J, Sonbol MB, Garcia-Carbonero R, Capdevila J, de Herder WW, Koumarianou A, Kaltsas G, Rossi M, Grozinsky-Glasberg S, Oleinikov K, Boselli S, Tamayo D, Bagnardi V, Laffi A, Rubino M, Spada F. Coronavirus disease 2019 in patients with neuroendocrine neoplasms: Preliminary results of the INTENSIVE study. Eur J Cancer 2021; 154:246-252. [PMID: 34298375 PMCID: PMC8241688 DOI: 10.1016/j.ejca.2021.06.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 06/16/2021] [Indexed: 12/12/2022]
Abstract
Background Specific data regarding coronavirus disease 2019 (COVID-19) in patients with neuroendocrine neoplasms (NENs) are lacking. The aim of this study is to describe the characteristics of patients with NENs who tested severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive. Material and methods This is a worldwide study collecting cases of patients with NENs along with a positive nasopharyngeal swab reverse transcriptase-polymerase chain reaction (RT-PCR) test for SARS-CoV-2 between June 1, 2020, and March 31, 2021. Centres treating patients with NENs were directly contacted by the principal investigator. Patients with NENs of any primary site, grade and stage were included, excluding small-cell lung carcinoma and mixed adenoneuroendocrine carcinoma. Results Among 81 centres directly contacted, 88.8% responded and 48.6% of them declined due to lack of cases or interest. On March 31st, 2021, eight recruiting centres enrolled 89 patients. The median age was 64 years at the time of COVID-19 diagnosis. Most patients had metastatic, non-functioning, low-/intermediate-grade gastroenteropancreatic NENs on treatment with somatostatin analogues and radioligand therapy. Most of them had comorbidities. Only 8% of patients had high-grade NENs and 12% were receiving chemotherapy. Most patients had symptoms or signs of COVID-19, mainly fever and cough. Only 3 patients underwent sub-intensive treatment, whereas most of them received medical therapies, mostly antibiotics. In two third of cases, no changes occurred for the anti-NEN therapy. More than 80% of patients completely recovered without sequelae, whereas 7.8% patients died due to COVID-19. Conclusions Patients included in this study reflect the typical NEN population regardless of SARS-CoV-2. In most cases, they overcome COVID-19 without need of intensive care, short-term sequelae and discontinuation of systemic oncological therapy.
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Affiliation(s)
- Nicola Fazio
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology (IEO) IRCCS, Milan, Italy.
| | - Lorenzo Gervaso
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology (IEO) IRCCS, Milan, Italy; Molecular Medicine Program, University of Pavia, Pavia, Italy
| | | | - Anna La Salvia
- Medical Oncology Department, Hospital Universitario Doce de Octubre, Imas12, UCM, Madrid, Spain
| | - Johannes Hofland
- Department of Internal Medicine, Sector Endocrinology, Rotterdam, the Netherlands
| | - Jorge Hernando
- Vall Hebron University Hospital and Vall Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Mohamad B Sonbol
- Department of Hematology and Oncology Mayo Clinic, Phoenix, AZ, USA
| | - Rocio Garcia-Carbonero
- Medical Oncology Department, Hospital Universitario Doce de Octubre, Imas12, UCM, Madrid, Spain
| | - Jaume Capdevila
- Vall Hebron University Hospital and Vall Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Wouter W de Herder
- Department of Internal Medicine, Sector Endocrinology, Rotterdam, the Netherlands
| | - Anna Koumarianou
- Hematology-Oncology Unit, Fourth Department of Internal Medicine, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Gregory Kaltsas
- 1st Department of Propaedeutic Internal Medicine, Endocrine Unit, National and Kapodistrian, University of Athens, 11527 Athens, Greece
| | - Maura Rossi
- Oncology Unit and Centro Documentazione Osteonecrosi, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Simona Grozinsky-Glasberg
- Neuroendocrine Tumors Unit, ENETS Center of Excellence, Department of Endocrinology and Metabolism Service, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Kira Oleinikov
- Neuroendocrine Tumors Unit, ENETS Center of Excellence, Department of Endocrinology and Metabolism Service, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Sabrina Boselli
- Data Management-Clinical Trial Office. Scientific Direction. European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | - Darina Tamayo
- Data Management-Clinical Trial Office. Scientific Direction. European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Alice Laffi
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | - Manila Rubino
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | - Francesca Spada
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology (IEO) IRCCS, Milan, Italy
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Spada F, Gervaso L, La Salvia A, Garcia-Carbonero R, Hernando J, Capdevila J, Hofland J, de Herder W, Koumarianou A, Rossi M, Boselli S, Tamayo D, Bagnardi V, Laffi A, Rubino M, Sonbol MB, Fazio N, Halfdanarson TR. INTENSIVE: InterNaTional rEgistry oN Sars-cov-2 posItiVe nEuroendocrine neoplasm patients. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e16205] [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
e16205 Background: Data about neuroendocrine neoplasms (NENs) patients with SARS-CoV-2 are scanty and specific indications for clinical practice are missing. Our aim is to create an international registry about NENs patients affected by SARS-CoV-2 positivity to give a worldwide representation of the situation. Methods: This is an observational retrospective/prospective multicenter survey based on a direct email invitation. All types of NEN are eligible except SCLC and MiNEN. Patients fulfilling the inclusion criteria from March 1st, 2020 up to the end pf pandemic will be recruited. Electronic CRFs are filled out using the REDCap database. Local Institutional Review Board approval is required before data entry. Results: Eighty-one centers, 24 in and 57 outside Italy, representing 39 countries and 5 continents, were contacted. Fourteen centers did not respond and 15 declined the invitation. Among the remaining 52, 6 centers are currently recruiting and 8 are active but not recruiting yet. As of the current abstract submission deadline, 67 patients have been included, mostly GEP-NET (75%), non-functioning (86%), metastatic (85%) and on active treatment [47% somatostatin analogs (SSAs), 10% everolimus, 12% tirosin-kinase inhibitors (TKIs), 10% peptide receptor radionuclide therapy (PRRT), 15% chemotherapy]. Median age at NEN diagnosis was 57 years whilst the median age at SARS-CoV-2 diagnosis was 62 years. Almost all patients reported COVID-19-related symptoms, more commonly fever (67% of patients), cough (55%) and dyspnea (51%), in 28% of cases exertional and in 22% at rest. More than one third of patients (n, 24) had a pneumonia. The most common therapies for COVID-19 were antibiotics, steroids and hydroxychloroquine. Eleven patients (16%) needed oxygen therapy, three (4%) sub-intensive care and none intensive care. Fifty-six patients (84%) clinically recovered, six (9%) with sequelae, whereas five (7%) died. Among these latter 4 had a NET and 1 a NEC, and no patients have been receiving chemotherapy. With regard to the anti-tumor therapy no change occurred in 66% of patients, temporary interruption in 30%, and definitive discontinuation in 3%, 2% missing. Conclusions: Most of the NEN patients completely recovered from COVID-19, in many cases without any anti-tumor therapy adjustment. No clear correlations were observed with type, primary site and treatment of NEN. The recruitment is ongoing.
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Affiliation(s)
| | | | - Anna La Salvia
- Hospital Universitario 12 de Octubre. GI and Neuroendocrine Oncology Unit, Oncology Department, Madrid, Spain
| | | | - Jorge Hernando
- Vall d’Hebron Institute of Oncology (VHIO), Medical Oncology, Vall d’Hebron University Hospital (HUVH), Barcelona, Spain
| | - Jaume Capdevila
- Vall d’Hebron Institute of Oncology (VHIO), Medical Oncology, Vall d’Hebron University Hospital (HUVH), Barcelona, Spain
| | - Johannes Hofland
- Erasmus Medical Center and Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Wouter de Herder
- Departement of Internal Medicine, Erasmus Medical Center, Rotterdam, Netherlands
| | - Anna Koumarianou
- On behalf of the Hellenic Society of Medical Oncology, Athens, AZ, Greece
| | - Maura Rossi
- Oncology SS Antonio e Biagio General Hospital, Alessandria, Italy
| | | | | | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy, Milan, Italy
| | - Alice Laffi
- European Institute of Oncology, Milan, Italy
| | | | - Mohamad Bassam Sonbol
- Mayo Clinic Cancer Center, Division of Hematology/Oncology, Mayo Clinic Arizona Phoenix, Phoenix, AZ
| | - Nicola Fazio
- Istituto Europeo di Oncologia, IRCCS, Milan, Italy
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Ghidini M, Petrillo A, Botticelli A, Trapani D, Parisi A, La Salvia A, Sajjadi E, Piciotti R, Fusco N, Khakoo S. How to Best Exploit Immunotherapeutics in Advanced Gastric Cancer: Between Biomarkers and Novel Cell-Based Approaches. J Clin Med 2021; 10:1412. [PMID: 33915839 PMCID: PMC8037391 DOI: 10.3390/jcm10071412] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 02/14/2021] [Revised: 03/17/2021] [Accepted: 03/22/2021] [Indexed: 02/07/2023] Open
Abstract
Despite extensive research efforts, advanced gastric cancer still has a dismal prognosis with conventional treatment options. Immune checkpoint inhibitors have revolutionized the treatment landscape for many solid tumors. Amongst gastric cancer subtypes, tumors with microsatellite instability and Epstein Barr Virus positive tumors provide the strongest rationale for responding to immunotherapy. Various predictive biomarkers such as mismatch repair status, programmed death ligand 1 expression, tumor mutational burden, assessment of tumor infiltrating lymphocytes and circulating biomarkers have been evaluated. However, results have been inconsistent due to different methodologies and thresholds used. Clinical implementation therefore remains a challenge. The role of immune checkpoint inhibitors in gastric cancer is emerging with data from monotherapy in the heavily pre-treated population already available and studies in earlier disease settings with different combinatorial approaches in progress. Immune checkpoint inhibitor combinations with chemotherapy (CT), anti-angiogenics, tyrosine kinase inhibitors, anti-Her2 directed therapy, poly (ADP-ribose) polymerase inhibitors or dual checkpoint inhibitor strategies are being explored. Moreover, novel strategies including vaccines and CAR T cell therapy are also being trialed. Here we provide an update on predictive biomarkers for response to immunotherapy with an overview of their strengths and limitations. We discuss clinical trials that have been reported and trials in progress whilst providing an account of future steps needed to improve outcome in this lethal disease.
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Affiliation(s)
- Michele Ghidini
- Medical Oncology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | | | - Andrea Botticelli
- Department of Clinical and Molecular Medicine, Sapienza University, 00189 Rome, Italy;
- Medical Oncology (B), Policlinico Umberto I, 00161 Rome, Italy
| | - Dario Trapani
- Division of Early Drug Development for innovative therapies, European Institute of Oncology, IRCCS, 20141 Milan, Italy;
| | - Alessandro Parisi
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
- Medical Oncology Unit, St. Salvatore Hospital, 67100 L’Aquila, Italy
| | - Anna La Salvia
- Department of Oncology, University Hospital 12 De Octubre, 28041 Madrid, Spain;
| | - Elham Sajjadi
- Division of Pathology, European Institute of Oncology, IRCCS, 20141 Milan, Italy; (E.S.); (R.P.); (N.F.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Roberto Piciotti
- Division of Pathology, European Institute of Oncology, IRCCS, 20141 Milan, Italy; (E.S.); (R.P.); (N.F.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Nicola Fusco
- Division of Pathology, European Institute of Oncology, IRCCS, 20141 Milan, Italy; (E.S.); (R.P.); (N.F.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Shelize Khakoo
- Department of Medicine, Royal Marsden Hospital, London and Surrey, Sutton SM25PT, UK;
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Giuppi M, La Salvia A, Evangelista J, Ghidini M. The Role and Expression of Angiogenesis-Related miRNAs in Gastric Cancer. Biology (Basel) 2021; 10:biology10020146. [PMID: 33673057 PMCID: PMC7918665 DOI: 10.3390/biology10020146] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/08/2021] [Accepted: 02/08/2021] [Indexed: 02/07/2023]
Abstract
Gastric cancer (GC) is the fifth most frequently diagnosed malignant tumor and the third highest cause of cancer mortality worldwide. For advanced GC, many novel drugs and combinations have been tested, but results are still disappointing, and the disease is incurable in the majority of cases. In this regard, it is critical to investigate the molecular mechanisms underlying GC development. Angiogenesis is one of the hallmarks of cancer with a fundamental role in GC growth and progression. Ramucirumab, a monoclonal antibody that binds to vascular endothelial growth factor-2 (VEGFR-2), is approved in the treatment of advanced and pretreated GC. However, no predictive biomarkers for ramucirumab have been identified so far. Micro RNAs (miRNAs) are a class of evolutionarily-conserved single-stranded non-coding RNAs that play an important role (via post-transcriptional regulation) in essentially all biologic processes, such as cell proliferation, differentiation, apoptosis, survival, invasion, and migration. In our review, we aimed to analyze the available data on the role of angiogenesis-related miRNAs in GC.
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Affiliation(s)
- Martina Giuppi
- Faculty of Medicine, CEU San Pablo University, 28003 Madrid, Spain;
| | - Anna La Salvia
- Department of Oncology, University Hospital 12 de Octubre, 28041 Madrid, Spain;
| | - Jessica Evangelista
- Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Michele Ghidini
- Oncology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Correspondence: ; Tel.: +39-02-5503-2660; Fax: +39-02-5503-2659
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Portigliatti Pomeri A, La Salvia A, Carletto S, Oliva F, Ostacoli L. EMDR in Cancer Patients: A Systematic Review. Front Psychol 2021; 11:590204. [PMID: 33536968 PMCID: PMC7847844 DOI: 10.3389/fpsyg.2020.590204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 07/31/2020] [Accepted: 12/16/2020] [Indexed: 11/24/2022] Open
Abstract
Background: Psychological distress is common among patients with cancer, with severe consequences on their quality of life. Anxiety and depression are the most common clinical presentation of psychological distress in cancer patients, but in some cases cancer may represent a traumatic event resulting in posttraumatic stress disorder (PTSD). Currently, Eye Movement Desensitization and Reprocessing (EMDR) therapy is considered an evidence-based treatment for PTSD, but recent studies also showed its effectiveness for anxiety and depression. The aim of the present systematic review is to summarize the current literature on the effect of EMDR on cancer-related psychological distress. Methods: A literature search was conducted for peer-reviewed articles about "EMDR" and "cancer patients" in the following electronic databases: PubMed, MEDLINE, Science Direct, Google Scholar, and Cochrane library. Results: Our search identified 7 studies in which EMDR was used with a total of 140 cancer patients. The psychiatric diagnosis was PTSD in 3 studies. Otherwise, the diagnosis concerned the anxious and depressive disorder spectrum. Overall, EMDR treatment schedules used were highly heterogeneous, with a different number of sessions (from 2 to 12) and a different duration of therapy (up to 4 months). However, across all studies analyzed EMDR therapy was judged to be adequate in reducing symptoms of psychological distress in this population. Conclusions: According to the results of our analysis, the level of evidence regarding EMDR efficacy in cancer patients is limited by the scarcity of studies and their low methodological quality. Although better quality research is needed, available data suggest that EMDR could be a promising treatment for psychological distress in patients with cancer.
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Affiliation(s)
| | - Anna La Salvia
- Department of Oncology, 12 de Octubre University Hospital, Madrid, Spain
| | - Sara Carletto
- Department of Neuroscience “Rita Levi Montalcini”, University of Torino, Torino, Italy
- Clinical Psychology Unit, University Hospital City of Science and Health, Torino, Italy
| | - Francesco Oliva
- Department of Clinical and Biological Sciences, University of Torino, Orbassano, Italy
| | - Luca Ostacoli
- Clinical Psychology Unit, University Hospital City of Science and Health, Torino, Italy
- Department of Clinical and Biological Sciences, University of Torino, Orbassano, Italy
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Muratori L, Pia A, Reimondo G, Pisano C, La Salvia A, Puglisi S, Scagliotti GV, Sperone P. Prolonged Adrenal Insufficiency After the Discontinuation of Mitotane Therapy. Endocr Metab Immune Disord Drug Targets 2021; 20:485-487. [PMID: 31544707 DOI: 10.2174/1871530319666190809144620] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 07/02/2019] [Accepted: 07/04/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Adrenocortical carcinoma (ACC) is a rare neoplasm characterized by a high risk of recurrence after radical resection. The role of adjuvant systemic therapy in radically resected patients is unclear. Mitotane, a steroidogenesis inhibitor, is the only drug approved for the systemic treatment of advanced ACC. In 2007, a retrospective case-control study provided the evidence that mitotane, administered for two years after successful surgery, could prolong recurrence-free survival. Adrenal insufficiency (AI), which occurs in almost all patients during the first 12 months of treatment, is an expected side effect of mitotane and requires steroid replacement therapy. Due to its long halflife, mitotane-induced AI persists several months after treatment discontinuation and is managed by cautious tapering of glucocorticoid replacement therapy. RESULTS We report a case of symptomatic AI diagnosed after a severe allergic reaction occurring three years after the discontinuation of adjuvant mitotane therapy. CONCLUSION The case suggests that mitotane-induced AI should be monitored for a long time to asses full recovery of adrenal function, in order to prevent adrenal crises.
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Affiliation(s)
- Leonardo Muratori
- Medical Oncology, Department of Oncology, University of Turin, Azienda Ospedaliera Universitaria San Luigi Gonzaga, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
| | - Anna Pia
- Internal Medicine and Endocrinology Unit, Department of Clinical and Biological Sciences, University of Turin, Azienda Ospedaliera Universitaria San Luigi Gonzaga, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
| | - Giuseppe Reimondo
- Internal Medicine and Endocrinology Unit, Department of Clinical and Biological Sciences, University of Turin, Azienda Ospedaliera Universitaria San Luigi Gonzaga, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
| | - Chiara Pisano
- Medical Oncology, Department of Oncology, University of Turin, Azienda Ospedaliera Universitaria San Luigi Gonzaga, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
| | - Anna La Salvia
- Medical Oncology, Department of Oncology, Hospital Universitario 12 de Octubre, Avenida Cordoba, s/n, 28041 Madrid, Spagna, Madrid, Spain
| | - Soraya Puglisi
- Internal Medicine and Endocrinology Unit, Department of Clinical and Biological Sciences, University of Turin, Azienda Ospedaliera Universitaria San Luigi Gonzaga, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
| | - Giorgio Vittorio Scagliotti
- Medical Oncology, Department of Oncology, University of Turin, Azienda Ospedaliera Universitaria San Luigi Gonzaga, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
| | - Paola Sperone
- Medical Oncology, Department of Oncology, University of Turin, Azienda Ospedaliera Universitaria San Luigi Gonzaga, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
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Giannetta E, La Salvia A, Rizza L, Muscogiuri G, Campione S, Pozza C, Colao AALI, Faggiano A. Are Markers of Systemic Inflammatory Response Useful in the Management of Patients With Neuroendocrine Neoplasms? Front Endocrinol (Lausanne) 2021; 12:672499. [PMID: 34367064 PMCID: PMC8339959 DOI: 10.3389/fendo.2021.672499] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/03/2021] [Indexed: 11/13/2022] Open
Abstract
Given the increasing incidence of neuroendocrine neoplasms (NENs) over the past few decades, a more comprehensive knowledge of their pathophysiological bases and the identification of innovative NEN biomarkers represents an urgent unmet need. There is still little advance in the early diagnosis and management of these tumors, due to the lack of sensible and specific markers with prognostic value and ability to early detect the response to treatment. Chronic systemic inflammation is a predisposing factor for multiple cancer hallmarks, as cancer proliferation, progression and immune-evading. Therefore, the relevance of inflammatory biomarkers has been identified as critical in several types of tumours, including NENs. A bidirectional relationship between chronic inflammation and development of NENs has been reported. Neuroendocrine cells can be over-stimulated by chronic inflammation, leading to hyperplasia and neoplastic transformation. As the modulation of inflammatory response represents a therapeutic target, inflammatory markers could represent a promising new key tool to be applied in the diagnosis, the prediction of response to treatment and also as prognostic biomarkers in NENs field. The present review provides an overview of the pre-clinical and clinical data relating the potentially usefulness of circulating inflammatory markers: neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), cytokines and tissue inflammatory markers (PD-1/PD-L1), in the management of NENs. (1) NLR and PLR have both demonstrated to be promising and simple to acquire biomarkers in patients with advanced cancer, including NEN. To date, in the context of NENs, the prognostic role of NLR and PLR has been confirmed in 15 and 4 studies, respectively. However, the threshold value, both for NLR and PLR, still remains not defined. (2) Cytokines seem to play a central role in NENs tumorigenesis. In particular, IL-8 levels seems to be a good predictive marker of response to anti-angiogenic treatments. (3) PD-1 and PD-L1 expression on tumour cells and on TILs, have demonstrated to be promising predictive and prognostic biomarkers in NENs. Unfortunately, these two markers have not been validated so far and further studies are needed to establish their indications and utility.
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Affiliation(s)
- Elisa Giannetta
- Department of Experimental Medicine, “Sapienza” University of Rome, Rome, Italy
- *Correspondence: Elisa Giannetta,
| | - Anna La Salvia
- Department of Oncology, University Hospital 12 de Octubre, Madrid, Spain
| | - Laura Rizza
- Endocrinology Unit, Department of Oncology and Medical Specialities, AO San Camillo-Forlanini, Rome, Italy
| | - Giovanna Muscogiuri
- Endocrinology Unit Department of Clinical Medicine and Surgery, University Federico II School of Medicine, Naples, Italy
| | - Severo Campione
- A. Cardarelli Hospital, Naples Department of Advanced Diagnostic-Therapeutic Technologies and Health Services Section of Anatomic Pathology, Naples, Italy
| | - Carlotta Pozza
- Department of Experimental Medicine, “Sapienza” University of Rome, Rome, Italy
| | | | - Antongiulio Faggiano
- Department of Clinical and Molecular Medicine, Endocrine-Metabolic Unit, Sant’Andrea University Hospital “Sapienza” University of Rome, Rome, Italy
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Muratori L, Sperone P, Gorzegno G, La Salvia A, Scagliotti GV. Systemic recurrence of endometrial cancer more than 10 years after hysterectomy: a report of two cases and a brief review of the literature. J Egypt Natl Canc Inst 2020; 32:41. [PMID: 33135114 DOI: 10.1186/s43046-020-00052-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 10/13/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Endometrial carcinoma is one of the most common female cancers in developed countries. Disease stage is associated with the risk of disease relapse after radical treatment. Typically, the risk of disease relapse peaks at 3 years from local radical treatment and then diminishes over time, so that late relapses (i.e., from year 5 afterward) are extremely infrequent. Here, we report two cases of women with endometrial cancer who developed a disease relapse more than 15 years after radical treatment. A review of the literature revealed other seven reports of women with relapse from endometrial cancer occurring more than 10 years after radical treatment. CASE PRESENTATION Case report 1 is a 56-year-old woman with an endometrioid cancer who underwent a hysterectomy with bilateral salpingo-oophorectomy in 1998. She relapsed in the lung in 2014, 16 years from radical surgery. Case report 2, a 75-year-old woman, with an endometrioid cancer, was treated by hysterectomy with bilateral salpingo-oophorectomy and adjuvant radiotherapy. The disease relapse in the lung was detected in 2019, 22 years from radical treatment. CONCLUSION Although guidelines do not support oncological follow-up beyond 5 years from surgery, oncologists should consider late recurrence of endometrial carcinoma in the differential diagnosis of women presenting with metastases of uncertain origin and prior history of this disease.
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Affiliation(s)
- Leonardo Muratori
- Medical Oncology, Department of Oncology, Azienda Ospedaliera Universitaria San Luigi Gonzaga, University of Turin, Regione Gonzole 10, 10043 Orbassano, Turin, Italy.
| | - Paola Sperone
- Medical Oncology, Department of Oncology, Azienda Ospedaliera Universitaria San Luigi Gonzaga, University of Turin, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
| | - Gabriella Gorzegno
- Medical Oncology, Department of Oncology, Azienda Ospedaliera Universitaria San Luigi Gonzaga, University of Turin, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
| | - Anna La Salvia
- Medical Oncology, Department of Oncology, Hospital Universitario 12 de Octubre, Avenida Cordoba, s/n, 28041, Madrid, Spain
| | - Giorgio Vittorio Scagliotti
- Medical Oncology, Department of Oncology, Azienda Ospedaliera Universitaria San Luigi Gonzaga, University of Turin, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
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Trevisi E, La Salvia A, Daniele L, Brizzi MP, De Rosa G, Scagliotti GV, Di Maio M. Neuroendocrine breast carcinoma: a rare but challenging entity. Med Oncol 2020; 37:70. [PMID: 32712767 PMCID: PMC7382662 DOI: 10.1007/s12032-020-01396-4] [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: 05/16/2020] [Accepted: 07/16/2020] [Indexed: 12/25/2022]
Abstract
Breast carcinoma with neuroendocrine differentiation, also known as neuroendocrine breast carcinoma (NEBC), includes a heterogeneous group of rare tumors, which account for 2–5% of all invasive breast carcinomas. Because of their low incidence, most of the current limited knowledge of these tumors derives from anecdotal case reports or small retrospective series. The diagnosis of NEBC is based on the presence of morphological features similar to gastrointestinal and lung NETs and neuroendocrine markers. NEBCs are usually hormone receptors positive and HER2 negative, but despite this luminal phenotype, most recent studies suggested that NEBC could be associated with worse prognosis compared to invasive breast cancer without neuroendocrine differentiation. Due to its rarity and lack of randomized data, there is little evidence to guide the choice of treatment, so NEBC is currently treated as any invasive breast carcinoma not-otherwise specified. Recently, attempts to molecularly characterize NEBC have been made, in order to provide new targets for a more personalized treatment of this uncommon entity.
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Affiliation(s)
- Elena Trevisi
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Regione Gonzole 10, 10043, Orbassano, Turin, Italy.
| | - Anna La Salvia
- Department of Oncology, University Hospital, 12 de Octubre, Madrid, Spain
| | | | - Maria Pia Brizzi
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Regione Gonzole 10, 10043, Orbassano, Turin, Italy
| | | | - Giorgio V Scagliotti
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Regione Gonzole 10, 10043, Orbassano, Turin, Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, Torino, Italy
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La Salvia A, Persano I, Trevisi E, Parlagreco E, Muratori L, Scagliotti GV, Brizzi MP. Ocular metastases from neuroendocrine tumors: A literature review. Semin Oncol 2020; 47:144-147. [PMID: 32402472 DOI: 10.1053/j.seminoncol.2020.04.003] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 04/11/2020] [Indexed: 11/11/2022]
Abstract
Background Neuroendocrine tumors (NETs) include malignancies with different origins, clinical presentations and prognosis. Synchronous or metachronous ocular metastases from NET are extremely rare. The diagnostic algorithm and the management of this entity has not been established. The aim of our study was to characterize this subgroup. Methods We performed an electronic search in PubMed Library databases for articles about ocular metastases from NET published from 1966 to August 2019. Results We identified 21 manuscripts with a total of 64 cases. The primary origin of the tumor was lung in 28 (43.7%) cases, ileum in 14, unknown in 8, colon in 3, rectum, esophagus, thymus, testicle and liver in 1 case each, and not reported in 6. The histopathological confirmation of NET metastasis was available in 25 cases (39%). The most common sites of intraocular lesions was the uvea in 30 (46.8%) cases, followed by the orbit in 27. Most of the patients (n = 44, 68.7%) presented eye symptoms. Locoregional interventions were performed in 40 patients (62.5%): 15 cases underwent surgery, 19 had external beam radiotherapy, 5 had brachytherapy, and 1 patient received laser photocoagulation. These treatments ensured the local control in 28 of the 40 (70%) cases treated with a locoregional approach. Conclusions Ocular metastases from NETs are exceptionally rare, and originate more frequently from foregut primary tumors (lung, esophageal, and thymic NETs). The most common ocular site of secondary lesions is the uvea, likely due to its high vascularization. Locoregional approaches appear to be effective in terms of local disease control.
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Affiliation(s)
- Anna La Salvia
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, TO, Italy; Department of Oncology, University Hospital 12 de Octubre, Madrid, Spain
| | - Irene Persano
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, TO, Italy
| | - Elena Trevisi
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, TO, Italy.
| | - Elena Parlagreco
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, TO, Italy
| | - Leonardo Muratori
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, TO, Italy
| | | | - Maria Pia Brizzi
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, TO, Italy
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La Salvia A, Brizzi MP, Trevisi E, Parisi F, Muratori L, Atzeni F, Di Maio M, Scagliotti GV. Carcinoid heart failure in a duodenal neuroendocrine tumor: role of cardiac surgery in a challenging patient and brief review of the literature. Acta Oncol 2020; 59:315-319. [PMID: 31583924 DOI: 10.1080/0284186x.2019.1672891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Anna La Salvia
- Medical Oncology, Department of Oncology, University of Turin, Azienda Ospedaliera Universitaria San Luigi, Orbassano, Turin, Italy
| | - Maria Pia Brizzi
- Medical Oncology, Department of Oncology, University of Turin, Azienda Ospedaliera Universitaria San Luigi, Orbassano, Turin, Italy
| | - Elena Trevisi
- Medical Oncology, Department of Oncology, University of Turin, Azienda Ospedaliera Universitaria San Luigi, Orbassano, Turin, Italy
| | | | - Leonardo Muratori
- Medical Oncology, Department of Oncology, University of Turin, Azienda Ospedaliera Universitaria San Luigi, Orbassano, Turin, Italy
| | - Francesco Atzeni
- Cardiac Surgery, University of Turin, A.O. Ordine Mauriziano, Turin, Italy
| | - Massimo Di Maio
- Medical Oncology, Department of Oncology, University of Turin, A.O. Ordine Mauriziano, Turin, Italy
| | - Giorgio V. Scagliotti
- Medical Oncology, Department of Oncology, University of Turin, Azienda Ospedaliera Universitaria San Luigi, Orbassano, Turin, Italy
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Lombardi P, Marandino L, De Luca E, Zichi C, Reale ML, Pignataro D, Di Stefano RF, Ghisoni E, Mariniello A, Trevisi E, Leone G, Muratori L, La Salvia A, Sonetto C, Leone F, Aglietta M, Novello S, Scagliotti GV, Perrone F, Di Maio M. Quality of life assessment and reporting in colorectal cancer: A systematic review of phase III trials published between 2012 and 2018. Crit Rev Oncol Hematol 2020; 146:102877. [PMID: 31981880 DOI: 10.1016/j.critrevonc.2020.102877] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 12/09/2019] [Accepted: 01/17/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND In this study, our aim was to describe quality of life (QoL) prevalence and heterogeneity in QoL reporting in colorectal cancer phase III trials. METHODS We included all phase III trials evaluating anticancer drugs in colorectal cancer patients published between 2012 and 2018 by 11 major journals. RESULTS Out of the 67 publications identified, in 41 (61.2 %) QoL was not listed among endpoints. Out of 26 primary publications of trials including QoL among endpoints, QoL results were not reported in 10 (38.5 %). Overall, no QoL data were available in 51/67 (76.1 %) primary publications. In particular, in the metastatic setting, QoL data were not available in 12/18 (66.7 %) trials with primary endpoint overall survival, and in 20/29 (69.0 %) trials with other primary endpoints. CONCLUSIONS QoL was absent in a high proportion of recently published phase III trials in colorectal cancer, even in trials of second or further lines, where attention to QoL should be particularly high.
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Affiliation(s)
- Pasquale Lombardi
- Department of Oncology, University of Turin, Candiolo Cancer Institute - FPO- IRCCS, Candiolo, TO, Italy
| | - Laura Marandino
- Department of Oncology, University of Turin, Candiolo Cancer Institute - FPO- IRCCS, Candiolo, TO, Italy
| | - Emmanuele De Luca
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, Torino, Italy
| | - Clizia Zichi
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, Torino, Italy
| | - Maria Lucia Reale
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, TO, Italy
| | - Daniele Pignataro
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, TO, Italy
| | - Rosario F Di Stefano
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, TO, Italy
| | - Eleonora Ghisoni
- Department of Oncology, University of Turin, Candiolo Cancer Institute - FPO- IRCCS, Candiolo, TO, Italy
| | - Annapaola Mariniello
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, TO, Italy
| | - Elena Trevisi
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, TO, Italy
| | - Gianmarco Leone
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, TO, Italy
| | - Leonardo Muratori
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, TO, Italy
| | - Anna La Salvia
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, TO, Italy
| | - Cristina Sonetto
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, TO, Italy
| | - Francesco Leone
- Department of Oncology, University of Turin, Candiolo Cancer Institute - FPO- IRCCS, Candiolo, TO, Italy
| | - Massimo Aglietta
- Department of Oncology, University of Turin, Candiolo Cancer Institute - FPO- IRCCS, Candiolo, TO, Italy
| | - Silvia Novello
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, TO, Italy
| | - Giorgio V Scagliotti
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, TO, Italy
| | - Francesco Perrone
- Clinical Trials Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale"-IRCCS, Napoli, Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, Torino, Italy.
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Lamberti G, Faggiano A, Brighi N, Tafuto S, Ibrahim T, Brizzi MP, Pusceddu S, Albertelli M, Massironi S, Panzuto F, Badalamenti G, Riccardi F, Butturini G, Gelsomino F, De Divitiis C, Modica R, Bongiovanni A, La Salvia A, Torchio M, Colao A, Ferone D, Campana D. Nonconventional Doses of Somatostatin Analogs in Patients With Progressing Well-Differentiated Neuroendocrine Tumor. J Clin Endocrinol Metab 2020; 105:5572657. [PMID: 31545377 DOI: 10.1210/clinem/dgz035] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 09/20/2019] [Indexed: 02/08/2023]
Abstract
PURPOSE To evaluate the antiproliferative activity and safety of nonconventional high doses of somatostatin analogs (HD-SSA) in patients with well-differentiated gastroenteropancreatic (GEP) neuroendocrine tumors (NET) with radiological disease progression according to Response Evaluation Criteria in Solid Tumors (RECIST) criteria on a previous treatment. METHODS A retrospective analysis of prospectively maintained databases from 13 Italian NET-dedicated centers was performed. Main inclusion criteria were: well-differentiated G1 or G2 GEP-NET, progressive disease on a previous treatment, and subsequent treatment with HD-SSA (either by increased administered dose [dose intensity] or shortened interval between administrations [dose density]). Main endpoints were progression-free survival (PFS) and safety. RESULTS Of 198 patients, 140 matched inclusion criteria and were included in the analysis. Overall, median PFS was 31 months. Use of HD-SSA as second-line treatment was associated with reduced risk for progression or death compared with third- or further-line treatment (HR: 2.12; P = 0.004). There was no difference in PFS between HD-SSA by increased dose density (N = 133; 95%) or intensity (N = 7; 5%). Partial response according to RECIST criteria was observed in 12 patients (8.6%), and stable disease was achieved in 106 (75.7%) patients. Adverse events occurred in 21 patients (15.0%), 2 of whom had grade 3 biliary stone disease. No patients discontinued HD-SSA treatment due to adverse events. CONCLUSIONS HD-SSA is an active and safe treatment option in patients with progressive well-differentiated GEP-NET. The high rate of objective responses observed deserves prospective validation in ad hoc clinical trials.
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Affiliation(s)
- Giuseppe Lamberti
- NET Team Bologna ENETS Center of Excellence, S. Orsola-Malpighi University Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | | | - Nicole Brighi
- NET Team Bologna ENETS Center of Excellence, S. Orsola-Malpighi University Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | | | - Toni Ibrahim
- Osteoncology and Rare Tumors Center- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCSS, Meldola, Italy
| | | | - Sara Pusceddu
- Department of medical oncology, Fondazione IRCCS Istituto Tumori Milano, ENETS Center of Excellence, Milan, Italy
| | - Manuela Albertelli
- Endocrinology Department of Internal Medicine and Medical Specialties (DiMi), San Martino University Hospital, Genova, Italy
| | - Sara Massironi
- Gastroenterology and Endoscopy Department, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesco Panzuto
- Digestive Disease Unit, Sant'Andrea University Hospital, ENETS Center of Excellence, Rome, Italy
| | - Giuseppe Badalamenti
- Medical Oncology, Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, Italy
| | | | | | - Fabio Gelsomino
- Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | | | - Roberta Modica
- Clinical medicine and Surgery Department - Federico II University, Naples, Italy
| | - Alberto Bongiovanni
- Osteoncology and Rare Tumors Center- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCSS, Meldola, Italy
| | | | - Martina Torchio
- Department of medical oncology, Fondazione IRCCS Istituto Tumori Milano, ENETS Center of Excellence, Milan, Italy
| | - Annamaria Colao
- Clinical medicine and Surgery Department - Federico II University, Naples, Italy
| | - Diego Ferone
- Endocrinology Department of Internal Medicine and Medical Specialties (DiMi), San Martino University Hospital, Genova, Italy
| | - Davide Campana
- NET Team Bologna ENETS Center of Excellence, S. Orsola-Malpighi University Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy
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Reale ML, De Luca E, Lombardi P, Marandino L, Zichi C, Pignataro D, Ghisoni E, Di Stefano RF, Mariniello A, Trevisi E, Leone G, Muratori L, La Salvia A, Sonetto C, Bironzo P, Aglietta M, Novello S, Scagliotti GV, Perrone F, Di Maio M. Quality of life analysis in lung cancer: A systematic review of phase III trials published between 2012 and 2018. Lung Cancer 2019; 139:47-54. [PMID: 31734586 DOI: 10.1016/j.lungcan.2019.10.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [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: 08/17/2019] [Revised: 10/20/2019] [Accepted: 10/23/2019] [Indexed: 01/13/2023]
Abstract
OBJECTIVES We previously reported that quality of life (QoL) is not included among trial endpoints and QoL results are underreported in a significant proportion of phase III oncology trials. Here we describe QoL adoption, reporting and methodology of QoL analysis in lung cancer trials. MATERIALS AND METHODS We selected all primary publications of lung cancer phase III trials assessing anticancer drugs published between 2012 and 2018 by 11 major journals. RESULTS 122 publications were included. In 39 (32.0%) publications, QoL was not listed among endpoints: in 10/17 (58.8%) early stage/locally advanced NSCLC, in 15/54 (27.8%) first-line of advanced NSCLC; in 10/41 (24.4%) second and further lines of advanced NSCLC, in 4/10 (40.0%) SCLC. Proportion of trials not including QoL was similar over time: 32.9% publications in 2012-2015 vs. 30.6% in 2016-2018. Out of 83 trials including QoL among endpoints, QoL results were absent in 36 primary publications (43.4%). Proportion of trials without QoL results in primary publication increased over time (30.6% 2012-2015 vs. 61.8% 2016-2018, p = 0.005). Overall, QoL data were not available in 75/122 (61.5%) primary publications, due to the absent endpoint or unpublished results. QoL data were lacking in 48/68 (70.6%) publications of trials with overall survival as primary endpoint, 27/54 (50.0%) with other primary endpoints and 28/54 (51.9%) publications with a positive result. For trials including QoL among endpoints but lacking QoL results in primary publication, probability of secondary publication was 6.3%, 30.1% and 49.8% after 1, 2 and 3 years respectively, without evidence of improvement comparing 2012-2015 vs. 2016-2018. CONCLUSION QoL is not assessed or published in many phase III lung cancer trials, a setting where QoL value should be highly considered, due to high symptom burden and generally limited life expectancy. Timely inclusion of results in primary publications is worsening in recent years.
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Affiliation(s)
- Maria Lucia Reale
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, TO, Italy
| | - Emmanuele De Luca
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, Torino, Italy
| | - Pasquale Lombardi
- Department of Oncology, University of Turin, Candiolo Cancer Institute - FPO- IRCCS, Candiolo, TO, Italy
| | - Laura Marandino
- Department of Oncology, University of Turin, Candiolo Cancer Institute - FPO- IRCCS, Candiolo, TO, Italy
| | - Clizia Zichi
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, Torino, Italy
| | - Daniele Pignataro
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, TO, Italy
| | - Eleonora Ghisoni
- Department of Oncology, University of Turin, Candiolo Cancer Institute - FPO- IRCCS, Candiolo, TO, Italy
| | - Rosario F Di Stefano
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, TO, Italy
| | - Annapaola Mariniello
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, TO, Italy
| | - Elena Trevisi
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, TO, Italy
| | - Gianmarco Leone
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, TO, Italy
| | - Leonardo Muratori
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, TO, Italy
| | - Anna La Salvia
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, TO, Italy
| | - Cristina Sonetto
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, TO, Italy
| | - Paolo Bironzo
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, TO, Italy
| | - Massimo Aglietta
- Department of Oncology, University of Turin, Candiolo Cancer Institute - FPO- IRCCS, Candiolo, TO, Italy
| | - Silvia Novello
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, TO, Italy
| | - Giorgio V Scagliotti
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, TO, Italy
| | - Francesco Perrone
- Clinical Trials Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale"-IRCCS, Napoli, Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, Torino, Italy.
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Marandino L, De Luca E, Zichi C, Lombardi P, Reale ML, Pignataro D, Di Stefano RF, Ghisoni E, Mariniello A, Trevisi E, Leone G, Muratori L, La Salvia A, Sonetto C, Buttigliero C, Tucci M, Aglietta M, Novello S, Scagliotti GV, Perrone F, Di Maio M. Quality-of-Life Assessment and Reporting in Prostate Cancer: Systematic Review of Phase 3 Trials Testing Anticancer Drugs Published Between 2012 and 2018. Clin Genitourin Cancer 2019; 17:332-347.e2. [PMID: 31416754 DOI: 10.1016/j.clgc.2019.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 07/06/2019] [Accepted: 07/15/2019] [Indexed: 01/20/2023]
Abstract
Quality of life (QoL) is not included among the end points in many studies, and QoL results are underreported in many phase 3 oncology trials. We performed a systematic review to describe QoL prevalence and heterogeneity in QoL reporting in recently published prostate cancer phase 3 trials. A PubMed search was performed to identify primary publications of randomized phase 3 trials testing anticancer drugs in prostate cancer, issued between 2012 and 2018. We analyzed QoL inclusion among end points, presence of QoL results, and methodology of QoL analysis. Seventy-two publications were identified (15 early-stage, 20 advanced hormone-sensitive, and 37 castration-resistant prostate cancer [CRPC]). QoL was not listed among study end points in 23 studies (31.9%) (40.0% early stage, 40.0% advanced hormone sensitive, and 24.3% CRPC). QoL results were absent in 15 (30.6%) of 49 primary publications of trials that included QoL among end points. Overall, as a result of absent end point or unpublished results, QoL data were lacking in 38 (52.8%) primary publications (53.3% early stage, 55.0% in advanced hormone sensitive, and 51.4% in CRPC). The most commonly used QoL tools were Functional Assessment of Cancer Therapy-Prostate (FACT-P) (21, 53.8%) and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) (14, 35.9%); most common methods of analysis were mean changes or mean scores (28, 71.8%), time to deterioration (14, 35.9%), and proportion of patients with response (10, 25.6%). In conclusion, QoL data are lacking in a not negligible proportion of recently published phase 3 trials in prostate cancer, although the presence of QoL results is better in positive trials, especially in CRPC. The methodology of QoL analysis is heterogeneous for type of instruments, analysis, and presentation of results.
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Affiliation(s)
- Laura Marandino
- Department of Oncology, University of Turin, at Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy
| | - Emmanuele De Luca
- Department of Oncology, University of Turin, at Ordine Mauriziano Hospital, Turin, Italy
| | - Clizia Zichi
- Department of Oncology, University of Turin, at Ordine Mauriziano Hospital, Turin, Italy
| | - Pasquale Lombardi
- Department of Oncology, University of Turin, at Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy
| | - Maria Lucia Reale
- Department of Oncology, University of Turin, at San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Daniele Pignataro
- Department of Oncology, University of Turin, at San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Rosario F Di Stefano
- Department of Oncology, University of Turin, at San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Eleonora Ghisoni
- Department of Oncology, University of Turin, at Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy
| | - Annapaola Mariniello
- Department of Oncology, University of Turin, at San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Elena Trevisi
- Department of Oncology, University of Turin, at San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Gianmarco Leone
- Department of Oncology, University of Turin, at San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Leonardo Muratori
- Department of Oncology, University of Turin, at San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Anna La Salvia
- Department of Oncology, University of Turin, at San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Cristina Sonetto
- Department of Oncology, University of Turin, at San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Consuelo Buttigliero
- Department of Oncology, University of Turin, at San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Marcello Tucci
- Department of Oncology, University of Turin, at San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Massimo Aglietta
- Department of Oncology, University of Turin, at Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy
| | - Silvia Novello
- Department of Oncology, University of Turin, at San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Giorgio V Scagliotti
- Department of Oncology, University of Turin, at San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Francesco Perrone
- Clinical Trials Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale"-IRCCS, Naples, Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin, at Ordine Mauriziano Hospital, Turin, Italy.
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Muratori L, La Salvia A, Sperone P, Di Maio M. Target therapies in recurrent or metastatic head and neck cancer: state of the art and novel perspectives. A systematic review. Crit Rev Oncol Hematol 2019; 139:41-52. [PMID: 31112881 DOI: 10.1016/j.critrevonc.2019.05.002] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 12/03/2018] [Accepted: 05/01/2019] [Indexed: 12/21/2022] Open
Abstract
Recurrent or metastatic head and neck squamous-cell carcinomas (R/M HNSCC) are a group of cancers with a very poor prognosis. Many clinical trials testing novel target therapies in this setting are currently ongoing. We performed a systematic review focusing our attention on all clinical trials, ongoing or already published, concerning the use of novel drugs for treatment of R/M HNSCC. We found that the research of novel molecules effective in treatment of R/M HNSCC has been intense during last decade, and nowadays it is still very active. Unfortunately, the results in this setting have been, overall, disappointing: until now, only cetuximab and, recently, nivolumab and pembrolizumab received authorization for treatment of R/M HNSCC. Nevertheless, the promising results showed by some novel drugs may lead to continue the research in this field, with the aim of producing more evidence and finding new therapeutic indication.
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Affiliation(s)
- Leonardo Muratori
- Medical Oncology, Department of Oncology, University of Turin, Azienda Ospedaliera Universitaria San Luigi Gonzaga, Regione Gonzole 10, 10043 Orbassano, Turin, Italy.
| | - Anna La Salvia
- Medical Oncology, Department of Oncology, Hospital Universitario 12 de Octubre, Avenida Cordoba, s/n, 28041 Madrid, Spain.
| | - Paola Sperone
- Medical Oncology, Department of Oncology, University of Turin, Azienda Ospedaliera Universitaria San Luigi Gonzaga, Regione Gonzole 10, 10043 Orbassano, Turin, Italy.
| | - Massimo Di Maio
- Medical Oncology, Department of Oncology, University of Turin, Azienda Ospedaliera Ordine Mauriziano, Corso Re Umberto 109, 10128 Turin, Italy.
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Muratori L, La Salvia A, Gorzegno G, Sperone P, Scagliotti GV. Long-term disease control in a metastatic squamous cell carcinoma of the oral cavity treated with maintenance metronomic capecitabine. J Oncol Pharm Pract 2019; 26:240-243. [PMID: 31042137 DOI: 10.1177/1078155219845433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Recurrent or metastatic disease occurs in two-thirds of head and neck squamous cell carcinomas and it is associated with poor prognosis. Systemic treatment with platinum-based chemotherapy in combination with the epidermal growth factor receptor-targeting monoclonal antibody cetuximab represents a preferred option for these patients. Upon the achievement of tumor response by combined treatment, maintenance with single-agent cetuximab is usually administered with the aim of prolonging disease control at the price of reasonable toxicity. Although rarely, however, cetuximab needs to be discontinued in the absence of disease progression because of intolerable side effects. Here we describe the case of a 66-year-old man with a metastatic cancer of oral cavity, who had to discontinue maintenance cetuximab and who achieved prolonged disease control with metronomic capecitabine. We suggest that capecitabine could be an effective and safe maintenance option in case of cetuximab intolerance.
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Affiliation(s)
- Leonardo Muratori
- Medical Oncology, Department of Oncology, University of Turin, Azienda Ospedaliera Universitaria San Luigi Gonzaga, Turin, Italy
| | - Anna La Salvia
- Medical Oncology, Department of Oncology, University of Turin, Azienda Ospedaliera Universitaria San Luigi Gonzaga, Turin, Italy
| | - Gabriella Gorzegno
- Medical Oncology, Department of Oncology, University of Turin, Azienda Ospedaliera Universitaria San Luigi Gonzaga, Turin, Italy
| | - Paola Sperone
- Medical Oncology, Department of Oncology, University of Turin, Azienda Ospedaliera Universitaria San Luigi Gonzaga, Turin, Italy
| | - Giorgio V Scagliotti
- Medical Oncology, Department of Oncology, University of Turin, Azienda Ospedaliera Universitaria San Luigi Gonzaga, Turin, Italy
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Marandino L, La Salvia A, Sonetto C, De Luca E, Pignataro D, Zichi C, Di Stefano RF, Ghisoni E, Lombardi P, Mariniello A, Reale ML, Trevisi E, Leone G, Muratori L, ButtIgliero C, Tucci M, Aglietta M, Scagliotti GV, Perrone F, Di Maio M. Quality-of-life (QoL) assessment and reporting in prostate cancer: A systematic review of phase III trials published between 2012 and 2016. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.7_suppl.219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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
219 Background: We previously reported that QoL is not included among endpoints and QoL results are significantly underreported in a high proportion of recently published phase III trials in oncology. In this study our aim was to describe QoL prevalence and heterogeneity in QoL reporting in prostate cancer (PC) phase III trials. Methods: Whole database included all primary publications (P) of phase III trials evaluating anticancer drugs published between 2012 and 2016 by 11 major journals. For this analysis, we extracted the subset of PC trials. We analyzed QoL inclusion among endpoints, presence of QoL results and methodology of QoL analysis. Results: 35 P were identified (21 in castration-resistant [CRPC], 9 in advanced hormone sensitive [aHSPC], incl. both metastatic and biochemical relapsed, and 5 in earlier stages). In 13 (37.1%) QoL was not listed among study endpoints: 7/21 (33.3%) in CRPC, 3/9 (33.3%) in aHSPC, and 3/5 (60%) in earlier stages. Out of 22 primary P of trials including QoL among endpoints, QoL results were not reported in 9 (40.9%). Overall, no QoL data were available in 22/35 (62.9%) primary P (61.9% in CRPC, 44.4% in aHSPC and 100% in earlier disease). QoL data were not available in 15/25 (60%) trials with overall survival (OS) as primary endpoint, and in 7/10 (70%) trials with other primary endpoints. QoL data were not available in 7/16 (43.8%) trials with a positive result (25% in CRPC, 40% in aHSPC, 100% in earlier stages). In 18 trials with available QoL results (incl. secondary publications), most common QoL tools were FACT-P (11, 61.1%) and EORTC QLQ-C30 (6, 33.3%). Common methods of analysis were mean changes (6, 33.3%), mean scores over time (6, 33.3%), time to deterioration (6, 33.3%) and proportion of responders (3, 16.7%). QoL analysis was focused on the impact of toxicity in 10 cases (mostly in earlier stages), and on disease symptoms in 10 cases (mostly in CRPC). Conclusions: QoL is absent in a high proportion of recently published phase III trials in PC, although presence of QoL results is better in positive trials, especially in CRPC. Methodology of QoL analysis is heterogeneous in terms of type of instruments, analysis and presentation of results.
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Affiliation(s)
- Laura Marandino
- Department of Oncology, University of Turin; Candiolo Cancer Institute - FPO- IRCCS, Candiolo (TO), Italy
| | - Anna La Salvia
- Department of Oncology, University of Turin; San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Cristina Sonetto
- Department of Oncology, University of Turin; San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Emmanuele De Luca
- Department of Oncology, University of Turin; San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Daniele Pignataro
- Department of Oncology, University of Turin; San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Clizia Zichi
- Department of Oncology, University of Turin; Ordine Mauriziano Hospital, Torino, Italy
| | - Rosario F Di Stefano
- Department of Oncology, University of Turin; San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Eleonora Ghisoni
- Department of Oncology, University of Turin; Candiolo Cancer Institute - FPO- IRCCS, Candiolo (TO), Italy
| | - Pasquale Lombardi
- Department of Oncology, University of Turin; Candiolo Cancer Institute - FPO- IRCCS, Candiolo (TO), Italy
| | - Annapaola Mariniello
- Department of Oncology, University of Turin; San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Maria Lucia Reale
- Department of Oncology, University of Turin; San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Elena Trevisi
- Department of Oncology, University of Turin; San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Gianmarco Leone
- Department of Oncology, University of Turin; San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Leonardo Muratori
- Department of Oncology, University of Turin; San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Consuelo ButtIgliero
- Department of Oncology, University of Turin; San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Marcello Tucci
- Department of Oncology, University of Turin; San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Massimo Aglietta
- Department of Oncology, University of Turin; Candiolo Cancer Institute - FPO- IRCCS, Candiolo (TO), Italy
| | - Giorgio V. Scagliotti
- Department of Oncology, University of Turin; San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Francesco Perrone
- Clinical Trials Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione Giovanni Pascale"-IRCCS, Napoli, Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin; Ordine Mauriziano Hospital, Torino, Italy
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Abstract
INTRODUCTION Colorectal cancer (CRC) is one of the most common malignant tumors; it is a focus of research globally, but the identification of clinically actionable oncogenic drivers remains elusive. Human epidermal growth factor receptor 2 (HER2) activation is present in approximately 5% of CRC and has acquired resistance to epidermal growth factor receptor (EGFR)-targeted therapy. Early clinical trials suggest an emerging role for personalized HER2-targeted therapy in a subset of metastatic CRC. AREAS COVERED This manuscript reviews the relevance of HER2 activation in CRC and its potential role as a target for therapy. A literature search was conducted in June 2018 of MEDLINE and EMBASE databases for published preclinical and clinical studies; abstracts of international cancer meetings (AACR, ASCO, and ESMO) were also reviewed. EXPERT OPINION HER2 is activated in a small but relevant proportion of CRC patients (particularly left-side, RAS wild-type, anti-EGFR resistant tumors). Dual HER2 blockade with monoclonal antibodies (mAbs) (trastuzumab and pertuzumab) or the combination of mAbs with tyrosine kinase inhibitors (trastuzumab and lapatinib) induces durable tumor responses in about one-third of HER2-positive CRC refractory to standard systemic therapy. Although immature, these results are remarkable and anticipate an expanding role for HER2 as a therapeutic target in CRC.
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Affiliation(s)
- Anna La Salvia
- a Oncology Department , Hospital Universitario 12 de Octubre , Madrid , Spain.,b Oncology Department , San Luigi Gonzaga Hospital , Orbassano , Italy
| | | | - Rocio Garcia-Carbonero
- a Oncology Department , Hospital Universitario 12 de Octubre , Madrid , Spain.,c Oncology Department , Instituto de Investigación Sanitaria Hospital 12 de Octubre (Imas12), CNIO, CIBERONC, UCM , Madrid , Spain
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Pusceddu S, Vernieri C, Di Maio M, Marconcini R, Spada F, Massironi S, Ibrahim T, Brizzi MP, Campana D, Faggiano A, Giuffrida D, Rinzivillo M, Cingarlini S, Aroldi F, Antonuzzo L, Berardi R, Catena L, De Divitiis C, Ermacora P, Perfetti V, Fontana A, Razzore P, Carnaghi C, Davì MV, Cauchi C, Duro M, Ricci S, Fazio N, Cavalcoli F, Bongiovanni A, La Salvia A, Brighi N, Colao A, Puliafito I, Panzuto F, Ortolani S, Zaniboni A, Di Costanzo F, Torniai M, Bajetta E, Tafuto S, Garattini SK, Femia D, Prinzi N, Concas L, Lo Russo G, Milione M, Giacomelli L, Buzzoni R, Delle Fave G, Mazzaferro V, de Braud F. Metformin Use Is Associated With Longer Progression-Free Survival of Patients With Diabetes and Pancreatic Neuroendocrine Tumors Receiving Everolimus and/or Somatostatin Analogues. Gastroenterology 2018; 155:479-489.e7. [PMID: 29655834 DOI: 10.1053/j.gastro.2018.04.010] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [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: 03/06/2017] [Revised: 03/21/2018] [Accepted: 04/06/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS Metformin seems to have anticancer effects. However, it is not clear whether use of glycemia and metformin affect outcomes of patients with advanced pancreatic neuroendocrine tumors (pNETs). We investigated the association between glycemia and progression-free survival (PFS) of patients with pNETs treated with everolimus and/or somatostatin analogues, as well as the association between metformin use and PFS time. METHODS We performed a retrospective analysis of 445 patients with advanced pNET treated at 24 medical centers in Italy from 1999 through 2015. Data on levels of glycemia were collected at time of diagnosis of pNET, before treatment initiation, and during treatment with everolimus (with or without somatostatin analogues), octreotide, or lanreotide. Diabetes was defined as prior or current use of glycemia control medication and/or fasting plasma glucose level ≥ 126 mg/dL, hemoglobin A1c ≥ 6.5% (48 mmol/L), or a random sample of plasma glucose ≥ 200 mg/dL (11.1 mmol/L), with reported classic symptoms of hyperglycemia or hyperglycemic crisis. Patients were assigned to groups based on diagnosis of diabetes before or during antitumor therapy. PFS was compared between patients with vs without diabetes. Among patients with diabetes, the association between metformin use and PFS was assessed. We performed sensitivity and landmark analyses to exclude patients who developed diabetes while receiving cancer treatment and to exclude a potential immortal time bias related to metformin intake. RESULTS PFS was significantly longer in patients with diabetes (median, 32.0 months) than without diabetes (median, 15.1 months) (hazard ratio for patients with vs without diabetes, 0.63; 95% confidence interval, 0.50-0.80; P = .0002). PFS of patients treated with metformin was significantly longer (median PFS, 44.2 months) than for patients without diabetes (hazard ratio for survival of patients with diabetes receiving metformin vs without diabetes, 0.45; 95% confidence interval, 0.32-0.62; P < .00001) and longer than for patients with diabetes receiving other treatments (median PFS, 20.8 months; hazard ratio, 0.49; 95% confidence interval, 0.34-0.69; P < .0001). In multivariable analysis, adjusted for other factors associated with outcomes, metformin was associated with longer PFS but level of glycemia was not. Metformin was associated with increased PFS of patients receiving somatostatin analogues and in those receiving everolimus, with or without somatostatin analogues. Sensitivity and landmark analyses produced similar results. CONCLUSIONS In a retrospective study of patients with pNETs, we found a significant association between metformin use and longer PFS.
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Affiliation(s)
- Sara Pusceddu
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, ENETS Center of Excellence, Milan, Italy.
| | - Claudio Vernieri
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, ENETS Center of Excellence, Milan, Italy; Fondazione Istituto FIRC di Oncologia Molecolare (IFOM), Milan, Italy
| | - Massimo Di Maio
- Dipartimento di Oncologia, Università degli Studi di Torino, A. O. Ordine Mauriziano, Turin, Italy
| | - Riccardo Marconcini
- Dipartimento di Oncologia, Santa Chiara Hospital, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Francesca Spada
- IEO - Istituto Europeo di Oncologia, ENETS Center of Excellence, Milan, Italy
| | - Sara Massironi
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Toni Ibrahim
- Centro di Osteoncologia e Tumori Rari, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Maria Pia Brizzi
- Azienda Ospedaliera Universitaria San Luigi Gonzaga, Orbassano, Italy
| | | | - Antongiulio Faggiano
- Unità di chirurgia tiroidea e paratiroidea, Istituto Nazionale per lo studio e la cura dei tumori "Fondazione G. Pascale" - IRCCS, Naples, Italy
| | | | - Maria Rinzivillo
- Azienda Ospedaliera Universitaria Sant'Andrea, ENETS Center of Excellence, Rome, Italy
| | | | | | | | - Rossana Berardi
- Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy
| | | | | | - Paola Ermacora
- Azienda Ospedaliero Universitaria Santa Maria della Misericordia, Udine, Italy
| | | | | | - Paola Razzore
- Unit of Endocrinology, Ospedale Mauriziano, Torino, Italy
| | - Carlo Carnaghi
- Istituto Clinico Humanitas, Rozzano, ENETS Center of Excellence, Italy
| | | | | | | | - Sergio Ricci
- Dipartimento di Oncologia, Santa Chiara Hospital, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Nicola Fazio
- IEO - Istituto Europeo di Oncologia, ENETS Center of Excellence, Milan, Italy
| | - Federica Cavalcoli
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Alberto Bongiovanni
- Centro di Osteoncologia e Tumori Rari, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Anna La Salvia
- Azienda Ospedaliera Universitaria San Luigi Gonzaga, Orbassano, Italy
| | | | - Annamaria Colao
- Endocrinology Section, Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Italy
| | | | - Francesco Panzuto
- Azienda Ospedaliera Universitaria Sant'Andrea, ENETS Center of Excellence, Rome, Italy
| | | | | | | | | | | | - Salvatore Tafuto
- IRCCS Fondazione Pascale, ENETS Center of Excellence, Naples, Italy
| | | | - Daniela Femia
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, ENETS Center of Excellence, Milan, Italy
| | - Natalie Prinzi
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, ENETS Center of Excellence, Milan, Italy
| | - Laura Concas
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, ENETS Center of Excellence, Milan, Italy
| | - Giuseppe Lo Russo
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, ENETS Center of Excellence, Milan, Italy; Medical-Surgical Science and Traslational Medicine Departement, Sapienza University, Rome, Italy
| | - Massimo Milione
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, ENETS Center of Excellence, Milan, Italy
| | - Luca Giacomelli
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Italy
| | - Roberto Buzzoni
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, ENETS Center of Excellence, Milan, Italy
| | - Gianfranco Delle Fave
- Azienda Ospedaliera Universitaria Sant'Andrea, ENETS Center of Excellence, Rome, Italy
| | - Vincenzo Mazzaferro
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, ENETS Center of Excellence, Milan, Italy; Universita' degli Studi di Milano, Milan, Italy
| | - Filippo de Braud
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, ENETS Center of Excellence, Milan, Italy; Universita' degli Studi di Milano, Milan, Italy
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Marandino L, La Salvia A, Sonetto C, De Luca E, Pignataro D, Zichi C, Di Stefano RF, Ghisoni E, Lombardi P, Mariniello A, Reale ML, Trevisi E, Leone G, Muratori L, Marcato M, Bironzo P, Aglietta M, Scagliotti GV, Perrone F, Di Maio M. Biases in assessment and reporting of health-related quality of life (QoL): A systematic review of oncology randomized phase III trials published between 2012 and 2016. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e18719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Laura Marandino
- Department of Oncology, University of Turin, Fondazione del Piemonte per l’Oncologia - IRCCS, Candiolo (TO), Italy
| | - Anna La Salvia
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Cristina Sonetto
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Emmanuele De Luca
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, Torino, Italy
| | - Daniele Pignataro
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Clizia Zichi
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, Torino, Italy
| | - Rosario F Di Stefano
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Eleonora Ghisoni
- Department of Oncology, University of Turin, Fondazione del Piemonte per l’Oncologia - IRCCS, Candiolo (TO), Italy
| | - Pasquale Lombardi
- Department of Oncology, University of Turin, Fondazione del Piemonte per l’Oncologia - IRCCS, Candiolo (TO), Italy
| | - Annapaola Mariniello
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Maria Lucia Reale
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Elena Trevisi
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Gianmarco Leone
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Leonardo Muratori
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Maddalena Marcato
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, Torino, Italy
| | - Paolo Bironzo
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | - Massimo Aglietta
- Department of Oncology, University of Turin, Fondazione del Piemonte per l’Oncologia - IRCCS, Candiolo (TO), Italy
| | - Giorgio V. Scagliotti
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano (TO), Italy
| | | | - Massimo Di Maio
- Department of Oncology, University of Turin; Ordine Mauriziano Hospital, Torino, Italy
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La Salvia A, De Luca E, Rossi A, Di Maio M. Can intercalating chemotherapy with epidermal growth factor receptor inhibitors delay development of treatment resistance in advanced non-small cell lung cancer? Expert Opin Pharmacother 2017; 18:1899-1902. [DOI: 10.1080/14656566.2017.1409721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Anna La Salvia
- Department of Oncology, University of Turin, Turin, Italy
- Division of Medical Oncology, “San Luigi Gonzaga” Hospital, Orbassano (TO), Italy
| | - Emmanuele De Luca
- Department of Oncology, University of Turin, Turin, Italy
- Division of MedicalOncology, “Ordine Mauriziano” Hospital, Turin, Italy
| | - Antonio Rossi
- OncologyDepartment, IRCSS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo (FG), Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin, Turin, Italy
- Division of MedicalOncology, “Ordine Mauriziano” Hospital, Turin, Italy
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Kasajima A, Papotti M, Ito W, Brizzi MP, La Salvia A, Rapa I, Tachibana T, Yazdani S, Sasano H, Volante M. High interlaboratory and interobserver agreement of somatostatin receptor immunohistochemical determination and correlation with response to somatostatin analogs. Hum Pathol 2017; 72:144-152. [PMID: 29180250 DOI: 10.1016/j.humpath.2017.11.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [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: 07/26/2017] [Revised: 11/13/2017] [Accepted: 11/17/2017] [Indexed: 01/12/2023]
Abstract
Monoclonal antibodies to somatostatin receptors 2A (SSTR2A, UMB-1) and 5 (SSTR5, UMB-4) were reported to be highly reliable for immunohistochemical detection of these receptors in neuroendocrine neoplasms. However, the standardization of either the immunohistochemical procedure and the methods of evaluation has yet to be established. Fifty-two tissues from 38 patients with neuroendocrine neoplasm were retrieved from 2 institutions in Italy and Japan. The tissues were immunostained using 3 staining methodologies: 1 automated and 2 manual protocols from the Italian and Japanese institutions. The slides were independently evaluated by 3 observers (2 experienced pathologists and 1 medical student) using 3 scoring systems (Volante-Score, HER2-Score, and H-Score). The scores obtained from the staining methods were highly correlated with each other (r>0.85, P<.0001). Especially, the Volante- and HER2-Scores were highly concordant (r≥0.95, P≤.0001). Very high interobserver agreement was obtained irrespective of the method used and the experience of the evaluator, with the best concordance obtained by experienced pathologists evaluating automated system-stained slides (SSTR2A, r>0.97; SSTR5, r>0.96). HER2- and H-Scores were reliable to represent the characteristics of the patients. SSTR2A expression evaluated by the HER2-Score was significantly associated with clinical efficacy to somatostatin analogs (P=.04). SSTRs determination is an easily standardizable tool in different laboratories and is highly reproducible irrespective of the method of evaluation used. Given the positive association with clinical efficacy to somatostatin analogs, as well as the simple and widespread use, HER2-Score can be proposed as a standard evaluation procedure of SSTR2A and SSTR5 expression in neuroendocrine neoplasms.
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Affiliation(s)
- Atsuko Kasajima
- Department of Pathology, Tohoku University Graduate School of Medicine, 980-8574 Sendai, Japan; Department of Pathology, Technical University Munich, 81675 Munich, Germany.
| | - Mauro Papotti
- Department of Oncology, University of Turin at San Luigi Hospital, Orbassano, 10043 Turin, Italy; Città della Salute Hospital, Orbassano, 10126 Turin, Italy.
| | - Wataru Ito
- Department of Pathology, Tohoku University Graduate School of Medicine, 980-8574 Sendai, Japan.
| | - Maria Pia Brizzi
- Oncology Unit, San Luigi Hospital, Orbassano, 10043 Turin, Italy.
| | - Anna La Salvia
- Oncology Unit, San Luigi Hospital, Orbassano, 10043 Turin, Italy.
| | - Ida Rapa
- Department of Oncology, University of Turin at San Luigi Hospital, Orbassano, 10043 Turin, Italy.
| | - Tomoyoshi Tachibana
- Department of Pathology, Tohoku University Graduate School of Medicine, 980-8574 Sendai, Japan.
| | - Samaneh Yazdani
- Department of Pathology, Tohoku University Graduate School of Medicine, 980-8574 Sendai, Japan.
| | - Hironobu Sasano
- Department of Pathology, Tohoku University Graduate School of Medicine, 980-8574 Sendai, Japan.
| | - Marco Volante
- Department of Oncology, University of Turin at San Luigi Hospital, Orbassano, 10043 Turin, Italy.
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Tampellini M, Di Maio M, Baratelli C, Anania L, Brizzi MP, Sonetto C, La Salvia A, Scagliotti GV. Treatment of Patients With Metastatic Colorectal Cancer in a Real-World Scenario: Probability of Receiving Second and Further Lines of Therapy and Description of Clinical Benefit. Clin Colorectal Cancer 2017; 16:372-376. [PMID: 28465170 DOI: 10.1016/j.clcc.2017.03.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 03/16/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND The optimal therapeutic strategy for metastatic colorectal cancer patients is still a matter of debate. There are no prognostic variables indicating how many lines individual patients ought to receive, and whether later lines could be effective even when earlier ones were not. PATIENTS AND METHODS We retrospectively collected data from 420 consecutive patients with metastatic colorectal cancer at our institution, describing the proportion of patients who received second or later lines of therapy and the chance of a line of treatment being active when the previous line was not. For each line of treatment, we defined clinical benefit as the probability of not having had evidence of disease progression 6 months after the start of chemotherapy. RESULTS Of the 373 patients with disease progression after first-line chemotherapy (1L), 277 received a second line (2L) (probability of being submitted to a 2L (P(2L)) = 74.3%): 143 (63.3%) of 226 received a 3L (P(3L)), and 56 (45.9%) of 122 were submitted to a 4L (P(4L)). Joint probabilities were: 2L 74.3%, 3L 47.0%, and 4L 21.6%. A total of 298 (71.5%) of 417 patients had a clinical benefit with 1L; 134 (48.6%) of 276 with 2L; 50 (35.2%) of 142 with 3L; and 12 (25.0%) of 48 with 4L. Taking all these data together, 31% of the patients who experienced early progression at 1L had the chance to have a clinical benefit with any further lines. CONCLUSION Our study demonstrated that of 4 patients submitted to a 1L, about 3 will receive a 2L, about 2 a 3L, and nearly 1 a 4L. Later lines could be beneficial even though earlier ones were not.
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Affiliation(s)
- Marco Tampellini
- Department of Oncology, University of Torino, AOU San Luigi di Orbassano, Orbassano, Italy.
| | | | | | - Lorenzo Anania
- Department of Oncology, University of Torino, AOU San Luigi di Orbassano, Orbassano, Italy
| | - Maria Pia Brizzi
- Department of Oncology, University of Torino, AOU San Luigi di Orbassano, Orbassano, Italy
| | - Cristina Sonetto
- Department of Oncology, University of Torino, AOU San Luigi di Orbassano, Orbassano, Italy
| | - Anna La Salvia
- Department of Oncology, University of Torino, AOU San Luigi di Orbassano, Orbassano, Italy
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Rossi A, La Salvia A, Di Maio M. Chemotherapy and intercalated gefitinib or erlotinib in the treatment of advanced non-small-cell lung cancer. Expert Rev Respir Med 2017; 11:171-180. [DOI: 10.1080/17476348.2017.1290526] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Antonio Rossi
- Division of Medical Oncology, IRCCS ‘Casa Sollievo della Sofferenza’ Hospital, San Giovanni Rotondo (FG), Italy
| | - Anna La Salvia
- Department of Oncology, University of Turin, ‘San Luigi Gonzaga’ Hospital, Orbassano (TO), Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin, ‘Ordine Mauriziano’ Hospital, Turin, Italy
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La Salvia A, Rossi A, Galetta D, Gobbini E, De Luca E, Novello S, Di Maio M. Intercalated Chemotherapy and Epidermal Growth Factor Receptor Inhibitors for Patients With Advanced Non-Small-cell Lung Cancer: A Systematic Review and Meta-analysis. Clin Lung Cancer 2016; 18:23-33.e1. [PMID: 27876230 DOI: 10.1016/j.cllc.2016.08.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 07/05/2016] [Accepted: 08/23/2016] [Indexed: 11/29/2022]
Abstract
Randomized clinical trials (RCTs) of concurrent epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) plus chemotherapy for unselected patients with advanced non-small-cell lung cancer (NSCLC) produced negative results. Intercalated administration could avoid the reduction of chemotherapy activity due to G1 cell-cycle arrest from EGFR-TKIs. A PubMed search was performed in December 2015 and updated in February 2016. The references from the selected studies were also checked to identify additional eligible trials. Furthermore, the proceedings of the main international meetings were searched from 2010 onward. We included RCTs comparing chemotherapy intercalated with an EGFR-TKI versus chemotherapy alone for patients with advanced NSCLC. Ten RCTs were eligible (6 with erlotinib, 4 with gefitinib): 39% of patients had a known EGFR mutational status, 43% of whom EGFR mutation positive. The intercalated combination was associated with a significant improvement in overall survival (OS; hazard ratio [HR], 0.82; 95% confidence interval [CI], 0.71-0.95; P = .01), progression-free survival (PFS; HR, 0.60; 95% CI, 0.53-0.68; P < .00001), and objective response rate (ORR; odds ratio [OR], 2.70; 95% CI, 2.08-3.49; P < .00001). Considering only first-line trials, similar differences were found in OS (HR, 0.85; 95% CI, 0.72-1.00; P = .05), PFS (HR, 0.63; 95% CI, 0.55-0.73; P < .00001), and ORR (OR, 2.21; 95% CI, 1.65-2.95; P < .00001). In EGFR mutation-positive patients, the addition of an intercalated EGFR-TKI produced a significant benefit in PFS (129 patients; HR, 0.24; 95% CI, 0.16-0.37; P < .00001) and ORR (168 patients; OR, 11.59; 95% CI, 5.54-24.25; P < .00001). In patients with advanced NSCLC, chemotherapy plus intercalated EGFR-TKIs was superior to chemotherapy alone, although a definitive interpretation was jeopardized by the variable proportion of patients with EGFR mutation-positive tumors included.
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Affiliation(s)
- Anna La Salvia
- Department of Oncology, University of Turin, "San Luigi Gonzaga" Hospital, Orbassano, Italy
| | - Antonio Rossi
- Division of Medical Oncology, "S. G. Moscati" Hospital, Avellino, Italy.
| | - Domenico Galetta
- Medical Oncology Department, Clinical Cancer Center Giovanni Paolo II, Bari, Italy
| | - Elisa Gobbini
- Department of Oncology, University of Turin, "San Luigi Gonzaga" Hospital, Orbassano, Italy
| | - Emmanuele De Luca
- Department of Oncology, University of Turin, "San Luigi Gonzaga" Hospital, Orbassano, Italy
| | - Silvia Novello
- Department of Oncology, University of Turin, "San Luigi Gonzaga" Hospital, Orbassano, Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin, "San Luigi Gonzaga" Hospital, Orbassano, Italy
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