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Elmer A, Lütolf VV, Carella C, Beyeler F, Krügel N, Straka L, Cardillo M, Immer F. Importance and Potential of European Cross-Border Deceased Donor Organ Allocation Through FOEDUS-EOEO Platform. Transpl Int 2023; 36:11327. [PMID: 38020752 PMCID: PMC10643207 DOI: 10.3389/ti.2023.11327] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023]
Abstract
The FOEDUS-EOEO platform was relaunched in 2015 to allocate deceased donor organs across European borders when there are no suitable recipients in the donor's country. We analyzed organ offers from 01.06.2015-31.12.2021 and present the number of offers and transplants, and utilization as percentage of transplanted organs. 1,483 organs were offered, 287 were transplanted (19.4% utilization). Yearly number of offers and transplants increased from 2017 to 2021, while utilization stabilized after 2018. Utilization was highest for organs offered by Slovakia (47.2%), followed for organs offered by Lithuania, France, Greece, and Czechia (19.3%-22.9%). The most frequently offered organ was the heart (n = 405; 27.3%), followed by the lungs (n = 369; 24.9%) and the liver (n = 345; 23.3%). Utilization differed significantly by organ type (highest for liver, 35.7%; followed by heart, 18.8%; and kidney, 18.3%) and by donor age (highest for 1 to 5 year-old donors (25.0%)). FOEDUS-EOEO allowed for many European patients receiving a long-awaited transplant, especially for very young pediatric patients waiting for a liver, a heart, or a kidney. The increasing number of participating countries has increased both the number of offered organs and, to a lesser extent, the number of transplanted organs.
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Affiliation(s)
| | | | - Claudia Carella
- National Transplant Center, National Institute of Health (ISS), Rome, Italy
| | | | | | | | - Massimo Cardillo
- National Transplant Center, National Institute of Health (ISS), Rome, Italy
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Cantullera AN, Petrisli E, Carella C, Chatzixiros E, Strong DM, Cardillo M. P6.4: Notify Library: tools available to support biovigilance. Transplantation 2023; 107:95. [PMID: 37846000 DOI: 10.1097/01.tp.0000993580.72957.a3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Affiliation(s)
| | - Evangelia Petrisli
- Microbiology Unit, RCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Claudia Carella
- National Transplant Centre, Instituto Superiore di Sanita, Rome, Italy
| | | | - Douglas M Strong
- Department of Orthopaedics and Sports Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Massimo Cardillo
- National Transplant Centre, Instituto Superiore di Sanita, Rome, Italy
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Basso U, Buti S, Verzoni E, Sorarù M, Di Napoli M, Fratino L, Santini D, Grillone F, Chiuri VEE, Carella C, Atzori F, Roviello G, Sartori D, Maruzzo M, Pierantoni F, Bersanelli M, Ballestrin M, De Toni C, Mattana A, Zagonel V. Cabozantinib in the elderly with metastatic renal cell carcinoma undergoing geriatric G8 screening test: A prospective multicenter observational study (ZEBRA/MEET-URO 9). J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.647] [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: 03/17/2023] Open
Abstract
647 Background: Cabozantinib (CABO) is an oral tyrosine kinase inhibitor registered for the treatment of metastatic renal cell carcinoma (mRCC) for the first or subsequent lines. Tolerability in real world elderly patients is poorly documented. G8 is a short test for vulnerability gaining increased interest as a screening tool for trials in geriatric oncology. Methods: ZEBRA/MEET-URO 9 was a prospective multicenter study of safety and activity of CABO administered to pts ≥70 years with mRCC, either in the first or subsequent lines of treatment, until progression or unacceptable toxicity. All pts underwent G8 score at baseline, with a cut-off for vulnerability of 14 or below. Data on tolerability and activity were collected prospectively after signature of informed consent. Results: A total of 104 pts started CABO at 13 Italian Centers, 38,5% as first line. Median age was 75.8 yrs (range 70.2-87.4 yrs, 26 pts ≥80 yrs), 73.1% males. IMDC score was good 19.2%, intermediate 53.9%, poor 26.9%. Primary tumor had been removed in 82.7% of pts, histology was clear cell 78.8%, papillary 8.7%, chromophobe 5.8%, unclassified 6.7%. G8 score was ≤14 in 65.4% of pts. Up-front dose reduction of CABO was more frequent in pts with low G8 score (79.4 vs 41.7%, p=0.003), but eventually the majority of pts (91.4%) underwent dose reductions of CABO. After a median treatment of 6.4 months (0.5-26.1 months), 38.4% of pts developed G3-4 toxicities, 22.1% interrupted treatment due to adverse events, 2.8% (3 pts) died due to cardiovascular or thromboembolic events. Median PFS was 7.6 months (95% CI=5.8-12.6 months) in first line, 10.0 months (5.8-15.6) in second or further lines, median OS was 20.1 months (11.1-not reached) and 15.6 months (12.5-not reached), respectively. G8 score ≤14 did not correlate with rate of temporary interruptions >7 days, hospitalization, incidence of G3-5 toxicities, as well as with PFS. Pts with G8 score ≤14 had a trend for reduced OS, but difference was not statistically significant both in the first and further lines of treatment. Conclusions: Screening G8 test was positive in more than a half of pts, underlying the need for detailed geriatric assessment and increased clinical monitoring of such patients. A G8 score ≤14 correlated with up-front dose reduction of CABO but not with G3-5 toxicities probably due to the high rates of dose reductions in the whole cohort. Correlation between low G8 score and OS could not be demonstrated in this population.
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Affiliation(s)
- Umberto Basso
- Oncology Unit 1, Department of Oncolgoy, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | - Sebastiano Buti
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Elena Verzoni
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Mariella Sorarù
- U.O. Oncologia, Ospedale di Camposampiero (PD), Camposampiero (PD), Italy
| | - Marilena Di Napoli
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Napoli, Italy
| | - Lucia Fratino
- Department of Medical Oncology, Centro di Riferimento Oncologico (CRO) IRCCS, Aviano, Italy
| | - Daniele Santini
- UOC Oncologia Medica Territoriale, La Sapienza University, Polo Pontino, Roma, Italy
| | - Francesco Grillone
- Azienda Ospedaliero-Universitario "Mater Domini", Policlinico of Catanzaro, Catanzaro, Italy
| | | | | | - Francesco Atzori
- Department of Oncology, Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Monserrato, Italy
| | | | - Donata Sartori
- Department of Oncology, Ospedale di Mirano, Mirano, Italy
| | - Marco Maruzzo
- Oncology Unit 1, Department of Oncolgoy, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | - Francesco Pierantoni
- Oncology 1 Unit, Department of Oncology, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | | | | | - Chiara De Toni
- Oncology Unit 1, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | - Alvise Mattana
- Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | - Vittorina Zagonel
- Oncology Unit 1, Department of Oncology Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
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Stellato M, Buti S, Maruzzo M, Bersanelli M, Pierantoni F, De Giorgi U, Di Napoli M, Iacovelli R, Vitale MG, Ermacora P, Malgeri A, Maiorano BA, Prati V, Mennitto A, Cavo A, Santoni M, Carella C, Fratino L, Procopio G, Verzoni E, Santini D. Pembrolizumab Plus Axitinib for Metastatic Papillary and Chromophobe Renal Cell Carcinoma: NEMESIA (Non Clear MEtaStatic Renal Cell Carcinoma Pembrolizumab Axitinib) Study, a Subgroup Analysis of I-RARE Observational Study (Meet-URO 23a). Int J Mol Sci 2023; 24:ijms24021096. [PMID: 36674615 PMCID: PMC9862874 DOI: 10.3390/ijms24021096] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/30/2022] [Accepted: 01/03/2023] [Indexed: 01/09/2023] Open
Abstract
Non-clear cell renal cell carcinoma (nccRCC) represents a heterogeneous histological group which is 20-25% of those with renal cell carcinoma (RCC). Patients with nccRCC have limited therapeutic options due to their exclusion from phase III randomized trials. The aim of the present study was to investigate the effectiveness and tolerability of pembrolizumabaxitinib combination in chromophobe and papillary metastatic RCC (mRCC) patients enrolled in the I-RARE (Italian Registry on rAre genitor-uRinary nEoplasms) observational ongoing study (Meet-URO 23). Baseline characteristics, objective response rate (ORR), disease control rate (DCR) and progression-free survival (PFS) and toxicities were retrospectively and prospectively collected from nccRCC patients treated in 14 Italian referral centers adhering to the Meet-Uro group, from December 2020 to April 2022. Only patients with chromophobe and papillary histology were considered eligible for the present pre-specified analysis. There were 32 eligible patients who received pembrolizumab-axitinib as first-line treatment, of whom 13 (40%) had chromophobe histology and 19 (60%) were classified as papillary RCC. The DCR was 78.1% whereas ORR was 43.7% (11 patients achieved stable disease and 14 patients obtained partial response: 9/19 papillary, 5/13 chromophobe). Six patients (18.7%) were primary refractory. Median PFS was 10.8 months (95%CI 1.7-11.5). Eleven patients (34.3%) interrupted the full treatment due to immune-related adverse events (irAEs): G3 hepatitis (n = 5), G3 hypophisitis (n = 1), G3 diarrhea (n = 1), G3 pancreatitis (n = 1), G3 asthenia (n = 1). Twelve patients (37.5%) temporarily interrupted axitinib only due to persistent G2 hand-foot syndrome or G2 hypertension. Pembrolizumab-axitinib combination could be an active and feasible first-line treatment option for patients with papillary or chromophobe mRCC.
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Affiliation(s)
- Marco Stellato
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milano, Italy
| | - Sebastiano Buti
- Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy
- Medical Oncology Unit, University Hospital of Parma, 43126 Parma, Italy
| | - Marco Maruzzo
- Medical Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IOV-IRCCS, 35128 Padua, Italy
| | | | - Francesco Pierantoni
- Medical Oncology Unit 3, Department of Oncology, Istituto Oncologico Veneto IOV-IRCCS, 35128 Padua, Italy
| | - Ugo De Giorgi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, 47014 Meldola, Italy
| | - Marilena Di Napoli
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, 80131 Napoli, Italy
| | - Roberto Iacovelli
- Department of Medical Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS Roma, 00168 Roma, Italy
| | | | - Paola Ermacora
- Department of Oncology, University and General Hospital, 33100 Udine, Italy
| | - Andrea Malgeri
- Department of Medical Oncology, Fondazione Policlinico Campus Bio-Medico, 00128 Roma, Italy
| | - Brigida Anna Maiorano
- Oncology Unit, Foundation Casa Sollievo della Sofferenza IRCCS, 73013 San Giovanni Rotondo, Italy
| | - Veronica Prati
- Department of Medical Oncology, Ospedale Michele e Pietro Ferrero, Verduno—Azienda Sanitaria Locale CN2, Alba-Bra, 12060 Cuneo, Italy
| | - Alessia Mennitto
- SCDU Oncologia, “Maggiore della Carità” University Hospital, 28100 Novara, Italy
| | - Alessia Cavo
- SSD Oncologia Ospedale Villa Scassi, ASL 3 Genovese, 16149 Genova, Italy
| | | | - Claudia Carella
- SSD Oncologia Medica, IRCCS Istituto Tumori Giovanni Paolo II, 70124 Bari, Italy
| | - Lucia Fratino
- Division of Medical Oncology C, Centro di Riferimento Oncologico National Cancer Institute, 33081 Aviano, Italy
| | - Giuseppe Procopio
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milano, Italy
- Correspondence:
| | - Elena Verzoni
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milano, Italy
| | - Daniele Santini
- UOC of Medical Oncology, Sapienza Università di Roma, Polo Pontino, 00196 Latina, Italy
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Rebuzzi SE, Signori A, Stellato M, Santini D, Maruzzo M, De Giorgi U, Pedrazzoli P, Galli L, Zucali PA, Fantinel E, Carella C, Procopio G, Milella M, Boccardo F, Fratino L, Sabbatini R, Ricotta R, Panni S, Massari F, Sorarù M, Santoni M, Cortellini A, Prati V, Soto Parra H, Atzori F, Di Napoli M, Caffo O, Messina M, Morelli F, Prati G, Nolè F, Vignani F, Cavo A, Roviello G, Llaja Obispo MA, Porta C, Buti S, Fornarini G, Banna GL. The prognostic value of baseline and early variations of peripheral blood inflammatory ratios and their cellular components in patients with metastatic renal cell carcinoma treated with nivolumab: The Δ-Meet-URO analysis. Front Oncol 2022; 12:955501. [PMID: 36212433 PMCID: PMC9541611 DOI: 10.3389/fonc.2022.955501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 08/23/2022] [Indexed: 11/14/2022] Open
Abstract
Background Treatment choice for metastatic renal cell carcinoma (mRCC) patients is still based on baseline clinical and laboratory factors. Methods By a pre-specified analysis of the Meet-URO 15 multicentric retrospective study enrolling 571 pretreated mRCC patients receiving nivolumab, baseline and early dynamic variations (Δ) of neutrophil, lymphocyte, and platelet absolute cell counts (ACC) and their inflammatory ratios (IR) were evaluated alongside their association with the best disease response and overall (OS) and progression-free survival (PFS). Multivariable analyses on OS and PFS between baseline and Δ ACC and IR values were investigated with receiving operating curves-based cut-offs. Results The analysis included 422 mRCC patients. Neutrophil-to-lymphocyte ratio (NLR) increased over time due to consistent neutrophil increase (p < 0.001). Higher baseline platelets (p = 0.044) and lower lymphocytes (p = 0.018), increasing neutrophil Δ (p for time-group interaction <0.001), higher baseline IR values (NLR: p = 0.012, SII: p = 0.003, PLR: p = 0.003), increasing NLR and systemic immune-inflammatory index (SII) (i.e., NLR x platelets) Δ (p for interaction time-group = 0.0053 and 0.0435, respectively) were associated with disease progression. OS and PFS were significantly shorter in patients with baseline lower lymphocytes (p < 0.001 for both) and higher platelets (p = 0.004 and p < 0.001, respectively) alongside early neutrophils Δ (p = 0.046 and p = 0.033, respectively). Early neutrophils and NLR Δ were independent prognostic factors for both OS (p = 0.014 and p = 0.011, respectively) and PFS (p = 0.023 and p = 0.001, respectively), alongside baseline NLR (p < 0.001 for both) and other known prognostic variables. Conclusions Early neutrophils and NLR Δ may represent new dynamic prognostic factors with clinical utility for on-treatment decisions.
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Affiliation(s)
- Sara Elena Rebuzzi
- Medical Oncology Unit, Ospedale San Paolo, Savona, Italy
- Department of Internal Medicine and Medical Specialties (Di.M.I.), University of Genova, Genova, Italy
| | - Alessio Signori
- Department of Health Sciences, Section of Biostatistics, University of Genova, Genova, Italy
| | - Marco Stellato
- SS Oncologia Medica Genitourinaria, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Daniele Santini
- Department of Medical Oncology, Università Campus Bio-Medico of Roma, Rome, Italy
| | - Marco Maruzzo
- Oncology Unit 1, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
| | - Ugo De Giorgi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
| | - Paolo Pedrazzoli
- Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy
- Medical Oncology Unit, IRCCS Policlinico San Matteo, Pavia, Italy
| | - Luca Galli
- Medical Oncology Unit 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Paolo Andrea Zucali
- Department of Biomedical Sciences, Humanitas University, Milano, Italy
- Department of Oncology, IRCCS, Humanitas Clinical and Research Center, Milano, Italy
| | - Emanuela Fantinel
- Department of Oncology, Azienda Ospedaliera Universitaria Integrata di Verona, University of Verona, Verona, Italy
| | - Claudia Carella
- Division of Medical Oncology, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari, Italy
| | - Giuseppe Procopio
- SS Oncologia Medica Genitourinaria, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Michele Milella
- Department of Oncology, Azienda Ospedaliera Universitaria Integrata di Verona, University of Verona, Verona, Italy
| | - Francesco Boccardo
- Academic Unit of Medical Oncology, IRCCS Ospedale Policlinico San Martino of Genova, Genova, Italy
| | - Lucia Fratino
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano CRO-IRCCS, Aviano, Italy
| | - Roberto Sabbatini
- Medical Oncology Unit, Department of Oncology and Hemathology, University Hospital of Modena, Modena, Italy
| | | | - Stefano Panni
- Medical Oncology Unit, ASSTl– Istituti Ospitalieri Cremona Hospital, Cremona, Italy
| | - Francesco Massari
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | | | | | - Alessio Cortellini
- Department of Surgery and Cancer, Imperial College London, Faculty of Medicine, Hammersmith Hospital, London, United Kingdom
- Department of Biotechnology and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | - Veronica Prati
- Department of Medical Oncology, Ospedale Michele e Pietro Ferrero, Verduno, Italy
| | - Hector Josè Soto Parra
- Department of Oncology, Medical Oncology, University Hospital Policlinico-San Marco, Catania, Italy
| | - Francesco Atzori
- Medical Oncology Department, University Hospital, University of Cagliari, Cagliari, Italy
| | - Marilena Di Napoli
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Napoli, Italy
| | - Orazio Caffo
- Medical Oncology Department, Santa Chiara Hospital, Trento, Italy
| | - Marco Messina
- UOC Oncologia Medica, Istituto Fondazione G. Giglio, Cefalù, Italy
| | | | - Giuseppe Prati
- Department of Oncology and Advanced Technologies AUSL - IRCCS, Reggio Emilia, Italy
| | - Franco Nolè
- Medical Oncology Division of Urogenital and Head and Neck Tumors, IEO, European Institute of Oncology IRCCS, Milano, Italy
| | - Francesca Vignani
- Division of Medical Oncology, Ordine Mauriziano Hospital, Torino, Italy
| | - Alessia Cavo
- Oncology Unit, Villa Scassi Hospital, Genova, Italy
| | - Giandomenico Roviello
- Department of Health Sciences, Section of Clinical Pharmacology and Oncology, University of Firenze, Firenze, Italy
| | | | - Camillo Porta
- Interdisciplinary Department of Medicine, University of Bari “A. Moro”, Bari, Italy
- Division of Medical Oncology, A.O.U. Consorziale Policlinico di Bari, Bari, Italy
| | - Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- *Correspondence: Sebastiano Buti,
| | - Giuseppe Fornarini
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Giuseppe Luigi Banna
- Department of Oncology, Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom
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Stellato M, Buti S, Maruzzo M, Bersanelli M, Ermacora P, Maiorano B, Prati V, De Giorgi U, Pierantoni F, Malgeri A, Mennitto A, Cavo A, Vitale M, Santoni M, Carella C, Procopio G, Verzoni E, Santini D. 1462P Clinical outcome of patients with non-clear metastatic renal cell carcinoma treated with pembrolizumab-axitinib combination: NEMESIA (non-clear metastatic renal cell carcinoma pembrolizumab axitinib) study, a subgroup analysis of I-RARE observational study (Meet-URO 23a). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Tuninetti V, Ghisoni E, Pignata S, Picardo E, Raspagliesi F, Andreetta C, Maldi E, Artioli G, Mammoliti S, Roccio M, Sikokis A, Biglia N, Parisi A, Mandato V, Carella C, Cormio G, Marinaccio M, Scotto G, Di Maio M, Valabrega G. 590P Ki67 as a predictor of response to PARP inhibitors in platinum sensitive BRCA wild type ovarian cancers: MITO 37 retrospective study. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Iacovelli RR, Ciccarese C, Brunelli M, Battelli N, Buttigliero C, Caserta C, Buti S, Santini D, Carella C, Galli L, Verri E, Ermacora P, Merler S, Masini C, De Vivo R, Milesi L, Spina F, Rizzo M, Sperduti I, Fornarini G, Tortora G. First-line avelumab for patients with PD-L1-positive metastatic or locally advanced urothelial cancer who are unfit for cisplatin. Ann Oncol 2022; 33:1179-1185. [PMID: 35926813 DOI: 10.1016/j.annonc.2022.07.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/19/2022] [Accepted: 07/23/2022] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Cisplatin-based chemotherapy is the most recommended treatment for metastatic urothelial cancer (mUC). However, about 50% of patients are considered to be cisplatin ineligible. Anti-PD1/PD-L1 therapies have, nevertheless, increased the options available to clinicians and are especially valuable for treating these patients. This study therefore tested the activity and safety of avelumab as first-line therapy for mUC. PATIENTS AND METHODS Patients with mUC who were ineligible for cisplatin-based chemotherapy were screened centrally for PD-L1 expression and only those with a tumour proportion score (TPS) ≥5% were enrolled in the trial. The primary endpoint was 1-year overall survival (OS), and the secondary endpoints were median OS, median PFS, the ORR, the duration of the response, safety, and tolerability. All the survival rates were estimated with the Kaplan-Meier product-limit methodology and compared across groups using the log-rank test. RESULTS 198 patients were screened, with 71 (35.9%) whose PD-L1 expression was ≥5% enrolled in the study. The median age was 75 years, bladder cancer was the primary tumour in 73.2% of cases, and 25.3% had liver metastases. The main reasons for the cisplatin ineligibility were a low rate of creatinine clearance (< 60 ml/min), present in 70.4% of patients, and an ECOG performance status of 2, which affected 31%. The median OS was 10.0 months (95% CI, 5.5-14.5) and 43% of patients were alive at one year. A complete response was achieved in 8.5% of cases and 15.5% had a partial response. Adverse any-grade and high-grade events occurred in 49.3% and 8.5% of patients, respectively. A grade 3 infusion reaction was the only high-grade treatment-related adverse event. No treatment-related deaths were reported. CONCLUSIONS This ARIES trial confirmed the activity and safety of avelumab for treating mUC, adding a new therapy option to the armamentarium of checkpoint inhibitors already approved for platinum-ineligible, locally advanced/mUC.
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Affiliation(s)
- Roberto R Iacovelli
- Oncology Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.
| | - C Ciccarese
- Oncology Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - M Brunelli
- Department of Diagnostics and Public Health, Pathology Unit, Azienda Ospedaliera Universitaria Integrata di Verona, University of Verona, Verona, Italy
| | - N Battelli
- Oncologia Medica, Ospedale Generale Provinciale di Macerata, Macerata, Italy
| | - C Buttigliero
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - C Caserta
- Medical and Translational Oncology Unit, Azienda Ospedaliera Santa Maria, Terni
| | - S Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy and Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - D Santini
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy; UOC Oncologia medica, Università "La Sapienza". Polo Pontino, Latina, Italy
| | - C Carella
- Istituto tumori "Giovanni Paolo II, Bari, Italy
| | - L Galli
- Medical Oncology Unit 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - E Verri
- Medical Oncology Division of Urogenital and Head and Neck Tumors, European Institute of Oncology, Milan, Italy
| | - P Ermacora
- Dipartimento di Oncologia, Azienda Ospedaliero-Universitaria, Udine, Italy
| | - S Merler
- Section of Oncology, University of Verona - School of Medicine, Verona, Italy
| | - C Masini
- Oncology Unit, AUSL-IRCCS di Reggio Emilia
| | - R De Vivo
- Department of Oncology, San Bortolo General Hospital, Azienda ULSS8 Berica, Vicenza, Italy
| | - L Milesi
- Oncologia Medica Asst Papa Giovanni XXIII, Bergamo, Italy
| | - F Spina
- Department of Hematology, Oncology and Molecular Medicine, Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - M Rizzo
- Division of Translational Oncology, I.R.C.C.S. Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | - I Sperduti
- Biostatistical Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - G Fornarini
- IRCCS Ospedale Policlinico San Martino, UO Oncologia Medica 1, Genova, Italy
| | - G Tortora
- Oncology Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
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9
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Procopio G, Chiuri V, Giordano M, Alitto A, Maisano R, Bordonaro R, Cinieri S, Rossetti S, De Placido S, Airoldi M, Galli L, Gasparro D, Ludovico G, Guglielmini P, Carella C, Nova P, Aglietta M, Schips L, Beccaglia P, Sciarra A, Livi L, Santini D, Procopio G, Chiuri V, Mantini G, Roberto Bordonaro RM, Cinieri S, Rossetti S, De Placido S, Airoldi M, Galli L, Gasparro D, Ludovico GM, Guglielmini PF, Santini D, Naglieri E, Fagnani D, Aglietta M, Livi L, Schips L, Passalacqua R, Fiore M, D'Angelillo RM, Ceresoli GL, Magrini S, Rondonotti D, Mirone V, Ferriero MC, Sciarra A, Acquati M, Boccardo F, Scagliotti GV, Mencoboni M, De Giorgi U, Micheletti G, Lanzetta G, Sartori D, Carlini P, Soto Parra HJ, Battaglia M, Uricchio F, Bernardo A, De Lisa A, Carrieri G, Ardizzoia A, Aieta M, Pisconti S, Marchetti P, Paiar F. Real-world experience of abiraterone acetate plus prednisone in chemotherapy-naive patients with metastatic castration-resistant prostate cancer: long-term results of the prospective ABItude study. ESMO Open 2022; 7:100431. [PMID: 35405438 PMCID: PMC9058899 DOI: 10.1016/j.esmoop.2022.100431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 01/14/2022] [Accepted: 02/07/2022] [Indexed: 12/24/2022] Open
Abstract
Background Limited real-world data exist on the effectiveness and safety of abiraterone acetate plus prednisone (abiraterone hereafter) in the treatment of patients with metastatic castration-resistant prostate cancer (mCRPC) naive to chemotherapy. Most of the few available studies had a retrospective design and included a small number of patients. In the interim analysis of the ABItude study, abiraterone showed good clinical effectiveness and safety profile in the chemotherapy-naive setting over a median follow-up of 18 months. Patients and methods We evaluated clinical and patient-reported outcomes (PROs) of chemotherapy-naive mCRPC patients treated with abiraterone as for clinical practice in the Italian, observational, prospective, multicentric ABItude study. mCRPC patients were enrolled at abiraterone start (February 2016-June 2017) and followed up for 3 years; clinical endpoints and PROs, including quality of life (QoL) and pain, were prospectively collected. Kaplan–Meier curves were estimated. Results Of the 481 patients enrolled, 454 were assessable for final study analyses. At abiraterone start, the median age was 77 years, with 58.6% elderly patients and 69% having at least one comorbidity (57.5% cardiovascular diseases). Visceral metastases were present in 8.4% of patients. Over a median follow-up of 24.8 months, median progression-free survival (any progression reported by the investigators), time to abiraterone discontinuation, and overall survival were, respectively, 17.3 months [95% confidence interval (CI) 14.1-19.4 months], 16.0 months (95% CI 13.1-18.2 months), and 37.3 months (95% CI 36.5 months-not estimable); 64.2% of patients achieved ≥50% reduction in prostate-specific antigen. QoL assessed by Functional Assessment of Cancer Therapy—Prostate, the European Quality of Life 5 Dimensions 3 Level, and European Quality of Life Visual Analog Scale remained stable during treatment. Median time to pain progression according to Brief Pain Inventory data was 31.1 months (95% CI 24.8 months-not estimable). Sixty-two patients (13.1%) had at least one adverse drug reaction (ADR) and 8 (1.7%) one serious ADR. Conclusion With longer follow-up, abiraterone therapy remains safe, well tolerated, and active in a large unselected population. A prospective real-life study of abiraterone acetate in mCRPC patients. In 481 chemotherapy-naive mCRPC patients (median follow-up: 25 months), abiraterone plus prednisone was effective and safe. QoL, measured with various tools, remained stable during treatment with abiraterone plus prednisone. The median time to pain progression was 31.1 months.
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10
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Roviello G, Gambale E, Giorgione R, Santini D, Stellato M, Fornarini G, Rebuzzi SE, Basso U, Bimbatti D, Doni L, Nesi G, Bersanelli M, Buti S, De Giorgi U, Galli L, Sbrana A, Conca R, Carella C, Naglieri E, Pignata S, Procopio G, Antonuzzo L. Effect of systemic therapies or best supportive care after disease progression to both nivolumab and cabozantinib in metastatic renal cell carcinoma: The Meet-Uro 19BEYOND study. Cancer Med 2022; 11:3084-3092. [PMID: 35312175 PMCID: PMC9385587 DOI: 10.1002/cam4.4681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/16/2022] [Accepted: 02/24/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Nivolumab and cabozantinib are currently approved agents in metastatic renal cell carcinoma (mRCC) but there are no data available for patients progressing to both treatments. The aim of this study was to compare active therapeutic options and best supportive care (BSC) after progression to nivolumab and cabozantinib in mRCC. METHODS In this retrospective study, we selected 50 patients from eight Italian centers. The primary endpoint of the study was the overall survival (OS) of patients on active treatment versus BSC. Secondary endpoints were the progression-free survival (PFS) and objective response rate (ORR). The efficacy of active therapy was also investigated. RESULTS After progression to both nivolumab and cabozantinib, 57.1% of patients were given active treatment (mainly everolimus and sorafenib) while 42.9% received BSC. The median OS was 13 months (95% CI: 4-NR) in actively treated patients and 3 months (95% CI: 2-4) in BSC patients (p = 0.001). Patients treated with sorafenib had better disease control than those treated with everolimus (stable disease: 71.4% vs. 16.7%, progression disease: 14.3% vs. 58.3%; p = 0.03), with no significant differences in PFS (5 and 3 months, 95% CI: 1-6 vs. 2-5; p = 0.6) and OS (12 and 4 months, 95% CI: 3-NR vs. 2-NR; p = 0.2). CONCLUSION After treatment with both nivolumab and cabozantinib, the choice of a safe active systemic therapy offered better outcomes than BSC.
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Affiliation(s)
| | | | | | - Daniele Santini
- Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
| | - Marco Stellato
- Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
| | - Giuseppe Fornarini
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino di Genova, Genoa, Italy
| | - Sara Elena Rebuzzi
- Medical Oncology Unit, San Paolo General Hospital, Savona, Italy.,Department of Internal Medicine and Medical Specialties (Di.M.I.), University of Genova, Genoa, Italy
| | - Umberto Basso
- MedicalOncology Unit 1, Istituto Oncologico Veneto IOV IRCCS, Padua, Italy
| | - Davide Bimbatti
- MedicalOncology Unit 1, Istituto Oncologico Veneto IOV IRCCS, Padua, Italy
| | - Laura Doni
- Medical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - Gabriella Nesi
- Department of Health Sciences, University of Florence, Florence, Italy
| | | | - Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Ugo De Giorgi
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Italy
| | - Luca Galli
- Medical Oncology Unit 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Andrea Sbrana
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Raffaele Conca
- Division of Medical Oncology, Department of Onco-Hematology, IRCCS-CROB, Referral Cancer Center of Basilicata, Rionero in Vulture, Italy
| | | | | | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy
| | - Giuseppe Procopio
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Lorenzo Antonuzzo
- Medical Oncology Unit, Careggi University Hospital, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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11
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Vignani F, Tambaro R, De Giorgi U, Giannatempo P, Bimbatti D, Carella C, Stellato M, Atzori F, Aieta M, Masini C, Hamzaj A, Ermacora P, Veccia A, Pignata S, Lolli C, Procopio G, Pierantoni F, Zonno A, Santini D, Di Maio M. Randomized phase II study of niraparib plus best supportive care (BSC) versus BSC alone as maintenance treatment in patients with advanced urothelial carcinoma (UC) whose disease did not progress after first-line platinum-based chemotherapy (PBCT): The Meet-URO12 trial. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.6_suppl.442] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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
442 Background: Niraparib is an oral inhibitor of poly ADP-ribose polymerase (PARP) enzymes. Based on the association of mutations in homologous recombination repair (HRR) genes with platinum sensitivity, aim of this phase II trial was to compare maintenance treatment with niraparib plus BSC vs. BSC alone in pts with advanced UC who obtain objective response (OR) or stable disease (SD) with first-line PBCT. Methods: Meet-URO12 is a randomized phase II multicentre trial enrolling pts with advanced transitional cell UC, without evidence of progression after 4-6 cycles of first-line PBCT (cisplatin or carboplatin). Pts were randomized (2:1) to experimental arm A (niraparib 300 or 200 mg daily according to body weight and baseline platelets, plus BSC) or control arm B (BSC alone). Primary endpoint was progression-free survival (PFS). 77 pts were planned and 65 PFS events were needed to detect Hazard Ratio 0.57, with 80% power and one-tailed alpha 0.1. Accrual was prematurely stopped due to availability of avelumab in the same setting, and protocol was amended to perform analysis with ≥ 40 PFS events. Molecular characteristics, including alteration of HRR genes, were assessed in formalin-fixed paraffin-embedded tumour samples using the FoundationOne CDx assay. Results: Between Aug 2019 and Mar 2021, 58 pts were randomized in 14 Italian centers (39 assigned to arm A and 19 to arm B); 1 pt assigned to arm A did never start niraparib. Median age was 69y (44-84); ECOG PS0 65.5%/ PS1 34.5%; best response with PBCT OR 55.2%/ SD 44.8%. As of Aug 2021, after a median follow-up of 8.5 mos, 47 PFS events were recorded. Median PFS was 2.1 mos in arm A and 2.4 mos in arm B (HR 0.92; 95%CI 0.49 – 1.75, p=0.81). 6-months progression-free rate was 28.2% and 26.3%, respectively. Time to treatment failure for pts who started niraparib was 2.4 mos. Out of 47 pts with molecular info, 21 (44.7%) had HRR alterations: 6 (12.8%) known pathogenic mutations and 15 (31.9%) variants of unknown significance. In pts with pathogenic mutations, median PFS was 2.0 mos in arm A and 1.9 mos in arm B. In pts with any HRR mutation, median PFS was 2.0 mos in arm A and 2.0 mos in arm B. Any grade≥3 treatment-emergent adverse event (AE) was reported in 25/38 pts (65.8%) in arm A and in 3/19 pts (15.8%) in arm B. 18/38 pts (47.4%) needed dose reduction of niraparib. Most common AEs with niraparib were anemia (50.0%, G3 10.5%), thrombocytopenia (36.8%, G3-4 15.8%), neutropenia (21.1%, G3 5.3%), fatigue (31.6%, G3 15.8%), constipation (31.6%, G3 2.6%), mucositis (13.2%, G3 2.6%), nausea (13.2%, G3 2.6%). Conclusions: Maintenance niraparib plus BSC did not prolong PFS, as compared with BSC alone, among pts with urothelial cancer without progression after first-line PBCT. Clinicaltrials.gov Identifier. NCT03945084. Clinical trial information: NCT03945084.
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Affiliation(s)
| | - Rosa Tambaro
- Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy
| | - Ugo De Giorgi
- IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Italy
| | | | - Davide Bimbatti
- Medical Oncology 1 Unit, Department of Oncology, Istituto Oncologico Veneto IOV IRCCS, Padua, Italy
| | | | - Marco Stellato
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Francesco Atzori
- Medical Oncology Department, University Hospital, University of Cagliari, Cagliari, Italy
| | - Michele Aieta
- IRCCS Centro di Riferimento Oncologico della Basilicata, Rionero in Vulture (Potenza), Italy
| | | | | | - Paola Ermacora
- Presidio Ospedaliero Universitario Santa Maria della Misericordia, Azienda Sanitaria Universitaria Integrata Friuli Centrale, Udine, Italy
| | | | - Sandro Pignata
- Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy
| | - Cristian Lolli
- IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Italy
| | | | - Francesco Pierantoni
- Medical Oncology 1 Unit, Department of Oncology, Istituto Oncologico Veneto IOV IRCCS, Padua, Italy
| | - Antonia Zonno
- IRCCS Istituto Oncologico Giovanni Paolo II, Bari, Italy
| | - Daniele Santini
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Massimo Di Maio
- AO Ordine Mauriziano-Department of Oncology, University of Turin, Turin, Italy
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12
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Petrisli E, Carella C, Navarro A, Fehily D, Strong DM, Cardillo M. Vigilance for Medical Products of Human Origin-Progress on the Notify Library's Global Effort to Share Information and Learning. Transplantation 2021; 105:1921-1929. [PMID: 33449611 PMCID: PMC8376274 DOI: 10.1097/tp.0000000000003589] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/29/2020] [Accepted: 10/30/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND World Health Assembly Resolution 63.22 mandated World Health Organization to facilitate Member State access to appropriate information on medical products of human origin (MPHO), including collecting data on serious adverse events and reactions. To meet this challenge, the Italian National Transplant Center, with a mandate from World Health Organization, has built and maintained an open-access searchable database of instructive records on disease transmission and other MPHO adverse occurrences. METHODS One record in the Notify Library describes a specific type of adverse occurrence in 1 type of MPHO and might be linked with 1 or multiple different references. The record inclusion criteria are that it has been reliably documented in a published article or official vigilance reporting system and that it has instructive value for the fields of transfusion, transplantation, or assisted reproduction. The selection and review of references for publication is performed by international experts who collaborate in 5 topic-specific editorial groups: infection transmission, malignancy transmission, living-donor reactions, process-related incidents, and clinical complications. New relevant references are identified through systematic searches and proactive communication by the experts. RESULTS The Library contains 1733 records, quoting 2632 references. Of the records, 41.8% are related to organs, 20.8% to blood and blood components, 16.5% to hematopoietic progenitor cells, 15.2% to tissues, 4.2% to reproductive tissues and cells, and 1.5% to other MPHO. CONCLUSIONS Notify Library is the first open-access, searchable database of systematically identified reports of disease transmission and other adverse occurrences arising from the donation and clinical application of MPHO.
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Affiliation(s)
- Evangelia Petrisli
- Operative Unit of Microbiology and Virology, Department of Specialized, Experimental, and Diagnostic Medicine, IRCCS St Orsola-Malpighi Polyclinic, University of Bologna, Bologna, Italy
| | - Claudia Carella
- National Transplant Centre, Istituto Superiore di Sanità, Rome, Italy
| | - Aurora Navarro
- Department of Biovigilance, Catalan Transplant Organization, Health Department, Generalitat of Catalonia, Barcelona, Spain
| | - Deirdre Fehily
- National Transplant Centre, Istituto Superiore di Sanità, Rome, Italy
- Directorate General for Health and Food Safety, European Commission, Brussels, Belgium (seconded from the Italian National Transplant Centre, Rome, Italy)
| | - Douglas Michael Strong
- Department of Orthopaedics and Sports Medicine, University of Washington School of Medicine, Seattle, WA
| | - Massimo Cardillo
- National Transplant Centre, Istituto Superiore di Sanità, Rome, Italy
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13
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Cecere SC, Musacchio L, Bartoletti M, Salutari V, Arenare L, Lorusso D, Ronzino G, Lauria R, Cormio G, Naglieri E, Scollo P, Marchetti C, Raspagliesi F, Greggi S, Cinieri S, Bergamini A, Orditura M, Valabrega G, Scambia G, Martinelli F, De Matteis E, Cardalesi C, Loizzi V, Perniola G, Carella C, Scandurra G, Giannone G, Pignata S. Cytoreductive surgery followed by chemotherapy and olaparib maintenance in BRCA 1/2 mutated recurrent ovarian cancer: a retrospective MITO group study. Int J Gynecol Cancer 2021; 31:1031-1036. [PMID: 33990353 DOI: 10.1136/ijgc-2020-002343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 04/06/2021] [Accepted: 04/08/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The role of cytoreductive surgery in the poly-ADP ribose polymerase inhibitors era is not fully investigated. We evaluated the impact of surgery performed prior to platinum-based chemotherapy followed by olaparib maintenance in platinum-sensitive BRCA-mutated recurrent ovarian cancer. METHODS This retrospective study included platinum-sensitive recurrent ovarian cancer BRCA-mutated patients from 13 Multicenter Italian Trials in Ovarian cancer and gynecological malignancies centers treated between September 2015 and May 2019. The primary outcomes were progression-free survival and overall survival. Data on post-progression treatment was also assessed. RESULTS Among 209 patients, 72 patients (34.5%) underwent cytoreductive surgery followed by platinum-based chemotherapy and olaparib maintenance, while 137 patients (65.5%) underwent chemotherapy treatment alone. After a median follow-up of 37.3 months (95% CI: 33.4 to 40.8), median progression-free survival in the surgery group was not reached, compared with 11 months in patients receiving chemotherapy alone (P<0.001). Median overall survival was nearly double in patients undergoing surgery before chemotherapy (55 vs 28 months, P<0.001). Post-progression therapy was assessed in 127 patients: response rate to chemotherapy was 29.2%, 8.8%, and 9.0% in patients with platinum-free interval >12 months, between 6 and 12 months, and <6 months, respectively. CONCLUSION Cytoreductive surgery performed before platinum therapy and olaparib maintenance was associated with longer progression-free survival and overall survival in BRCA-mutated platinum-sensitive relapsed ovarian cancer patients. In accordance with our preliminary results, the response rate to chemotherapy given after progression during olaparib was associated with platinum-free interval.
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Affiliation(s)
- Sabrina Chiara Cecere
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy
| | - Lucia Musacchio
- Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy.,Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, Sapienza, University of Rome, Rome, Italy
| | - Michele Bartoletti
- Unit of Medical Oncology and Cancer Prevention, Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano, CRO, Aviano, Italy.,Department of Medicine, University of Udine, Udine, Italy
| | - Vanda Salutari
- Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Laura Arenare
- Clinical Trial Unit, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
| | - Domenica Lorusso
- Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy.,Department of Life Science and Public Health, Catholic University of Sacred Heart, Largo Agostino Gemelli, Rome, Italy.,Gynecologic Oncology Unit, Fondazione Istituto Nazionale Tumori IRCCS, Milan, Italy
| | | | - Rossella Lauria
- Division of Medical Oncology, Azienda Ospedaliera Universitaria Federico II, Napoli, Campania, Italy
| | - Gennaro Cormio
- Gynecologic Oncology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy
| | - Emanuele Naglieri
- Medical Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Paolo Scollo
- Medical Oncology Unit, Cannizzaro Hospital, Catania, Italy
| | - Claudia Marchetti
- Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | | | - Stefano Greggi
- Gynecologic Oncology, National Cancer Institute, Institute for Hospitalization and Care Scientific Foundation Pascale, Napoli, Campania, Italy
| | - Saverio Cinieri
- Division of Medical Oncology, Ospedale "Senatore Antonio Perrino", Brindisi, Brindisi, Italy
| | - Alice Bergamini
- Department of Obstetrics and Gynecology, IRCCS, San Raffaele Hospital, Milan, Italy.,Università Vita Salute San Raffaele, Milan, Italy
| | - Michele Orditura
- Università degli Studi della Campania Luigi Vanvitelli, Napoli, Campania, Italy
| | - Giorgio Valabrega
- Candiolo Cancer Institute, FPO- IRCCS, Candiolo (TO), Italy.,Department of Oncology, University of Turin, Torino, Piemonte, Italy
| | - Giovanni Scambia
- Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy.,Department of Life Science and Public Health, Catholic University of Sacred Heart, Largo Agostino Gemelli, Rome, Italy
| | - Fabio Martinelli
- Gynecologic Oncology Unit, Fondazione Istituto Nazionale Tumori IRCCS, Milan, Italy
| | | | - Cinzia Cardalesi
- Division of Medical Oncology, Azienda Ospedaliera Universitaria Federico II, Napoli, Campania, Italy
| | - Vera Loizzi
- Gynecologic Oncology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy
| | - Giorgia Perniola
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, Sapienza, University of Rome, Rome, Italy
| | - Claudia Carella
- Interventional Oncology Unit with Integrated Section of Translational Medical Oncology, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | | | - Gaia Giannone
- Candiolo Cancer Institute, FPO- IRCCS, Candiolo (TO), Italy.,Department of Oncology, University of Turin, Torino, Piemonte, Italy
| | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy
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14
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Ranieri G, Laface C, Fazio V, De Ceglia D, Macina F, Gisone V, Porcelli M, Vinciarelli G, Carella C, Molinari P, Laricchia G, Laforgia M, Gadaleta Cosmo D. Local treatment with deep percutaneous electrochemotherapy of different tumor lesions: pain relief and objective response results from an observational study. Eur Rev Med Pharmacol Sci 2021; 24:7764-7775. [PMID: 32744703 DOI: 10.26355/eurrev_202007_22279] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The aim of this investigation focuses on the evaluation of the efficacy of deep-seated Electrochemotherapy (ECT) in terms of pain relief and local objective response, in pre-treated patients with neither further available pharmacological treatments nor eligible for surgery. PATIENTS AND METHODS Deep percutaneous ECT has been performed in 20 patients subjected to systemic anaesthesia. Bleomycin was administrated intravenously before the application of the electrical pulses on the target area, employing multiple single needles depending on the size and location of the target tumor. RESULTS Pain assessment based on Visual Analogue Scale showed significant pain relief one month after treatment in all patients, reducing from 7.5 to 3 as a median value (p-value at Wilcoxon test <0.001). Local symptom-free survival median value was 5.5 months. At the first follow-up (1-2 months), a local disease control rate (LDCR) was observed in 19/20 (95%) patients: complete responses in 2 (10%), partial responses in 8 (40%) and stable disease in 9 (45%). Local progression-free survival median value was 5.7 months. Overall, no major adverse effects were observed. CONCLUSIONS Our study indicates that deep percutaneous ECT can produce a significant pain reduction and a high LDCR in different tumor lesions, for anatomical site or histotype. In particular, ECT has demonstrated to be effective in various histotypes and deep-seated tumor lesions never treated before by this approach giving a new chance to physicians for reducing oncological pain in patients not eligible to other therapeutic routes. The innovative peculiarity of our study was the successful application of deep percutaneous ECT on adrenal metastasis, malignant pleural mesothelioma, uterine leiomyosarcoma and the uncommon case of a male müllerian tumor.
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Affiliation(s)
- G Ranieri
- Interventional and Medical Oncology Unit, and Pharmacy Unit; IRCCS Istituto Tumori "G. Paolo II", Bari, Italy.
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15
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Giorgione R, Santini D, Stellato M, Basso U, Bimbatti D, Palmieri VE, Doni L, Antonuzzo L, Bersanelli M, Buti S, De Giorgi U, Galli L, Sbrana A, Conca R, Carella C, Naglieri E, Mini E, Pignata S, Procopio G, Roviello G. Active therapy or best supportive care after disease progression to both nivolumab and cabozantinib in metastatic renal cell carcinoma: The BEYOND study (Meet-Uro 19). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.6_suppl.319] [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
319 Background: Nivolumab is approved in the second or further line of treatment for patients with metastatic renal cell carcinoma (mRCC); cabozantinib is approved in a similar setting of patients. Unfortunately, no evidence is currently available regarding the best treatment option after disease progression to both nivolumab and cabozantinib. The aim of this study is to compare the treatment choices after progression to nivolumab and cabozantinib including patients followed in best supportive care (BSC) or active therapy. Methods: In this retrospective observational study, we selected 42 patients from 8 Italian cancer centers. Enrolled patients had progressed to both nivolumab and cabozantinib and subsequently referred to active treatment or BSC. Primary endpoint of the study was the OS of patients on active treatment versus BSC. Secondary endpoints were ORR, PFS and OS of patients on active treatment who received sorafenib versus everolimus. Results: The median age was 65 years, 76.2% were male. The majority of patients had undergone nephrectomy (78.6%), had clear cell histology (83%) and were at intermediate-poor risk at the diagnosis (85.7%). The most frequent site of metastatic disease in the general population and in patients referred to BSC was the lung (73.8% and 88.9%, respectively). For patients referred to active treatment, the most frequent site of metastasis was bone (70.8%). Sunitinib (71.4%), nivolumab (64.3%), and cabozantinib (54.7%) were the most commonly used drugs in the I, II and III lines of treatment, respectively. After progression to both nivolumab and cabozantinib 42.9% of patients were referred to BSC, while 57.1% received active treatment (28.6% everolimus, 16.7% sorafenib, 4.8% sunitinib, 4.8% IL2-HD, 2.4% lenvatinib + everolimus). Median OS was 13 (95% CI: 4-NR) and 3 months (95% CI: 2-4) in patients on active treatment versus BSC ( p=0.001). Patients treated with sorafenib had better disease control when compared with those treated with everolimus (SD 71.4% versus 16.7%, PD 14.3% versus 58.3%; p=0.03), but no significant advantage in terms of PFS (5 versus 3 months, 95% CI: 2-6 versus 2-5; p= 0.5) and OS (NR versus 13 months, 95% CI: 3-NR versus 2-NR; p=0.2) was observed. Conclusions: After treatment with both nivolumab and cabozantinib, when possible, the choice of an active treatment seems to produce an OS advantage when compared with BSC. However, although sorafenib seems to demonstrate better results, we cannot indicate which is the drug of choice, as no significant advantage was shown in terms of OS or PFS from the comparison between sorafenib and everolimus. The limitations of this study are given by the size of the sample examined and its retrospective nature. Further studies are needed to confirm whether active treatment choice is associated with improved OS.
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Affiliation(s)
- Roberta Giorgione
- School of Human Health Sciences, University of Florence, Florence, Italy
| | - Daniele Santini
- Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
| | - Marco Stellato
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Umberto Basso
- Medical Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IOV IRCCS, Padua, Italy
| | - Davide Bimbatti
- Medical Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IOV IRCCS, Padua, Italy
| | | | - Laura Doni
- Clinical Oncology Unit, Careggi Hospital, University of Florence, Florence, Italy
| | - Lorenzo Antonuzzo
- Clinical Oncology Unit, Careggi Hospital, University of Florence, Florence, Italy
| | | | - Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Ugo De Giorgi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola, Italy
| | - Luca Galli
- Medical Oncology Unit 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Andrea Sbrana
- Medical Oncology Unit 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Raffaele Conca
- Unit of Medical Oncology, Department of Onco-Hematology, IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture (PZ), Italy
| | | | | | - Enrico Mini
- Department of Health Sciences, Section of Clinical Pharmacology and Oncology, University of Florence, Florence, Italy
| | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy
| | - Giuseppe Procopio
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giandomenico Roviello
- Department of Health Sciences, Section of Clinical Pharmacology and Oncology, University of Florence, Florence, Italy
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16
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Cecere SC, Giannone G, Salutari V, Arenare L, Lorusso D, Ronzino G, Lauria R, Cormio G, Carella C, Scollo P, Ghizzoni V, Raspagliesi F, Di Napoli M, Mazzoni E, Marchetti C, Bergamini A, Orditura M, Valabrega G, Scambia G, Maltese G, De Matteis E, Cardalesi C, Loizzi V, Boccia S, Naglieri E, Scandurra G, Pignata S. Olaparib as maintenance therapy in patients with BRCA 1–2 mutated recurrent platinum sensitive ovarian cancer: Real world data and post progression outcome. Gynecol Oncol 2020; 156:38-44. [DOI: 10.1016/j.ygyno.2019.10.023] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/17/2019] [Accepted: 10/19/2019] [Indexed: 11/25/2022]
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17
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Naglieri E, Niccoli Asabella A, Nappi AG, Carella C, Ferrari C, Rubini G. Heterogeneous response to target therapy in metastatic papillary renal cell carcinoma evaluated by morphologic and metabolic multimodality imaging: A case report. Medicine (Baltimore) 2019; 98:e18093. [PMID: 31852068 PMCID: PMC6922556 DOI: 10.1097/md.0000000000018093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
RATIONALE Papillary renal cell carcinoma (PRCC) accounts for about 15% to 20% of renal cell carcinoma and is histologically distinguished in type I and type II. The last one is associated with poorer prognosis.Treatment options for PRCC patients are surgery, immunotherapy, revolutionized by Nivolumab, and other target-therapy with an improvement in overall survival. Heterogenous response and a pseudo-progression may be observed in the initial phase of biological treatment that could induce premature discontinuation. PATIENT CONCERNS We present the case of a 44-year-old woman with left cervical palpable mass increased in size and without concomitant disease or previous surgery. DIAGNOSIS Neck ultrasonography, contrast-enhanced Computed Tomography, and 18F-FDG PET/CT were performed with the detection of lymph nodes involvement and a left renal lesion. INTERVENTIONS The patients underwent left radical nephrectomy and homolateral cervical and para-aortic lymphadenectomy, with histological diagnosis of PRCC, type II. After disease relapse, the inter-aortocaval lymph node was laparoscopically removed. Following the detection of further disease relapse in several lymph nodes and the lung, several lines of target-therapy were started; then disease progression and worsening of clinical and hematological status led us to start Nivolumab as last-line therapy. OUTCOMES A heterogeneous response to therapies was documented with morphological and nuclear medicine imaging, however the concomitant deterioration of performance status and liver function led to discontinuation of Nivolumab; then the patient died, 30 months after diagnosis. LESSONS Here we describe the clinical case and radiological and nuclear medicine imaging investigations performed by our patient, highlighting that 18F-FDG PET/CT shows greater adequacy in assessing the response to therapy, avoiding premature drug discontinuation, and ensuring better management of a patient with advanced PRCC.
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Affiliation(s)
| | - Artor Niccoli Asabella
- Nuclear Medicine Unit, Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, Bari, Italy
| | - Anna Giulia Nappi
- Nuclear Medicine Unit, Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, Bari, Italy
| | - Claudia Carella
- Medical Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”
| | - Cristina Ferrari
- Nuclear Medicine Unit, Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, Bari, Italy
| | - Giuseppe Rubini
- Nuclear Medicine Unit, Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, Bari, Italy
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18
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Lomero M, Gardiner D, Coll E, Haase‐Kromwijk B, Procaccio F, Immer F, Gabbasova L, Antoine C, Jushinskis J, Lynch N, Foss S, Bolotinha C, Ashkenazi T, Colenbie L, Zuckermann A, Adamec M, Czerwiński J, Karčiauskaitė S, Ström H, López‐Fraga M, Dominguez‐Gil B, Sarkissian A, Liashchuk S, Tsvetkova E, Bušić M, Michael N, Ilkjaer LB, Dmitriev P, Makisalo H, Rahmel A, Tomadze G, Ioannis B, Mihály S, Carella C, Codreanu I, Jansen N, Konijn C, França A, Zota V, Žilinská Z, Avsec D, Gautier S, Sánchez‐Ibáñez J, Terrón C, Vidal C, Beyeler F, Weiss J, Ilbars T, Forsythe J, Johnson R, Enckevort A. Donation after circulatory death today: an updated overview of the European landscape. Transpl Int 2019; 33:76-88. [DOI: 10.1111/tri.13506] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 05/28/2019] [Accepted: 08/26/2019] [Indexed: 01/03/2023]
Affiliation(s)
- Mar Lomero
- European Directorate for the Quality of Medicines & Healthcare/Council of Europe Strasbourg France
| | - Dale Gardiner
- National Clinical Lead for Organ Donation NHS Blood and Transplant Watford UK
| | | | | | - Francesco Procaccio
- Italian National Transplant Centre Italian National Institute of Health Rome Italy
| | - Franz Immer
- Swisstransplant The Swiss National Foundation for Organ Donation and Transplantation Bern Switzerland
| | - Lyalya Gabbasova
- Ministry of Health of the Russian Federation Moscow Russian Federation
| | | | | | - Nessa Lynch
- Organ Donation Transplant Ireland Dublin Ireland
| | | | - Catarina Bolotinha
- National Transplantation Coordination Instituto Português do Sangue e da Transplantação Lisboa Portugal
| | - Tamar Ashkenazi
- Israel Transplant Center State of Israel Ministry of Health Tel‐Aviv Israel
| | - Luc Colenbie
- DG Health Care Organs Embryo's and Bio‐Ethics Brussels Belgium
| | | | - Miloš Adamec
- Koordinační Středisko Transplantací Prague Czech Republic
| | | | - Sonata Karčiauskaitė
- National Transplant Bureau Under the Ministry of Health of the Republic Lithuania Vilnius Lithuania
| | - Helena Ström
- Department for Knowledge‐Based Policy of Health Care National Donation Centre Stockholm Sweden
| | - Marta López‐Fraga
- European Directorate for the Quality of Medicines & Healthcare/Council of Europe Strasbourg France
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19
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Tommasi S, Pilato B, Carella C, Lasorella A, Danza K, Vallini I, De Summa S, Naglieri E. Standardization of CTC AR-V7 PCR assay and evaluation of its role in castration resistant prostate cancer progression. Prostate 2019; 79:54-61. [PMID: 30141201 DOI: 10.1002/pros.23710] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 08/06/2018] [Indexed: 11/11/2022]
Abstract
BACKGROUND Castration resistant prostate cancer (CRPC) represents the most aggressive status of this neoplastic disease, also characterized by the absence of biomarkers predictive of clinical outcome. New drugs as abiraterone or enzalutamide, affecting androgen receptor pathway at different levels, inhibit the proliferative advantage of prostate cancer cells with important long term benefits. Despite the advantages of this second-generation androgen deprivation therapy (ADT), resistance mechanisms, primitive or acquired, often develop. The existence of androgen receptor (AR) splice variants (AR-Vs), in particular AR-V7 expression detected in circulating tumor cells (CTCs), represents an example of acquired resistance, as evidenced in preclinical and clinical studies. Recent studies also have suggested the role of AR-V7 as a prognostic biomarker in mCRPC. In this field, hot topics are the methodology used to isolate CTC and the assay for AR-V7 measurement. Our study aims to develop a standardized operating procedure (SOP) to evaluate AR-V7 in CRPC. METHOD The application of a realized cell based Reference Sample as Standardized Quality Control tool for CTC-AR-V7 assay has been shown. Then the development, the performance evaluation and contextualization in a clinical setting of this standardized operating procedure (SOP) have been reported to evaluate the prognostic biomarker AR-V7 in metastatic prostate cancer. RESULTS AND CONCLUSIONS The standardized procedure has high sensitivity and specificity and enables the detection and quantification of the spliced variant with respect to the full length AR (AR-FL) mRNA in CTC DNA purified from the blood of patients with CRPC. This procedure has been further validated in a consecutive series of patients with mCRPC, confirming its role as prognostic biomarker.
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MESH Headings
- Aged
- Aged, 80 and over
- Biomarkers, Tumor/blood
- Biomarkers, Tumor/genetics
- Cell Line, Tumor
- Disease Progression
- Follow-Up Studies
- Humans
- Male
- Middle Aged
- Neoplastic Cells, Circulating/metabolism
- Polymerase Chain Reaction/standards
- Prostatic Neoplasms, Castration-Resistant/blood
- Prostatic Neoplasms, Castration-Resistant/diagnosis
- Prostatic Neoplasms, Castration-Resistant/genetics
- Protein Isoforms/blood
- Protein Isoforms/genetics
- Receptors, Androgen/blood
- Receptors, Androgen/genetics
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Affiliation(s)
- Stefania Tommasi
- Molecular Diagnostics and Pharmacogenetics Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Brunella Pilato
- Molecular Diagnostics and Pharmacogenetics Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Claudia Carella
- Medical Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Antonia Lasorella
- Molecular Diagnostics and Pharmacogenetics Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
- Bird srl, R&D Facility, Rezzato, Italy
| | - Katia Danza
- Molecular Diagnostics and Pharmacogenetics Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | | | - Simona De Summa
- Molecular Diagnostics and Pharmacogenetics Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Emanuele Naglieri
- Medical Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
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20
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Palmirotta R, Carella C, Silvestris E, Cives M, Stucci SL, Tucci M, Lovero D, Silvestris F. SNPs in predicting clinical efficacy and toxicity of chemotherapy: walking through the quicksand. Oncotarget 2018; 9:25355-25382. [PMID: 29861877 PMCID: PMC5982750 DOI: 10.18632/oncotarget.25256] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 04/07/2018] [Indexed: 12/19/2022] Open
Abstract
In the "precision medicine" era, chemotherapy still remains the backbone for the treatment of many cancers, but no affordable predictors of response to the chemodrugs are available in clinical practice. Single nucleotide polymorphisms (SNPs) are gene sequence variations occurring in more than 1% of the full population, and account for approximately 80% of inter-individual genomic heterogeneity. A number of studies have investigated the predictive role of SNPs of genes enrolled in both pharmacodynamics and pharmacokinetics of chemotherapeutics, but the clinical implementation of related results has been modest so far. Among the examined germline polymorphic variants, several SNPs of dihydropyrimidine dehydrogenase (DPYD) and uridine diphosphate glucuronosyltransferases (UGT) have shown a robust role as predictors of toxicity following fluoropyrimidine- and/or irinotecan-based treatments respectively, and a few guidelines are mandatory in their detection before therapy initiation. Contrasting results, however, have been reported on the capability of variants of other genes as MTHFR, TYMS, ERCC1, XRCC1, GSTP1, CYP3A4/3A5 and ABCB1, in predicting either therapy efficacy or toxicity in patients undergoing treatment with pyrimidine antimetabolites, platinum derivatives, irinotecan and taxanes. While formal recommendations for routine testing of these SNPs cannot be drawn at this moment, therapeutic decisions may indeed benefit of germline genomic information, when available. Here, we summarize the clinical impact of germline genomic variants on the efficacy and toxicity of major chemodrugs, with the aim to facilitate the therapeutic expectance of clinicians in the odiern quicksand field of complex molecular biology concepts and controversial trial data interpretation.
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Affiliation(s)
- Raffaele Palmirotta
- Department of Biomedical Sciences and Human Oncology, Section of Clinical and Molecular Oncology, University of Bari Aldo Moro, 70124 Bari, Italy
| | - Claudia Carella
- Department of Biomedical Sciences and Human Oncology, Section of Clinical and Molecular Oncology, University of Bari Aldo Moro, 70124 Bari, Italy
| | - Erica Silvestris
- Department of Biomedical Sciences and Human Oncology, Section of Clinical and Molecular Oncology, University of Bari Aldo Moro, 70124 Bari, Italy
| | - Mauro Cives
- Department of Biomedical Sciences and Human Oncology, Section of Clinical and Molecular Oncology, University of Bari Aldo Moro, 70124 Bari, Italy
| | - Stefania Luigia Stucci
- Department of Biomedical Sciences and Human Oncology, Section of Clinical and Molecular Oncology, University of Bari Aldo Moro, 70124 Bari, Italy
| | - Marco Tucci
- Department of Biomedical Sciences and Human Oncology, Section of Clinical and Molecular Oncology, University of Bari Aldo Moro, 70124 Bari, Italy
| | - Domenica Lovero
- Department of Biomedical Sciences and Human Oncology, Section of Clinical and Molecular Oncology, University of Bari Aldo Moro, 70124 Bari, Italy
| | - Franco Silvestris
- Department of Biomedical Sciences and Human Oncology, Section of Clinical and Molecular Oncology, University of Bari Aldo Moro, 70124 Bari, Italy
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21
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Giordano C, De Santo N, Carella C, Capodicasa G, Amato G, Nuzzi F, Mioli V, Bazzato G, De Simone V, Tarchini A, Landini A, Coli U, Bordoni V, Mottola G, Capuano F. Thyroid Status and Nephron Loss - A study in Patients with Chronic Renal Failure, End Stage Renal Disease and/or on Hemodialysis. Int J Artif Organs 2018. [DOI: 10.1177/039139888400700303] [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]
Abstract
Thyroid function was measured in 30 healthy subjects and 84 patients with various degrees of nephron loss (GRF: 70 ± 15 m/min, 30 ± 16 ml/min, 10 ± 7 ml/min and 2.1 ± 1.3 ml/min). A low T3 and T4 syndrome is evident when GRF is reduced to 30 ± 16 ml/min while a blunted TSH response is detected earlier in the course of nephron loss. T3 response to TRH was normal and FT4 was not affected by renal dysfunction. The data indicate that in nephron loss hypothalamic-pituitary abnormalities occur.
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Affiliation(s)
- C. Giordano
- Istituto di Medicine Interna e Nefrologia Cattedra di Nefrologia Pediatrica, Istituto di Endocrinologia I Facoltà di Medicina, Università di Napoli Cattedra di Nefrologia Medica Università di Ancona Divisione Nefrologica Ospedale Umberto I, Mestre
| | - N.G. De Santo
- Istituto di Medicine Interna e Nefrologia Cattedra di Nefrologia Pediatrica, Istituto di Endocrinologia I Facoltà di Medicina, Università di Napoli Cattedra di Nefrologia Medica Università di Ancona Divisione Nefrologica Ospedale Umberto I, Mestre
| | - C. Carella
- Istituto di Medicine Interna e Nefrologia Cattedra di Nefrologia Pediatrica, Istituto di Endocrinologia I Facoltà di Medicina, Università di Napoli Cattedra di Nefrologia Medica Università di Ancona Divisione Nefrologica Ospedale Umberto I, Mestre
| | - G. Capodicasa
- Istituto di Medicine Interna e Nefrologia Cattedra di Nefrologia Pediatrica, Istituto di Endocrinologia I Facoltà di Medicina, Università di Napoli Cattedra di Nefrologia Medica Università di Ancona Divisione Nefrologica Ospedale Umberto I, Mestre
| | - G. Amato
- Istituto di Medicine Interna e Nefrologia Cattedra di Nefrologia Pediatrica, Istituto di Endocrinologia I Facoltà di Medicina, Università di Napoli Cattedra di Nefrologia Medica Università di Ancona Divisione Nefrologica Ospedale Umberto I, Mestre
| | - F. Nuzzi
- Istituto di Medicine Interna e Nefrologia Cattedra di Nefrologia Pediatrica, Istituto di Endocrinologia I Facoltà di Medicina, Università di Napoli Cattedra di Nefrologia Medica Università di Ancona Divisione Nefrologica Ospedale Umberto I, Mestre
| | - V. Mioli
- Istituto di Medicine Interna e Nefrologia Cattedra di Nefrologia Pediatrica, Istituto di Endocrinologia I Facoltà di Medicina, Università di Napoli Cattedra di Nefrologia Medica Università di Ancona Divisione Nefrologica Ospedale Umberto I, Mestre
| | - G. Bazzato
- Istituto di Medicine Interna e Nefrologia Cattedra di Nefrologia Pediatrica, Istituto di Endocrinologia I Facoltà di Medicina, Università di Napoli Cattedra di Nefrologia Medica Università di Ancona Divisione Nefrologica Ospedale Umberto I, Mestre
| | - V. De Simone
- Istituto di Medicine Interna e Nefrologia Cattedra di Nefrologia Pediatrica, Istituto di Endocrinologia I Facoltà di Medicina, Università di Napoli Cattedra di Nefrologia Medica Università di Ancona Divisione Nefrologica Ospedale Umberto I, Mestre
| | - A. Tarchini
- Istituto di Medicine Interna e Nefrologia Cattedra di Nefrologia Pediatrica, Istituto di Endocrinologia I Facoltà di Medicina, Università di Napoli Cattedra di Nefrologia Medica Università di Ancona Divisione Nefrologica Ospedale Umberto I, Mestre
| | - A. Landini
- Istituto di Medicine Interna e Nefrologia Cattedra di Nefrologia Pediatrica, Istituto di Endocrinologia I Facoltà di Medicina, Università di Napoli Cattedra di Nefrologia Medica Università di Ancona Divisione Nefrologica Ospedale Umberto I, Mestre
| | - U. Coli
- Istituto di Medicine Interna e Nefrologia Cattedra di Nefrologia Pediatrica, Istituto di Endocrinologia I Facoltà di Medicina, Università di Napoli Cattedra di Nefrologia Medica Università di Ancona Divisione Nefrologica Ospedale Umberto I, Mestre
| | - V. Bordoni
- Istituto di Medicine Interna e Nefrologia Cattedra di Nefrologia Pediatrica, Istituto di Endocrinologia I Facoltà di Medicina, Università di Napoli Cattedra di Nefrologia Medica Università di Ancona Divisione Nefrologica Ospedale Umberto I, Mestre
| | - G. Mottola
- Istituto di Medicine Interna e Nefrologia Cattedra di Nefrologia Pediatrica, Istituto di Endocrinologia I Facoltà di Medicina, Università di Napoli Cattedra di Nefrologia Medica Università di Ancona Divisione Nefrologica Ospedale Umberto I, Mestre
| | - F. Capuano
- Istituto di Medicine Interna e Nefrologia Cattedra di Nefrologia Pediatrica, Istituto di Endocrinologia I Facoltà di Medicina, Università di Napoli Cattedra di Nefrologia Medica Università di Ancona Divisione Nefrologica Ospedale Umberto I, Mestre
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22
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Giordano C, De Santo N, Carella C, Mioli V, Bazzato G, Amato G, Di Leo V, Tarchini G, Coli U, Capodicasa G, Landini G, Nuzzi F, De Simone V, Esposito A. TSH Response to TRH in Hemodialysis and CAPD Patients. Int J Artif Organs 2018. [DOI: 10.1177/039139888400700102] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The thyroid status was studied in 19 uremic patients (11 on HD and 8 on CAPD) and in a group of 17 healthy adult patients. In uremic patients T3 and T4 were significantly reduced (p < 0.001) and rT3 was increased (p < 0.001). The time course TSH response to TRH showed a lower peak response (in 5 patients it did not exceed 5 μU/ml) which on turn was also delayed (the peak was observed at 60 minutes in 63% of them). TSH concentrations in uremics were increased at 0 time (p < 0.02), lower at 20 minutes (p < 0.01) and increased at 120 minutes (p < 0.02). No difference existed between HD and CAPD. The thyroid response to TSH was normal as showed by a normal percent increase over basal values of T3 concentrations at 120 minutes. Uremic patients also showed a peak GH response at 20 minutes which was not observed in controls. The data exclude the existence on a primary form of hypothyroidism and point to the existence of hypothalamic-pituitary abnormalities, which should not be taken as indicative of secondary and/or tertiary hypothyroidism since FT4 values were normal in HD and increased in patients undergoing CAPD (p < 0.05) who on turn showed lower plasma albumin concentrations (p < 0.05).
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Affiliation(s)
- C. Giordano
- Institues of Internal Medicine and Nephrology, and Endocrinology of the 1st Faculty of Medicine and Surgery at the University of Naples, Chair of Nephrology University of Ancona, Division of Nephrology Umberto I Hospital Mestre, Italy
| | - N.G. De Santo
- Institues of Internal Medicine and Nephrology, and Endocrinology of the 1st Faculty of Medicine and Surgery at the University of Naples, Chair of Nephrology University of Ancona, Division of Nephrology Umberto I Hospital Mestre, Italy
| | - C. Carella
- Institues of Internal Medicine and Nephrology, and Endocrinology of the 1st Faculty of Medicine and Surgery at the University of Naples, Chair of Nephrology University of Ancona, Division of Nephrology Umberto I Hospital Mestre, Italy
| | - V. Mioli
- Institues of Internal Medicine and Nephrology, and Endocrinology of the 1st Faculty of Medicine and Surgery at the University of Naples, Chair of Nephrology University of Ancona, Division of Nephrology Umberto I Hospital Mestre, Italy
| | - G. Bazzato
- Institues of Internal Medicine and Nephrology, and Endocrinology of the 1st Faculty of Medicine and Surgery at the University of Naples, Chair of Nephrology University of Ancona, Division of Nephrology Umberto I Hospital Mestre, Italy
| | - G. Amato
- Institues of Internal Medicine and Nephrology, and Endocrinology of the 1st Faculty of Medicine and Surgery at the University of Naples, Chair of Nephrology University of Ancona, Division of Nephrology Umberto I Hospital Mestre, Italy
| | - V.A. Di Leo
- Institues of Internal Medicine and Nephrology, and Endocrinology of the 1st Faculty of Medicine and Surgery at the University of Naples, Chair of Nephrology University of Ancona, Division of Nephrology Umberto I Hospital Mestre, Italy
| | - G. Tarchini
- Institues of Internal Medicine and Nephrology, and Endocrinology of the 1st Faculty of Medicine and Surgery at the University of Naples, Chair of Nephrology University of Ancona, Division of Nephrology Umberto I Hospital Mestre, Italy
| | - U. Coli
- Institues of Internal Medicine and Nephrology, and Endocrinology of the 1st Faculty of Medicine and Surgery at the University of Naples, Chair of Nephrology University of Ancona, Division of Nephrology Umberto I Hospital Mestre, Italy
| | - G. Capodicasa
- Institues of Internal Medicine and Nephrology, and Endocrinology of the 1st Faculty of Medicine and Surgery at the University of Naples, Chair of Nephrology University of Ancona, Division of Nephrology Umberto I Hospital Mestre, Italy
| | - G. Landini
- Institues of Internal Medicine and Nephrology, and Endocrinology of the 1st Faculty of Medicine and Surgery at the University of Naples, Chair of Nephrology University of Ancona, Division of Nephrology Umberto I Hospital Mestre, Italy
| | - F. Nuzzi
- Institues of Internal Medicine and Nephrology, and Endocrinology of the 1st Faculty of Medicine and Surgery at the University of Naples, Chair of Nephrology University of Ancona, Division of Nephrology Umberto I Hospital Mestre, Italy
| | - V. De Simone
- Institues of Internal Medicine and Nephrology, and Endocrinology of the 1st Faculty of Medicine and Surgery at the University of Naples, Chair of Nephrology University of Ancona, Division of Nephrology Umberto I Hospital Mestre, Italy
| | - A. Esposito
- Institues of Internal Medicine and Nephrology, and Endocrinology of the 1st Faculty of Medicine and Surgery at the University of Naples, Chair of Nephrology University of Ancona, Division of Nephrology Umberto I Hospital Mestre, Italy
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Carella C, Viggiano A, Pergola V, Imparato L, Mongiello F, Ammirati G, Coletta S, Koci E, Abbate FG, De Rosa S, Indolfi C, Trimarco B, Rapacciuolo A. P452Transcoronary concentration gradients of circulating miRNAs in heart failure. Europace 2018. [DOI: 10.1093/europace/euy015.261] [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: 11/14/2022] Open
Affiliation(s)
- C Carella
- Federico II University of Naples, Department of Advanced Biomedical Sciences, Naples, Italy
| | - A Viggiano
- Federico II University of Naples, Department of Advanced Biomedical Sciences, Naples, Italy
| | - V Pergola
- Federico II University of Naples, Department of Advanced Biomedical Sciences, Naples, Italy
| | - L Imparato
- Federico II University of Naples, Department of Advanced Biomedical Sciences, Naples, Italy
| | - F Mongiello
- Federico II University of Naples, Department of Advanced Biomedical Sciences, Naples, Italy
| | - G Ammirati
- Federico II University of Naples, Department of Advanced Biomedical Sciences, Naples, Italy
| | - S Coletta
- Federico II University of Naples, Department of Advanced Biomedical Sciences, Naples, Italy
| | - E Koci
- Federico II University of Naples, Department of Advanced Biomedical Sciences, Naples, Italy
| | - F G Abbate
- Federico II University of Naples, Department of Advanced Biomedical Sciences, Naples, Italy
| | - S De Rosa
- Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - C Indolfi
- Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - B Trimarco
- Federico II University of Naples, Department of Advanced Biomedical Sciences, Naples, Italy
| | - A Rapacciuolo
- Federico II University of Naples, Department of Advanced Biomedical Sciences, Naples, Italy
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Imparato LI, Viggiano A, Pergola V, Carella C, Abbate FG, Canciello G, Mongiello F, Koci E, Mancusi C, De Simone G, Losi MA, Izzo R, De Luca N, Trimarco B, Rapacciuolo A. P400CHA2DS2-VASc score and dilated left atrial volume index predict incident atrial fibrillation in hypertensive patients. Europace 2018. [DOI: 10.1093/europace/euy015.211] [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: 11/13/2022] Open
Affiliation(s)
- L I Imparato
- Federico II University of Naples, Department of Advanced Biomedical Sciences, Naples, Italy
| | - A Viggiano
- Federico II University of Naples, Department of Advanced Biomedical Sciences, Naples, Italy
| | - V Pergola
- Federico II University of Naples, Department of Advanced Biomedical Sciences, Naples, Italy
| | - C Carella
- Federico II University of Naples, Department of Advanced Biomedical Sciences, Naples, Italy
| | - F G Abbate
- Federico II University of Naples, Department of Advanced Biomedical Sciences, Naples, Italy
| | - G Canciello
- Federico II University of Naples, Department of Advanced Biomedical Sciences, Naples, Italy
| | - F Mongiello
- Federico II University of Naples, Department of Advanced Biomedical Sciences, Naples, Italy
| | - E Koci
- Federico II University of Naples, Department of Advanced Biomedical Sciences, Naples, Italy
| | - C Mancusi
- Federico II University of Naples, Department of Advanced Biomedical Sciences, Naples, Italy
| | - G De Simone
- Federico II University of Naples, Department of Advanced Biomedical Sciences, Naples, Italy
| | - M A Losi
- Federico II University of Naples, Department of Advanced Biomedical Sciences, Naples, Italy
| | - R Izzo
- Federico II University of Naples, Department of Advanced Biomedical Sciences, Naples, Italy
| | - N De Luca
- Federico II University of Naples, Department of Advanced Biomedical Sciences, Naples, Italy
| | - B Trimarco
- Federico II University of Naples, Department of Advanced Biomedical Sciences, Naples, Italy
| | - A Rapacciuolo
- Federico II University of Naples, Department of Advanced Biomedical Sciences, Naples, Italy
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Arredondo E, López-Fraga M, Chatzixiros E, Senemaud B, Brezovsky P, Carella C, Ballesté C, Aydin Mehmet A, Tomadze G, Codreanu I, Sarkissian A, Simeonova M, Nikonenko A, Zota V, Gómez M, Manyalich M, Bolotinha C, Franca A, Costa A, Ott MO, Buchheit KH. Council of Europe Black Sea Area Project: International Cooperation for the Development of Activities Related to Donation and Transplantation of Organs in the Region. Transplant Proc 2018; 50:374-381. [DOI: 10.1016/j.transproceed.2017.12.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 12/04/2017] [Indexed: 10/17/2022]
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26
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Viggiano A, Coletta S, Carella C, Rapacciuolo A. P470Syntax score as a potential predictor tool for ventricular events in ischemic dilated cardiomyopathy. Europace 2017. [DOI: 10.1093/ehjci/eux141.193] [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: 11/14/2022] Open
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27
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Peritore D, Rizzato L, Di Ciaccio P, Trapani S, Carella C, Oliveti A, Rizzo A, Nanni Costa A. Analysis of the Organ Offers Received From European Union Countries Before and After the Introduction of a Dedicated Information Technology Portal: The COORENOR/FOEDUS Portal. Transplant Proc 2017; 49:629-631. [DOI: 10.1016/j.transproceed.2017.02.034] [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: 11/30/2022]
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28
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Palmirotta R, Acquafredda S, Argentiero A, Carella C, Lanotte L, Pappagallo N, Quaresmini D, Silvestris F. [Genomics of lung adenocarcinoma: pathogenetic significance and clinical applications.]. Recenti Prog Med 2016; 107:652-672. [PMID: 27997009 DOI: 10.1701/2502.26236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Diagnostic and therapeutic approaches to non small cell lung cancer (NSCLC), especially adenocarcinoma, have recently undergone dramatic evolution according to the tremendous amount of molecular data collected on this cancer. In fact, the application of oncogenomics has identified novel molecular subtypes of NSCLC and led the way to diagnostic criteria based on the expression of specific genetic alterations that can provide prognostic and specific indications to the molecular targeted therapies. In NSCLC, several genes show "driver" molecular alterations that confer oncogenic potential to progenitor cells through the enrollment of metabolic pathways critical for cell proliferation and tumor development. On the other hand, clinical management of NSCLC with small molecules has undoubtedly provided optimistic results with both a significant increase in overall survival and reduction in therapy-related toxicity including relative complications. Thus, pharmacogenomics, as the newest tool for using the targeted therapy represents the most innovative approach for treatment of this cancer once the molecular aberrations are identified. In particular, the relative mutational status of several driver genes including EGFR, ALK, ROS1 and others, is directly correlated to a better response to thyrosin-kinase inhibitors. Furthermore, other therapeutic strategies with inhibitors of angiogenic receptors, PARP, histone-deacetylase, PI3K and HSP90, are intensively studied in pre-clinical models as well as in clinical trials for a potential adoption in clinical practice. The introduction of more advanced techniques for molecular profiling also allows to identify pathogenic variants of many other genes involved in the progression of lung adenocarcinoma with the aim to develop novel molecular targets for pharmacological research. In this review, we will revisit the current applications of oncogenomics in the diagnosis and treatment of this tumor.
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Affiliation(s)
- Raffaele Palmirotta
- Dipartimento di Scienze Biomediche e Oncologia Clinica, Università di Bari "Aldo Moro"
| | - Silvana Acquafredda
- Dipartimento di Scienze Biomediche e Oncologia Clinica, Università di Bari "Aldo Moro"
| | - Antonella Argentiero
- Dipartimento di Scienze Biomediche e Oncologia Clinica, Università di Bari "Aldo Moro"
| | - Claudia Carella
- Dipartimento di Scienze Biomediche e Oncologia Clinica, Università di Bari "Aldo Moro"
| | - Laura Lanotte
- Dipartimento di Scienze Biomediche e Oncologia Clinica, Università di Bari "Aldo Moro"
| | - Nicla Pappagallo
- Dipartimento di Scienze Biomediche e Oncologia Clinica, Università di Bari "Aldo Moro"
| | - Davide Quaresmini
- Dipartimento di Scienze Biomediche e Oncologia Clinica, Università di Bari "Aldo Moro"
| | - Franco Silvestris
- Dipartimento di Scienze Biomediche e Oncologia Clinica, Università di Bari "Aldo Moro"
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Mosillo C, Iacovelli R, De Tursi M, Ciardi A, Carella C, Natoli C, Naso G, Corstesi E. Relationship and predictive role of the dual expression of FGFR and IL8 in metastatic renal cell carcinoma (mRCC). Ann Oncol 2015. [DOI: 10.1093/annonc/mdv341.05] [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: 11/14/2022] Open
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30
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DeSanto NG, Carella C, Fine RN, Leumann E, Fine S, Amato G, Capodicasa G, Nuzzi F, Capasso G, De Simone V. Thyroid function in uremic children--studies at various stages of nephron loss and during treatment with hemodialysis and/or CAPD. Contrib Nephrol 2015; 49:56-62. [PMID: 3938373 DOI: 10.1159/000411896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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31
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Conforti A, Biagini S, Starc N, Proia A, Grisendi G, Carella C, Dominici M, Locatelli F, Bernardo M. Exposure to ionizing radiations and starvation culture does not modify phenotype, functions and genetic profile of mesenchymal stromal cells isolated from bone marrow of healthy donors. Cytotherapy 2014. [DOI: 10.1016/j.jcyt.2014.01.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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32
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Massari R, Barone M, Basilico R, Carella C, Colasante A, De Tursi M, Filippone A, Guetti L, Mani A. Peritonectomy and hyperthermic chemotherapy in patients with advanced or recurrent ephitelial ovarian cancer: a single center cohort study. MINERVA CHIR 2014; 69:17-26. [PMID: 24675243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM The present study reports our experience concerning with the advanced cancer treatment (cytoreductive surgery and hyperthermic intraperitoneal chemotherapy) in patients with advanced ovarian cancer ephitelial (AEOS) or recurrent ovarian cancer ephitelial (REOC). METHODS In a period from October 2006 to December 2009, we observed 25 patients affected by advanced ephitelial ovarian cancer or recurrent ephitelial ovarian cancer. All patients underwent CRS + HIPEC procedures. Peritoneal involvement was valued according to the Peritoneal Cancer Index (PCI) and the remaining postoperative disease according to the Completeness of Cytoreduction score (CC). HIPEC was always performed with closed technique for 60 min, with an average inflow temperature of 42.5 °C. The drugs were administered in combination according two schemes: 1) cisplatin 60 mg/m2/L and caelyx 20 mg/m2/L; 2) 60 mg/m2/L taxotere and caelyx 20 mg/m2/L. Morbidity and mortality were evaluated in accordance with the NCI CTCAE v. 3.0 (USA). Finally, the Disease Free Survival and Overall Survival by the Kaplan-Meier method was rated. RESULTS The average age observed was 64 years (range 46-76). Fourteen patients (56%) were affected by AEOC. From this group, 12 (48%) were subjected to neoadjuvant therapy and 2 (8%) to surgery as a first; 11 (44%) patients had REOC and all of them had previously undergone to surgery and adjuvant CHT. The average PCI was 12.63 (range 2-27). In 22 patients (88%), cytoreduction was considered total or almost total (CC-0 in 14 patients, CC-1 in 8); in 3 patients (12%), it had not been optimal (CC-2 or CC-3). In all 18 patients with PCI less than 15, it was possible to achieve an optimal cytoreduction, and this was possible only in 3 of the 7 patients who had a PCI greater than 15. The average operative time, including HIPEC, was of 612 min (range 425 min-840 min). In 9 patients (36%), the postoperative course was uncomplicated, in 10 patients (40%) complications were minor (G1-G2) and in 4 patients (16%) morbidity was important (G4). Mortality rate was 8%. The average OS was 30.8 months and the median OS was 30.8 months (respectively 36.5 months for AEOC and 27 months for REOC). The median DFS total (calculated from the day of surgery or from the day of the beginning of the CHT) was 12months (respectively 12.9 months for AEOC, 11.9 months for REOC). CONCLUSION Although the CRS and HIPEC procedure in the treatment of advanced or recurrent ovarian cancer represents now a reliable method with good results both in terms of morbidity and of distance results, there are still many controversial aspects that may in the future be better clarified only with a randomized phase III study, which is in progress, involving international working groups and experts on the procedure.
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Affiliation(s)
- R Massari
- Istituto di Clinica Chirurgica Centro di Riferimento Regionale Neoplasie Peritoneali Università di Chieti, Chieti, Italy -
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33
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Lombardini L, Bosi A, Grosz S, Pamphilon D, Fehily D, Mareri M, Carella C, Pia Mariani M, Pupella S, Grazzini G, Costa AN. Haematopoietic stem cell transplantation: a comparison between the accreditation process performed by competent authorities and JACIE in Italy. Vox Sang 2013; 105:174-6. [DOI: 10.1111/vox.12026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Revised: 12/12/2012] [Accepted: 12/14/2012] [Indexed: 11/30/2022]
Affiliation(s)
- L. Lombardini
- Italian National Transplant Centre, Istituto Superiore di Sanità; Rome; Italy
| | - A. Bosi
- University of Florence, Florence, Italy and GITMO; Genova; Italy
| | - S. Grosz
- University of Applied Sciences Bioengineering; FH Campus Wien; Austria
| | | | - D. Fehily
- Italian National Transplant Centre, Istituto Superiore di Sanità; Rome; Italy
| | - M. Mareri
- Italian National Transplant Centre, Istituto Superiore di Sanità; Rome; Italy
| | - C. Carella
- Italian National Transplant Centre, Istituto Superiore di Sanità; Rome; Italy
| | - M. Pia Mariani
- Italian National Transplant Centre, Istituto Superiore di Sanità; Rome; Italy
| | - S. Pupella
- Italian National Blood Centre, Istituto Superiore di Sanità; Rome; Italy
| | - G. Grazzini
- Italian National Blood Centre, Istituto Superiore di Sanità; Rome; Italy
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34
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De Tursi M, Salvatorelli E, Carella C, Bianco N, Massari R, Sacco R, Menna P, Minotti G, Iacobelli S. The use of pegylated liposomal doxorubicin with hyperthermic intraperitoneal chemotherapy (HIPEC) in patients undergoing cytoreductive surgery (CS) for peritoneal carcinomatosis of ovarian origin. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.5040] [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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35
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Tursi MD, Carella C, Ricevuto E, Gennari A, Orlandini C, Frassoldati A, Conte PF, Iacobelli S. A multicenter phase II study of epirubicin (E) with low-dose herceptin (LD-H) as a first-line treatment in HER2 overexpressing metastatic breast cancer (MBC). J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.1060] [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
1060 Background: The combination of doxorubicin and herceptin (H) has been proven to be an effective regimen in metastatic breast cancer (MBC), although it was associated with an increased risk of cardiotoxicity. Methods: The aim of this study was to evaluate cardiac safety and efficacy of epirubicin (E) in combination with low-dose herceptin (LD-H) as first-line chemotherapy for women with HER-2 positive MBC. Forty-five patients were enrolled in a two-step, multicenter phase II study. In the first step, H was given at 2 mg/Kg loading dose on day 1, followed by 1 mg/Kg weekly; in the second step (≥ 12 objective responses/21pts), H dose was maintained at 1 mg/kg weekly. E was administered at 90 mg/m2 on day 1 every 3 weeks. After 6–8 courses, H was continued as a single agent for a maximum of 52 weeks. To assess cardiotoxicity, patients were evaluated for the left ventricular ejection fraction (LVEF) at baseline, every two cycles during E and LD-H, and every three months during LD-H alone. Cardiotoxicity was defined as signs or symptoms of congestive heart failure in = 10% of patients at an E dose of 720 mg/ m2 or in = 20% of patients at an E dose > 720 < 1,000 mg/m2. Results: Eight episodes of cardiotoxicity were observed (an asymptomatic decrease in LVEF =15% in 6 patients and an asymptomatic decline of LVEF at = 50% in 2 patients). Grade 3–4 neutropenia, alopecia and thrombocytopenia occurred in 25%, 45.5% and 6.8% of patients, respectively. Complete and partial responses were 2.4 and 61.9%, respectively, for an overall response rate of 64.3%. The median time to progression was 8.2 months (95% CI, 5.2–9.2 months) and the median overall survival was 32.8 months (95% CI, 17.1–48.6 months). Conclusions: E plus LD-H is an active treatment regimen for HER-2 positive MBC and demonstrates a very favourable safety profile, with manageable cardiotoxicity. No significant financial relationships to disclose.
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Affiliation(s)
- M. De Tursi
- University, Chieti, Italy; University, L’Aquila, Italy; National Cancer Research Institute, Genova, Italy; University, Pisa, Italy; University, Modena, Italy
| | - C. Carella
- University, Chieti, Italy; University, L’Aquila, Italy; National Cancer Research Institute, Genova, Italy; University, Pisa, Italy; University, Modena, Italy
| | - E. Ricevuto
- University, Chieti, Italy; University, L’Aquila, Italy; National Cancer Research Institute, Genova, Italy; University, Pisa, Italy; University, Modena, Italy
| | - A. Gennari
- University, Chieti, Italy; University, L’Aquila, Italy; National Cancer Research Institute, Genova, Italy; University, Pisa, Italy; University, Modena, Italy
| | - C. Orlandini
- University, Chieti, Italy; University, L’Aquila, Italy; National Cancer Research Institute, Genova, Italy; University, Pisa, Italy; University, Modena, Italy
| | - A. Frassoldati
- University, Chieti, Italy; University, L’Aquila, Italy; National Cancer Research Institute, Genova, Italy; University, Pisa, Italy; University, Modena, Italy
| | - P. F. Conte
- University, Chieti, Italy; University, L’Aquila, Italy; National Cancer Research Institute, Genova, Italy; University, Pisa, Italy; University, Modena, Italy
| | - S. Iacobelli
- University, Chieti, Italy; University, L’Aquila, Italy; National Cancer Research Institute, Genova, Italy; University, Pisa, Italy; University, Modena, Italy
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36
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Natoli C, Cianchetti E, Tinari N, Angelucci D, Grassadonia A, Zilli M, Ficorella C, Ricevuto E, Grossi S, De Tursi M, Carella C, Rispoli AI, Iacobelli S. A phase II study of dose-dense epirubicin plus cyclophosphamide followed by docetaxel plus capecitabine and pegfilgrastim support as preoperative therapy for patients with stage II, IIIA breast cancer. Ann Oncol 2007; 18:1015-20. [PMID: 17369601 DOI: 10.1093/annonc/mdm076] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND This phase II study was conducted to evaluate tumor response rate and safety profile of dose-dense epirubicin plus cyclophosphamide followed by docetaxel plus capecitabine given preoperatively to patients with stage II or IIIA breast cancer. PATIENTS AND METHODS Patients underwent four cycles of dose-dense cyclophosphamide 600 mg/m(2) and epirubicin 90 mg/m(2) every 2 weeks followed by two cycles of docetaxel 36 mg/m(2) on days 1, 8, and 15 plus capecitabine 1250 mg/m(2) on days 5-18 every 4 weeks, with prophylactic pegfilgrastim. The primary objective of the study was to determine the incidence of pathologic complete response defined as the absence of invasive or in situ cancer in the breast and the axillary nodes at definitive surgery. RESULTS Forty-four patients were enrolled in the study and 41 (93%) were assessable for response to chemotherapy. An objective clinical response was observed in 38 (93%) patients. Seven patients (17.1%) exhibited a pathologic complete response. Breast-conserving surgery was carried out in 36 (88%) patients. Grade 3/4 neutropenia occurred in 4.3% of 252 administered chemotherapy cycles. No febrile neutropenia, cardiac toxicity, thrombocytopenia or other serious adverse event was registered. CONCLUSION The sequential combination of dose-dense epirubicin plus cyclophosphamide followed by docetaxel plus capecitabine is an effective and well-tolerated neo-adjuvant chemotherapy for stage II, IIIA breast cancer.
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Affiliation(s)
- C Natoli
- Department of Oncology and Neurosciences and Foundation, University G. D'Annunzio, Chieti-Pescara, Italy
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37
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Carella C, Bonten J, Sirma S, Kranenburg TA, Terranova S, Klein-Geltink R, Shurtleff S, Downing JR, Zwarthoff EC, Liu PP, Grosveld GC. MN1 overexpression is an important step in the development of inv(16) AML. Leukemia 2007; 21:1679-90. [PMID: 17525718 DOI: 10.1038/sj.leu.2404778] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The gene encoding the transcriptional co-activator MN1 is the target of the reciprocal chromosome translocation (12;22)(p13;q12) in some patients with acute myeloid leukemia (AML). In addition, expression array analysis showed that MN1 was overexpressed in AML specified by inv(16), in some AML overexpressing ecotropic viral integration 1 site (EVI1) and in some AML without karyotypic abnormalities. Here we describe that mice receiving transplants of bone marrow (BM) overexpressing MN1 rapidly developed myeloproliferative disease (MPD). This BM also generated myeloid cell lines in culture. By mimicking the situation in human inv(16) AML, forced coexpression of MN1 and Cbfbeta-SMMHC rapidly caused AML in mice. These findings identify MN1 as a highly effective hematopoietic oncogene and suggest that MN1 overexpression is an important cooperative event in human inv(16) AML.
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MESH Headings
- Acute Disease
- Animals
- Bone Marrow Transplantation
- Cells, Cultured
- Chromosome Inversion
- Chromosomes, Human, Pair 16/genetics
- Female
- Flow Cytometry
- Gene Expression Regulation, Neoplastic/physiology
- Humans
- Leukemia, Myeloid/etiology
- Leukemia, Myeloid/metabolism
- Leukemia, Myeloid/pathology
- Mice
- Mice, Transgenic
- Myeloproliferative Disorders/etiology
- Myeloproliferative Disorders/metabolism
- Myeloproliferative Disorders/pathology
- Oncogene Proteins/genetics
- Oncogene Proteins, Fusion/genetics
- Oncogene Proteins, Fusion/metabolism
- Survival Rate
- Trans-Activators
- Translocation, Genetic/genetics
- Tumor Suppressor Proteins
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Affiliation(s)
- C Carella
- Department of Genetics and Tumor Cell Biology, St Jude Children's Research Hospital, Memphis, TN 38105-0318, USA
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38
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De Tursi M, Carella C, Ricevuto E, Gennari A, Orlandini C, Frassoldati A, Conte P, Iacobelli S. P101 A multicenter phase II study of Epirubicin with low-dose Herceptin as a first line treatment in HER-2 overexpressing metastatic breast cancer. Breast 2007. [DOI: 10.1016/s0960-9776(07)70161-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Carella C, Bonten J, Rehg J, Grosveld GC. MN1-TEL, the product of the t(12;22) in human myeloid leukemia, immortalizes murine myeloid cells and causes myeloid malignancy in mice. Leukemia 2006; 20:1582-92. [PMID: 16810199 DOI: 10.1038/sj.leu.2404298] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
MN1-TEL is the product of the recurrent t(12;22)(p12;q11) associated with human myeloid malignancies. MN1-TEL functions as an activated transcription factor, exhibiting weak transforming activity in NIH3T3 fibroblasts that depends on the presence of a functional TEL DNA-binding domain, the N-terminal transactivating sequences of MN1 and C-terminal sequences of MN1. We determined the transforming activity of MN1-TEL in mouse bone marrow (BM) by using retroviral transfer. MN1-TEL-transduced BM showed increased self-renewal capacity of primitive progenitors in vitro, and prolonged in vitro culture of MN1-TEL-expressing BM produced immortalized myeloid, interleukin (IL)-3/stem cell factor-dependent cell lines with a primitive morphology. Transplantation of such cell lines into lethally irradiated mice rescued them from irradiation-induced death and resulted in the contribution of MN1-TEL-expressing cells to all hematopoietic lineages, underscoring the primitive nature of these cells and their capacity to differentiate in vivo. Three months after transplantation, all mice succumbed to promonocytic leukemia. Transplantation of freshly MN1-TEL-transduced BM into lethally irradiated mice also caused acute myeloid leukemia within 3 months of transplantation. We infer that MN1-TEL is a hematopoietic oncogene that stimulates the growth of hematopoietic cells, but depends on secondary mutations to cause leukemia in mice.
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MESH Headings
- Animals
- Cell Proliferation
- Cell Transformation, Neoplastic
- Cell Transplantation
- Chromosomes, Human, Pair 12
- Chromosomes, Human, Pair 22
- Hematopoietic Stem Cells/pathology
- Humans
- Leukemia, Myeloid/genetics
- Leukemia, Myeloid/pathology
- Mice
- Mice, Inbred C57BL
- Oncogene Proteins, Fusion/genetics
- Transcription Factors/genetics
- Translocation, Genetic
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Affiliation(s)
- C Carella
- Department of Genetics and Tumor Cell Biology, St Jude Children's Research Hospital, Memphis, TN 38105, USA
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Zilli M, De Tursi M, Carella C, Ricevuto E, Marchetti P, Gennari A, Orlandini C, Frassoldati A, Conte P, Iacobelli S. A multicenter phase II study of epirubicin with low-dose trastuzumab as a first line treatment in Her-2 overexpressing metastatic breast cancer: preliminary results. EJC Suppl 2006. [DOI: 10.1016/s1359-6349(06)80420-9] [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: 11/17/2022] Open
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Carella C, Mazziotti G, Sorvillo F, Piscopo M, Cioffi M, Pilla P, Nersita R, Iorio S, Amato G, Braverman LE, Roti E. Serum thyrotropin receptor antibodies concentrations in patients with Graves' disease before, at the end of methimazole treatment, and after drug withdrawal: evidence that the activity of thyrotropin receptor antibody and/or thyroid response modify during the observation period. Thyroid 2006; 16:295-302. [PMID: 16571093 DOI: 10.1089/thy.2006.16.295] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIM AND METHODS We performed a quantitative retrospective analysis of serum thyrotropin receptor antibody (TRAb) concentrations measured by a second-generation radioreceptor assay in 58 patients with Graves' disease (GD) at the onset of the disease, at the end of 18 month methimazole (MMI) treatment, and after MMI withdrawal in order to evaluate the correlation between the presence of these antibodies and the relapse of hyperthyroidism. Sixty healthy subjects were enrolled as a control group. RESULTS Before MMI treatment the best cutoff TRAb value for identifying patients with GD was 1.45 UI/L (specificity, 100%; sensitivity, 98.3%). At the end of MMI treatment, serum TRAb concentrations were significantly lower (p < 0.001) than those measured at baseline, but they were still significantly higher (p < 0.001) than those found in the control subjects. At the end of MMI treatment, 44 patients (75.9%) had positive TRAb values (>1.45 UI/L). After MMI withdrawal (median, 15 months), 34 patients (58.6%) became hyperthyroid, 4 patients (6.9%) became hypothyroid, and 20 patients (34.5%) remained euthyroid. There was a significant correlation between serum TRAb concentrations at the end of MMI treatment and the percentage of patients who became hyperthyroid (r: 0.56; p < 0.001) and the time of appearance of hyperthyroidism (r: -0.38; p = 0.03). All 4 patients with TRAb values below 0.9 UI/L at the end of MMI treatment remained euthyroid throughout the follow-up period. Among the 27 patients who had serum TRAb values higher than 4.4 UI/L, 23 developed hyperthyroidism and 4 hypothyroidism. The TRAb values between 0.9 and 4.4 UI/L did not discriminate between the 27 patients (46.6%) who remained euthyroid from those who had relapse of hyperthyroidism. Thus a different TRAb end of treatment cutoff was calculated to identify patients who became again hyperthyroid. This TRAb cutoff value was 3.85 UI/L (sensitivity, 85.3%; specificity, 96.5%). All but 1 patient who had serum TRAb values above 3.85 UI/L became hyperthyroid after MMI was withdrawn (positive predictive value, 96.7%). In these patients, relapse of hyperthyroidism was independent of the changes in serum TRAb concentrations (r: 0.27; p = 0.15) and occurred after a median period of 8 weeks (range, 4-48). Hyperthyroidism also developed in 5 of 24 patients who had serum TRAb concentrations lower than 3.85 UI/L at the end of MMI treatment. In these 5 patients the relapse of hyperthyroidism occurred after a median period of 56 weeks (range, 24-120) and was always accompanied by an increase in serum TRAb concentrations. CONCLUSIONS TRAb persist in the blood of most patients with GD after 18 months of MMI treatment. Both the frequency and the time of appearance of hyperthyroidism are closely correlated with serum TRAb concentrations at the end of MMI treatment. Our data would suggest that TRAb maintain stimulating activity after a full course of MMI treatment in the large majority of patients with GD. However, it is likely that the potency of these antibodies and/or the thyroid response to them change during treatment, as suggested by the different values measured in euthyroid control subjects and in euthyroid patients after MMI treatment.
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Affiliation(s)
- C Carella
- Department of Clinical and Experimental Medicine F. Magrassi & A. Lanzara, Second University of Naples, Italy
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Mazziotti G, Sorvillo F, Piscopo M, Morisco F, Cioffi M, Stornaiuolo G, Gaeta GB, Molinari AM, Lazarus JH, Amato G, Carella C. Innate and acquired immune system in patients developing interferon-alpha-related autoimmune thyroiditis: a prospective study. J Clin Endocrinol Metab 2005; 90:4138-44. [PMID: 15855253 DOI: 10.1210/jc.2005-0093] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE In this prospective study, we investigated whether the development of interferon (IFN)-alpha-related autoimmune thyroiditis (IFN-AT) was correlated with the sequential changes of cytokine pattern induced by IFNalpha in the peripheral lymphocytes. PATIENTS AND METHODS We enrolled 18 hepatitis C virus (HCV)-positive patients who developed IFN-AT, eight patients with euthyroidism [IFN-AT(Eu)] and 10 with thyroid dysfunction [IFN-AT(Dy)]. Twenty HCV-positive patients without IFN-AT acted as control group (Co-HCV+). Intracellular expression of IFNgamma and IL-4 was evaluated by multicolor flow-cytometry analysis in peripheral lymphocytes in vitro stimulated by phorbol-12-myristate-13-acetate (PMA) (25 ng/ml) and ionomycin (1 mug/ml) in presence of monensin (5 microm). RESULTS At the appearance of thyroid disease, both IFN-AT(Eu) and IFN-AT(Dy) patients showed a significant increase of IFNgamma expression in CD3+CD56+ and CD3-CD56+ cells but not in CD4+ and CD8+ cells. At this time point, IFN-AT(Eu) but not IFN-AT(Dy) patients also showed an increase of IL-4 expression in CD3+CD56+ cells and CD4+ cells. Six months later, IFN-AT(Eu) patients maintained high expression of IL-4 in CD4+ and CD3+CD56+ cells without any further increase in IFNgamma expression. By contrast, IFN-AT(Dy) patients showed an increase of IFNgamma expression in CD4+ and CD8+ cells, with a concomitant decrease of IL-4 expression in CD4+ cells. CONCLUSIONS Type 2 immune response is activated early and specifically in patients with IFN-AT who remain euthyroid throughout the follow-up. Predominant in patients developing thyroid dysfunction, by contrast, is the type 1 immune response that seems to occur earlier in innate than acquired immune system.
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Affiliation(s)
- G Mazziotti
- Department of Clinical and Experimental Medicine, F. Magrassi and A. Lanzara, Second University of Naples, Via Crispi 44, 80121 Naples, Italy
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Farzati B, Mazziotti G, Cuomo G, Ressa M, Sorvillo F, Amato G, La Montagna G, Carella C, Valentini G. Hashimoto's thyroiditis is associated with peripheral lymphocyte activation in patients with systemic sclerosis. Clin Exp Rheumatol 2005; 23:43-9. [PMID: 15789886] [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: 05/02/2023]
Abstract
OBJECTIVE To investigate whether autoimmune thyroiditis [HT] (i.e., a TH1 disease) influences the pattern of peripheral lymphocyte activation in systemic sclerosis [SSc] (commonly regarded as a TH2 disease). Twenty SSc patients, 6 with (SSc+HT+) and 14 without HT (SSc+HT-) and 20 controls were investigated for the intracellular content of IFN-gamma and IL-4 in unstimulated and stimulated (25 ng/ml PMA and 1 microg/ml ionomycin) CD4+ and CD8+ T lymphocytes. Results Under basal conditions the percentages of CD4+IFN-gamma, CD4+IL-4+ and CD8+IFN-gammawere significantly higher in the patients than the control subjects, no significant differences being detectable between the two patient subgroups. Upon PMA stimulation, the 20 SSc patients showed a higher percentage of CD4+IFN-gamma+ and CD8+IFN-gamma+ than the control subjects. In particular, the 14 SSc+HT- patients showed a higher number of CD4+IFN-y+ and CD4+IL-4+ cells, while the SSc+HT+ patients showed higher percentage of CD8+IFN-gamma+ cells. The latter patients showed a reduced percentage of CD4+IL-4+ cells and an increased percentage of CD8+IFN-y+ in comparison with the SSc+HT- patients. Type-1 activation in the peripheral blood of SSc patients has been already pointed out by other authors and ourselves. This study shows that such activation mainly affects SSc patients with coexistent HT.
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Affiliation(s)
- B Farzati
- Institute of Immunology, F Magrassi & A. Lanzara Department of Clinical and Experimental Medicine, Second University of Naples, Italy
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Amato G, Mazziotti G, Sorvillo F, Piscopo M, Lalli E, Biondi B, Iorio S, Molinari A, Giustina A, Carella C. High serum osteoprotegerin levels in patients with hyperthyroidism: effect of medical treatment. Bone 2004; 35:785-91. [PMID: 15336617 DOI: 10.1016/j.bone.2004.04.021] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2004] [Revised: 04/13/2004] [Accepted: 04/23/2004] [Indexed: 11/17/2022]
Abstract
This study was aimed at evaluating serum osteoprotegerin (OPG) concentrations in a cohort of patients with hyperthyroidism before and after methimazole (MMI) treatment. One hundred fourteen hyperthyroid patients [93 with Graves disease (GD) and 21 with toxic nodular goitre (TNG)] and 68 matched for sex and age healthy subjects were evaluated for serum free-thyroxine (FT4), free-triiodiothyronine (FT3), thyrotropin (TSH), TSH receptor antibodies (TRAb), bone alkaline phosphatase (BALP), C-telopeptides of type-1 collagen (CrossLaps), OPG levels, and bone mineral density (BMD). In hyperthyroid patients, the biochemical evaluations were performed before and after 6 and 12 months of MMI treatment, whereas BMD was measured at baseline and after 12 months of treatment. Hyperthyroidism was more severe in GD than TNG patients. Serum OPG levels were found to be significantly higher in hyperthyroid patients than in the healthy subjects (4.3 pmol/l, range: 1.6-12.0, vs. 2.2 pmol/l, range: 1.4-6.0; P < 0.001), the values being higher in GD patients than TNG. A significant correlation between serum OPG levels and age was found in the healthy subjects (r: 0.48; P < 0.001) but not in hyperthyroid patients (r: -0.03; P = 0.8). In the healthy subjects, serum OPG levels were also positively correlated with both serum FT4 (r: 0.23; P = 0.03) and FT3 (r: 0.24; P = 0.04) levels. In hyperthyroid patients, however, serum OPG was still correlated with FT3 levels (r: 0.38; P < 0.001), whereas the correlation with serum FT4 was lost (r: 0.19; P = 0.06). In hyperthyroid patients, but not in the healthy subjects, serum OPG levels were correlated positively with CrossLaps (r: 0.20; P = 0.03) and negatively with BALP (r: -0.24; P = 0.01) and BMD (r: -0.33; P = 0.01). After 6 months of MMI treatment, serum OPG concentrations decreased significantly in TNG patients (from 3.5 pmol/l, range: 1.6-8.0, to 2.3 pmol/l, range: 1.0-4.3; P < 0.001), whereas a not significant change in OPG levels occurred in GD patients (from 4.8 pmol/l, range: 1.8-12.0, to 4.2 pmol/l, range: 1.0-14.0; P = 0.7). At Month 12 of treatment, serum OPG concentrations were significantly lower than those measured at baseline in both TNG (2.5 pmol/l, range: 1.0-3.1, vs. 3.5 pmol/l, range: 1.6-8.0; P < 0.001) and GD (2.1 pmol/l, range: 1.0-8.6, vs. 4.8 pmol/l, range: 1.8-12.0; P < 0.001). At this time, no significant differences in serum OPG, CrossLaps, and BALP values were found between patients and control subjects. At the end of follow-up, BMD was higher than those measured at baseline but still significantly lower than those measured in the control subjects. This study shows that hyperthyroid patients have serum OPG concentrations significantly higher in comparison with euthyroid subjects, in relation to thyroid hormone excess and high bone turnover. Medical treatment of hyperthyroidism normalizes serum OPG levels in temporal relationship with the normalization of bone metabolism markers, even in presence of persistent abnormal bone structure as determined by ultrasonography.
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Affiliation(s)
- G Amato
- Department of Clinical and Experimental Medicine F. Magrassi and A. Lanzara, Second University of Naples, 80121, Naples, Italy
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Carella C, Mazziotti G, Amato G, Braverman LE, Roti E. Clinical review 169: Interferon-alpha-related thyroid disease: pathophysiological, epidemiological, and clinical aspects. J Clin Endocrinol Metab 2004; 89:3656-61. [PMID: 15292282 DOI: 10.1210/jc.2004-0627] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- C Carella
- Department of Clinical and Experimental Medicine F. Magrassi and A. Lanzara, Second University of Naples, 80121 Naples, Italy
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Di Serio C, Caccavale C, Borriello M, Rotondi M, Di Serio M, Rotondi M, Tolino A, Carella C. Unusual case of cervical pregnancy after curettage for a presumptive diagnosis of intrauterine blighted ovum. CLIN EXP OBSTET GYN 2003; 30:67-9. [PMID: 12731750] [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: 03/02/2023]
Abstract
A case of cervical pregnancy after curettage for presumptive intrauterine blighted ovum is presented. The woman was successfully treated by vacuum evacuation and curettage. A 29-year-old woman, gravida 2, nulliparous, was admitted to our department at ten weeks and two days of gestation after a diagnosis of cervical pregnancy. She had been treated by curettage five days before for an initial diagnosis of intrauterine blighted ovum. Ultrasound scan examination revealed a gestational sac without foetus in the cervix four days after the first curettage. Vacuum evacuation and curettage of the cervical canal were performed and a Foley catheter was also inserted and left in place for three days. The patient was discharged in good condition on the fourth postoperative day.
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Affiliation(s)
- C Di Serio
- Department of Obstetrics and Gynaecology, University of Naples "Federico II", Naples, Italy
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Rotondi M, Labriola D, Rotondi M, Ammaturo FP, Amato G, Carella C, Izzo A, Panariello S. Depot leuprorelin acetate versus danazol in the treatment of infertile women with symptomatic endometriosis. EUR J GYNAECOL ONCOL 2003; 23:523-6. [PMID: 12556096] [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: 02/28/2023]
Abstract
PURPOSE OF INVESTIGATION Endometriosis is a common finding in women with infertility, but the mechanism by which it renders a woman infertile remains unclear. The medical treatment of pelvic endometriosis includes hormonal therapy that directly attacks endometriosis lesions or indirectly by inhibiting endometrial proliferation through estrogenic deprivation. The aim of this study was to compare the efficacy and safety of leuprorelin acetate depot and danazol for endometriosis in infertile women. METHODS This randomized trial involved 81 women 19-41 years old with regular menses and known pelvic endometriosis who were recruited from the Fertility Center of the Second University of Naples between 1992 and 1999. Fifty-four women were given 3.75 mg of leuprolide acetate depot every 28 days for 24 weeks and the remaining 27 took 200 mg of danazol three times daily for 24 weeks. Efficacy assessments were based on pre-admission and end-of-treatment laparoscopic scores and subjective symptoms scores at 4-week intervals during and after treatment. Safety was evaluated by adverse events and clinical laboratory tests. RESULTS In each group, endometriosis growth and symptoms significantly improved during treatment (p < 0.001). Significantly fewer patients randomized to leuprorelin acetate (5.5%) withdrew during treatment compared with 18.5% randomized to danazol (p < 0.05). After treatment symptoms returned in each group, but severity was less than at admission at all time points (p < 0.02). Hypoestrogenic side-effects were more common in those receiving leuprorelin, particularly hot flushes, but anabolic/androgenic side-effects of weight gain and acne were more common in those receiving danazol. CONCLUSION Both leuprorelin acetate depot and danazol are effective in the treatment of endometriosis in infertile patients. The hypoestrogenic side-effects of leuprorelin may be better tolerated than the androgenic, anabolic effects of danazol.
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Affiliation(s)
- M Rotondi
- Institute of Obstetrics and Gynecology, II University of Naples, Italy
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Amato G, Lalli E, Mazziotti G, De Felice G, Rotondi M, Vitolo G, Saggese A, Livrea A, Bellastella A, Carella C. Eight parathyroid glands incidentally discovered during a surgical intervention for secondary hyperparathyroidism: an unusual clinical finding. J Endocrinol Invest 2002; 25:800-3. [PMID: 12398239 DOI: 10.1007/bf03345515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Here we describe the uncommon case of a Caucasian male with secondary hyperparathyroidism due to 8 parathyroid glands discovered in the course of a surgical exploration. The patient (age 49 yr) with a 21-yr history of chronic renal failure came to our observation in June 1999 complaining of depression, muscle weakness, bone and joint pain, movement hindrance. The biochemical evaluation evidenced low-normal serum calcium, high phosphorus and PTH levels. The symptoms and the biochemical findings were suggestive for secondary hyperparathyroidism. The neck US revealed an increase of thyroid gland volume with diffuse hyperechogenity; two nodules of 20 and 25 mm as maximum diameter were found in the thyroid parenchyma, while 4 hypoechogenous nodules (maximum diameter ranging from 13.0 to 30.0 mm) with clean borders and anechogenous areas inside were evidenced in the rear side of the thyroid lobes. The parathyroid scan with 99mTc and 201 Tl demonstrated increased uptake bilaterally in the inferior side of the neck. The patient underwent a total parathyroidectomy with near total thyroidectomy in November 1999. Histological examination of surgical specimen evidenced 6 hyperplastic parathyroid glands in back side of the 2 lobes (3 on the right and 3 on the left), and the examination of the thyroid gland showed 2 hyperplastic parathyroids (5 mm and 15 mm maximum diameter) into the 2 nodules previously evidenced by US. The physiopathological and clinical and therapeutic implications of this observation are discussed.
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Affiliation(s)
- G Amato
- Institute of Endocrinology, Second University of Naples, Italy.
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Mazziotti G, Sorvillo F, Carbone A, Cioffi M, Morisco F, Carella C. Is the IFN-alpha-related thyroid autoimmunity an immunologically heterogeneous disease? J Intern Med 2002; 252:377-8; author reply 379. [PMID: 12366611 DOI: 10.1046/j.1365-2796.2002.01045.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Mazziotti G, Sorvillo F, Stornaiuolo G, Rotondi M, Morisco F, Ruberto M, Cioffi M, Amato G, Caporaso N, Gaeta GB, Carella C. Temporal relationship between the appearance of thyroid autoantibodies and development of destructive thyroiditis in patients undergoing treatment with two different type-1 interferons for HCV-related chronic hepatitis: a prospective study. J Endocrinol Invest 2002; 25:624-30. [PMID: 12150338 DOI: 10.1007/bf03345087] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In this prospective study we performed repeated evaluations of thyroid status in patients undergoing treatment with different preparations of recombinant interferons (IFNs), in order to identify early markers of thyroid dysfunction. Moreover, we aimed to investigate whether the development of thyroid dysfunction was related to the appearance of thyroid autoimmunity. Our study included 51 consecutive patients without pre-existing thyroid disease, admitted to our hospital for Hepatitis C virus (HCV)-related chronic hepatitis. Thirty-six patients (Gr. A) were treated with IFN-alpha 2b plus ribavirin (RIBA), whereas 15 patients (Gr. B) underwent treatment with IFN-alphacon-1 (CIFN) plus RIBA. Thyroid autoimmunity and function were prospectively evaluated before, every month during treatment and for 6 months after IFN withdrawal. At study entry, all patients were euthyroid and negative for thyroid autoantibodies. In Gr. A, 10 patients developed thyroid autoimmunity after a median period of 3 months (range: 1-6) treatment with IFN-alpha+RIBA. At the time of appearance of thyroid autoantibodies, 4 patients developed destructive thyrotoxicosis (overt in one case, subclinical in 3 cases), while other 4 patients showed a high reduction of serum TSH levels (median decrease: -75.7%, range: -61.9- -84.2), which reached the low values of normal range. After a median period of 2 months (range: 1-3) from these biochemical abnormalities, 6 patients continuing antiviral treatment developed hypothyroidism (overt in 3 cases and subclinical in the other 3). In Gr. B, 5 patients developed thyroid autoimmunity after a median period of 3 months (range: 2-10) of treatment with CIFN+RIBA. Soon after the appearance of thyroid autoantibodies, all patients developed an overt thyrotoxicosis (with hyperthyroidism in 2 cases). Antiviral treatment was discontinued in all 5 cases. Thereafter, thyroid function recovered spontaneously without significant modifications of serum TGAb and TPOAb levels until the end of the study. In conclusion our prospective study demonstrated that: 1) the appearance of thyroid autoantibodies during treatment with IFN was accompanied in most cases by the occurrence of a destructive process in the thyroid gland; 2) The clinical expression of destructive thyroiditis was more evident in patients treated with CIFN than that in patients treated with IFN; 3) The thyroid clinical outcome of these patients was strictly correlated to the continuation of cytokine treatment.
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Affiliation(s)
- G Mazziotti
- Department of Clinical and Experimental Medicine F Magrassi, Second University of Naples, Italy
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