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Goodman RS, Di Guardo L, Maurichi A, Kirwin B, Khattak A, Vanella V, Lee J, Lawless A, Czapla J, Spagnoletti A, Ambrosini M, Livingstone E, Long GV, Sullivan RJ, Carlino MS, Atkinson V, Trojanello C, Ascierto PA, Schadendorf D, Warburton L, Menzies AM, Santinami M, Johnson DB. Long-term outcomes and persistent toxicities following BRAF/MEK inhibitor therapy for advanced melanoma. Eur J Cancer 2023; 194:113354. [PMID: 37827067 PMCID: PMC10843257 DOI: 10.1016/j.ejca.2023.113354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 09/05/2023] [Accepted: 09/12/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Recent studies have shown that approximately 20% of patients have 4-5 year progression free survival (PFS) on BRAF/MEK inhibitors. The long-term safety and efficacy in these patients with more durable responses have not been studied. METHODS This retrospective multicenter cohort study assessed response, progression, and adverse events in patients from eight institutions in four countries with >4-year PFS following BRAF/MEK inhibitors. RESULTS Among 146 patients, 112 (76.7%) remained progression-free at median follow-up of 7.8 years from treatment start; 131 (89.7%) were alive. Among progressors (n = 34), 21 (62%) were on treatment at progression. Among those who discontinued treatment for reasons other than progression (toxicity, preference, etc.) (n = 68, with median 49 months treatment duration), 13 (19%) progressed (median 15.3 months from treatment cessation to progression). Surgery or radiation for single-organ progression resulted in durable benefit in 11 of 22 patients (50%). Subsequent systemic therapy included immune therapy (24% responded) and BRAF/MEK rechallenge (56% responded). Thirteen (8.9%) patients had ongoing toxicities at last follow-up, 10 (77%) of which remained on active treatment; all cardiac adverse events had resolved (n = 9). Twenty-four (16.4%) patients developed any new primary cancer, and 28 (19%) patients experienced other major health events. CONCLUSIONS Over 75% of patients with 4-year PFS from BRAF/MEK inhibitors had continued durable antitumor responses after nearly 8-year median follow-up, with similar results in patients who discontinued therapy for reasons other than progression. Long-term toxicities were uncommon and low-grade. These findings highlight the often-favourable outcomes in patients with extended benefit from BRAF/MEK inhibitors.
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Affiliation(s)
| | - Lorenza Di Guardo
- Department of Medical Oncology, Fondazione IRCCS Instituto Nazionale dei Tumori, Milan, Milano Province, Italy
| | - Andrea Maurichi
- Department of Medical Oncology, Fondazione IRCCS Instituto Nazionale dei Tumori, Milan, Milano Province, Italy
| | - Brendan Kirwin
- Department of Medical Oncology, Melanoma Institute of Australia, The University of Sydney, Mater and Royal North Shore Hospitals, Sydney, NSW, Australia
| | - Adnan Khattak
- Department of Medical Oncology, Fiona Stanley Hospital, Edith Cowan University, Perth, WA, Australia
| | - Vito Vanella
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS Fondazione 'G. Pascale', Napoli, Napoli Province, Italy
| | - Joanna Lee
- Department of Medical Oncology, Blacktown and Westmead Hospitals, Sydney, New South Wales, Australia
| | - Aleigha Lawless
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Juliane Czapla
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Andrea Spagnoletti
- Department of Medical Oncology, Fondazione IRCCS Instituto Nazionale dei Tumori, Milan, Milano Province, Italy
| | - Margherita Ambrosini
- Department of Medical Oncology, Fondazione IRCCS Instituto Nazionale dei Tumori, Milan, Milano Province, Italy
| | - Elisabeth Livingstone
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, North Rhine Westphalia, Germany
| | - Georgina V Long
- Department of Medical Oncology, Melanoma Institute of Australia, The University of Sydney, Mater and Royal North Shore Hospitals, Sydney, NSW, Australia
| | - Ryan J Sullivan
- Division of Hematology and Medical Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Matteo S Carlino
- Department of Medical Oncology, Blacktown and Westmead Hospitals, Sydney, New South Wales, Australia; Melanoma Institute of Australia, The University of Sydney, Sydney, New South Wales, Australia
| | - Victoria Atkinson
- University of Queensland, Princess Alexandra Hospital, Greenslopes Private Hospital, Brisbane, QLD, Australia
| | - Claudia Trojanello
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS Fondazione 'G. Pascale', Napoli, Napoli Province, Italy
| | - Paolo A Ascierto
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS Fondazione 'G. Pascale', Napoli, Napoli Province, Italy
| | - Dirk Schadendorf
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, North Rhine Westphalia, Germany
| | - Lydia Warburton
- Department of Medical Oncology, Fiona Stanley Hospital, Edith Cowan University, Perth, WA, Australia
| | - Alexander M Menzies
- Department of Medical Oncology, Melanoma Institute of Australia, The University of Sydney, Mater and Royal North Shore Hospitals, Sydney, NSW, Australia
| | - Mario Santinami
- Department of Medical Oncology, Fondazione IRCCS Instituto Nazionale dei Tumori, Milan, Milano Province, Italy
| | - Douglas B Johnson
- Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, TN, USA.
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2
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Bhave P, Ahmed T, Lo SN, Shoushtari A, Zaremba A, Versluis JM, Mangana J, Weichenthal M, Si L, Lesimple T, Robert C, Trojanello C, Wicky A, Heywood R, Tran L, Batty K, Dimitriou F, Stansfeld A, Allayous C, Schwarze JK, Mooradian MJ, Klein O, Mehmi I, Roberts-Thomson R, Maurichi A, Yeoh HL, Khattak A, Zimmer L, Blank CU, Ramelyte E, Kähler KC, Roy S, Ascierto PA, Michielin O, Lorigan PC, Johnson DB, Plummer R, Lebbe C, Neyns B, Sullivan R, Hamid O, Santinami M, McArthur GA, Haydon AM, Long GV, Menzies AM, Carlino MS. Efficacy of anti-PD-1 and ipilimumab alone or in combination in acral melanoma. J Immunother Cancer 2022; 10:e004668. [PMID: 35793872 PMCID: PMC9260790 DOI: 10.1136/jitc-2022-004668] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Acral melanoma is a rare melanoma subtype with poor prognosis. Importantly, these patients were not identified as a specific subgroup in the landmark melanoma trials involving ipilimumab and the anti-programmed cell death protein-1 (PD-1) agents nivolumab and pembrolizumab. There is therefore an absence of prospective clinical trial evidence regarding the efficacy of checkpoint inhibitors (CPIs) in this population. Acral melanoma has lower tumor mutation burden (TMB) than other cutaneous sites, and primary site is associated with differences in TMB. However the impact of this on the effectiveness of immune CPIs is unknown. We examined the efficacy of CPIs in acral melanoma, including by primary site. METHODS Patients with unresectable stage III/IV acral melanoma treated with CPI (anti-PD-1 and/or ipilimumab) were studied. Multivariable logistic and Cox regression analyses were conducted. Primary outcome was objective response rate (ORR); secondary outcomes were progression-free survival (PFS) and overall survival (OS). RESULTS In total, 325 patients were included: 234 (72%) plantar, 69 (21%) subungual and 22 (7%) palmar primary sites. First CPI included: 184 (57%) anti-PD-1, 59 (18%) anti-PD-1/ipilimumab combination and 82 (25%) ipilimumab. ORR was significantly higher with initial anti-PD-1/ipilimumab compared with anti-PD-1 (43% vs 26%, HR 2.14, p=0.0004) and significantly lower with ipilimumab (15% vs 26%, HR 0.49, p=0.0016). Landmark PFS at 1 year was highest for anti-PD-1/ipilimumab at 34% (95% CI 24% to 49%), compared with 26% (95% CI 20% to 33%) with anti-PD-1 and 10% (95% CI 5% to 19%) with ipilimumab. Despite a trend for increased PFS, anti-PD-1/ipilimumab combination did not significantly improve PFS (HR 0.85, p=0.35) or OS over anti-PD-1 (HR 1.30, p=0.16), potentially due to subsequent therapies and high rates of acquired resistance. No outcome differences were found between primary sites. CONCLUSION While the ORR to anti-PD-1/ipilimumab was significantly higher than anti-PD-1 and PFS numerically higher, in this retrospective cohort this benefit did not translate to improved OS. Future trials should specifically include patients with acral melanoma, to help determine the optimal management of this important melanoma subtype.
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Affiliation(s)
- Prachi Bhave
- Sir Peter MacCallum Cancer Centre Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
- Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, New South Wales, Australia
| | - Tasnia Ahmed
- Melanoma Institute Australia, North Sydney, New South Wales, Australia
| | - Serigne N Lo
- Melanoma Institute Australia, North Sydney, New South Wales, Australia
| | - Alexander Shoushtari
- Medicine, Melanoma and Immunotherapeutics Service, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Anne Zaremba
- Dermatology, University Hospital Essen, Essen, Germany
| | - Judith M Versluis
- Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Joanna Mangana
- Dermatology, University Hospital Zürich, Zurich, Switzerland
| | - Michael Weichenthal
- Dermatology, University Hospital Schleswig-Holstein - Campus Kiel, Kiel, Germany
| | - Lu Si
- Melanoma and Sarcoma, Peking University Cancer Hospital, Beijing, China
| | - Thierry Lesimple
- Research and Medical Oncology, Centre Eugène Marquis, Rennes, France
| | | | - Claudia Trojanello
- Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione "G.Pascale", Napoli, Italy
| | - Alexandre Wicky
- Oncology, Lausanne University Hospital, Lausanne, Switzerland
| | - Richard Heywood
- Christie NHS Foundation Trust and Division of Cancer Services, University of Manchester, Manchester, UK
| | - Lena Tran
- Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kathleen Batty
- Melanoma Institute Australia, North Sydney, New South Wales, Australia
| | - Florentia Dimitriou
- Melanoma Institute Australia, North Sydney, New South Wales, Australia
- Dermatology, University Hospital Zürich, Zurich, Switzerland
| | - Anna Stansfeld
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne, UK
| | - Clara Allayous
- Dermatology, Saint-Louis hospital, INSERM U976, AP-HP, Paris, France
| | - Julia K Schwarze
- Medical Oncology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, Brussel, Belgium
| | - Meghan J Mooradian
- Medical Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Oliver Klein
- Medical Oncology, Olivia Newton John Cancer Centre, Austin Health, Melbourne, Victoria, Australia
- Medical Oncology, Warrnambool Hospital, Warrnambool, Victoria, Australia
- Medical Oncology, Peninsula Health, Melbourne, Victoria, Australia
| | - Inderjit Mehmi
- The Angeles Clinic and Research Institute, a Cedars-Sinai Affiliate, Los Angeles, California, USA
| | | | - Andrea Maurichi
- Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Hui-Ling Yeoh
- Medical Oncology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Adnan Khattak
- Medical Oncology, Fiona Stanley Hospital & Edith Cowan Univserity, Perth, Western Australia, Australia
| | - Lisa Zimmer
- Dermatology, University Hospital Essen, Essen, Germany
| | - Christian U Blank
- Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Egle Ramelyte
- Dermatology, University Hospital Zürich, Zurich, Switzerland
| | - Katharina C Kähler
- Dermatology, University Hospital Schleswig-Holstein - Campus Kiel, Kiel, Germany
| | | | - Paolo A Ascierto
- Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione "G.Pascale", Napoli, Italy
| | | | - Paul C Lorigan
- Christie NHS Foundation Trust and Division of Cancer Services, University of Manchester, Manchester, UK
| | - Douglas B Johnson
- Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ruth Plummer
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne, UK
| | - Celeste Lebbe
- Université de Paris, AP-HP Department of Dermatology, Hôpital Saint-Louis, Paris, France
| | - Bart Neyns
- Medical Oncology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, Brussel, Belgium
| | - Ryan Sullivan
- Medical Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Omid Hamid
- The Angeles Clinic and Research Institute, a Cedars-Sinai Affiliate, Los Angeles, California, USA
| | - Mario Santinami
- Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Grant A McArthur
- Sir Peter MacCallum Cancer Centre Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew M Haydon
- Medical Oncology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Georgina V Long
- Melanoma Institute Australia, North Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, New South Wales, Australia
| | - Alexander M Menzies
- Melanoma Institute Australia, North Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, New South Wales, Australia
| | - Matteo S Carlino
- Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, New South Wales, Australia
- Melanoma Institute Australia, North Sydney, New South Wales, Australia
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3
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Pires da Silva I, Zakria D, Ahmed T, Trojanello C, Dimitriou F, Allayous C, Gerard C, Zimmer L, Lo S, Michielin O, Lebbe C, Mangana J, Ascierto PA, Johnson DB, Carlino M, Menzies A, Long G. Efficacy and safety of anti-PD1 monotherapy or in combination with ipilimumab after BRAF/MEK inhibitors in patients with BRAF mutant metastatic melanoma. J Immunother Cancer 2022; 10:e004610. [PMID: 35798536 PMCID: PMC9263926 DOI: 10.1136/jitc-2022-004610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Patients with V600BRAF mutant metastatic melanoma have higher rates of progression-free survival (PFS) and overall survival (OS) with first-line anti-PD1 (PD1]+anti-CTLA-4 (IPI) versus PD1. Whether this is also true after BRAF/MEKi therapy is unknown. We aimed to determine the efficacy and safety of PD1 versus IPI +PD1 after BRAF/MEK inhibitors (BRAF/MEKi). METHODS Patients with V600BRAF mutant metastatic melanoma treated with BRAF/MEKi who had subsequent PD1 versus IPI+PD1 at eight centers were included. The endpoints were objective response rate (ORR), PFS, OS and safety in each group. RESULTS Of 200 patients with V600E (75%) or non-V600E (25%) mutant metastatic melanoma treated with BRAF/MEKi (median time of treatment 7.6 months; treatment cessation due to progressive disease in 77%), 115 (57.5%) had subsequent PD1 and 85 (42.5%) had IPI+PD1. Differences in patient characteristics between PD1 and IPI+PD1 groups included, age (med. 63 vs 54 years), time between BRAF/MEKi and PD1±IPI (16 vs 4 days), Eastern Cooperative Oncology Group Performance Status (ECOG PS) of ≥1 (62% vs 44%), AJCC M1C/M1D stage (72% vs 94%) and progressing brain metastases at the start of PD1±IPI (34% vs 57%). Median follow-up from PD1±IPI start was 37.8 months (95% CI, 33.9 to 52.9). ORR was 36%; 34% with PD1 vs 39% with IPI+PD1 (p=0.5713). Median PFS was 3.4 months; 3.4 with PD1 vs 3.6 months with IPI+PD1 (p=0.6951). Median OS was 15.4 months; 14.4 for PD1 vs 20.5 months with IPI+PD1 (p=0.2603). The rate of grade 3 or 4 toxicities was higher with IPI+PD1 (31%) vs PD1 (7%). ORR, PFS and OS were numerically higher with IPI+PD1 vs PD1 across most subgroups except for females, those with <10 days between BRAF/MEKi and PD1±IPI, and those with stage III/M1A/M1B melanoma. The combination of ECOG PS=0 and absence of liver metastases identified patients with >3 years OS (area under the curve, AUC=0.74), while ECOG PS ≥1, progressing brain metastases and presence of bone metastases predicted primary progression (AUC=0.67). CONCLUSIONS IPI+PD1 and PD1 after BRAF/MEKi have similar outcomes despite worse baseline prognostic features in the IPI+PD1 group, however, IPI+PD1 is more toxic. A combination of clinical factors can identify long-term survivors, but less accurately those with primary resistance to immunotherapy after targeted therapy.
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Affiliation(s)
- Ines Pires da Silva
- Melanoma Institute Australia, The University of Sydney, North Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Blacktown & Westmead Hospital, Sydney, New South Wales, Australia
| | - Danny Zakria
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Tasnia Ahmed
- Melanoma Institute Australia, The University of Sydney, North Sydney, New South Wales, Australia
| | - Claudia Trojanello
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - Florentia Dimitriou
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | - Clara Allayous
- Dermatolo-Oncology AP-HP Hôpital Saint-Louis, INSERM U976, Paris, France
| | | | - Lisa Zimmer
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Serigne Lo
- Melanoma Institute Australia, The University of Sydney, North Sydney, New South Wales, Australia
| | | | - Celeste Lebbe
- Université Paris Cite, Dermatolo-Oncology AP-HP Hôpital Saint-Louis, INSERM U976, Paris, France
| | - Johanna Mangana
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | - Paolo Antonio Ascierto
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | | | - Matteo Carlino
- Melanoma Institute Australia, The University of Sydney, North Sydney, New South Wales, Australia
- Blacktown & Westmead Hospital, Sydney, New South Wales, Australia
| | - Alexander Menzies
- Melanoma Institute Australia, The University of Sydney, North Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Royal North Shore and Mater Hospitals, Sydney, New South Wales, Australia
| | - Georgina Long
- Melanoma Institute Australia, The University of Sydney, North Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Royal North Shore and Mater Hospitals, Sydney, New South Wales, Australia
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4
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Ottaviano M, Curvietto M, Rescigno P, Tortora M, Palmieri G, Giannarelli D, Aieta M, Assalone P, Attademo L, Avallone A, Bloise F, Bosso D, Borzillo V, Buono G, Calderoni G, Caputo F, Cartenì G, Cavallero D, Cavo A, Ciardiello F, Conca R, Conteduca V, De Falco S, De Felice M, De Laurentiis M, De Placido P, De Placido S, De Santo I, De Stefano A, Della Corte CM, Di Franco R, Di Lauro V, Fabbrocini A, Federico P, Festino L, Giordano P, Giuliano M, Gridelli C, Grimaldi AM, Lia M, Marretta AL, Massa V, Mennitto A, Merler S, Merz V, Messina C, Messina M, Milano M, Minisini AM, Montesarchio V, Morabito A, Morgillo F, Mucci B, Nappi L, Napolitano F, Paciolla I, Pagliuca M, Palmieri G, Parola S, Pepe S, Petrillo A, Piantedosi F, Piccin L, Picozzi F, Pietroluongo E, Pignata S, Prati V, Riccio V, Rosanova M, Rossi A, Russo A, Salati M, Santabarbara G, Sbrana A, Simeone E, Silvestri A, Spada M, Tarantino P, Taveggia P, Tomei F, Vincenzo T, Trapani D, Trojanello C, Vanella V, Vari S, Ventriglia J, Vitale MG, Vitiello F, Vivaldi C, von Arx C, Zacchi F, Zampiva I, Zivi A, Daniele B, Ascierto PA. Impact of COVID-19 outbreak on cancer immunotherapy in Italy: a survey of young oncologists. J Immunother Cancer 2020; 8:jitc-2020-001154. [PMID: 33060148 PMCID: PMC7565202 DOI: 10.1136/jitc-2020-001154] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2020] [Indexed: 01/20/2023] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has overwhelmed the health systems worldwide. Data regarding the impact of COVID-19 on cancer patients (CPs) undergoing or candidate for immune checkpoint inhibitors (ICIs) are lacking. We depicted the practice and adaptations in the management of patients with solid tumors eligible or receiving ICIs during the COVID-19 pandemic, with a special focus on Campania region. Methods This survey (25 questions), promoted by the young section of SCITO (Società Campana di ImmunoTerapia Oncologica) Group, was circulated among Italian young oncologists practicing in regions variously affected by the pandemic: high (group 1), medium (group 2) and low (group 3) prevalence of SARS-CoV-2–positive patients. For Campania region, the physician responders were split into those working in cancer centers (CC), university hospitals (UH) and general hospitals (GH). Percentages of agreement, among High (H) versus Medium (M) and versus Low (L) group for Italy and among CC, UH and GH for Campania region, were compared by using Fisher’s exact tests for dichotomous answers and χ2 test for trends relative to the questions with 3 or more options. Results This is the first Italian study to investigate the COVID-19 impact on cancer immunotherapy, unique in its type and very clear in the results. The COVID-19 pandemic seemed not to affect the standard practice in the prescription and delivery of ICIs in Italy. Telemedicine was widely used. There was high consensus to interrupt immunotherapy in SARS-CoV-2–positive patients and to adopt ICIs with longer schedule interval. The majority of the responders tended not to delay the start of ICIs; there were no changes in supportive treatments, but some of the physicians opted for delaying surgeries (if part of patients’ planned treatment approach). The results from responders in Campania did not differ significantly from the national ones. Conclusion Our study highlights the efforts of Italian oncologists to maintain high standards of care for CPs treated with ICIs, regardless the regional prevalence of COVID-19, suggesting the adoption of similar solutions. Research on patients treated with ICIs and experiencing COVID-19 will clarify the safety profile to continue the treatments, thus informing on the most appropriate clinical conducts.
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Affiliation(s)
- Margaret Ottaviano
- Oncology Unit, Ospedale del Mare, Napoli, Campania, Italy.,Department of Clinical Medicine and Surgery, Università degli Studi di Napoli Federico II and CRCTR Coordinating Rare Tumors Reference Center of Campania Region, AOU Federico II, Napoli, Italy
| | - Marcello Curvietto
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
| | - Pasquale Rescigno
- Clinical Studies, The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK
| | - Marianna Tortora
- CRCTR Coordinating Rare Tumors Reference Center of Campania Region, AOU Federico II, Napoli, Campania, Italy
| | - Giovannella Palmieri
- CRCTR Coordinating Rare Tumors Reference Center of Campania Region, AOU Federico II, Napoli, Campania, Italy
| | - Diana Giannarelli
- Biostatistics Unit, IRCCS Regina Elena National Cancer Institute, Roma, Lazio, Italy
| | - Michele Aieta
- Medical Oncology Unit, Department of Onco-Hematology, IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Basilicata, Italy
| | - Pasquale Assalone
- Oncology Unit, Ospedale Ferdinando Veneziale, Isernia, Molise, Italy
| | - Laura Attademo
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
| | - Antonio Avallone
- Abdominal Oncology Unit, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
| | | | | | - Valentina Borzillo
- Department of Radioterapia, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
| | - Giuseppe Buono
- Oncology Unit, San Rocco Hospital, Sessa Aurunca, Campania, Italy
| | | | - Francesca Caputo
- U.O.C. Oncologia, Azienda Ospedaliera dei Colli, Monaldi Hospital, Napoli, Campania, Italy
| | - Giacomo Cartenì
- Department of Medical Oncology, AORN "A. Cardarelli", Napoli, Campania, Italy
| | | | - Alessia Cavo
- Oncology Unit, Villa Scassi Hospital, Genova, Italy
| | - Fortunato Ciardiello
- Oncology, Department of Precision Medicine, Università della Campania "L. Vanvitelli", Napoli, Campania, Italy
| | - Raffaele Conca
- Medical Oncology Unit, Department of Onco-Hematology, IRCCS-CROB Referral Cancer Center of Basilicata, Rionero in Vulture, Basilicata, Italy
| | - Vincenza Conteduca
- Medical Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Emilia-Romagna, Italy
| | - Stefano De Falco
- Oncology Unit, Sant'Ottone Frangipane Hospital, Avellino, Campania, Italy
| | - Marco De Felice
- Oncology, Department of Precision Medicine, Università della Campania "L. Vanvitelli", Napoli, Campania, Italy.,Oncology Unit, Sant'Anna e San Sebastiano, Caserta, Campania, Italy
| | | | - Pietro De Placido
- Department of Clinical Medicine and Surgery, Oncology Unit, Università degli Studi di Napoli Federico II, Napoli, Campania, Italy
| | - Sabino De Placido
- CRCTR Coordinating Rare Tumors Reference Center of Campania Region, AOU Federico II, Napoli, Campania, Italy.,Department of Clinical Medicine and Surgery, Oncology Unit, Università degli Studi di Napoli Federico II, Napoli, Campania, Italy
| | - Irene De Santo
- Oncology Unit, Gemelli Molise s.p.a, Campobasso, Molise, Italy
| | - Alfonso De Stefano
- Abdominal Oncology Unit, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
| | - Carminia Maria Della Corte
- Oncology, Department of Precision Medicine, Università della Campania "L. Vanvitelli", Napoli, Campania, Italy
| | - Rossella Di Franco
- Department of Radioterapia, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
| | - Vincenzo Di Lauro
- Breast Unit, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy.,Department of Clinical Medicine and Surgery, Oncology Unit, Università degli Studi di Napoli Federico II, Napoli, Campania, Italy
| | | | | | - Lucia Festino
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
| | | | - Mario Giuliano
- CRCTR Coordinating Rare Tumors Reference Center of Campania Region, AOU Federico II, Napoli, Campania, Italy.,Department of Clinical Medicine and Surgery, Oncology Unit, Università degli Studi di Napoli Federico II, Napoli, Campania, Italy
| | - Cesare Gridelli
- Division of Medical Oncology, "San Giuseppe Moscati" Hospital, Avellino, Campania, Italy
| | - Antonio Maria Grimaldi
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
| | - Michela Lia
- Oncology Unit, SS Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Piemonte, Italy
| | - Antonella Lucia Marretta
- Department of Clinical Medicine and Surgery, Oncology Unit, Università degli Studi di Napoli Federico II, Napoli, Campania, Italy
| | - Valentina Massa
- Medical Oncology Unit, University of Pisa, Pisa, Toscana, Italy
| | - Alessia Mennitto
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Lombardia, Italy
| | - Sara Merler
- Department of Oncology, University of Verona, Verona, Veneto, Italy
| | - Valeria Merz
- Department of Medical Oncology, Santa Chiara Hospital, Trento, Trentino Alto Adige, Italy
| | - Carlo Messina
- Department of Medical Oncology, Santa Chiara Hospital, Trento, Trentino Alto Adige, Italy
| | - Marco Messina
- UOC Oncologia Medica, Ospedali Riuniti Villa Sofia Cervello, Palermo, Sicilia, Italy
| | - Monica Milano
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Lombardia, Italy
| | - Alessandro Marco Minisini
- Department of Oncology, Azienda Sanitaria Universitaria Integrata del Friuli Centrale, Udine, Friuli Venezia Giulia, Italy
| | - Vincenzo Montesarchio
- U.O.C. Oncologia, Azienda Ospedaliera dei Colli, Monaldi Hospital, Napoli, Campania, Italy
| | - Alessandro Morabito
- Thoracic Medical Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
| | - Floriana Morgillo
- Oncology, Department of Precision Medicine, Università della Campania "L. Vanvitelli", Napoli, Campania, Italy
| | - Brigitta Mucci
- Department of Clinical Medicine and Surgery, Oncology Unit, Università degli Studi di Napoli Federico II, Napoli, Campania, Italy
| | - Lucia Nappi
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada and British Columbia Cancer Agency-Vancouver Center-Department of Medicine, Division of Medical Oncology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fabiana Napolitano
- Department of Clinical Medicine and Surgery, Oncology Unit, Università degli Studi di Napoli Federico II, Napoli, Campania, Italy
| | - Immacolata Paciolla
- Oncology Unit, Ospedale Sacro Cuore di Gesù Fatebenefratelli, Benevento, Campania, Italy
| | - Martina Pagliuca
- Department of Clinical Medicine and Surgery, Oncology Unit, Università degli Studi di Napoli Federico II, Napoli, Campania, Italy
| | - Giuseppe Palmieri
- Institute of Research on Genetics and Biomedicine (IRGB), National Research Council (CNR), Sassari, Sardegna, Italy
| | - Sara Parola
- Department of Clinical Medicine and Surgery, Oncology Unit, Università degli Studi di Napoli Federico II, Napoli, Campania, Italy
| | - Stefano Pepe
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Oncology Unit, University of Salerno, Baronissi, Campania, Italy
| | - Angelica Petrillo
- Oncology Unit, Ospedale del Mare, Napoli, Italy.,Oncology, Department of Precision Medicine, Università della Campania "L. Vanvitelli", Napoli, Campania, Italy
| | - Francovito Piantedosi
- U.O.C. Pneumologia Oncologica, Azienda Ospedaliera dei Colli, Monaldi Hospital, Naples, Campania, Italy
| | - Luisa Piccin
- Veneto Institute of Oncology IOV-IRCCS, Padova, Veneto, Italy
| | - Fernanda Picozzi
- Department of Clinical Medicine and Surgery, Oncology Unit, Università degli Studi di Napoli Federico II, Napoli, Campania, Italy
| | - Erica Pietroluongo
- Department of Clinical Medicine and Surgery, Oncology Unit, Università degli Studi di Napoli Federico II, Napoli, Campania, Italy
| | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
| | | | - Vittorio Riccio
- Department of Clinical Medicine and Surgery, Oncology Unit, Università degli Studi di Napoli Federico II, Napoli, Campania, Italy
| | | | - Alice Rossi
- Department of Oncology, University of Verona, Verona, Veneto, Italy
| | - Anna Russo
- Medical Oncology Unit, Fondazione IRCCS Giovanni Paolo II, Bari, Puglia, Italy
| | - Massimiliano Salati
- Medical Oncology Unit, University Hospital Modena, Modena, Emilia Romagna, Italy
| | - Giuseppe Santabarbara
- Division of Medical Oncology, "San Giuseppe Moscati" Hospital, Avellino, Campania, Italy
| | - Andrea Sbrana
- Medical Oncology Unit, University of Pisa, Pisa, Toscana, Italy
| | - Ester Simeone
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
| | | | - Massimiliano Spada
- Oncology Unit, Fondazione Istituto San Raffaele G Giglio di Cefalu, Cefalu, Sicilia, Italy
| | - Paolo Tarantino
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Milano, Lombardia, Italy
| | | | - Federica Tomei
- Oncology Unit, Ospedale Ferdinando Veneziale, Isernia, Molise, Italy
| | - Tortora Vincenzo
- Department of Clinical Medicine and Surgery, Oncology Unit, Università degli Studi di Napoli Federico II, Napoli, Campania, Italy.,Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Oncology Unit, University of Salerno, Baronissi, Campania, Italy
| | - Dario Trapani
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Milano, Lombardia, Italy
| | - Claudia Trojanello
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
| | - Vito Vanella
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
| | - Sabrina Vari
- Medical Oncology 1 Unit, IRCCS Regina Elena National Cancer Institute, Rome, Lazio, Italy
| | - Jole Ventriglia
- Oncology Division, ASL San Felice a Cancello, Caserta, Campania, Italy
| | - Maria Grazia Vitale
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy.,Department of Oncology, Azienda Sanitaria Universitaria Integrata del Friuli Centrale, Udine, Friuli Venezia Giulia, Italy
| | - Fabiana Vitiello
- U.O.C. Pneumologia Oncologica, Azienda Ospedaliera dei Colli, Monaldi Hospital, Naples, Campania, Italy
| | | | - Claudia von Arx
- Department of Surgery and Cancer, Imperial College, London, UK
| | - Francesca Zacchi
- Oncology Unit, Università degli Studi di Verona, sede Borgo Roma, Verona, Veneto, Italy
| | - Ilaria Zampiva
- Oncology Unit, Università degli Studi di Verona, sede Borgo Roma, Verona, Veneto, Italy
| | - Andrea Zivi
- Department of Surgery and Cancer, Imperial College, London, UK.,Medical Oncology Department, AOUI di Verona, Verona, Veneto, Italy
| | | | - Paolo Antonio Ascierto
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
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