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Ghilli M, Becherini C, Meattini I, Angiolini C, Bengala C, Marconi A, Galli L, Angiolucci G, Coltelli L, Borghesi S, Lastrucci L, Manca G, Bianchi S, Doria M, Casella D, Marotti L, Amunni G, Roncella M. Management of the axilla in breast cancer patients: critical review, regional modified Delphi consensus and implementation in the Tuscan breast network. Radiol Med 2024:10.1007/s11547-024-01818-7. [PMID: 38683499 DOI: 10.1007/s11547-024-01818-7] [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] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 04/16/2024] [Indexed: 05/01/2024]
Abstract
PURPOSE Data from recently trials have provided practice-changing recommendations in management of the axilla in early breast cancer (eBC). However, further controversies have been raised, resulting in heterogeneous diffusion of these recommendations. Our purpose was to obtain a better homogeneity. MATERIAL AND METHODS In 2021, the Tuscan Breast Network (TBN) established a consensus with the aim to update recommendations in this area. We performed a literature review on axillary management in eBC patients which led to an expert Delphi consensus aiming to explore the gray areas, build consensus and propose evidence-based suggestions for an appropriate management. Thereafter, we investigate their implementation in clinical practice. RESULTS (1) DCIS patients should have SLN biopsy only in case of mastectomy or in conservative surgery if tumor is in a location that would preclude future nodal sampling or in case of a mass; (2) ALND may be omitted for 1-2 positive SLN patients undergoing BCS in T1-2 tumors with 1-2 SLN positive, eligible for whole-breast irradiation and adjuvant systemic therapies; (3) consider the option of RNI in patients with 1-3 positive lymph nodes and one or more high-risk characteristics; (4) the population identified in 2) should NOT undergo lymph node irradiation as an alternative to axillary surgery and (5) patients with clinically (pre-operatively) positive axilla, or undergoing primary systemic therapy, or outside the criteria reported in 2) must receive additional ALND and/or RT as per local policy. CONCLUSION This consensus provided a practical tool to stimulate local and national breast surgical and radiotherapy protocols.
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Affiliation(s)
- Matteo Ghilli
- Breast Centre, Breast Surgery, University Hospital of Pisa, Via Roma 67, Pisa, Italy.
| | - Carlotta Becherini
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Icro Meattini
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Catia Angiolini
- Breast Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, A. Brambilla 3, 50134, Florence, Italy
| | - Carmelo Bengala
- Oncology Department, Unit of Medical Oncology, Misericordia Hospital, Grosseto, Italy
| | - Aroldo Marconi
- Breast Oncological and Reconstructive Surgery, S.Luca Hospital- V. G. Lippi Francesconi, 55100, Lucca, Italy
| | - Lorenzo Galli
- Azienda Usl Toscana Centro, Ospedale San Giovanni Di Dio, Via Di Torregalli N 3, 50143, Florence, Italy
| | - Giovanni Angiolucci
- Radiologia Senologica, Azienda Usl Toscana Sud-Est, Ospedale Arezzo, Giovanni Valdarno, Italy
| | - Luigi Coltelli
- Division of Medical Oncology, Livorno Hospital, Department of Oncology, Azienda USL Toscana Nord Ovest, Viale Alfieri 36, Leghorn, Italy
| | - Simona Borghesi
- Department of Radiation Oncology, Azienda Usl Toscana Sud-Est, Ospedale Arezzo E S., Giovanni Valdarno, Italy
| | - Luciana Lastrucci
- Department of Radiation Oncology, Livorno Hospital, Azienda USL Toscana Nord Ovest, Viale Alfieri 36, Leghorn, Italy
| | - Gianpiero Manca
- Breast Centre, Nuclear Medicine, University Hospital of Pisa, Via Roma 67, Pisa, Italy
| | - Simonetta Bianchi
- Department of Health Sciences, Division of Pathological Anatomy, University of Florence, Viale Pieraccini 6, Florence, Italy
| | - Morena Doria
- SOC Anatomia Patologica, Azienda Usl Toscana Centro, Ospedale San Giovanni Di Dio, Via Di Torregalli N° 3, 50143, Florence, Italy
| | | | - Lorenza Marotti
- European Society of Breast Cancer Specialists, Florence, Italy
| | - Gianni Amunni
- Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Manuela Roncella
- Breast Centre, Breast Surgery, University Hospital of Pisa, Via Roma 67, Pisa, Italy
- University Hospital of Pisa, Via Roma 67, Pisa, Italy
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2
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Guglielmi G, Del Re M, Gol LS, Bengala C, Danesi R, Fogli S. Pharmacological insights on novel oral selective estrogen receptor degraders in breast cancer. Eur J Pharmacol 2024; 969:176424. [PMID: 38402929 DOI: 10.1016/j.ejphar.2024.176424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 02/08/2024] [Accepted: 02/14/2024] [Indexed: 02/27/2024]
Abstract
The therapeutic landscape of estrogen receptor (ER)-positive breast cancer includes endocrine treatments with aromatase inhibitors (AIs), selective estrogen receptor modulators (SERMs), and selective estrogen receptor degraders (SERDs). Fulvestrant is the first approved SERD with proven efficacy and good tolerability in clinical practice. However, drug resistance, low receptor affinity, and parental administration stimulated the search for new oral SERDs opening a new therapeutic era in ER + breast cancer. Elacestrant is an orally bioavailable SERD that has been recently approved by the FDA for postmenopausal women with ER+, human epidermal growth factor receptor 2-negative (HER2-), estrogen receptor 1 (ESR1)-mutated advanced or metastatic breast cancer with disease progression following at least one line of endocrine therapy. Other molecules of the same class currently tested in clinical trials are amcenestrant, giredestrant, camizestrant, and imlunestrant. The current review article offers a detailed pharmacological perspective of this emerging drug class, which may help with their possible future clinical applications.
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Affiliation(s)
- Giorgio Guglielmi
- Clinical Pharmacology and Pharmacogenetics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marzia Del Re
- Clinical Pharmacology and Pharmacogenetics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Leila Sadeghi Gol
- Clinical Pharmacology and Pharmacogenetics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Carmelo Bengala
- Clinical Oncology Unit 1, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Romano Danesi
- Clinical Pharmacology and Pharmacogenetics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy; Department of Oncology and Hemato-Oncology, University of Milano, Milano, Italy.
| | - Stefano Fogli
- Clinical Pharmacology and Pharmacogenetics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Passarelli A, Carbone V, Pignata S, Mazzeo R, Lorusso D, Scambia G, Canova S, Di Palma T, Tasca G, Mantiero M, Naglieri E, Andreetta C, Rauso M, Brunetti AE, Laera L, Abeni C, Scandurra G, Gambaro AR, Pastore A, Bengala C, Gunnellini M, Farolfi A, Spinello M, Bartoletti M. Alpelisib for PIK3CA-mutated advanced gynecological cancers: First clues of clinical activity. Gynecol Oncol 2024; 183:61-67. [PMID: 38518529 DOI: 10.1016/j.ygyno.2024.02.029] [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: 12/15/2023] [Revised: 02/20/2024] [Accepted: 02/28/2024] [Indexed: 03/24/2024]
Abstract
OBJECTIVE Recurrent gynecological tumors (e.g., endometrial, and ovarian cancers) are incurable diseases; therefore, new treatment options are urgently needed. The PTEN-AKT-PI3K pathway is frequently altered in these tumors, representing a potential treatment target. Alpelisib is an α-specific PI3K inhibitor approved in PIK3CA-mutated advanced breast cancer. We report outcomes from a large series of patients with PIK3CA-mutated gynecological cancers prospectively treated with alpelisib within a controlled program. METHODS From April 2021 to December 2022, 36 patients with PIK3CA-mutated advanced gynecological cancers received alpelisib 300 mg orally once daily. Objective response (ORR) and disease control (DCR) rates provided measure of the antitumor activity of alpelisib, the primary objective of the study. RESULTS Included patients had endometrial (17/36 [47%]), ovarian (10/36 [28%]), or other gynecological cancers (9/36 [25%]). Most patients had received 2-3 prior systemic treatments (endometrial, 47·2%; ovarian, 60%; other, 56%), and presented with visceral metastases at baseline (82%, 70%, and 56%, respectively). Overall, 17 different PIK3CA mutations were found, including 53% in the kinase domain (most commonly H1047R) and 36% in the helical domain (most commonly E545K). Overall, the ORR was 28% and DCR was 61%, with the greatest benefit observed in patients with endometrial cancer (35% and 71%, respectively). CONCLUSION Alpelisib represents an active treatment option in patients with recurrent gynecological cancers harboring a PIK3CA mutation. These findings support the need of biomarker-driven randomized trials of PI3K inhibitors in gynecological cancers.
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Affiliation(s)
- Anna Passarelli
- Department of Urology and Gynecology, Istituto Nazionale Tumori Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione G. Pascale, Naples, Italy
| | - Vittoria Carbone
- Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione G. Pascale, Naples, Italy.
| | - Roberta Mazzeo
- Unit of Medical Oncology and Cancer Prevention, Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), Aviano, Italy
| | - Domenica Lorusso
- Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Life Science and Public Health, Catholic University of Sacred Heart Largo Agostino Gemelli, Rome, Italy
| | - Giovanni Scambia
- Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Life Science and Public Health, Catholic University of Sacred Heart Largo Agostino Gemelli, Rome, Italy
| | - Stefania Canova
- Medical Oncology Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Teresa Di Palma
- Medical Oncology Unit, Ospedale S Maria Goretti, Latina, Italy
| | - Giulia Tasca
- Division of Oncology 2, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Mara Mantiero
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Emanuele Naglieri
- Department of Oncology, Istituto Oncologico Giovanni Paolo II, Bari, Italy
| | - Claudia Andreetta
- Department of Oncology, ASU FC S. Maria della Misericordia, Udine, Italy
| | - Martina Rauso
- Oncological Medical and Specialists Department, Oncology Unit, University Hospital of Ferrara, Ferrara, Italy
| | | | - Letizia Laera
- Department of Medical Oncology, Miulli General Regional Hospital, Acquaviva delle Fonti, Italy
| | - Chiara Abeni
- Department of Clinical Oncology, Fondazione Poliambulanza, Brescia, Italy
| | | | - Anna Rita Gambaro
- Medical Oncology Unit, ASST Fatebenefratelli Sacco, Ospedale Sacco Polo Universitario, Milano, Italy
| | - Alessia Pastore
- Medical Oncology Unit, Azienda Ospedaliera S. Anna, Como, Italy
| | - Carmelo Bengala
- Medical Oncology Unit, Misericordia Hospital, Grosseto, Italy
| | - Marco Gunnellini
- Medical Oncology Unit, Presidio Ospedaliero Alto Chiascio, Gubbio, Italy
| | - Alberto Farolfi
- Department of Medical Oncology, IRCCS- Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Emilia-Romagna, Italy
| | | | - Michele Bartoletti
- Unit of Medical Oncology and Cancer Prevention, Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), Aviano, Italy
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Borelli B, Conca V, Carullo M, Sainato A, Mattioni R, Manfredi B, Balestri R, Buccianti P, Morelli L, Rossi P, Vagli P, Prete AA, Luca F, Morano F, Donato SD, Salvatore L, Bengala C, Rossini D, Boni L, Antoniotti C, Cremolini C, Masi G, Moretto R. ShorTrip Trial: A Prospective, Multicentric Phase II Single-Arm Trial of Short-Course Radiotherapy Followed by Intensified Consolidation Chemotherapy With the Triplet FOLFOXIRI as Total Neoadjuvant Therapy in Locally Advanced Rectal Cancer. Clin Colorectal Cancer 2023; 22:339-343.e3. [PMID: 37429749 DOI: 10.1016/j.clcc.2023.06.002] [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: 03/16/2023] [Accepted: 06/05/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND In patients with locally advanced rectal cancer (LARC) treated with preoperative (chemo) radiotherapy and surgery, adjuvant chemotherapy is poorly feasible and its benefit is questionable. In the last years, several total neoadjuvant treatment (TNT) strategies, moving the adjuvant chemotherapy to the neoadjuvant setting, have been investigated with the aim of improving compliance to systemic chemotherapy, treating micrometastases earlier and then reducing distant recurrence. PATIENTS AND METHODS ShorTrip (NTC05253846) is a prospective, multicentre, single-arm phase II trial where 63 patients with LARC will be treated with short-course radiotherapy followed by intensified consolidation chemotherapy with FOLFOXIRI regimen and surgery. Primary endpoint is pCR. Among the first 11 patients who started consolidation chemotherapy, a preliminary safety analysis showed a high rate of grade 3 to 4 neutropenia (N = 7, 64%) during the first cycle of FOLFOXIRI. Therefore, the protocol has been emended with the recommendation to omit irinotecan during the first cycle of consolidation chemotherapy. After amendment, in a subsequent safety analysis focused on the first 9 patients treated with FOLFOX as first cycle and then with FOLFOXIRI, grade 3 to 4 neutropenia was reported in only one case during the second cycle. AIM OF THE STUDY The aim of this study is to assess the safety and activity of a TNT strategy including SCRT, intensified consolidation treatment with FOLFOXIRI and delayed surgery. After protocol amendment, the treatment seems feasible without safety concern. Results are expected at the end of 2024.
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Affiliation(s)
- Beatrice Borelli
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy; Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Veronica Conca
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy; Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Martina Carullo
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy; Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Aldo Sainato
- Radiation Oncology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Roberto Mattioni
- Radiation Oncology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Bruno Manfredi
- Radiation Oncology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Riccardo Balestri
- General Surgery, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Piero Buccianti
- General Surgery, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Luca Morelli
- General Surgery, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Piercarlo Rossi
- Cisanello Radiology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Paola Vagli
- Cisanello Radiology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | | | | | - Federica Morano
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Samantha Di Donato
- Department of Medical Oncology, Nuovo Ospedale di Prato Santo Stefano, Prato, Italy
| | - Lisa Salvatore
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy; Oncologia Medica, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Carmelo Bengala
- Medical Oncology Unit, Ospedale Misericordia, Grosseto, Italy
| | - Daniele Rossini
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy; Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Luca Boni
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Carlotta Antoniotti
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy; Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Chiara Cremolini
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy; Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Gianluca Masi
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy; Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Roberto Moretto
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
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Munzone E, Regan MM, Cinieri S, Montagna E, Orlando L, Shi R, Campadelli E, Gianni L, Palleschi M, Petrelli F, Bengala C, Generali D, Collovà E, Puglisi F, Cretella E, Zamagni C, Chini C, Ruepp B, Loi S, Colleoni M. Efficacy of Metronomic Oral Vinorelbine, Cyclophosphamide, and Capecitabine vs Weekly Intravenous Paclitaxel in Patients With Estrogen Receptor-Positive, ERBB2-Negative Metastatic Breast Cancer: Final Results From the Phase 2 METEORA-II Randomized Clinical Trial. JAMA Oncol 2023; 9:1267-1272. [PMID: 37440239 PMCID: PMC10346502 DOI: 10.1001/jamaoncol.2023.2150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/04/2023] [Indexed: 07/14/2023]
Abstract
Importance In spite of the effectiveness of endocrine therapy plus cyclin-dependent kinase (CDK) 4/6 inhibitors as the first-line treatment for estrogen receptor (ER)-positive, erb-b2 receptor tyrosine kinase 2 (ERBB2 [formerly HER2/neu])-negative (ER+/ERBB2-) metastatic breast cancer (MBC), patients eventually develop resistance, and eventually most will receive chemotherapy. The METEORA-II trial compared a metronomic all-oral treatment with intravenous (IV) chemotherapy. Objective To compare the efficacy of the oral vinorelbine plus cyclophosphamide plus capecitabine (VEX) regimen vs weekly IV paclitaxel among patients with ER+/ERBB2- MBC who are candidates for chemotherapy. Design, Setting, and Participants This phase 2 randomized clinical trial including 140 women 18 years and older (randomized 1:1) with ER+/ERBB2- MBC was carried out from September 13, 2017, to January 14, 2021 at 15 centers in Italy. Eligible patients could have received 1 prior line of chemotherapy for MBC and/or 2 lines of endocrine therapy (including CDK4/6 inhibitors). Interventions In 4-week cycles, patients received either metronomic oral VEX or weekly IV paclitaxel. Main Outcomes and Measures The primary end point was investigator-assessed time to treatment failure (TTF) defined as the interval between the date of randomization to the end of treatment (because of disease progression or lack of tolerability or because further trial treatment was declined). Secondary end points included progression-free survival (PFS), overall survival (OS), and disease control rate (complete or partial response or stable disease lasting for at least 24 weeks). Results In total, 133 patients received either VEX (n = 70) or paclitaxel (n = 63) in 4-weekly cycles. The median age was 61 (range, 30-80) years. The VEX treatment significantly prolonged TTF vs paclitaxel (hazard ratio [HR], 0.61; 95% CI, 0.42-0.88; P = .008), median TTF was 8.3 (95% CI, 5.6-11.1) months for VEX vs 5.7 (95% CI, 4.1-6.1) months for paclitaxel, and the 12-month TTF was 34.3% for VEX vs 8.6% for paclitaxel. The median PFS was 11.1 (95% CI, 8.3-13.8) months vs 6.9 (95% CI, 5.4-10.1) months favoring VEX (HR, 0.67; 95% CI, 0.46-0.96, P = .03). The 12-month PFS was 43.5% for VEX vs 21.9% for paclitaxel. No difference in OS was found. The TF event for 55.6% of patients was progression of disease; for 23% it was AEs. More patients assigned to VEX had at least 1 grade 3 or 4 targeted adverse event (VEX, 42.9%; 95% CI, 31.1%-55.3% vs paclitaxel, 28.6%; 95% CI, 17.9%-41.3%), but essentially no alopecia. Conclusion and Relevance This randomized clinical trial found significantly prolonged TTF and PFS for oral VEX but no improvement in OS compared with intravenous paclitaxel, despite increased but still manageable toxic effects. The VEX regimen may provide more prolonged disease control than weekly paclitaxel for ER+/ERBB2- MBC. Trial Registration ClinicalTrials.gov Identifier: NCT02954055.
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Affiliation(s)
- Elisabetta Munzone
- Division of Medical Senology, European Institute of Oncology (IEO), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Meredith M. Regan
- IBCSG Statistical Center, Division of Biostatistics, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Saverio Cinieri
- Department of Medical Oncology, Perrino Hospital, ASL Brindisi, Brindisi, Italy
| | - Emilia Montagna
- Division of Medical Senology, European Institute of Oncology (IEO), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Laura Orlando
- Department of Medical Oncology, Perrino Hospital, ASL Brindisi, Brindisi, Italy
| | - Ruichao Shi
- IBCSG Statistical Center, Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Lorenzo Gianni
- Department of Medical Oncology, Ospedale Infermi, AUSL Della Romagna, Rimini, Italy
| | - Michela Palleschi
- Department of Oncology, IRCCS, Istituto Romagnolo per lo Studio dei Tumori “Dino Amadori,” Meldola, Italy
| | - Fausto Petrelli
- Medical Oncology Unit, ASST Bergamo Ovest, Treviglio, Bergamo, Italy
| | - Carmelo Bengala
- Division of Medical Oncology, Department of Medical Oncology, Department of Oncology, Azienda USL Toscana, Misericordia Hospital, Grosseto, Italy
| | - Daniele Generali
- Women’s Cancer Center, Azienda Socio-Sanitaria Territoriale di Cremona and University of Trieste, Cremona, Italy
| | - Elena Collovà
- Medical Oncology Unit, ASST Ovest Milanese Legnano, Milan, Italy
| | - Fabio Puglisi
- Department of Medical Oncology, CRO di Aviano, National Cancer Institute, IRCCS, Aviano, Italy
- Department of Medicine, University of Udine, Udine, Italy
| | - Elisabetta Cretella
- Department of Medical Oncology, Azienda Sanitaria Dell’Alto Adige, Bolzano, Italy
| | - Claudio Zamagni
- IRCCS Azienda Ospedaliero-universitaria di Bologna, Bologna, Italy
| | - Claudio Chini
- Department of Medical Oncology, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | | | - Sherene Loi
- ETOP IBCSG Partners Foundation, Bern, Switzerland
- Peter MacCallum Cancer Centre, Division of Cancer Research, The Sir Peter MacCallum Department of Medical Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Marco Colleoni
- Division of Medical Senology, European Institute of Oncology (IEO), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
- ETOP IBCSG Partners Foundation, Bern, Switzerland
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6
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Pancrazzi A, Bloise F, Moncada A, Perticucci R, Vecchietti S, Pompili F, Ricciarini F, Lenzi S, Gatteschi C, Giusti S, Rosito MP, Del Buono S, Belardi P, Bruni A, Borri F, Campione A, Laurini L, Occhini R, Presenti L, Viticchi V, Rossi M, Bardi S, D'Urso A, Dei S, Venezia D, Scala R, Bengala C, Decarli NL, Carnevali A, Milandri C, Ognibene A. BL-MOL-AR Project, Preliminary Results about Liquid Biopsy: Molecular Approach Experience and Research Activity in Oncological Settings. Glob Med Genet 2023; 10:172-187. [PMID: 37457625 PMCID: PMC10348843 DOI: 10.1055/s-0043-1771193] [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] [Indexed: 07/18/2023] Open
Abstract
Background Liquid biopsy is mainly used to identify tumor cells in pulmonary neoplasms. It is more often used in research than in clinical practice. The BL-MOL-AR study aims to investigate the efficacy of next-generation sequencing (NGS) and clinical interpretation of the circulating free DNA (cfDNA) levels. This study reports the preliminary results from the first samples analyzed from patients affected by various neoplasms: lung, intestinal, mammary, gastric, biliary, and cutaneous. Methods The Biopsia Liquida-Molecolare-Arezzo study aims to enroll cancer patients affected by various malignancies, including pulmonary, intestinal, advanced urothelial, biliary, breast, cutaneous, and gastric malignancies. Thirty-nine patients were included in this preliminary report. At time zero, a liquid biopsy is executed, and two types of NGS panels are performed, comprising 17 genes in panel 1, which is already used in the routine tissue setting, and 52 genes in panel 2. From the 7th month after enrollment, 10 sequential liquid biopsies are performed up to the 17th month. The variant allele frequency (%) and cfDNA levels (ng/mL) are measured in every plasmatic sample. Results The NGS results obtained by different panels are similar even though the number of mutations is more concordant for lung pathologies. There are no significant differences in the actionability levels of the identified variants. Most of the molecular profiles of liquid biopsies reflect tissue data. Conclusions Preliminary data from this study confirm the need to clarify the limitations and potential of liquid biopsy beyond the lung setting. Overall, parameters related to cfDNA levels and variant allele frequency could provide important indications for prognosis and disease monitoring.
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Affiliation(s)
- Alessandro Pancrazzi
- Laboratory Medicine Department, Clinical and Molecular Pathology Sector, San Donato Hospital, Arezzo, Italy
| | - Francesco Bloise
- Oncology Department, Unit of Medical Oncology, San Donato Hospital, Arezzo, Italy
| | - Alice Moncada
- Laboratory Medicine Department, Clinical and Molecular Pathology Sector, San Donato Hospital, Arezzo, Italy
| | - Roberta Perticucci
- Laboratory Medicine Department, Clinical and Molecular Pathology Sector, San Donato Hospital, Arezzo, Italy
| | - Stefania Vecchietti
- Laboratory Medicine Department, Clinical and Molecular Pathology Sector, San Donato Hospital, Arezzo, Italy
| | - Francesca Pompili
- Laboratory Medicine Department, Clinical and Molecular Pathology Sector, San Donato Hospital, Arezzo, Italy
| | - Francesca Ricciarini
- Laboratory Medicine Department, Clinical and Molecular Pathology Sector, San Donato Hospital, Arezzo, Italy
| | - Silvia Lenzi
- Laboratory Medicine Department, Clinical and Molecular Pathology Sector, San Donato Hospital, Arezzo, Italy
| | - Cristina Gatteschi
- Laboratory Medicine Department, Clinical and Molecular Pathology Sector, San Donato Hospital, Arezzo, Italy
| | - Sabrina Giusti
- Oncology Department, Unit of Medical Oncology, San Donato Hospital, Arezzo, Italy
| | - Maria Pia Rosito
- Oncology Department, Unit of Medical Oncology, San Donato Hospital, Arezzo, Italy
| | - Sabrina Del Buono
- Oncology Department, Unit of Medical Oncology, San Donato Hospital, Arezzo, Italy
| | - Paola Belardi
- Oncology Department, Unit of Medical Oncology, San Donato Hospital, Arezzo, Italy
| | - Alessandra Bruni
- Oncology Department, Pathological Anatomy Laboratory, San Donato Hospital, Italy
| | - Filippo Borri
- Oncology Department, Pathological Anatomy Laboratory, San Donato Hospital, Italy
| | - Andrea Campione
- Oncology Department, Pathological Anatomy Laboratory, San Donato Hospital, Italy
| | - Lorella Laurini
- Oncology Department, Pathological Anatomy Laboratory, San Donato Hospital, Italy
| | - Rossella Occhini
- Oncology Department, Pathological Anatomy Laboratory, San Donato Hospital, Italy
| | - Loretta Presenti
- Oncology Department, Pathological Anatomy Laboratory, San Donato Hospital, Italy
| | - Viviana Viticchi
- Oncology Department, Pathological Anatomy Laboratory, San Donato Hospital, Italy
| | - Maja Rossi
- Laboratory Medicine Department, Clinical and Molecular Pathology Sector, Misericordia Hospital, Grosseto, Italy
| | - Sara Bardi
- Laboratory Medicine Department, Clinical and Molecular Pathology Sector, Misericordia Hospital, Grosseto, Italy
| | - Antonio D'Urso
- General Management, Local Health Unit South-East Tuscany, Tuscany, Italy
| | - Simona Dei
- General Management, Local Health Unit South-East Tuscany, Tuscany, Italy
| | - Duccio Venezia
- Diagnostic Imaging Department, Radiology Unit, San Donato Hospital, Arezzo, Italy
| | - Raffaele Scala
- Cardio Thoracic Neuro Vascular Department, Pneumology Unit, San Donato Hospital, Arezzo, Italy
| | - Carmelo Bengala
- Oncology Department, Unit of Medical Oncology, Misericordia Hospital, Grosseto, Italy
| | - Nicola Libertà Decarli
- Oncology Department, Pathological Anatomy Laboratory, Misericordia Hospital, Grosseto, Italy
| | - Andrea Carnevali
- Oncology Department, Pathological Anatomy Laboratory, San Donato Hospital, Italy
| | - Carlo Milandri
- Oncology Department, Unit of Medical Oncology, San Donato Hospital, Arezzo, Italy
| | - Agostino Ognibene
- Laboratory Medicine Department, Clinical and Molecular Pathology Sector, San Donato Hospital, Arezzo, Italy
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7
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Giuliani G, Guerra F, Messinese S, Santelli F, Salvischiani L, Esposito S, Ferraro L, Esposito A, De Pastena M, Rega D, Delrio P, La Raja C, Spinelli A, Massaron S, De Nardi P, Kauffmann EF, Boggi U, Deidda S, Restivo A, Marano A, Borghi F, Piccoli M, Depalma N, D'Ugo S, Spampinato M, Cozzani F, Del Rio P, Marcellinaro R, Carlini M, De Rosa R, Scabini S, Maiello F, Polastri R, Turri G, Pedrazzani C, Zese M, Parini D, Casaril A, Moretto G, De Leo A, Catarci M, Trapani R, Zonta S, Marsanic P, Muratore A, Di Franco G, Morelli L, Coppola A, Caputo D, Andreuccetti J, Pignata G, Mastrangelo L, Jovine E, Mazzola M, Ferrari G, Mariani L, Ceccarelli G, Giuseppe R, Bolzon S, Grasso M, Testa S, Germani P, de Manzini N, Langella S, Ferrero A, Coletta D, Bianchi PP, Bengala C, Coratti A. The COVID - AGICT study: COVID-19 and advanced gastro-intestinal cancer surgical treatment. A multicentric Italian study on the SARS-CoV-2 pandemic impact on gastro-intestinal cancers surgical treatment during the 2020. Analysis of perioperative and short-term oncological outcomes. Surg Oncol 2023; 47:101907. [PMID: 36924550 PMCID: PMC9892255 DOI: 10.1016/j.suronc.2023.101907] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 12/31/2022] [Accepted: 01/22/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND This Italian multicentric retrospective study aimed to investigate the possible changes in outcomes of patients undergoing surgery for gastrointestinal cancers during the COVID-19 pandemic. METHOD Our primary endpoint was to determine whether the pandemic scenario increased the rate of patients with colorectal, gastroesophageal, and pancreatic cancers resected at an advanced stage in 2020 compared to 2019. Considering different cancer staging systems, we divided tumors into early stages and advanced stages, using pathological outcomes. Furthermore, to assess the impact of the COVID-19 pandemic on surgical outcomes, perioperative data of both 2020 and 2019 were also examined. RESULTS Overall, a total of 8250 patients, 4370 (53%) and 3880 (47%) were surgically treated during 2019 and 2020 respectively, in 62 Italian surgical Units. In 2020, the rate of patients treated with an advanced pathological stage was not different compared to 2019 (P = 0.25). Nevertheless, the analysis of quarters revealed that in the second half of 2020 the rate of advanced cancer resected, tented to be higher compared with the same months of 2019 (P = 0.05). During the pandemic year 'Charlson Comorbidity Index score of cancer patients (5.38 ± 2.08 vs 5.28 ± 2.22, P = 0.036), neoadjuvant treatments (23.9% vs. 19.5%, P < 0.001), rate of urgent diagnosis (24.2% vs 20.3%, P < 0.001), colorectal cancer urgent resection (9.4% vs. 7.37, P < 0.001), and the rate of positive nodes on the total nodes resected per surgery increased significantly (7 vs 9% - 2.02 ± 4.21 vs 2.39 ± 5.23, P < 0.001). CONCLUSIONS Although the SARS-CoV-2 pandemic did not influence the pathological stage of colorectal, gastroesophageal, and pancreatic cancers at the time of surgery, our study revealed that the pandemic scenario negatively impacted on several perioperative and post-operative outcomes.
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Affiliation(s)
- Giuseppe Giuliani
- Department of General and Emergency Surgery, Misericordia Hospital, Azienda Usl Toscana Sud Est. School of Robotic Surgery, Grosseto, Italy
| | - Francesco Guerra
- Department of General and Emergency Surgery, Misericordia Hospital, Azienda Usl Toscana Sud Est. School of Robotic Surgery, Grosseto, Italy
| | | | - Francesco Santelli
- Department of Economics, Business, Mathematics and Statistics (DEAMS), University of Trieste, Trieste, Italy
| | - Lucia Salvischiani
- Department of General and Emergency Surgery, Misericordia Hospital, Azienda Usl Toscana Sud Est. School of Robotic Surgery, Grosseto, Italy
| | - Sofia Esposito
- Department of General, Emergency Surgery and New Technologies, Baggiovara General Hospital, AOU Modena, Italy
| | - Luca Ferraro
- Division of General and Robotic Surgery, Dipartimento di Scienze della Salute, Università di Milano, ASST Santi Paolo e Carlo, 20142 Milano, Italy
| | - Alessandro Esposito
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Matteo De Pastena
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Daniela Rega
- Colorectal Surgical Oncology, Abdominal Oncology Department, Fondazione Giovanni Pascale IRCCS, Naples, Italy
| | - Paolo Delrio
- Colorectal Surgical Oncology, Abdominal Oncology Department, Fondazione Giovanni Pascale IRCCS, Naples, Italy
| | - Carlotta La Raja
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072, Milan, Italy; IRCCS Humanitas Research Hospital, Division of Colon and Rectal Surgery, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Antonino Spinelli
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072, Milan, Italy; IRCCS Humanitas Research Hospital, Division of Colon and Rectal Surgery, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Simonetta Massaron
- Division of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy
| | - Paola De Nardi
- Division of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy
| | | | - Ugo Boggi
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Simona Deidda
- Department of Surgery, Colorectal Surgery Center, University of Cagliari, Cagliari, Italy
| | - Angelo Restivo
- Department of Surgery, Colorectal Surgery Center, University of Cagliari, Cagliari, Italy
| | - Alessandra Marano
- General and Specialist Surgery Department, Emergency General Surgery Unit, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Felice Borghi
- Oncological Surgery, Candiolo Cancer Institute-FPO-IRCCS, Candiolo, 10060, Torino, Italy
| | - Micaela Piccoli
- Department of General, Emergency Surgery and New Technologies, Baggiovara General Hospital, AOU Modena, Italy
| | - Norma Depalma
- Department of General Surgery, "Vito Fazzi" Hospital, Piazza Muratore, 1-73100, Lecce, Italy
| | - Stefano D'Ugo
- Department of General Surgery, "Vito Fazzi" Hospital, Piazza Muratore, 1-73100, Lecce, Italy
| | - Marcello Spampinato
- Department of General Surgery, "Vito Fazzi" Hospital, Piazza Muratore, 1-73100, Lecce, Italy
| | | | - Paolo Del Rio
- General Surgery Unit, Parma University Hospital, Parma, Italy
| | - Rosa Marcellinaro
- Department of General Surgery, S. Eugenio Hospital, Piazzale dell'Umanesimo, 10, 00144, Rome, Italy
| | - Massimo Carlini
- Department of General Surgery, S. Eugenio Hospital, Piazzale dell'Umanesimo, 10, 00144, Rome, Italy
| | - Raffaele De Rosa
- Surgical Oncology Surgery, IRCCS Policlinico San Martino, Genoa, Italy
| | - Stefano Scabini
- Surgical Oncology Surgery, IRCCS Policlinico San Martino, Genoa, Italy
| | - Fabio Maiello
- Department of Surgery - General Surgery Unit, Hospital of Biella, Biella, Italy
| | - Roberto Polastri
- Department of Surgery - General Surgery Unit, Hospital of Biella, Biella, Italy
| | - Giulia Turri
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Unit of General and Hepatobiliary Surgery, University and Hospital Trust of Verona, 37134, Verona, Italy
| | - Corrado Pedrazzani
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Unit of General and Hepatobiliary Surgery, University and Hospital Trust of Verona, 37134, Verona, Italy
| | - Monica Zese
- Department of General and Urgent Surgery, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Dario Parini
- Department of General and Urgent Surgery, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Andrea Casaril
- Department of Surgery, "Pederzoli" Hospital, Peschiera del Garda, Verona, Italy
| | - Gianluigi Moretto
- Department of Surgery, "Pederzoli" Hospital, Peschiera del Garda, Verona, Italy
| | - Antonio De Leo
- General Surgery Unit, Sandro Pertini Hospital, ASL Roma 2, Via dei Monti Tiburtini, 385, 00157, Rome, Italy
| | - Marco Catarci
- General Surgery Unit, Sandro Pertini Hospital, ASL Roma 2, Via dei Monti Tiburtini, 385, 00157, Rome, Italy
| | - Renza Trapani
- Department of General Surgery, Ospedale San Biagio, ASL VCO, Domodossola, Italy
| | - Sandro Zonta
- Department of General Surgery, Ospedale San Biagio, ASL VCO, Domodossola, Italy
| | | | - Andrea Muratore
- Surgical Department, E. Agnelli Hospital, 10064, Pinerolo, Italy
| | - Gregorio Di Franco
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56125, Pisa, Italy
| | - Luca Morelli
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56125, Pisa, Italy
| | | | - Damiano Caputo
- Research Unit of Generale Surgery, Department of Medicine and Surgery, University Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, 00128, Rome, Italy; Operative Research Unit of General Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Roma, Italy
| | | | - Giusto Pignata
- Second General Surgery, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Laura Mastrangelo
- Division of General and Emergency Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Elio Jovine
- Division of General and Emergency Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Michele Mazzola
- Division of Minimally-Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3 20162, Milan, Italy
| | - Giovanni Ferrari
- Division of Minimally-Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3 20162, Milan, Italy
| | - Lorenzo Mariani
- General Surgery, San Giovanni Battista Hospital, USL Umbria 2, Foligno, Italy
| | - Graziano Ceccarelli
- General Surgery, San Giovanni Battista Hospital, USL Umbria 2, Foligno, Italy
| | - Rocco Giuseppe
- Hepatobiliary, Pancreatic and General Surgery Unit, Department of Surgery, Azienda Unità Sanitaria Locale Area Vasta Romagna, Santa Maria delle Croci - Ravenna Hospital, Ravenna, Italy
| | - Stefano Bolzon
- Hepatobiliary, Pancreatic and General Surgery Unit, Department of Surgery, Azienda Unità Sanitaria Locale Area Vasta Romagna, Santa Maria delle Croci - Ravenna Hospital, Ravenna, Italy
| | | | - Silvio Testa
- S.C. Chirurgia Generale, Ospedale S.Andrea, Vercelli, Italy
| | - Paola Germani
- Surgical Clinic Unit, University Hospital of Trieste, Trieste, Italy
| | - Nicolò de Manzini
- Surgical Clinic Unit, University Hospital of Trieste, Trieste, Italy
| | - Serena Langella
- Department of General and Oncological Surgery, Mauriziano Hospital, Largo Turati 62, 10128, Turin, Italy
| | - Alessandro Ferrero
- Department of General and Oncological Surgery, Mauriziano Hospital, Largo Turati 62, 10128, Turin, Italy
| | - Diego Coletta
- Department of Surgical Sciences, Policlinico Umberto I University Hospital, Sapienza University of Rome, Rome, Italy
| | - Paolo Pietro Bianchi
- Division of General and Robotic Surgery, Dipartimento di Scienze della Salute, Università di Milano, ASST Santi Paolo e Carlo, 20142 Milano, Italy
| | - Carmelo Bengala
- Medical Oncology Unit, Misericordia Hospital, Grosseto, Italy
| | - Andrea Coratti
- Department of General and Emergency Surgery, Misericordia Hospital, Azienda Usl Toscana Sud Est. School of Robotic Surgery, Grosseto, Italy
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Munzone E, Regan M, Cinieri S, Montagna E, Orlando L, Shi R, Campadelli E, Gianni L, De Giorgi U, Bengala C, Generali D, Collova E, Puglisi F, Cretella E, Zamagni C, Chini C, Goldhirsch A, Colleoni M. 216MO A randomized phase II trial of metronomic oral vinorelbine plus cyclophosphamide and capecitabine (VEX) vs weekly paclitaxel (P) as first- or second-line treatment in patients (pts) with ER+/HER2- metastatic breast cancer (MBC): The METEORA-II trial (IBCSG 54-16). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Migliorino R, Landi L, Galetta D, Soregaroli D, Ricciardi S, Minuti G, Montrone M, Marech I, Morabito A, Berardi R, Novello S, Rocco D, Pilotto S, Zanelli F, Bengala C, Delmonte A, Aieta M, Cortinovis DL, Cappuzzo F. FoRT 05-BEAT: A phase II randomized trial comparing atezolizumab versus atezolizumab + bevacizumab as first-line treatment in patients with PD-L1 high advanced/metastatic NSCLC. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.tps9145] [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
TPS9145 Background: Several ongoing phase III studies are evaluating the efficacy of first-line atezolizumab in combination with chemotherapy in patients with non small-cell lung cancer (NSCLC). Among angiogenesis inhibitors, bevacizumab is approved as first-line therapy in combination with chemotherapy or in combination with erlotinib in patients with NSCLC harboring activating EGFR mutations. Recent evidence (Wallin 2016) suggests that the combination of atezolizumab and bevacizumab increases intra-tumoral CD8+T cells, suggesting that dual VEGF and PD-L1 inhibition improves antigen-specific T-cell migration. In addition, preliminary clinical data suggested a strong synergistic effects of bevacizumab with immune checkpoint inhibitors. There is therefore a strong rationale for investigating the combination of atezolizumab and bevacizumab in patients with advanced/metastatic NSCLC. The FoRT 05-BEAT is a multicenter, Italian, phase II, randomized study comparing atezolizumab monotherapy versus the combination of atezolizumab and bevacizumab in patients with chemo-naive metastatic NSCLC and high levels of PD-L1 expression. Methods: The trial was conducted in 35 Italian centers: chemotherapy naive metastatic NSCLC patients, with high levels of PD-L1 expression (PD-L1 TPS ≥50% or TC/IC 3 scoring) were randomly assigned to atezolizumab monotherapy (1200 mg every 3 weeks) or to the combination of atezolizumab (1200 mg every 3 weeks) and bevacizumab (15 mg/kg every 3 weeks).The primary endpoint is overall survival (OS) rate at 18 months. Secondary endpoints include response rate (RR), PFS, OS according to presence of bone and/or hepatic metastases. Safety considerations will be considered. Exploratory analysis of predictive biomarker on tumor tissue and blood samples has been planned. Sample size has been calculated assuming a 18 months OS of 50% in the atezolizumab arm. Therefore, a total of 186 patients is needed to detect an absolute improvement of 20%, thus obtaining a 18mOS of 70% in the combination arm, with a power of 80% at a significance level of 5%. Taking into account the percentage of patients lost-to-follow-up, the sample size has been increased by 10% (N = 206 patients, 103 per arm). At the drafting of this abstract, 57 patients have already been enrolled (47 randomized). Clinical trial information: NCT03896074.
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Affiliation(s)
- Rita Migliorino
- Pulmonary Oncology Unit, San Camillo-Forlanini Hospital, Rome, Italy
| | | | - Domenico Galetta
- Medical Oncology Department, Clinical Cancer Center Giovanni Paolo II, Bari, Italy
| | | | | | - Gabriele Minuti
- UOC Oncologia Medica 2 Istituto Nazionale Tumori "Regina Elena", Roma, Italy
| | | | - Ilaria Marech
- Istituto Tumori “Giovanni Paolo II” IRCCS, National Cancer Research Center Onc, Bari, Italy
| | | | - Rossana Berardi
- Clinical Oncology, Polytechnic University of Marche, AOU Ospedali Riuniti, Ancona, Italy
| | - Silvia Novello
- University of Turin, Department of Oncology, S. Luigi Hospital, Torino, Italy
| | - Danilo Rocco
- Pneumology and Oncology Department, AORN dei Colli, Naples, Italy
| | - Sara Pilotto
- U.O.C. Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | | | - Angelo Delmonte
- Istituto Romagnolo per lo Studio dei Tumori Dino Amadori-RCCS, Meldola, Italy
| | - Michele Aieta
- IRCCS Centro di Riferimento Oncologico della Basilicata, Rionero in Vulture (Potenza), Italy
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Canale ML, Camerini A, Orso F, Misuraca L, Carluccio M, Talini E, Sorini Dini C, Grippo G, Simonetti F, Amoroso D, Allegrini G, Bengala C, Casolo G. [A clinical cardio-oncology pathway for the cardiology management of cancer outpatients: a joint proposal by ANMCO and AIOM Tuscany]. G Ital Cardiol (Rome) 2022; 23:437-443. [PMID: 35674034 DOI: 10.1714/3810.37940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Cardio-oncology is now part of the standard clinical approach for patients with cancer and cannot be overlooked anymore. While its scientific background is solid and its clinical relevance is well known, its application in daily practice varies greatly among hospitals. To provide the best cardio-oncology care to cancer patients and to make cardio-oncology's clinical use uniform, we developed a shared multidisciplinary proposal for a dedicated clinical pathway. Our proposition presents the minimum requirements needed to which this path caters for, identifies patient categories to be entered into the path, highlights the role of a specific inter-hospital clinical and imaging network and indicates follow-up strategies during and after oncological treatments. The proposed pathway is based on some key elements and is easily adaptable to different hospitals with minimal changes.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Federico Simonetti
- Ematologia, Ospedale Versilia, Azienda USL Toscana Nord Ovest, Lido di Camaiore (LU)
| | - Domenico Amoroso
- Oncologia Medica, Ospedale Versilia, Azienda USL Toscana Nord Ovest, Lido di Camaiore (LU)
| | - Giacomo Allegrini
- Oncologia Medica, Ospedale di Livorno, Azienda USL Toscana Nord Ovest, Livorno
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Francini E, Montagnani F, Nuzzo PV, Gonzalez-Velez M, Alimohamed NS, Rosellini P, Moreno-Candilejo I, Cigliola A, Rubio-Perez J, Crivelli F, Shaw GK, Zhang L, Petrioli R, Bengala C, Francini G, Garcia-Foncillas J, Sweeney CJ, Higano CS, Bryce AH, Harshman LC, Lee-Ying R, Heng DYC. Association of Concomitant Bone Resorption Inhibitors With Overall Survival Among Patients With Metastatic Castration-Resistant Prostate Cancer and Bone Metastases Receiving Abiraterone Acetate With Prednisone as First-Line Therapy. JAMA Netw Open 2021; 4:e2116536. [PMID: 34292336 PMCID: PMC8299314 DOI: 10.1001/jamanetworkopen.2021.16536] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
IMPORTANCE Bone resorption inhibitors (BRIs) are recommended by international guidelines to prevent skeletal-related events (SREs) among patients with metastatic castration-resistant prostate cancer (mCRPC) and bone metastases. Abiraterone acetate with prednisone is currently the most common first-line therapy for the treatment of patients with mCRPC; however, the clinical impact of the addition of BRIs to abiraterone acetate with prednisone in this disease setting is unknown. OBJECTIVE To evaluate the association of the use of concomitant BRIs with overall survival (OS) and time to first SRE among patients with mCRPC and bone metastases receiving abiraterone acetate with prednisone as first-line therapy. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study collected data from 745 consecutive patients who began receiving abiraterone acetate with prednisone as first-line therapy for mCRPC with bone metastases between January 1, 2013, and December 31, 2016. Data were collected from 8 hospitals in Canada, Europe, and the US from June 15 to September 15, 2019. EXPOSURES Patients were classified by receipt vs nonreceipt of concomitant BRIs and subclassified by volume of disease (high volume or low volume, using definitions from the Chemohormonal Therapy Vs Androgen Ablation Randomized Trial for Extensive Disease in Prostate Cancer [CHAARTED] E3805 study) at the initiation of abiraterone acetate with prednisone therapy. MAIN OUTCOMES AND MEASURES The primary end point was OS. The secondary end point was time to first SRE. The Kaplan-Meier method and Cox proportional hazards models were used. RESULTS Of the 745 men (median age, 77.6 years [interquartile range, 68.1-83.6 years]; 699 White individuals [93.8%]) included in the analysis, 529 men (71.0%) received abiraterone acetate with prednisone alone (abiraterone acetate cohort), and 216 men (29.0%) received abiraterone acetate with prednisone plus BRIs (BRI cohort). A total of 420 men (56.4%) had high-volume disease, and 276 men (37.0%) had low-volume disease. The median follow-up was 23.5 months (95% CI, 19.8-24.9 months). Patients in the BRI cohort experienced significantly longer OS compared with those in the abiraterone acetate cohort (31.8 vs 23.0 months; hazard ratio [HR], 0.65; 95% CI, 0.54-0.79; P < .001). The OS benefit in the BRI cohort was greater for patients with high-volume vs low-volume disease (33.6 vs 19.7 months; HR, 0.51; 95% CI, 0.38-0.68; P < .001). The BRI cohort also had a significantly shorter time to first SRE compared with the abiraterone acetate cohort (32.4 vs 42.7 months; HR, 1.27; 95% CI, 1.00-1.60; P = .04), and the risk of a first SRE was more than double in the subgroup with low-volume disease (HR, 2.29; 95% CI, 1.57-3.35; P < .001). In the multivariable analysis, concomitant BRIs use was independently associated with longer OS (HR, 0.64; 95% CI, 0.52-0.79; P < .001). CONCLUSIONS AND RELEVANCE In this study, the addition of BRIs to abiraterone acetate with prednisone as first-line therapy for the treatment of patients with mCRPC and bone metastases was associated with longer OS, particularly in patients with high-volume disease. These results suggest that the use of BRIs in combination with abiraterone acetate with prednisone as first-line therapy for the treatment of mCRPC with bone metastases could be beneficial.
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Affiliation(s)
- Edoardo Francini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Pier Vitale Nuzzo
- Lank Center for Genitourinary Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | | | | | - Pietro Rosellini
- Department of Medical and Surgical Sciences and Neuroscience, University of Siena, Siena, Italy
| | | | - Antonio Cigliola
- Department of Medical and Surgical Sciences and Neuroscience, University of Siena, Siena, Italy
| | - Jaime Rubio-Perez
- University Hospital Fundacion Jimenez Diaz, Autonomous University of Madrid, Madrid, Spain
| | | | - Grace K. Shaw
- Lank Center for Genitourinary Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Li Zhang
- DFCI at Geisinger Medical Center, Danville, Pennsylvania
| | - Roberto Petrioli
- Department of Medical and Surgical Sciences and Neuroscience, University of Siena, Siena, Italy
| | - Carmelo Bengala
- Medical Oncology Unit, Misericordia Hospital, Grosseto, Italy
| | - Guido Francini
- Department of Medical and Surgical Sciences and Neuroscience, University of Siena, Siena, Italy
| | - Jesus Garcia-Foncillas
- University Hospital Fundacion Jimenez Diaz, Autonomous University of Madrid, Madrid, Spain
| | - Christopher J. Sweeney
- Lank Center for Genitourinary Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Celestia S. Higano
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle
| | - Alan H. Bryce
- Genomic Oncology Clinic, Mayo Clinic, Phoenix, Arizona
| | - Lauren C. Harshman
- Lank Center for Genitourinary Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Richard Lee-Ying
- Division of Medical Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Daniel Y. C. Heng
- Division of Medical Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
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Guarneri V, Cinieri S, Dieci MV, Bengala C, Mariani G, Bisagni G, Frassoldati A, Zamagni C, Orlando L, Giorgi CA, De Salvo GL, Conte P. Abstract PS12-22: Maintenance therapy with everolimus plus aromatase inhibitors vs aromatase inhibitors as after first-line chemotherapy in HR+/HER2- metastatic breast cancer: Updated analyses of the phase III randomized MAIN-A trial. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps12-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background Despite endocrine therapy is the mainstay of treatment for HR+/HER2- metastatic breast cancer (MBC), patients with high disease burden or those at risk of visceral crisis are still offered first-line chemotherapy (CT). Chemotherapy is generally followed by maintenance hormonal therapy. The MAIN-A study is an investigator-driven, randomized phase III trial designed to compare maintenance everolimus (EVE) combined with aromatase inhibitors (AI) versus AI alone in pts with disease control after first-line CT.Methods Postmenopausal pts achieving disease control (stable disease, partial response or complete response) after first-line CT were randomly assigned to EVE 10 mg po daily plus AI or to AI alone. Primary aim was PFS in the ITT. We present here overall survival (OS) results and the impact of tumor characteristics on PFS.Results 110 pts were randomized to EVE+AI (n=52) or to AI (n= 58). Primary aim results have been already presented (Guarneri V, ESMO Breast 2019), showing a non-significant prolongation of median PFS in the ITT population for EVE+AI (9.9 mos vs 7.2 mos, HR 0.764, 95% CI 0.501-1.164. Patients with visceral metastases tended to experience shorter PFS as compared with patients with patients with bone/soft tissues metastases (median 11.1 mos vs 6.4 mos, p=0.0746). The levels of estrogen receptor expression (>or< 50%) did not impact PFS, overall and by treatment arm. At the time of this writing, a total of 61 death events have been recorded. No difference in OS was observed between the two arms (median 33.9 mos for EVE+AI vs 33.5 mos for AI, HR 0.97, 95% CI 0.59-1.61).Conclusions Maintenance EVE+AI did not significantly impact on the outcome of metastatic breast cancer patients deemed suitable for first line chemotherapy.
Citation Format: Valentina Guarneri, Saverio Cinieri, Maria Vittoria Dieci, Carmelo Bengala, Gabriella Mariani, Giancarlo Bisagni, Antonio Frassoldati, Claudio Zamagni, Laura Orlando, Carlo Alberto Giorgi, Gian Luca De Salvo, PierFranco Conte. Maintenance therapy with everolimus plus aromatase inhibitors vs aromatase inhibitors as after first-line chemotherapy in HR+/HER2- metastatic breast cancer: Updated analyses of the phase III randomized MAIN-A trial [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS12-22.
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Affiliation(s)
| | - Saverio Cinieri
- 2Medical Oncology, Antonio Perrino Hospital, Brindisi, Italy
| | | | - Carmelo Bengala
- 3Medical Oncology, Ospedale Misericordia, Azienda Toscana Sud-Est, Grosseto, Italy
| | - Gabriella Mariani
- 4Oncologia Medica 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Giancarlo Bisagni
- 5Department of Oncology and Advanced Technologies, Oncology Unit, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Antonio Frassoldati
- 6Clinical Oncology, Department of Morphology, Surgery and Experimental Medicine, S Anna University Hospital, Ferrara, Italy
| | - Claudio Zamagni
- 7Medical Oncology Unit, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Laura Orlando
- 2Medical Oncology, Antonio Perrino Hospital, Brindisi, Italy
| | | | | | - PierFranco Conte
- 1University of Padova, Istituto Oncologico Veneto IRCCS, Padova, Italy
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Cremolini C, Antoniotti C, Rossini D, Lonardi S, Loupakis F, Pietrantonio F, Bordonaro R, Latiano TP, Tamburini E, Santini D, Passardi A, Marmorino F, Grande R, Aprile G, Zaniboni A, Murgioni S, Granetto C, Buonadonna A, Moretto R, Corallo S, Cordio S, Antonuzzo L, Tomasello G, Masi G, Ronzoni M, Di Donato S, Carlomagno C, Clavarezza M, Ritorto G, Mambrini A, Roselli M, Cupini S, Mammoliti S, Fenocchio E, Corgna E, Zagonel V, Fontanini G, Ugolini C, Boni L, Falcone A, Falcone A, Lonardi S, De Braud FGM, Bordonaro R, Maiello E, Tamburini E, Santini D, Frassineti GL, Gamucci T, Aprile G, Zaniboni A, Granetto C, Buonadonna A, Di Costanzo F, Tomasello G, Gianni L, Di Donato S, Carlomagno C, Clavarezza M, Racca P, Mambrini A, Roselli M, Allegrini G, Sobrero A, Aglietta M, Corgna E, Cortesi E, Corsi DC, Ballestrero A, Bonetti A, Di Clemente F, Ruggeri E, Ciardiello F, Benasso M, Vitello S, Cinieri S, Mosconi S, Silvestris N, Frassoldati A, Cupini S, Bertolini A, Tortora G, Bengala C, Ferrari D, Ardizzoia A, Milandri C, Chiara S, Romano G, Miraglia S, Scaltriti L, Pucci F, Blasi L, Brugnatelli S, Fioretto L, Ribecco AS, Longarini R, Frisinghelli M, Banzi M. Upfront FOLFOXIRI plus bevacizumab and reintroduction after progression versus mFOLFOX6 plus bevacizumab followed by FOLFIRI plus bevacizumab in the treatment of patients with metastatic colorectal cancer (TRIBE2): a multicentre, open-label, phase 3, randomised, controlled trial. Lancet Oncol 2020; 21:497-507. [DOI: 10.1016/s1470-2045(19)30862-9] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/18/2019] [Accepted: 12/19/2019] [Indexed: 01/07/2023]
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14
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Francini E, Montagnani F, Nuzzo PV, Gonzalez-Velez M, Alimohamed NS, Cigliola A, Moreno I, Rubio J, Crivelli F, Shaw G, Petrioli R, Bengala C, Francini G, Foncillas JG, Sweeney C, Higano CS, Bryce AH, Harshman LC, Lee-Ying R, Heng DYC. Clinical outcomes of abiraterone acetate + prednisone (AA) + bone resorption inhibitors (BRI) versus AA alone as first-line therapy for castration-resistant prostate cancer (CRPC) with bone metastases (BM) in an international multicenter database. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.30] [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
30 Background: BM in patients (pts) with CRPC are associated with shorter overall survival (OS) and higher costs. BRI zoledronic acid and denosumab are frequently used to prevent skeletal-related events (SRE) in pts with CRPC and BM. AA is the most common 1st line therapy for men with metastatic CRPC. We aimed to assess the impact of BRI on OS and time to first SRE (ttSRE) of pts receiving 1st line treatment AA for CRPC with BM. Methods: A retrospective cohort of pts starting AA as 1st line therapy for CRPC with BM between 2013-2016 was identified through 8 hospitals’ IRB approved registries. Pts were classified by use of concomitant BRI and subgrouped by volume of disease (per E3805 definition) at AA start. Kaplan-Meier method and Cox models were used to assess OS and ttSRE with hazard ratio (HR) estimates (95% CI). Results: Of the 745 pts included (543 deaths), 529 (71.0%) had AA alone and 216 (29.0%) AA+BRI. Median follow-up was 23.5 months. Pts receiving concomitant BRI showed a significantly longer OS and a 35% reduced risk of death compared to AA alone (HR=0.65; 95% CI, 0.54-0.79; P<.0001). The OS benefit with BRI was greater for the subgroup with high volume disease (HV) (HR=0.51; 95% CI, 0.38-0.68; P<.0001). The cohort with AA+BRI had a significantly shorter ttSRE (HR=1.27; 95% CI; 1.0-1.60; P=.0439) and, notably, the risk of first SRE was more than doubled for the subgroup with LV (HR=2.29; 95% CI, 1.57-3.35; P<.0001). On MVA, BRI vs. no BRI, prior local therapy (PLT) vs. no PLT, LV vs. HV, baseline VAS pain ≤3 vs. >5, PS 0 vs. ≥1, and PSA are independently associated with longer OS. Conclusions: The addition of BRI to 1st line AA for CRPC men with BM was associated with improved OS, particularly in HV, and worsened ttSRE, more evident in LV. These data suggest a potentially different impact of concomitant BRI on HV vs. LV, which could affect clinical decision making.[Table: see text]
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Affiliation(s)
| | | | | | | | | | - Antonio Cigliola
- Medical Oncology Unit, Santa Maria alle Scotte Hospital, Siena, Italy
| | - Irene Moreno
- Oncology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Jaime Rubio
- Fundacion Jimenez Diaz University Hospital, Madrid, Spain
| | | | - Grace Shaw
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Roberto Petrioli
- Medical Oncology, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | | | - Guido Francini
- Medical Oncology, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | | | - Christopher Sweeney
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
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Palmieri M, Baldassarri M, Fava F, Fabbiani A, Gelli E, Tita R, Torre P, Petrioli R, Hadijstilianou T, Galimberti D, Cinotti E, Bengala C, Mandalà M, Piu P, Miano ST, Martellucci I, Vannini A, Pinto AM, Mencarelli MA, Marsili S, Renieri A, Frullanti E. Two-point-NGS analysis of cancer genes in cell-free DNA of metastatic cancer patients. Cancer Med 2020; 9:2052-2061. [PMID: 31991072 PMCID: PMC7064095 DOI: 10.1002/cam4.2782] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/18/2019] [Accepted: 12/02/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although the efficacy of molecularly target agents in vitro, their use in routine setting is limited mainly to the use of anti-HER2 and antiEGFR agents in vivo. Moreover, core biopsy of a single cancer site may not be representative of the whole expanding clones and cancer molecular profile at relapse may differ with respect to the primary tumor. METHODS We assessed the status of a large panel of cancer driver genes by cell-free DNA (cfDNA) analysis in a cohort of 68 patients with 13 different solid tumors at disease progression. Whenever possible, a second cfDNA analysis was performed after a mean of 2.5 months, in order to confirm the identified clone(s) and to check the correlation with clinical evolution. RESULTS The approach was able to identify clones plausibly involved in the disease progression mechanism in about 65% of cases. A mean of 1.4 mutated genes (range 1-3) for each tumor was found. Point mutations in TP53, PIK3CA, and KRAS and copy number variations in FGFR3 were the gene alterations more commonly observed, with a rate of 48%, 20%, 16%, and 20%, respectively. Two-points-Next-Generation Sequencing (NGS) analysis demonstrated statistically significant correlation between allele frequency variation and clinical outcome (P = .026). CONCLUSIONS Irrespective of the primary tumor mutational burden, few mutated genes are present at disease progression. Clinical outcome is consistent with variation of allele frequency of specific clones indicating that cfDNA two-point-NGS analysis of cancer driver genes could be an efficacy tool for precision oncology.
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Affiliation(s)
| | | | - Francesca Fava
- Medical Genetics, University of Siena, Siena, Italy.,Genetica Medica, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Alessandra Fabbiani
- Medical Genetics, University of Siena, Siena, Italy.,Genetica Medica, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Elisa Gelli
- Medical Genetics, University of Siena, Siena, Italy
| | - Rossella Tita
- Genetica Medica, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Pamela Torre
- Oncology, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Roberto Petrioli
- Oncology, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Theodora Hadijstilianou
- Department of Ophthalmology, Referral Center for Retinoblastoma, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Daniela Galimberti
- Department of Ophthalmology, Referral Center for Retinoblastoma, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Elisa Cinotti
- Department of Medical, Surgical and Neurosciences, Dermatology Unit, University of Siena, Siena, Italy
| | - Carmelo Bengala
- Medical Oncology, Ospedale Misericordia, Azienda Toscana Sud-Est, Grosseto, Italy
| | - Marco Mandalà
- Department of Otology and Skull Base Surgery, University of Siena, Siena, Italy
| | - Pietro Piu
- VisMederi s.r.l, Strada del Petriccio e Belriguardo, Siena, Italy
| | | | | | - Agnese Vannini
- Oncology, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Anna Maria Pinto
- Genetica Medica, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | | | - Stefania Marsili
- Oncology, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Alessandra Renieri
- Medical Genetics, University of Siena, Siena, Italy.,Genetica Medica, Azienda Ospedaliera Universitaria Senese, Siena, Italy
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16
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Yardley DA, Coleman R, Conte P, Cortes J, Brufsky A, Shtivelband M, Young R, Bengala C, Ali H, Eakel J, Schneeweiss A, de la Cruz-Merino L, Wilks S, O'Shaughnessy J, Glück S, Li H, Miller J, Barton D, Harbeck N. nab-Paclitaxel plus carboplatin or gemcitabine versus gemcitabine plus carboplatin as first-line treatment of patients with triple-negative metastatic breast cancer: results from the tnAcity trial. Ann Oncol 2019; 29:1763-1770. [PMID: 29878040 PMCID: PMC6096741 DOI: 10.1093/annonc/mdy201] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [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] [Indexed: 12/16/2022] Open
Abstract
Background Metastatic triple-negative breast cancer (mTNBC) has a poor prognosis and aggressive clinical course. tnAcity evaluated the efficacy and safety of first-line nab-paclitaxel plus carboplatin (nab-P/C), nab-paclitaxel plus gemcitabine (nab-P/G), and gemcitabine plus carboplatin (G/C) in patients with mTNBC. Patients and methods Patients with pathologically confirmed mTNBC and no prior chemotherapy for metastatic BC received (1 : 1 : 1) nab-P 125 mg/m2 plus C AUC 2, nab-P 125 mg/m2 plus G 1000 mg/m2, or G 1000 mg/m2 plus C AUC 2, all on days 1, 8 q3w. Phase II primary end point: investigator-assessed progression-free survival (PFS); secondary end points included overall response rate (ORR), overall survival (OS), percentage of patients initiating cycle 6 with doublet therapy, and safety. Results In total, 191 patients were enrolled (nab-P/C, n = 64; nab-P/G, n = 61; G/C, n = 66). PFS was significantly longer with nab-P/C versus nab-P/G [median, 8.3 versus 5.5 months; hazard ratio (HR), 0.59 [95% CI, 0.38-0.92]; P = 0.02] or G/C (median, 8.3 versus 6.0 months; HR, 0.58 [95% CI, 0.37-0.90]; P = 0.02). OS was numerically longer with nab-P/C versus nab-P/G (median, 16.8 versus 12.1 months; HR, 0.73 [95% CI, 0.47-1.13]; P = 0.16) or G/C (median, 16.8 versus 12.6 months; HR, 0.80 [95% CI, 0.52-1.22]; P = 0.29). ORR was 73%, 39%, and 44%, respectively. In the nab-P/C, nab-P/G, and G/C groups, 64%, 56%, and 50% of patients initiated cycle 6 with a doublet. Grade ≥3 adverse events were mainly hematologic. Conclusions First-line nab-P/C was active in mTNBC and resulted in a significantly longer PFS and improved risk/benefit profile versus nab-P/G or G/C.
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Affiliation(s)
- D A Yardley
- Sarah Cannon Research Institute and Tennessee Oncology PLLC, Medical Oncology, Nashville, USA.
| | - R Coleman
- Department of Oncology and Metabolism, Weston Park Hospital, University of Sheffield, Sheffield, UK
| | - P Conte
- Department of Surgery, Oncology and Gastroenterology, University of Padova and Medical Oncology 2, Istituto Oncologico Veneto, Padova, Italy
| | - J Cortes
- Medical Oncology, Ramon y Cajal University Hospital, Madrid; Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - A Brufsky
- Hematology/Oncology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - M Shtivelband
- Medical Oncology, Ironwood Physicians, PC, Chandler, USA
| | - R Young
- Medical Oncology, The Center for Cancer and Blood Disorders, Fort Worth, USA
| | - C Bengala
- Medical Oncology, Misericordia General Hospital, Grosseto, Italy
| | - H Ali
- Medical Oncology, Henry Ford Health System, Detroit, USA
| | - J Eakel
- Hematology and Oncology, Florida Cancer Specialists, Sarasota, USA
| | - A Schneeweiss
- Gynecology and Medical Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - S Wilks
- Hematology and Medical Oncology, Texas Oncology, San Antonio, USA
| | - J O'Shaughnessy
- Hematology, Medical Oncology, Baylor Sammons Cancer Center, Texas Oncology, US Oncology, Dallas, USA
| | - S Glück
- GMA Early Assets, Celgene Corporation, Summit, USA
| | - H Li
- Department of Biostatistics, Celgene Corporation, Summit, USA
| | - J Miller
- Clinical Research and Development, Hematology/Oncology, Celgene Corporation, Summit, USA
| | - D Barton
- Clinical Research and Development, Hematology/Oncology, Celgene Corporation, Summit, USA
| | - N Harbeck
- Breast Cancer Center, University of Munich, Munich, Germany
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Procopio G, Di Cosimo S, De Giorgi U, Cartenì G, Cortesi E, Caserta C, Sabbatini R, Bearz A, Buti S, Pignata S, Berruti A, Ruggeri E, Bengala C, Livi L, Fagnani D, Bonetti A, Mitterer M, Ortega C, Cognetti F, Di Nicola MA. Effect of gender on the outcome of patients receiving nivolumab for metastatic renal cancer: Results from a large study population. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e16087] [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
e16087 Background: Several studies, the majority on melanoma and lung cancer, have addressed the value of gender with respect to immune check point inhibitors outcome as compared to standard therapy, showing conflicting results. Nevertheless, few focused on gender-related clinical outcome and toxicity in renal cell carcinoma (RCC) patients. Methods: This analysis evaluated the effect of gender on overall survival and adverse events (AEs) using Common Terminology Criteria for Adverse Events (CTCAE) v.4.0 in an expanded access programme of nivolumab 3 mg/kg once every 2 weeks in second-line and beyond metastatic RCC. Only patients assuming at least one dose of nivolumab were analyzed. Results: Of 389 patients analyzed, 25.2% were female. On study entry, no differences were found in women as compared to men in terms of age, on average 64 years, p = 0.91; overweight/obesity, 45 versus (vs) 49%, p = 0.47; LDH , mean U/L 391 vs 32, p = 0.17); and neutrophils/lymphocytes ratio> 3 (62 vs 63%, p = 0.87). Disease presentation was similar according to gender, although women tended to present less lung (66% vs 76%, p = 0.06) and bone metastases (42% vs 52%, p = 0.07). Notably, there was no differences in the IDMC prognostic model by gender (p = 0.94). Any drug related AEs (38 vs 30%, p 0.15), grade 3-4 (6% vs 6%) and median number of drug doses 12 (53% vs50%, p = 0.58 ) did not differ between gender. After adjusting for known prognostic variables, multivariate analysis showed that women had similar overall survival as compared to men (hazard ratio 0.81, 95% confidence interval 0.56-1.17, p = 0.26). Conclusions: Women demonstrate similar overall survival than men in metastatic RCC treated with secondal line and beyond nivolumab, with no differences observed in serious AEs and dose administered.
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Affiliation(s)
- Giuseppe Procopio
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Serena Di Cosimo
- Division of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Ugo De Giorgi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | | | | | | | | | | | - Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Sandro Pignata
- Uro-Gynecological Department, Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione “G. Pascale”, Naples, Italy
| | - Alfredo Berruti
- Medical Oncology, University of Brescia, Spedali Civili Hospital, Brescia, Italy
| | | | | | | | | | - Andrea Bonetti
- Department of Medical Oncology Mater Salutis Hospital, Legnago, Italy
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Francini E, Montagnani F, Pier Vitale N, Alimohamed NS, Moreno Candilejo I, Rosellini P, Gonzalez-Velez M, Rubio J, Zhang L, Shaw G, Crivelli F, Petrioli R, Bengala C, Francini G, Foncillas JG, Bryce AH, Sweeney C, Harshman LC, Lee-Ying R, Heng DYC. Efficacy of bone resorption inhibitors (BRI) + abiraterone acetate + prednisone (AA) vs. AA alone as first-line therapy for men with castration-resistant prostate cancer (CRPC) and bone metastases (BM) in an international multicenter hospital-based registry. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e16508] [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
e16508 Background: BM in patients (pts) with CRPC correlate with higher mortality and costs. BRI zoledronic acid and denosumab are frequently used for the prevention of skeletal-related events (SRE) in pts with CRPC and BM. AA is the most common 1st line treatment for men with metastatic CRPC. We sought to evaluate the impact of BRI on time to first SRE (ttSRE) and OS of pts receiving 1st line therapy AA for CRPC with BM. Methods: We identified a cohort of men starting AA as 1st line therapy for CRPC with BM between 2013-2015 from 7 hospitals’ IRB approved registries. Pts were grouped by use of concomitant BRI and subgrouped by volume of disease (per E3805 definition) at AA start. The endpoints were OS, defined as time from AA start to death or last follow-up visit, and ttSRE. Results: Of the 338 pts included, 256 (76%) received AA alone and 82 (24%) AA+BRI. ECOG PS (PS) was ≥1 for 178 pts (52.7%). No statistically significant difference in ttSRE was found between the 2 cohorts [see Table]. Median follow-up for OS was 25.6 months. Pts receiving concomitant BRI showed a significantly longer OS and a 36% decreased risk of death compared to AA alone (HR = 0.64; 95% CI, 0.64 0.46-0.91; p = 0.012). Notably, OS in the AA alone group was shorter than commonly described. The OS benefit with BRI was greater for men with high volume disease (HV) (HR = 0.42; 95% CI, 0.25-0.71; p = 0.001). On MVA, BRI vs. no BRI, low volume of disease vs. HV, PS 0 vs. ≥1, baseline VAS pain ≤3 vs. > 5, and baseline PSA are independently associated with longer OS. Conclusions: Using a multicenter database, the addition of BRI to 1st line AA for CRPC men with BM and poor prognostic factors did not improve prevention of SRE. However, concomitant use of BRI and AA was associated with a significantly improved OS, particularly in HV. Further research to determine the driving factors is needed. [Table: see text]
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Affiliation(s)
| | | | | | | | | | - Pietro Rosellini
- Santa Maria Alle Scotte Hospital of University of Siena, Siena, Italy
| | | | - Jaime Rubio
- Fundacion Jimenez Diaz University Hospital, Madrid, Spain
| | - Li Zhang
- Geisinger Medical Center, Danville, PA
| | - Grace Shaw
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | | - Roberto Petrioli
- Santa Maria Alle Scotte Hospital of University of Siena, Siena, Italy
| | | | - Guido Francini
- Medical Oncology, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | | | | | - Christopher Sweeney
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
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Guarneri V, Cinieri S, Orlando L, Bengala C, Mariani G, Bisagni G, Frassoldati A, Zamagni C, De Salvo G, Conte P. Everolimus plus aromatase inhibitors vs aromatase inhibitors as maintenance therapy after first-line chemotherapy in HR+/HER2- metastatic breast cancer: Final results of the phase III randomized MAIN-A trial. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz118.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Zambetti M, Montemurro F, Morandi P, Zamagni C, Brandes AA, Bisagni G, Cagossi K, Bengala C, Gori S, Iannacone C, Stell A, Gianni L. Safety profile of subcutaneous trastuzumab for the treatment of patients with HER2-positive early or locally advanced breast cancer: primary analysis of the SCHEARLY study. Eur J Cancer 2018; 105:61-70. [DOI: 10.1016/j.ejca.2018.09.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 09/25/2018] [Accepted: 09/25/2018] [Indexed: 10/27/2022]
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Garassino MC, Crinò L, Catino A, Ardizzoni A, Cortesi E, Cappuzzo F, Bordi P, Calabrò L, Barbieri F, Santo A, Altavilla G, Ambrosio F, Mini E, Vasile E, Morgillo F, Scoppola A, Bengala C, Follador A, Tedde N, Giannarelli D, Lo Russo G, Vitiello F. Nivolumab in never-smokers with advanced squamous non-small cell lung cancer: Results from the Italian cohort of an expanded access program. Tumour Biol 2018; 40:1010428318815047. [DOI: 10.1177/1010428318815047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives: Never-smokers may be a distinct subgroup among patients with advanced non-small cell lung cancer, appearing to benefit less from immunotherapy than smokers. We report results from never-smokers enrolled in the Italian cohort of the nivolumab expanded access program in pre-treated patients with advanced squamous non-small cell lung cancer. Materials and methods: Nivolumab (3 mg/kg every 2 weeks for ≤24 months) was available on physician request. Efficacy data included objective tumor response, date of progression, and survival information. Safety was monitored. Results: Overall, 371 patients received at least one dose of nivolumab, including 31 never-smokers (8%). Objective response rate, disease-control rate, and median overall survival were 23%, 45%, and 12.1 months (95% confidence interval: 3.7–20.4), respectively, in never-smokers, and 18%, 47%, and 7.9 months (95% confidence interval: 6.2–9.6), respectively, in the overall expanded access program population. Any-grade and grade 3–4 treatment-related adverse events were reported in 12 (39%) and 3 (10%) never-smokers, respectively, and in 109 (29%) and 21 (6%) patients, respectively, in the overall expanded access program population. Grade 3–4 treatment-related adverse events in non-smokers were increased transaminases (n = 2; 6%) and diarrhea (n = 1; 3%). Treatment-related adverse events led to treatment discontinuation in 4 non-smokers (17%) and in 26 patients (9%) overall. Conclusion: Pre-treated never-smokers with advanced squamous non-small cell lung cancer in this Italian expanded access program demonstrated efficacy and safety that were consistent with those in the overall expanded access program population and clinical trials. These results suggest that a proportion of never-smoker patients with squamous non-small cell lung cancer may be responsive to immunotherapy. Other factors, such as the tumor mutational load and the status of programmed death-ligand 1, anaplastic lymphoma kinase, and epidermal growth factor receptor, might play a potential key role.
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Affiliation(s)
| | - Lucio Crinò
- Santa Maria della Misericordia Hospital, Perugia, Italy
| | | | | | | | | | | | | | | | - Antonio Santo
- Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | | | | | | | - Enrico Vasile
- Azienda Ospedaliera Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | | | | | | | | | - Natale Tedde
- Presidio ospedaliero ASL 2 di Olbia, Olbia, Italy
| | | | - Giuseppe Lo Russo
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
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Bassanelli M, Giannarelli D, Ricciuti B, Magri V, Cecere F, Roberto M, Giacinti S, Barucca V, Cassese R, De Giglio A, Scagnoli S, Milella M, Santarelli M, Bengala C, Ruggeri E, Marchetti P, Cognetti F, Gelibter A, Cortesi E, Chiari R, Ceribelli A. P1.15-01 Radiotherapy (RT) and Nivolumab in Non-Small-Cell Lung Cancer (NSCLC): A Multicenter Real-Life Experience. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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23
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Bassanelli M, Giannarelli D, Ricciuti B, Magri V, Cecere FL, Roberto M, Giacinti S, Barucca V, Cassese R, De Giglio A, Scagnoli S, Milella M, Santarelli M, Bengala C, Ruggeri EM, Marchetti P, Cognetti F, Gelibter A, Chiari R, Ceribelli A. Updated outcomes of previously irradiated non-small-cell lung cancer (NSCLC) patients (pts) receiving programmed death 1 (PD-1) inhibitors. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e15158] [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)
| | | | - Biagio Ricciuti
- Clinical Oncology, S. Maria della Misericordia Hospital, Perugia, Italy
| | | | | | - Michela Roberto
- Sant Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Viola Barucca
- Department of Oncology; Misericordia Hospital, Grosseto, Italy
| | - Raffaele Cassese
- department of Radiotherapy- San Camillo de Lellis Hospital, Rieti, Italy
| | - Andrea De Giglio
- Medical Oncology, Santa Maria della Misericordia Hospital, Perugia, Italy
| | | | - Michele Milella
- Medical Oncology A, Regina Elena National Cancer Institute, Rome, Italy
| | | | | | | | - Paolo Marchetti
- S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
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Masini C, Iotti C, Ciammella P, Gnoni R, Berselli A, Vitale MG, De Giorgi U, Mucciarini C, Buti S, Procopio G, Iacovelli R, Scagliotti GV, Bracarda S, Caffo O, Morelli F, Bengala C, Nole F, Baier S, Panni S, Pinto C. NIVES study: A phase II trial of nivolumab (NIVO) plus stereotactic body radiotherapy (SBRT) in II and III line of patients (pts) with metastatic renal cell carcinoma (mRCC). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.tps4602] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Cristina Masini
- Medical Oncology Unit, Clinical Cancer Center, AUSL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Cinzia Iotti
- Oncological Radiotherapy Unit, AUSL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Patrizia Ciammella
- Oncological Radiotherapy Unit, AUSL IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Roberta Gnoni
- Medical Oncology Unit, Clinical Cancer Center, AUSL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Annalisa Berselli
- Medical Oncology Unit, Clinical Cancer Center, AUSL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | | | - Ugo De Giorgi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori IRCCS, Meldola, Italy
| | - Claudia Mucciarini
- Department of Oncology and Haematology, Ramazzini Hospital, Carpi, Italy
| | - Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | | | - Roberto Iacovelli
- Medical Oncology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | | | | | | | - Franco Morelli
- IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, San Giovanni Rotondo, Italy
| | | | - Franco Nole
- Medical Oncology Division of Urogenital and Head and Neck Tumors, European Institute of Oncology, Milan, Italy
| | - Susanne Baier
- Medical Oncology Unit, Azienda Sanitaria dell'Alto Adige, Bolzano, Italy
| | - Stefano Panni
- Medical Oncology Unti, Azienda Socio-Sanitaria Territoriale di Cremona, Cremona, Italy
| | - Carmine Pinto
- Medical Oncology Unit, Clinical Cancer Center, AUSL-IRCCS Reggio Emilia, Reggio Emilia, Italy
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25
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Garassino M, Cortesi E, Grossi F, Chiari R, Parra HS, Cascinu S, Cognetti F, Turci D, Blasi L, Bengala C, Mini E, Baldini E, Gamucci T, Ceresoli G, Antonelli P, Vasile E, Pinto C, Galetta D, Macerelli M, De Marinis F. MA 11.11 Italian Nivolumab Expanded Access Program in Non-Squamous NSCLC Patients: Results in Never Smokers and EGFR Positive Patients. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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26
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Garassino M, Cortesi E, Grossi F, Chiari R, Soto Parra H, Cascinu S, Cognetti F, Turci D, Blasi L, Bengala C, Mini E, Baldini E, Gamucci T, Ceresoli G, Antonelli P, Vasile E, Pagano M, Macerelli M, Lagroscino A, De Marinis F. Italian nivolumab expanded access programme in non-squamous non-small cell lung cancer patients: Real-world results in never smokers and EGFR positive patients. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx380.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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27
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De Santis S, Spinosi M, Cambi J, Bengala C, Boccuzzi S. Oropharyngeal squamous cell carcinoma and HPV. Systematic review on overall management. Journal of Stomatology, Oral and Maxillofacial Surgery 2017; 118:103-108. [DOI: 10.1016/j.jormas.2017.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 02/15/2017] [Indexed: 10/20/2022]
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28
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Martino M, Lanza F, Pavesi L, Öztürk M, Blaise D, Leno Núñez R, Schouten HC, Bosi A, De Giorgi U, Generali D, Rosti G, Necchi A, Ravelli A, Bengala C, Badoglio M, Pedrazzoli P, Bregni M. High-Dose Chemotherapy and Autologous Hematopoietic Stem Cell Transplantation as Adjuvant Treatment in High-Risk Breast Cancer: Data from the European Group for Blood and Marrow Transplantation Registry. Biol Blood Marrow Transplant 2015; 22:475-81. [PMID: 26723932 DOI: 10.1016/j.bbmt.2015.12.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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: 11/18/2015] [Accepted: 12/17/2015] [Indexed: 11/19/2022]
Abstract
The aim of this retrospective study was to assess toxicity and efficacy of adjuvant high-dose chemotherapy (HDC) and autologous hematopoietic stem cell transplantation (AHSCT) in 583 high-risk breast cancer (BC) patients (>3 positive nodes) who were transplanted between 1995 and 2005 in Europe. All patients received surgery before transplant, and 55 patients (9.5%) received neoadjuvant treatment before surgery. Median age was 47.1 years, 57.3% of patients were premenopausal at treatment, 56.5% had endocrine-responsive tumors, 19.5% had a human epidermal growth factor receptor 2 (HER2)-negative tumor, and 72.4% had ≥10 positive lymph nodes at surgery. Seventy-nine percent received a single HDC procedure. Overall transplant-related mortality was 1.9%, at .9% between 2001 and 2005, whereas secondary tumor-related mortality was .9%. With a median follow-up of 120 months, overall survival and disease-free survival rates at 5 and 10 years in the whole population were 75% and 64% and 58% and 44%, respectively. Subgroup analysis demonstrated that rates of overall survival were significantly better in patients with endocrine-responsive tumors, <10 positive lymph nodes, and smaller tumor size. HER2 status did not affect survival probability. Adjuvant HDC with AHSCT has a low mortality rate and provides impressive long-term survival rates in patients with high-risk BC. Our results suggest that this treatment modality should be considered in selected high-risk BC patients and further investigated in clinical trials.
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Affiliation(s)
- Massimo Martino
- Hematology and Stem Cell Transplant Unit, Azienda Ospedaliera BMM, Reggio Calabria, Italy.
| | - Francesco Lanza
- Section of Hematology and Bone Marrow Transplant Unit, AO Isituti Ospitalieri di Cremona, Cremona, Italy
| | - Lorenzo Pavesi
- Department of Medical Oncology, Fondazione Salvatore Maugeri I.R.C.C.S., Pavia, Italy
| | - Mustafa Öztürk
- Gulhane Medical Academy, Department of Medical Oncology, General Tevfik Saglam Caddesi, Etlik/Ankara, Turkey
| | - Didier Blaise
- Department of Hematology, Institut Paoli Calmettes, Marseille, France
| | - Rubén Leno Núñez
- Department of Medical Oncology, Hospital Clínico Universitario, Salamanca, Spain
| | - Harry C Schouten
- Department of Hematology, Academische Ziekenhuis Maastricht, Maastricht, Netherlands
| | - Alberto Bosi
- Hematology Department, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Ugo De Giorgi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Italy
| | - Daniele Generali
- Breast Cancer Unit, AO Isituti Ospitalieri di Cremona, Cremona, Italy
| | - Giovanni Rosti
- Department of Medical Oncology, Civil Hospital, Ravenna, Italy
| | - Andrea Necchi
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andrea Ravelli
- Section of Hematology and Bone Marrow Transplant Unit, AO Isituti Ospitalieri di Cremona, Cremona, Italy
| | - Carmelo Bengala
- Department of Medical Oncology, Misericordia Hospital, Grosseto, Italy
| | - Manuela Badoglio
- European Group for Blood and Marrow Transplantation Study Office, Solid Tumors Working Party-EBMT, Hôpital Saint-Antoine, Assistance Publique des Hôpitaux de Paris, France
| | - Paolo Pedrazzoli
- Department of Medical Oncology, I.R.C.C.S. San Matteo University Hospital Foundation, Pavia, Italy
| | - Marco Bregni
- Department of Medical Oncology, di Circolo Hospital, Busto Arsizio, Italy
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Yardley DA, Cortes J, Coleman RE, Conte PF, Brufsky A, O'Shaughnessy J, Wright GLS, Eakle JF, Wilks S, Shtivelband M, Young RR, Bengala C, Li H, Miller JA, Barton D, Harbeck N. Weekly nab-paclitaxel ( nab-P) plus gemcitabine (gem) or carboplatin (carbo) vs gem/carbo as first-line treatment for metastatic triple-negative breast cancer (mTNBC) in a phase 2/3 trial (tnAcity). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.tps1106] [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)
- Denise A. Yardley
- Sarah Cannon Research Institute, Tennessee Oncology, PLLC, Nashville, TN
| | | | - Robert E. Coleman
- University of Sheffield, Weston Park Hospital, Sheffield, United Kingdom
| | | | - Adam Brufsky
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | | | | | - Sharon Wilks
- US Oncology-Cancer Care Centers of South Texas, San Antonio, TX
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30
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Necchi A, Mariani L, Di Nicola M, Lo Vullo S, Nicolai N, Giannatempo P, Raggi D, Farè E, Magni M, Piva L, Matteucci P, Catanzaro M, Biasoni D, Torelli T, Stagni S, Bengala C, Barone C, Schiavetto I, Siena S, Carlo-Stella C, Pizzocaro G, Salvioni R, Gianni AM. High-dose sequential chemotherapy (HDS) versus PEB chemotherapy as first-line treatment of patients with poor prognosis germ-cell tumors: mature results of an Italian randomized phase II study. Ann Oncol 2015; 26:167-172. [PMID: 25344361 DOI: 10.1093/annonc/mdu485] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In the late 1990s, the use of high-dose chemotherapy (HDCT) and stem-cell rescue held promise for patients with advanced and poor prognosis germ-cell tumors (GCT). We started a randomized phase II trial to assess the efficacy of sequential HDCT compared with cisplatin, etoposide, and bleomycin (PEB). PATIENTS AND METHODS Patients were randomly assigned to receive four cycles of PEB every 3 weeks or two cycles of PEB followed by a high-dose sequence (HDS) comprising HD-cyclophosphamide (7.0 g/m(2)), 2 courses of cisplatin and HD-etoposide (2.4 g/m(2)) with stem-cell support, and a single course of HD-carboplatin [area under the curve (AUC) 27 mg/ml × min] with autologous stem-cell transplant. Postchemotherapy surgery was planned on responding residual disease in both arms. The primary end point was progression-free survival (PFS). The study was designed to detect a 30% improvement of 5-year PFS (from 40% to 70%), with 80% power and two-sided α at 5%. RESULTS From December 1996 to March 2007, 85 patients were randomized: 43 in PEB and 42 in HDS arm. Median follow-up was 114.2 months [interquartile range (IQR): 87.7-165.8]. Complete or partial response with normal markers (PRm-) were obtained in 28 (65.1%) and 29 (69.1%) patients, respectively. Five-year PFS was 55.8% [95% confidence interval (CI) 42.8-72.8] and 54.8% (95% CI 41.6%-72.1%) in PEB and HDS arm, respectively (log-rank test P = 0.726). Five-year overall survival was 62.8% (95% CI 49.9-79.0) and 59.3% (95% CI 46.1-76.3). One toxic death (PEB arm) was recorded. CONCLUSIONS The study failed to meet the primary end point. Furthermore, survival estimates of conventional-dose chemotherapy higher than expected should be accounted for and will likely limit further improvements in the first-line setting. CLINICALTRIALS.GOV: NCT02161692.
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Affiliation(s)
| | - L Mariani
- Clinical Epidemiology and Trials Organization Unit
| | | | - S Lo Vullo
- Clinical Epidemiology and Trials Organization Unit
| | - N Nicolai
- Department of Surgery, Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | | | - D Raggi
- Department of Medical Oncology
| | - E Farè
- Department of Medical Oncology
| | - M Magni
- Department of Medical Oncology
| | - L Piva
- Department of Surgery, Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | | | - M Catanzaro
- Department of Surgery, Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - D Biasoni
- Department of Surgery, Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - T Torelli
- Department of Surgery, Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - S Stagni
- Department of Surgery, Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - C Bengala
- Department of Medical Oncology, Ospedale Misericordia, Grosseto
| | - C Barone
- Department of Medical Oncology, Oncologia Medica ASL TO5 Ospedale di Carmagnola, Turin
| | - I Schiavetto
- Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan
| | - S Siena
- Niguarda Cancer Center, Ospedale Niguarda Ca' Granda, Milan
| | - C Carlo-Stella
- Department of Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano; Department of Medical Biotechnology and Translational Medicine
| | - G Pizzocaro
- Department of Surgery, Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - R Salvioni
- Department of Surgery, Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - A M Gianni
- Department of Medical Oncology; Department of Pathophysiology and Transplantation, University of Milano, Milan, Italy
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Pedrazzoli P, Martinelli G, Gianni AM, Da Prada GA, Ballestrero A, Rosti G, Frassineti GL, Aieta M, Secondino S, Cinieri S, Fedele R, Bengala C, Bregni M, Grasso D, De Giorgi U, Lanza F, Castagna L, Bruno B, Martino M. Adjuvant high-dose chemotherapy with autologous hematopoietic stem cell support for high-risk primary breast cancer: results from the Italian national registry. Biol Blood Marrow Transplant 2013; 20:501-6. [PMID: 24374214 DOI: 10.1016/j.bbmt.2013.12.569] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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: 10/15/2013] [Accepted: 12/23/2013] [Indexed: 01/07/2023]
Abstract
The efficacy of high-dose chemotherapy (HDC) and autologous hemopoietic progenitor cell transplantation (AHPCT) for breast cancer (BC) patients has been an area of intense controversy among the medical oncology community. The aim of this study was to assess toxicity and efficacy of this procedure in a large cohort of high-risk primary BC patients who underwent AHPCT in Italy. A total of 1183 patients receiving HDC for high-risk BC (HRBC) (>3 positive nodes) were identified in the Italian registry. The median age was 46 years, 62% of patients were premenopausal at treatment, 60.1% had endocrine-responsive tumors, and 20.7% had a human epidermal growth factor receptor 2 (HER2)-positive tumor. The median number of positive lymph nodes (LN) at surgery was 15, with 71.5% of patients having ≥ 10 positive nodes. Seventy-three percent received an alkylating agent-based HDC as a single procedure, whereas 27% received epirubicin or mitoxantrone-containing HDC, usually within a multitransplantation program. The source of stem cells was peripheral blood in the vast majority of patients. Transplantation-related mortality was .8%, whereas late cardiac and secondary tumor-related mortality were around 1%, overall. With a median follow-up of 79 months, median disease-free and overall survival (OS) in the entire population were 101 and 134 months, respectively. Subgroup analysis demonstrated that OS was significantly better in patients with endocrine-responsive tumors and in patients receiving multiple transplantation procedures. HER2 status did not affect survival probability. The size of the primary tumor and number of involved LN negatively affected OS. Adjuvant HDC with AHPCT has a low mortality rate and provides impressive long-term survival rates in patients with high-risk primary BC. Our results suggest that this treatment modality should be proposed in selected HRBC patients and further investigated in clinical trials.
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Affiliation(s)
- Paolo Pedrazzoli
- Medical Oncology, IRCCS Foundation, San Matteo Hospital, Pavia, Italy
| | | | | | | | | | | | - Giovanni Luca Frassineti
- Department of Medical Oncology, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Italy
| | - Michele Aieta
- Medical Oncology, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy
| | | | - Saverio Cinieri
- Medical Oncology, European Institute of Oncology, Milan, Italy
| | - Roberta Fedele
- Hematology and Bone Marrow Transplant Unit, Azienda Ospedaliera "BMM", Reggio Calabria, Italy
| | | | - Marco Bregni
- Hematology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Donatella Grasso
- Medical Oncology, IRCCS Foundation, San Matteo Hospital, Pavia, Italy
| | - Ugo De Giorgi
- Department of Medical Oncology, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Italy
| | - Francesco Lanza
- Section of Hematology and Bone Marrow Transplant Unit, Cremona, Italy
| | - Luca Castagna
- Hematology Unit, Humanitas Cancer Center, Rozzano, Milan, Italy
| | - Barbara Bruno
- National Registry GITMO & Data Managing, Ospedale San Martino, Genova, Italy
| | - Massimo Martino
- Hematology and Bone Marrow Transplant Unit, Azienda Ospedaliera "BMM", Reggio Calabria, Italy.
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Martino M, Ballestrero A, Zambelli A, Secondino S, Aieta M, Bengala C, Liberati AM, Zamagni C, Musso M, Aglietta M, Schiavo R, Castagna L, Rosti G, Bruno B, Pedrazzoli P. Long-term survival in patients with metastatic breast cancer receiving intensified chemotherapy and stem cell rescue: data from the Italian registry. Bone Marrow Transplant 2012; 48:414-8. [PMID: 22863724 DOI: 10.1038/bmt.2012.149] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The median survival of women with metastatic breast cancer (MBC) is 18-24 months, and fewer than 5% are alive and disease free at 5 years. We report toxicity and survival in a cohort of MBC patients receiving high-dose chemotherapy (HDC) with autologous hematopoietic SCT (AHSCT) in Italy between 1990 and 2005. Data set for survival analysis has been obtained for 415 patients. Clinical parameters including probability of transplant-related mortality (TRM), PFS and OS. With a median follow-up of 27 months (range 0-172), OS and PFS at 5 and 10 years in the whole population were 47/23 and 32/14%, respectively. A total 239 patients are alive with a median follow-up of 33 months (range 2-174). Survival was significantly more pronounced in patients harboring hormone receptor positive tumors (P=0.028), without visceral metastases (P=0.009) and in women with chemosensitive disease (P<0.0001). Sixty eight patients (20.4%) who received HDC in partial response, stable or progressive disease underwent conversion to CR. TRM was 2.5% overall and 1.3% since 2000. Our findings suggest that could be a role for HDC and AHSCT in delaying disease progression and possibly cure a subset of MBC patient harboring chemosensitive tumors.
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Affiliation(s)
- M Martino
- Hematology and Bone Marrow Transplant Unit, Azienda Ospedaliera BMM, Reggio Calabria, Italy.
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Finn RS, Bengala C, Ibrahim N, Roché H, Sparano J, Strauss LC, Fairchild J, Sy O, Goldstein LJ. Dasatinib as a Single Agent in Triple-Negative Breast Cancer: Results of an Open-Label Phase 2 Study. Clin Cancer Res 2011; 17:6905-13. [DOI: 10.1158/1078-0432.ccr-11-0288] [Citation(s) in RCA: 155] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Bengala C, Bettelli S, Bertolini F, Sartori G, Fontana A, Malavasi N, Depenni R, Zironi S, Del Giovane C, Luppi G, Conte PF. Prognostic role of EGFR gene copy number and KRAS mutation in patients with locally advanced rectal cancer treated with preoperative chemoradiotherapy. Br J Cancer 2010; 103:1019-24. [PMID: 20842128 PMCID: PMC2965865 DOI: 10.1038/sj.bjc.6605853] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: Epidermal growth factor receptor (EGFR), evaluated by immunohistochemistry, has been shown to have prognostic significance in patients with colorectal cancer. Gene copy number (GCN) of EGFR and KRAS status predict response and outcome in patients treated with anti-EGFR therapy, but their prognostic significance in colorectal cancer patients is still unclear. Methods: We have retrospectively reviewed the baseline EGFR GCN, KRAS status and clinical outcome of 146 locally advanced rectal cancer (LARC) patients treated with preoperative chemoradiotherapy. Pathological response evaluated by Dworak's tumour regression grade (TRG), disease-free survival (DFS) and overall survival (OS) were analysed. Results: Tumour regression grade 4 and TRG3–4 were achieved in 14.4 and 30.8% of the patients respectively. Twenty-nine (19.9%) and 33 patients (19.2%) had an EGFR/nuclei ratio >2.9 and CEP7 polisomy >50% respectively; 28 patients (19.2%) had a KRAS mutation. Neither EGFR GCN nor KRAS status was statistically correlated to TRG. 5-year DFS and OS were 63.3 and 71.5%, respectively, and no significant relation with EGFR GCN or KRAS status was found. Conclusion: Our data show that EGFR GCN and KRAS status are not prognostic factors in LARC treated with preoperative chemoradiation.
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Affiliation(s)
- C Bengala
- Division of Medical Oncology, Department of Oncology, Hematology and Respiratory Disease, University Hospital, University of Modena and Reggio Emilia, Via del Pozzo, 71, Modena-41100, Italy.
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Bengala C, Bertolini F, Malavasi N, Boni C, Aitini E, Dealis C, Zironi S, Depenni R, Fontana A, Del Giovane C, Luppi G, Conte P. Sorafenib in patients with advanced biliary tract carcinoma: a phase II trial. Br J Cancer 2009; 102:68-72. [PMID: 19935794 PMCID: PMC2813746 DOI: 10.1038/sj.bjc.6605458] [Citation(s) in RCA: 169] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Advanced biliary tract carcinoma has a very poor prognosis, with chemotherapy being the mainstay of treatment. Sorafenib, a multikinase inhibitor of VEGFR-2/-3, PDGFR-beta, B-Raf, and C-Raf, has shown to be active in preclinical models of cholangiocarcinoma. METHODS We conducted a phase II trial of single-agent sorafenib in patients with advanced biliary tract carcinoma. Sorafenib was administered at a dose of 400 mg twice a day. The primary end point was the disease control rate at 12 weeks. RESULTS A total of 46 patients were treated. In all, 26 (56%) had received chemotherapy earlier, and 36 patients completed at least 45 days of treatment. In intention-to-treat analysis, the objective response was 2% and the disease control rate at 12 weeks was 32.6%. Progression-free survival (PFS) was 2.3 months (range: 0-12 months), and the median overall survival was 4.4 months (range: 0-22 months). Performance status was significantly related to PFS: median PFS values for ECOG 0 and 1 were 5.7 and 2.1 months, respectively (P=0.0002). The most common toxicities were skin rash (35%) and fatigue (33%), requiring a dose reduction in 22% of patients. CONCLUSIONS Sorafenib as a single agent has a low activity in cholangiocarcinoma. Patients having a good performance status have a better PFS. The toxicity profile is manageable.
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Affiliation(s)
- C Bengala
- Division of Medical Oncology, University Hospital, University of Modena and Reggio Emilia, 41100 Modena, Italy.
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Abstract
Triple-negative breast cancer (TNBC) has been recently recognized as an important subgroup of breast cancer with a distinct outcome and therapeutic approach compared with other breast cancer subgroups. Because TNBC is defined by the absence of a target (either hormone receptors or HER-2), conventional cytotoxic therapy is still the mainstay of treatment. This report focuses on the current state and recent advances in managing TNBC.
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Affiliation(s)
- Carmelo Bengala
- Division of Medical Oncology, Department of Oncology, Hematology and Respiratory Diseases, University Hospital, University of Modena and Reggio EmiliaVia del Pozzo, 71 - 41100, ModenaItaly
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Bengala C, Bettelli S, Fontana A, Bertolini F, Sartori G, Malavasi N, Losi L, Del Giovane C, Luppi G, Conte P. EGFR gene copy number, KRAS and BRAF status, PTEN and AKT expression analysis in patients with metastatic colon cancer treated with anti-EGFR monoclonal antibodies ± chemotherapy. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e15055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15055 Background: Cetuximab and panitumumab have proven to be effective in metastatic colon cancer (mCRC). KRAS mutation has been demonstrated to be a biomarker of resistance to both monoclonal antibodies. However the status and expression of other biomarkers of the RAS-RAF-MAPK signalling pathway can have a crucial role in sensitivity to anti-EGFR monoclonal antibodies. Methods: We have retrospectively analyzed tumor tissue biomarkers including EGFR gene copy number (GCN) by FISH, KRAS and BRAF status by PCR-based sequencing, PTEN and AKT expression by IHC in patients with mCRC treated with cetuximab and panitumumab ±chemotherapy. Response to treatment, TTP and OS were evaluated. Results: Sixty-three patients (pts) have been analyzed. Median age was 59 years (34–80); 53 pts had received cetuximab and 10 pts panitunumab. Concomitatnt chemotherapy was FOLFIRI, CPT-11, FOLFOX4 and Xeliri in 35, 13, 6 and 4 pts respectively. Five pts had received monoclonal antibodies only. Twenty- one pts were treated in 1st-2nd line and 42 pts in 3rd-4th line. So far EGFR GCN is available on 55 pts, KRAS and BRAF on 63 pts, PTEN in primary tumor (PT) on 36 pts and in metastatic (MTS) site on 24 pts, AKT on 19 pts. EGFR/nuclei ratio was > 2.9 in 31 % of the pts, KRAS and BRAF were mutated in 36.5 % and 3 % of the pts respectively; PTEN was positive in 42 % and 79 % in PT and MTS respectively. Moreover 21.8 % of the pts had EGFR/nuclei > 2.9 and CEP7 Polisomy > 50 %. Four pts achieved a partial remission (6.3 %). Partial response rate was 17 % vs. 2.6 % in pts with high and low EGFR GCN respectively (p: 0.007) and 13 % vs. 2.5 % in pts with WT and mutated KRAS respectively (p: 0.048). Median TTP was 3 months (0.83–32.9). It was 4.2 vs. 2.3 mos in pts with WT and mutated KRAS respectively (p: 0.001). Median OS was 9.7 mos (2.03–49.0) and no statistically significant differences were observed according to the biomarkers status. However a trend was observed for pts with KRAS WT 10.6 vs. 7.8 mos and for PTEN positive in PT: 9.0 vs. 5.67 mos. Conclusions: Our data confirm the predictive role of EGFR gene copy number and KRAS status on the response and survival. Complete biomarker characterization is ongoing and an analysis for interaction will be performed. No significant financial relationships to disclose.
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Affiliation(s)
| | | | | | | | | | | | - L. Losi
- University Hospital, Modena, Italy
| | | | - G. Luppi
- University Hospital, Modena, Italy
| | - P. Conte
- University Hospital, Modena, Italy
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Bertolini F, Chiara S, Bengala C, Antognoni P, Dealis C, Zironi S, Malavasi N, Scolaro T, Depenni R, Jovic G, Sonaglio C, Rossi A, Luppi G, Conte PF. Neoadjuvant Treatment With Single-Agent Cetuximab Followed by 5-FU, Cetuximab, and Pelvic Radiotherapy: A Phase II Study in Locally Advanced Rectal Cancer. Int J Radiat Oncol Biol Phys 2009; 73:466-72. [DOI: 10.1016/j.ijrobp.2008.04.065] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Revised: 04/25/2008] [Accepted: 04/25/2008] [Indexed: 10/21/2022]
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Finn RS, Bengala C, Ibrahim N, Strauss LC, Fairchild J, Sy O, Roche H, Sparano J, Goldstein LJ. Phase II trial of dasatinib in triple-negative breast cancer: results of study CA180059. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-3118] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
Abstract
Abstract #3118
Background: Dasatinib (SprycelR; BMS-354825) is a potent orally-available inhibitor of Src-family kinases and other kinases with anti-proliferative, anti-osteoclastic and anti-metastatic activity demonstrated pre-clinically. Expression profiling suggested that basal-like cancers may be preferentially sensitive to dasatinib. Methods: A Phase II single-agent trial of dasatinib, using a continuous schedule, was performed in patients with advanced triple-negative (as proxy for basal-like) breast cancers. Subjects were required to have measurable locally-advanced or metastatic triple-negative (ER/PR-negative, Her2-normal) disease and prior anthracycline and/or taxane therapy. A 2-stage Gehan design was adopted, with RECIST-defined response as primary endpoint; subjects discontinued for toxicity were considered non-responders. The original dasatinib dose of 100 mg BID (n=21) was reduced to 70 mg BID (n=23) to improve tolerability. Biomarkers were analyzed in tumor and plasma samples obtained for PK analysis. Results: From 12/06 through 12/07, 44 subjects were treated at 14 institutions: median age 55 yrs, median time from diagnosis 30 mo, prior therapy for advanced disease in 29 (66%). Of 43 response-evaluable subjects, 7 discontinued for toxicity prior to on-study assessment. Of 36 subjects with radiographic assessment, there were 2 confirmed PR [1 continues >1 year + 1 discontinued for intolerance at week 16] plus 2 SD lasting >16 weeks. Four additional subjects had transient clinical benefit reflected by improvement in bone pain (anecdotal) or short-term tumor shrinkage (reductions of 11 - 29%). Tolerability was improved at a dose of 70 mg compared with 100 mg BID. In preliminary analysis, fewer subjects experienced any serious adverse event (13% at 70 mg BID vs 48% at 100 mg BID), fewer reported Grade 3 toxicity, including gastrointestinal (10% vs 26%), pleural effusion (4% vs 9%), generalized edema (0% vs 9%) or pericardial effusion (0% vs 9%), and fewer had dasatinib dose reduction (24% vs 61%). Fatigue, myalgia/arthralgia and headache were comparable at the two doses. No Grade 4 drug-related events occurred. Grade 3-4 abnormal laboratory values were uncommon. Biomarker and PK data will be presented. Conclusions: Modest but encouraging single-agent activity was observed with dasatinib in patients with advanced triple-negative breast cancers, with clinical benefit rate of 9.3% (4/43). Future studies are warranted to address optimal dose and schedule of dasatinib in combination with chemotherapy for this challenging tumor type.
Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 3118.
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Affiliation(s)
- RS Finn
- 1 UCLA Medical Ctr, Los Angeles
| | - C Bengala
- 2 Policlinica Di Modena, Modena, Italy
| | - N Ibrahim
- 3 U Texas MD Anderson Cancer Ctr, Houston
| | | | | | - O Sy
- 4 Bristol-Myers Squibb Inc, Wallingford
| | - H Roche
- 5 Inst Claudius Regaud, Toulouse, France
| | - J Sparano
- 6 Montefiore-Einstein Cancer Ctr, Bronx
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Bengala C, Bettelli S, Bertolini F, Salvi S, Chiara S, Sonaglio C, Losi L, Bigiani N, Sartori G, Dealis C, Malavasi N, D'Amico R, Luppi G, Gatteschi B, Maiorana A, Conte PF. Epidermal growth factor receptor gene copy number, K-ras mutation and pathological response to preoperative cetuximab, 5-FU and radiation therapy in locally advanced rectal cancer. Ann Oncol 2008; 20:469-74. [PMID: 19095777 DOI: 10.1093/annonc/mdn647] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Cetuximab improves activity of chemotherapy in metastatic colorectal cancer (mCRC). Gene copy number (GCN) of epidermal growth factor receptor (EGFR) has been suggested to be a predictive factor of response to cetuximab in patients (pts) with mCRC; on the contrary, K-ras mutation has been associated with cetuximab resistance. PATIENTS AND METHODS We have conducted a phase II study with cetuximab administered weekly for 3 weeks as single agent and then with 5-fluorouracil and radiation therapy as neo-adjuvant treatment for locally advanced rectal cancer (LARC). EGFR immunohistochemistry expression, EGFR GCN and K-ras mutation were evaluated on diagnostic tumor biopsy. Dworak's tumor regression grade (TRG) was evaluated on surgical specimens. RESULTS Forty pts have been treated; 39 pts are assessable. TRG 3 and 4 were achieved in nine (23.1%) and three pts (7.7%) respectively; TRG 3-4 rate was 55% and 5.3% in case of high and low GCN, respectively (P 0.0016). Pts with K-ras mutated tumors had lower rate of high TRG: 11% versus 36.7% (P 0.12). In pts with wild-type K-ras, TRG 3-4 rate was 58.8% versus 7.7% in case of high or low GCN, respectively (P 0.0012). CONCLUSIONS In pts with LARC, EGFR GCN is predictive of high TRG to cetuximab plus 5-FU radiotherapy. Moreover, our data suggest that a wild-type K-ras associated with a high EGFR GCN can predict sensitivity to cetuximab-based treatment.
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Affiliation(s)
- C Bengala
- Division of Medical Oncology, Department of Oncology and Hematology, University of Modena and Reggio Emilia, Modena, Italy.
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Bengala C, Bettelli S, Bertolini F, Salvi S, Sonaglio C, Losi L, Sartori G, Dealis C, Gatteschi B, Conte PF. Predictive value of EGFR gene copy number and K-ras mutation for pathological response to preoperative cetuximab, 5FU, and radiation therapy in locally advanced rectal cancer (LARC). J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.4125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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42
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Pedrazzoli P, Gianni AM, Da Prada G, Ballestrero A, Martino MV, Rosti G, Bregni M, Aglietta M, Bengala C, Martinelli G. Adjuvant high-dose chemotherapy with autologous hematopoietic stem cell transplantation for breast cancer with > 9 positive nodes: 15-year results from the Italian registry. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Conte P, Guarneri V, Bengala C. Evolving Nonendocrine Therapeutic Options for Metastatic Breast Cancer: How Adjuvant Chemotherapy Influences Treatment. Clin Breast Cancer 2007; 7:841-9. [DOI: 10.3816/cbc.2007.n.048] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Möbus V, Wandt H, Frickhofen N, Bengala C, Champion K, Kimmig R, Ostermann H, Hinke A, Ledermann JA. Phase III Trial of High-Dose Sequential Chemotherapy With Peripheral Blood Stem Cell Support Compared With Standard Dose Chemotherapy for First-Line Treatment of Advanced Ovarian Cancer: Intergroup Trial of the AGO-Ovar/AIO and EBMT. J Clin Oncol 2007; 25:4187-93. [PMID: 17698804 DOI: 10.1200/jco.2006.09.7527] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PurposeAlthough ovarian cancer is one of the most chemotherapy-sensitive solid tumors, cure after radical surgery and chemotherapy is uncommon. A randomized trial comparing high-dose sequential chemotherapy with peripheral blood stem cell (PBSC) support with platinum-based combination chemotherapy was conducted to investigate whether dose-intensification improves outcome.Patients and MethodsOne hundred forty-nine patients with untreated ovarian cancer were randomly assigned after debulking surgery to receive standard combination chemotherapy or sequential high-dose (HD) treatment with two cycles of cyclophosphamide and paclitaxel followed by three cycles of HD carboplatin and paclitaxel with PBSC support. HD melphalan was added to the final cycle. The median age was 50 years (range, 20 to 65 years) and International Federation of Gynecology and Obstetrics stage was IIb/IIc in 4%, III in 78%, and IV in 17%.ResultsSeventy-six percent of patients received all five cycles in the HD arm and the main toxicities were neuro-/ototoxicity, gastrointestinal toxicity, and infection and one death from hemorrhagic shock. After a median follow-up of 38 months, the progression-free survival was 20.5 months in the standard arm and 29.6 months in the HD arm (hazard ratio [HR], 0.84; 95% CI, 0.56 to 1.26; P, .40). Median overall survival (OS) was 62.8 months in the standard arm and 54.4 months in the HD arm (HR, 1.17; 95% CI, 0.71 to 1.94; P, .54).ConclusionThis is the first randomized trial comparing sequential HD versus standard dose chemotherapy in first-line treatment of patients with advanced ovarian cancer. We observed no statistically significant difference in progression-free survival or OS and conclude that HD chemotherapy does not appear to be superior to conventional dose chemotherapy.
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Affiliation(s)
- Volker Möbus
- Department of Obstetrics and Gynecology, Städtisches Klinikum, Gotenstrasse 6-8, D-65929 Frankfurt, Germany.
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Bengala C, Rasini V, Sternieri R, Dominici M, Andreotti A, Gelmini R, Cafarelli L, Bevini P, Berti A, Conte P. Phase I study of intraperitoneal MHC unrestricted adoptive cell therapy with TALL-104 cells in patients with peritoneal carcinosis. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.3054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3054 Background: TALL-104 is an irradiated human leukemic T cell line (CD3+, CD4- CD8+, CD56+, CD16-) grown in IL-2- containing medium, that has the ability to kill tumor cells in preclinical models in a MHC unrestricted way. A phase I trial in metastatic breast cancer patients, has shown that multiple i.v. infusions (infs) of TALL-104 cells can be given safely. In order to optimise the tumor:effector cell ratio, we have designed a phase I study of intraperitoneal infs of γ-irradiated TALL-104 cells. Methods: Patients (pts) with peritoneal carcinosis from ovarian or gastrointestinal tumors not responding to at least 2 lines of chemotherapy were eligible for study entry. The treatment included 5 i.p. infs (day 1, 3, 5, 15, 30) and the study aimed to test three cell dose levels: 1 x 108, 5 x 108, 2.5 x 109. End points of the study were: safety, kinetic of TALL-104 cells on ascites (if present) and peripheral blood (PB) by PCR, levels of cytokines (TGF-β, GM-CSF, IL-2, IL-4, IL-10, IFN-γ, TNF-a and -β, HGF, sIL-2R, sICAM-1) on ascites and serum, and cytotoxicity of autologous PB mononuclear cells (MNC) against K562 cells. Results: So far 10 pts have been treated: 6 with GI and 4 with ovarian cancer; 7 patients had ascites. Five pts have been treated at the 1st and 5 pts at the 2nd dose level. No treatment-related adverse events were observed. TALL-104 cells were detected in ascites (100 % of the pts) and PB (43 % of the pts) up to 48 hrs after the infs. Cytotoxicity of MNC showed a mean 5-fold increase at day 3 through 7 and it was still evident at day 30 in both dose levels. Cytokine levels are available for the first 5 pts. In one pt 18-fold increase of TNF-a was observed in ascites after the first infusion with a peak of 40-fold at day 15. sIL-2R and sICAM-1 showed both a mean 1.2-fold and 1.5-fold increase in serum in ascites respectively up to day 45. TGF-β1 level increased in average 3.3-fold in serum and 1.5-fold in ascites during the same observation period. HGF showed a mean 1.2-fold increase both in serum and ascites. Conclusions: These preliminary results show that the i.p. infusion of TALL-104 is safe. Moreover, the increased autologous cell-mediated cytotoxicity and the levels of soluble cytokines after i.p. infs indicate that TALL-104 cells may elicit potential antitumor activity. No significant financial relationships to disclose.
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Affiliation(s)
- C. Bengala
- University of Modena and Reggio Emilia, Modena, Italy
| | - V. Rasini
- University of Modena and Reggio Emilia, Modena, Italy
| | - R. Sternieri
- University of Modena and Reggio Emilia, Modena, Italy
| | - M. Dominici
- University of Modena and Reggio Emilia, Modena, Italy
| | - A. Andreotti
- University of Modena and Reggio Emilia, Modena, Italy
| | - R. Gelmini
- University of Modena and Reggio Emilia, Modena, Italy
| | - L. Cafarelli
- University of Modena and Reggio Emilia, Modena, Italy
| | - P. Bevini
- University of Modena and Reggio Emilia, Modena, Italy
| | - A. Berti
- University of Modena and Reggio Emilia, Modena, Italy
| | - P. Conte
- University of Modena and Reggio Emilia, Modena, Italy
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Bertolini F, Bengala C, Losi L, Pagano M, Iachetta F, Dealis C, Jovic G, Depenni R, Zironi S, Falchi AM, Luppi G, Conte PF. Prognostic and predictive value of baseline and posttreatment molecular marker expression in locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy. Int J Radiat Oncol Biol Phys 2007; 68:1455-61. [PMID: 17445998 DOI: 10.1016/j.ijrobp.2007.02.018] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2006] [Revised: 02/12/2007] [Accepted: 02/13/2007] [Indexed: 12/20/2022]
Abstract
PURPOSE To evaluate expression of a panel of molecular markers, including p53, p21, MLH1, MSH2, MIB-1, thymidylate synthase, epidermal growth factor receptor (EGFR), and tissue vascular endothelial growth factor (VEGF), before and after treatment in patients treated with neoadjuvant chemoradiotherapy for locally advanced rectal cancer, to correlate the constitutive profile and dynamics of expression with pathologic response and outcome. METHODS AND MATERIALS Expression of biomarkers was evaluated by immunohistochemistry in tumor samples from 91 patients with clinical Stage II and III rectal cancer treated with preoperative pelvic radiotherapy (50 Gy) plus concurrent 5-fluorouracil by continuous intravenous infusion. RESULTS A pathologic complete remission was observed in 14 patients (15.4%). Patients with MLH1-positive tumors had a higher pathologic complete response rate (24.3% vs. 9.4%; p = 0.055). Low expression of constitutive p21, absence of EGFR expression after chemoradiotherapy, and high Dworak's tumor regression grade (TRG) were significantly associated with improved disease-free survival and overall survival. A high MIB-1 value after chemoradiotherapy was significantly associated with worse overall survival. Multivariate analysis confirmed the prognostic value of constitutive p21 expression as well as EGFR expression and MIB-1 value after chemoradiotherapy among patients not achieving TRG 3-4. CONCLUSIONS In our study, we observed the independent prognostic value of EGFR expression after chemoradiotherapy on disease-free survival. Moreover, our study suggests that a constitutive high p21 expression and a high MIB-1 value after neoadjuvant chemoradiotherapy treatment could predict worse outcome in locally advanced rectal cancer.
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Affiliation(s)
- Federica Bertolini
- Division of Medical Oncology, Department of Oncology and Hematology, University of Modena and Reggio Emilia, Modena, Italy.
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Conte PF, Guarneri V, Bengala C. Treatment of metastatic disease after current adjuvant approaches (taxanes, aromatase inhibitors, trastuzumab). Breast Cancer Res 2007. [DOI: 10.1186/bcr1697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Marangolo M, Bengala C, Conte P, Danova M, Pronzato P, Rosti G, Sagrada P. Dose and outcome: The hurdle of neutropenia (Review). Oncol Rep 2006. [DOI: 10.3892/or.16.2.233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Marangolo M, Bengala C, Conte PF, Danova M, Pronzato P, Rosti G, Sagrada P. Dose and outcome: the hurdle of neutropenia (Review). Oncol Rep 2006; 16:233-48. [PMID: 16820898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
The development of chemotherapy in the early 1970s resulted in the availability of curative therapeutic strategies for hematological malignancies and several types of solid tumors. It is evident that drugs should be used at their optimal dose and schedule, and drug combinations should be given at consistent intervals. According to the mathematical models that suggested the direct dose-response relationship in the improvement of outcomes in cancer chemotherapy, the dose intensity and, more recently, the dose-dense approach was considered one of the most important tools in conventional chemotherapy. Anticancer drugs are often associated with myelotoxicity, and reducing the dose or increasing the time interval between each cycle of treatment is a frequent empiric approach. Unfortunately, a dose reduction of >or=20% causes a loss of 50% in the cure rate, particularly in chemosensitive tumors. To accelerate bone marrow recovery and prevent the onset of severe myelosuppression and its complications, the standard use of granulocyte colony-stimulating factors (G-CSF), such as filgrastim and the long-acting pegfilgrastim, is recommended. The aim of this review is to analyze how dose intensification concepts and dose-dense regimens are able to increase the cure rate of chemosensitive solid tumors and lymphomas.
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Affiliation(s)
- Maurizio Marangolo
- Azienda USL S. Maria delle Croci, Dipartimento di Oncologia ed Ematologia,Unità Operativa di Oncologia Medica, Ravenna.
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