1
|
Corti F, Brizzi MP, Amoroso V, Giuffrida D, Panzuto F, Campana D, Prinzi N, Milione M, Cascella T, Spreafico C, Randon G, Oldani S, Leporati R, Scotto G, Pulice I, Stocchetti BL, Porcu L, Coppa J, Di Bartolomeo M, de Braud F, Pusceddu S. Assessing the safety and activity of cabozantinib combined with lanreotide in gastroenteropancreatic and thoracic neuroendocrine tumors: rationale and protocol of the phase II LOLA trial. BMC Cancer 2023; 23:908. [PMID: 37752423 PMCID: PMC10523723 DOI: 10.1186/s12885-023-11287-2] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 08/09/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Well-differentiated (WD) neuroendocrine tumors (NETs) are a group of rare neoplasms with limited therapeutic options. Cabozantinib is an inhibitor of multiple tyrosine kinases with a pivotal role in NET pathogenesis, including c-MET and Vascular Endothelial Growth Factor Receptor 2 (VEGFR2). LOLA is the first prospective phase II trial aiming to assess the safety and activity of cabozantinib combined with lanreotide in WD NETs of gastroenteropancreatic (GEP), thoracic and of unknown origin. METHODS This is a multicenter, open-label, double-cohort, non comparative, non-randomized, three-stage phase II trial. Eligible patients have to meet the following inclusion criteria: diagnosis of advanced or metastatic, progressive, non-functioning WD thoracic NETs, GEP-NETs or NETs of unknown origin with Ki67 ≥ 10%; positive 68 Ga-PET uptake or somatostatin receptor 2 immunohistochemical (IHC) stain; maximum 1 prior systemic regimen for metastatic disease. Two cohorts will be considered: pNETs and carcinoids (typical or atypical lung and thymus NETs, gastro-intestinal NETs or NETs of unknown origin). In stage I, the primary objective is to find the optimal dose of cabozantinib in combination with lanreotide and to evaluate the safety of the combination (percentage of patients experiencing grade 3-5 toxicities according to NCI-CTCAE version 5.0). Starting dose of cabozantinib is 60 mg/day continuously, plus lanreotide 120 mg every 28 days. In stage II and III, co-primary endpoints are safety and overall response rate (ORR) according to RECIST version 1.1. The uninteresting antitumor activity is fixed in ORR ≤ 5%. Secondary endpoints are progression-free survival and overall survival. Exploratory objectives include the assessment of c-MET, AXL and VEGFR2 IHC expression, to identify predictive or prognostic tissue biomarkers. Enrolment started in July 2020, with an expected trial duration of 42 months comprehensive of accrual, treatment and follow-up. Considering a drop-out rate of 5%, the maximum number of enrolled patients will be 69. DISCUSSION Supported by a solid rationale, the trial has the potential to generate milestone data about the synergistic effects of cabozantinib plus lanreotide in a group of NET patients with relatively aggressive disease and limited therapeutic options. TRIAL REGISTRATION LOLA is registered at ClinicalTrials.gov (NCT04427787) and EudraCT (2019-004506-10).
Collapse
Affiliation(s)
- Francesca Corti
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori Di Milano, ENETS Center of Excellence, Via Giacomo Venezian 1, 20133, Milan, Italy
| | - Maria Pia Brizzi
- Azienda Ospedaliera Universitaria San Luigi Gonzaga, Orbassano, Italy
| | - Vito Amoroso
- Medical Oncology Unit, Department of Medical & Surgical Specialties, Radiological Sciences & Public Health, University of Brescia at Spedali Civili Hospital, Brescia, Italy
| | - Dario Giuffrida
- Medical Oncology Department, Istituto Oncologico del Mediterraneo, Catania, Viagrande, Italy
| | - Francesco Panzuto
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Digestive Disease Unit, ENETS Center of Excellence, Sant' Andrea University Hospital, Rome, Italy
| | - Davide Campana
- Division of Medical Oncology, IRCCS Azienda Ospedaliera- Universitaria Bologna, NET Team Bologna, ENETS Center of Excellence, Bologna, Italy
| | - Natalie Prinzi
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori Di Milano, ENETS Center of Excellence, Via Giacomo Venezian 1, 20133, Milan, Italy
| | - Massimo Milione
- First Division of Pathology, Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale Dei Tumori Di Milano, Milan, Italy
| | - Tommaso Cascella
- Department of Radiology, Fondazione IRCCS Istituto Nazionale Dei Tumori Di Milano, ENETS Center of Excellence, Milan, Italy
| | - Carlo Spreafico
- Department of Radiology, Fondazione IRCCS Istituto Nazionale Dei Tumori Di Milano, ENETS Center of Excellence, Milan, Italy
| | - Giovanni Randon
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori Di Milano, ENETS Center of Excellence, Via Giacomo Venezian 1, 20133, Milan, Italy
| | - Simone Oldani
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori Di Milano, ENETS Center of Excellence, Via Giacomo Venezian 1, 20133, Milan, Italy
| | - Rita Leporati
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori Di Milano, ENETS Center of Excellence, Via Giacomo Venezian 1, 20133, Milan, Italy
| | - Giulia Scotto
- Azienda Ospedaliera Universitaria San Luigi Gonzaga, Orbassano, Italy
| | - Iolanda Pulice
- Clinical Trial Center, Fondazione IRCCS Istituto Nazionale Dei Tumori Di Milano, Milan, Italy
| | - Benedetta Lombardi Stocchetti
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori Di Milano, ENETS Center of Excellence, Via Giacomo Venezian 1, 20133, Milan, Italy
| | - Luca Porcu
- Methodology for Clinical Research Laboratory, Oncology Department, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Jorgelina Coppa
- Gastro-Entero-Pancreatic Surgical and Liver Transplantation Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori Di Milano, ENETS Center of Excellence, Milan, Italy
| | - Maria Di Bartolomeo
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori Di Milano, ENETS Center of Excellence, Via Giacomo Venezian 1, 20133, Milan, Italy
| | - Filippo de Braud
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori Di Milano, ENETS Center of Excellence, Via Giacomo Venezian 1, 20133, Milan, Italy
- Department of Oncology and Hemato-Oncology, Università Degli Studi Di Milano, Milan, Italy
| | - Sara Pusceddu
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori Di Milano, ENETS Center of Excellence, Via Giacomo Venezian 1, 20133, Milan, Italy.
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
La Verde N, Riva A, Cona MS, Gabrieli A, Cattaneo M, Fasola C, Lipari G, De Stradis C, Favorito V, Lombardi Stocchetti B, Chizzoniti D, Covizzi A, Rulli E, Galli F, Ruggieri L, Gambaro A, Ferrario S, Dalu D, Tarkowski MS. Immunogenicity of two doses of BNT162b2 and mRNA-1273 vaccines for solid cancer patients on treatment with or without a previous SARS-CoV-2 infection. Int J Cancer 2022; 152:661-671. [PMID: 36056571 PMCID: PMC9538813 DOI: 10.1002/ijc.34273] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/19/2022] [Accepted: 08/18/2022] [Indexed: 02/01/2023]
Abstract
Previous studies on the immunogenicity of SARS-CoV-2 mRNA vaccines showed a reduced seroconversion in cancer patients. The aim of our study is to evaluate the immunogenicity of two doses of mRNA vaccines in solid cancer patients with or without a previous exposure to the virus. This is a single-institution, prospective, nonrandomized study. Patients in active treatment and a control cohort of healthy people received two doses of BNT162b2 (Comirnaty, BioNTech/Pfizer, The United States) or mRNA-1273 (Spikevax, Moderna). Vaccine was administered before starting anticancer therapy or on the first day of the treatment cycle. SARS-CoV-2 antibody levels against S1, RBD (to evaluate vaccine response) and N proteins (to evaluate previous infection) were measured in plasma before the first dose and 30 days after the second one. From January to June 2021, 195 consecutive cancer patients and 20 healthy controls were enrolled. Thirty-one cancer patients had a previous exposure to SARS-CoV-2. Cancer patients previously exposed to the virus had significantly higher median levels of anti-S1 and anti-RBD IgG, compared to healthy controls (P = .0349) and to cancer patients without a previous infection (P < .001). Vaccine type (anti-S1: P < .0001; anti-RBD: P = .0045), comorbidities (anti-S1: P = .0274; anti-RBD: P = .0048) and the use of G-CSF (anti-S1: P = .0151) negatively affected the antibody response. Conversely, previous exposure to SARS-CoV-2 significantly enhanced the response to vaccination (anti-S1: P < .0001; anti-RBD: P = .0026). Vaccine immunogenicity in cancer patients with a previous exposure to SARS-CoV-2 seems comparable to that of healthy subjects. On the other hand, clinical variables of immune frailty negatively affect humoral immune response to vaccination.
Collapse
Affiliation(s)
- Nicla La Verde
- Department of OncologySacco Hospital, ASST Fatebenefratelli SaccoMilanItaly
| | - Agostino Riva
- Department of Infectious DiseasesSacco Hospital, ASST Fatebenefratelli SaccoMilanItaly,Luigi Sacco Department of Biomedical and Clinical Sciences DIBICUniversity of MilanMilanItaly
| | - Maria Silvia Cona
- Department of OncologySacco Hospital, ASST Fatebenefratelli SaccoMilanItaly
| | - Arianna Gabrieli
- Luigi Sacco Department of Biomedical and Clinical Sciences DIBICUniversity of MilanMilanItaly
| | - Monica Cattaneo
- Department of OncologySacco Hospital, ASST Fatebenefratelli SaccoMilanItaly
| | - Cinzia Fasola
- Department of OncologySacco Hospital, ASST Fatebenefratelli SaccoMilanItaly
| | - Giuseppe Lipari
- Luigi Sacco Department of Biomedical and Clinical Sciences DIBICUniversity of MilanMilanItaly
| | - Claudia De Stradis
- Luigi Sacco Department of Biomedical and Clinical Sciences DIBICUniversity of MilanMilanItaly
| | - Valentina Favorito
- Department of OncologySacco Hospital, ASST Fatebenefratelli SaccoMilanItaly
| | | | - Davide Chizzoniti
- Department of OncologySacco Hospital, ASST Fatebenefratelli SaccoMilanItaly
| | - Alice Covizzi
- Department of Infectious DiseasesSacco Hospital, ASST Fatebenefratelli SaccoMilanItaly
| | - Eliana Rulli
- Laboratory of Methodology for Clinical ResearchIstituto di Ricerche Farmacologiche Mario Negri IRCCSMilanItaly
| | - Francesca Galli
- Laboratory of Methodology for Clinical ResearchIstituto di Ricerche Farmacologiche Mario Negri IRCCSMilanItaly
| | - Lorenzo Ruggieri
- Department of OncologySacco Hospital, ASST Fatebenefratelli SaccoMilanItaly
| | - Anna Gambaro
- Department of OncologySacco Hospital, ASST Fatebenefratelli SaccoMilanItaly
| | - Sabrina Ferrario
- Department of OncologySacco Hospital, ASST Fatebenefratelli SaccoMilanItaly
| | - Davide Dalu
- Department of OncologySacco Hospital, ASST Fatebenefratelli SaccoMilanItaly
| | - Maciej S. Tarkowski
- Luigi Sacco Department of Biomedical and Clinical Sciences DIBICUniversity of MilanMilanItaly
| |
Collapse
|
4
|
Cona MS, Dalu D, Rulli E, Galli F, Rota S, Ferrario S, Tosca N, Gambaro A, Filipazzi V, Fasola C, Oldani S, Chizzoniti D, Tricella C, Lombardi Stocchetti B, La Verde NM. COVID-19 and cancer: How outpatients (pts) and their caregivers (CGs) face to the pandemic—A survey from the midst of the Italian outbreak. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e24119] [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
e24119 Background: COVID-19 pandemic led to a reorganization of Health Care System for cancer pts, also because of the application of containment measures. The aim of our study was to investigate the emotional discomfort of pts and their CGs who needed to access the day-hospital to receive treatment during pandemic. Methods: This is a single-institution, prospective, cross-sectional study. From 5th May to 5th June 2020 a survey was conducted at a Department of Oncology in the midst of the Italian outbreak. We compared the points of view of both the “players” through 2 different multiple-choice questionnaires enquiring demographic characteristics, changes in emotional status, interpersonal relationships with health professionals (HCPs) and self-perception of treatment outcomes. Results: 625 pts and 254 CGs were enrolled. Female were prevalent (pts:65%, CGs:56%). Pts were generally older than CGs (pts:70% > 60 y, CGs:50.4% 41-60 y; p < 0.001). 50.5% pts had a low education level (EL) while 67.5% CGs had a higher degree. About half of pts (52.8%) reached the hospital with their own CG who lived together in the 58.3% of cases. 52.5% of pts felt more vulnerable to COVID-19 compared to CGs. Differently, CGs did not feel more exposed to infection, although they were involved in taking care or lived together with pts. The EL influenced the risk contagion perception: people with a lower EL were less worried about being infected with SARS-CoV-2. Regardless of the perceived contagion risk, study participants considered the containment measures a valid support to avoid the spread of infection (pts:92%, CGs:89%; p = 0.163) without an excessive loss of time (pts:78%, CGs:88.6%; p = 0.003). A personal emotional change caused by waiting and performing visits/treatments alone was reported more by CGs (66%) than by pts (32.7%; p < 0.001). Specifically, CGs had greater anxiety (58.8%) and fear of not properly managing pts at home (19.8%). The majority of pts (73%) and CGs (62%) thought that the pandemic didn’t influence treatment outcomes. The relationship with HCPs was not negatively affected for both pts (79.6%) and CGs (95%), but about a quarter of pts (25%) and CGs (29%) thought that the attention of HCPs was more focused on COVID-19 than on cancer treatment. Conclusions: The majority of pts felt at higher risk of COVID-19 infection and therefore approved the application of safety standards to help them feel more protected. Good relationships with HCPs contributed to receive treatments without experiencing additional distress. For CGs the main troubles are limitations which don’t allow to fully share the pts' care route and the perceive an impairment in HCPs relationship. Starting from these data, we can better understand the current psychological distress of pts and their families in order to develop potential strategies to support them in this strenuous period of crisis.
Collapse
Affiliation(s)
| | - Davide Dalu
- Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Eliana Rulli
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Francesca Galli
- IRCCS Istituto di ricerche farmacologiche Mario Negri, Milan, Italy
| | - Selene Rota
- Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | | | - Nicoletta Tosca
- Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | | | | | - Cinzia Fasola
- Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Simone Oldani
- Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | | | - Chiara Tricella
- Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | | | | |
Collapse
|