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Di Nardo P, Basile D, Siciliano A, Pelizzari G, Corvaja C, Buriolla S, Ongaro E, Maria Grazia D, Garattini SK, Foltran L, Guardascione M, Casagrande M, Buonadonna A, Prantera T, Aprile G, Puglisi F. Second-line treatment strategies for RAS wild-type colorectal cancer: A systematic review and Network Meta-analysis (NMA). Dig Liver Dis 2024; 56:786-794. [PMID: 37586908 DOI: 10.1016/j.dld.2023.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/07/2023] [Accepted: 07/10/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND The optimal strategy for second-line (IIL) treatment in KRAS wt metastatic colorectal cancer (mCRC) is not determined yet. METHODS A random-effect NMA of phase II/III RCTs was conducted to evaluate IIL treatment for all-RAS wt mCRC, comparing anti-EGFR or anti-VEGF, and chemotherapy (CT). RESULTS Overall, 11 RCTs (3613 patients) were included. In KRAS wt patients, PFS was improved with anti-VEGF (HR 0.43) and anti-EGFR (HR 0.63) vs CT. However, anti-VEGF based therapy had the highest likelihood of being ranked as the best treatment in terms of PFS (SUCRA 99.3%) and OS (SUCRA 99.4%). Bevacizumab-based treatment is most likely to be the best treatment in terms of PFS (SUCRA 89.1%) and OS (SUCRA 86.7%). CONCLUSIONS Second line treatment with anti-VEGF and anti-EGFR improved PFS in mCRC patients, however, anti-VEGF based therapy, particularly CT plus bevacizumab, is the best treatment according to SUCRA in terms of PFS and OS.
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Affiliation(s)
- P Di Nardo
- Department of Medical Oncology, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano, Italy
| | - D Basile
- Unit of Medical Oncology, Lamezia Terme Hospital, Italy.
| | - A Siciliano
- Unit of Medical Oncology, AO Pugliese-Ciaccio of Catanzaro, Italy
| | - G Pelizzari
- Department of Oncology, University Hospital of Udine, Italy
| | - C Corvaja
- Department of Medicine, University of Udine, Udine, Italy
| | - S Buriolla
- Department of Medicine, University of Udine, Udine, Italy
| | - E Ongaro
- Department of Medical Oncology, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano, Italy
| | | | - S K Garattini
- Department of Oncology, University Hospital of Udine, Italy
| | - L Foltran
- Department of Medical Oncology, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano, Italy
| | - M Guardascione
- Department of Medical Oncology, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano, Italy
| | - M Casagrande
- Department of Oncology, University Hospital of Udine, Italy
| | - A Buonadonna
- Department of Medical Oncology, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano, Italy
| | - T Prantera
- Unit of Medical Oncology, Lamezia Terme Hospital, Italy
| | - G Aprile
- Medical Oncology, ULSS 8 Berica, Vicenza, Italy
| | - F Puglisi
- Department of Medical Oncology, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano, Italy; Department of Medicine, University of Udine, Udine, Italy
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Torresan S, de Scordilli M, Bortolot M, Di Nardo P, Foltran L, Fumagalli A, Guardascione M, Ongaro E, Puglisi F. Liquid biopsy in colorectal cancer: Onward and upward. Crit Rev Oncol Hematol 2024; 194:104242. [PMID: 38128627 DOI: 10.1016/j.critrevonc.2023.104242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/20/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023] Open
Abstract
Colorectal cancer (CRC) remains a leading cause of cancer-related deaths worldwide. In recent years, liquid biopsy has emerged as one of the most interesting areas of research in oncology, leading to innovative trials and practical changes in all aspects of CRC management. RNAs and cell free DNA (cfDNA) methylation are emerging as promising biomarkers for early diagnosis. Post-surgical circulating tumour DNA (ctDNA) can aid in evaluating minimal residual disease and personalising adjuvant treatment. In rectal cancer, ctDNA could improve response assessment to neoadjuvant therapy and risk stratification, especially in the era of organ-preservation trials. In the advanced setting, ctDNA analysis offers the opportunity to monitor treatment response and identify driver and resistance mutations more comprehensively than traditional tissue analysis, providing prognostic and predictive information. The aim of this review is to provide a detailed overview of the clinical applications and future perspectives of liquid biopsy in CRC.
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Affiliation(s)
- Sara Torresan
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy; Department of Medicine, University of Udine, 33100 Udine, Italy
| | - Marco de Scordilli
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy; Department of Medicine, University of Udine, 33100 Udine, Italy.
| | - Martina Bortolot
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy; Department of Medicine, University of Udine, 33100 Udine, Italy
| | - Paola Di Nardo
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
| | - Luisa Foltran
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
| | - Arianna Fumagalli
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
| | - Michela Guardascione
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
| | - Elena Ongaro
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
| | - Fabio Puglisi
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy; Department of Medicine, University of Udine, 33100 Udine, Italy
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de Scordilli M, Michelotti A, Zara D, Palmero L, Alberti M, Noto C, Totaro F, Foltran L, Guardascione M, Iacono D, Ongaro E, Fasola G, Puglisi F. Preoperative treatments in borderline resectable and locally advanced pancreatic cancer: current evidence and new perspectives. Crit Rev Oncol Hematol 2023; 186:104013. [PMID: 37116817 DOI: 10.1016/j.critrevonc.2023.104013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 04/10/2023] [Accepted: 04/24/2023] [Indexed: 04/30/2023] Open
Abstract
Surgery is the only curative treatment for non-metastatic pancreatic adenocarcinoma, but less than 20% of patients present a resectable disease at diagnosis. Treatment strategies and disease definition for borderline resectable pancreatic cancer (BRPC) and locally advanced pancreatic cancer (LAPC) vary in the different cancer centres. Preoperative chemotherapy (CT) is the standard of care for both BRPC and LAPC patients, however literature data are still controversial concerning the type, dose and duration of the different CT regimens, as well as regarding the integration of radiotherapy (RT) or chemoradiation (CRT) in the therapeutic algorithm. In this unsettled debate, we aimed at focusing on the therapeutic regimens currently in use and relative literature data, to report international trials comparing the available therapeutic options or explore the introduction of new pharmacological agents, and to analyse possible new scenarios in microenvironment evaluation before and after neoadjuvant therapies or in patients' selection at a molecular level.
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Affiliation(s)
- Marco de Scordilli
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy; Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy.
| | - Anna Michelotti
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy; Department of Oncology, ASUFC University Hospital of Udine, 33100 Udine, Italy.
| | - Diego Zara
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy; Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy.
| | - Lorenza Palmero
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy; Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy.
| | - Martina Alberti
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy; Department of Oncology, ASUFC University Hospital of Udine, 33100 Udine, Italy.
| | - Claudia Noto
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy; Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy.
| | - Fabiana Totaro
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy; Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy.
| | - Luisa Foltran
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy.
| | - Michela Guardascione
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy.
| | - Donatella Iacono
- Department of Oncology, ASUFC University Hospital of Udine, 33100 Udine, Italy.
| | - Elena Ongaro
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy.
| | - Gianpiero Fasola
- Department of Oncology, ASUFC University Hospital of Udine, 33100 Udine, Italy.
| | - Fabio Puglisi
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy; Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy.
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Lisanti C, Basile D, Garattini SK, Parnofiello A, Corvaja C, Cortiula F, Bertoli E, Ongaro E, Foltran L, Casagrande M, Di Nardo P, Cardellino GG, Fasola G, Buonadonna A, Pella N, Aprile G, Puglisi F. The SAFFO Study: Sex-Related Prognostic Role and Cut-Off Definition of Monocyte-to-Lymphocyte Ratio (MLR) in Metastatic Colorectal Cancer. Cancers (Basel) 2022; 15:cancers15010175. [PMID: 36612170 PMCID: PMC9818397 DOI: 10.3390/cancers15010175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/12/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022] Open
Abstract
Background: Emerging data suggest that gender-related immune system composition affects both immune response and efficacy of immunotherapy in cancer patients (pts). This study aimed to investigate the sex-related prognostic role of MLR in metastatic colorectal cancer (mCRC) pts. Methods: We analyzed a retrospective consecutive cohort of 490 mCRC patients treated from 2009 to 2018 at the Oncology Departments of Aviano and Pordenone (training set) and Udine (validation set), Italy. The prognostic impact of MLR on overall survival (OS) was evaluated with uni- and multivariable Cox regression models. The best cut-off value to predict survival was defined through ROC analyses. Results: Overall, we identified 288 males (59%) and 202 females (41%); 161 patients (33%) had a right-sided, 202 (42%) a left-sided primary, and 122 (25%) a rectal tumor. Interestingly, gender was associated with MLR (p = 0.004) and sidedness (p = 0.006). The obtained cut-off value for MLR in females and males was 0.27 and 0.49, respectively. According to univariate analysis of the training set, MLR (HR 9.07, p ≤ 0.001), MLR > 0.27 in females (HR 1.95, p = 0.003), and MLR > 0.49 in males (HR 2.65, p = 0.010) were associated with poorer OS, which was also confirmed in the validation set. In multivariate analysis, MLR > 0.27 in females (HR 2.77, p = 0.002), MLR > 0.49 in males (HR 5.39, p ≤ 0.001), BRAF mutation (HR 3.38, p ≤ 0.001), and peritoneal metastases (HR 2.50, p = 0.003) were still independently associated with worse OS. Conclusions: Males and females have a different immune response. Our study showed that high MLR, both in males and females, is an unfavorable Independent prognostic factor. Further prospective studies are needed to confirm these data.
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Affiliation(s)
- Camilla Lisanti
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy
- Correspondence: ; Tel.: +39-0434-659136
| | - Debora Basile
- Department of Medical Oncology, San Giovanni di Dio Hospital, 88900 Crotone, Italy
| | | | - Annamaria Parnofiello
- Sandro Pitigliani Medical Oncology Department, Hospital of Prato, 59100 Prato, Italy
| | - Carla Corvaja
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
| | | | - Elisa Bertoli
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
| | - Elena Ongaro
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy
| | - Luisa Foltran
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy
| | | | - Paola Di Nardo
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy
| | | | - Gianpiero Fasola
- Department of Oncology, ASUFC University Hospital, 33100 Udine, Italy
| | - Angela Buonadonna
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy
| | - Nicoletta Pella
- Department of Oncology, ASUFC University Hospital, 33100 Udine, Italy
| | - Giuseppe Aprile
- Department of Medical Oncology, San Bortolo Hospital, Azienda ULSS8 Berica, 36100 Vicenza, Italy
| | - Fabio Puglisi
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
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5
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Michelotti A, de Scordilli M, Sperti E, Mazzeo R, Corvaja C, Aimar G, Gerratana L, Guardascione M, Rampin F, Buriolla S, Di Nardo P, Fanotto V, Andreotti V, Bartoletti M, Bertoli E, Noto C, Buonadonna A, Di Maio M, Ongaro E, Puglisi F. LDH as prognostic factor in second line treatment for advanced gastric cancer: The LINE study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e16102] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16102 Background: Lactate dehydrogenase (LDH) is recognized as indirect marker of tumor hypoxia and angiogenesis for several solid tumors. Ramucirumab is the first antiangiogenic agent approved for second-line therapy in advanced gastric cancer (GC), alone or in association with chemotherapy. To date, no reliable biomarkers can predict the potential benefit from anti-VEGFR2 treatment. This retrospective multicenter study aimed to assess the prognostic role of baseline LDH levels in patients (pts) undergoing second-line treatment for advanced GC. Methods: The study analyzed a retrospective cohort of consecutive advanced GC pts treated with second line therapy at IRCCS, CRO of Aviano and at Mauriziano Hospital of Torino, Italy, from 2010 to 2020. LDH levels prior to second-line treatment were classified as low-normal or high and standardized according to the upper limit of the reference range. To better determine the optimal LDH cut-off value, ROC analysis was performed (using PFS < 3 months as binary outcome). Normalized LDH values were subsequently sorted according to the ROC curve cut-off in order to test the association with overall survival (OS) through the Kaplan-Meier method and compared using the Log-Rank test. A multivariate Cox regression analysis assessed the prognostic impact of normalized LDH levels for OS calculated from the start of second line treatment. Results: Overall, 125 pts were enrolled. Of these, 81 pts (64.80%) received ramucirumab alone or plus paclitaxel as second line treatment, while 44 (35.20%) had taxanes or fluoropyrimidines combined with irinotecan. Median age was 68 years, 93% had an ECOG PS ≤ 1, 64.80% was first diagnosed with metastatic disease and 40.80% underwent primary tumor resection. Median second line PFS and OS were 4.2 and 7.9 months, respectively. Baseline LDH values were available for 99 pts. ROC analysis identified a normalized LDH value of 0.83 as the optimized cut-off point to define pts with poor prognosis. At univariate analyses, surgery of the primary tumor (HR 0.51, 95% CI 0.31-0.82, p = 0.005) was associated with better OS, while low-normal BMI ( < 25 kg/m2) at second line start (HR 1.99, 95% CI 1.21-3.28, p = 0.007), normalized LDH values ≥ 0.83 (HR 1.86, 95% CI 1.13-3.07, p = 0.015) and PS > 1 (HR 5.65, 95% CI 2.29-13.92, p < 0.001) were associated with poorer outcome. At multivariable model, only PS > 1 was independently associated with poor prognosis (HR 9.93, 95% CI 3.27-30.08, p < 0.001). Subgroup analyses showed no significant heterogeneity in OS outcome according to normalized LDH levels between patients treated with or without ramucirumab. Conclusions: Elevated LDH levels are indicators of worse outcome in advanced gastric cancer pts. Notably, the LDH cut-off value identified a poor prognosis subgroup among pts with normal baseline levels, suggesting that current laboratory ranges could be suboptimal for patient stratification.
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Affiliation(s)
- Anna Michelotti
- Department of Medical Area, University of Udine; Department of Medical Oncology, IRCCS, CRO of Aviano, Udine, Italy
| | - Marco de Scordilli
- Department of Medical Area, University of Udine; Department of Medical Oncology, IRCCS, CRO of Aviano, Udine, Italy
| | - Elisa Sperti
- Medical Oncology, Ordine Mauriziano Hospital, Turin, Italy
| | - Roberta Mazzeo
- Department of Medical Area, University of Udine; Department of Medical Oncology, IRCCS, CRO of Aviano, Udine, Italy
| | - Carla Corvaja
- Department of Oncology, University Hospital of Udine (ASUFC); Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Giacomo Aimar
- Universita degli Studi di Torino Dipartimento di Oncologia, Torino, Italy
| | - Lorenzo Gerratana
- Department of Medicine-Hematology and Oncology, Feinberg School of Medicine, Northwestern University; Department of Medicine (DAME), University of Udine, Chicago, IL
| | - Michela Guardascione
- Department of Medical Oncology, Clinical and Experimental Pharmacology, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano, Italy
| | - Federica Rampin
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, Torino, Italy
| | - Silvia Buriolla
- Department of Medical Area, University of Udine; Department of Medical Oncology, IRCCS, CRO of Aviano, Udine, Italy
| | - Paola Di Nardo
- Dipartimento di Oncologia Medica, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Valentina Fanotto
- Department of Medical Oncology, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano, Italy
| | - Victoria Andreotti
- Department of Medicine, University of Udine and Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Michele Bartoletti
- Department of Medicine (DAME), University of Udine; Dipartimento di Oncologia Medica, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Udine, Italy
| | - Elisa Bertoli
- Department of Medicine (DAME) - University of Udine, Udine, Italy
| | - Claudia Noto
- Department of Medicine (DAME), University of Udine; Department of Medical Oncology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Angela Buonadonna
- Oncologia Medica e Prevenzione Oncologica, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano (PN), Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, Torino, Italy
| | - Elena Ongaro
- Department of Oncology, Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico (CRO) di Aviano, IRCCS, Aviano, Italy
| | - Fabio Puglisi
- Department of Medicine (DAME), University of Udine; Dipartimento di Oncologia Medica, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Udine, Italy
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Basile D, Bartoletti M, Polano M, Bortot L, Gerratana L, Di Nardo P, Borghi M, Fanotto V, Pelizzari G, Lisanti C, Garutti M, Buriolla S, Ongaro E, Andreuzzi E, Montico M, Balestreri L, Miolo G, Toffoli G, Aprile G, Puglisi F, Buonadonna A. Prognostic role of visceral fat for overall survival in metastatic colorectal cancer: A pilot study. Clin Nutr 2021; 40:286-294. [DOI: 10.1016/j.clnu.2020.05.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 04/29/2020] [Accepted: 05/13/2020] [Indexed: 02/07/2023]
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Ruzzo A, Graziano F, Bagaloni I, Di Bartolomeo M, Prisciandaro M, Aprile G, Ongaro E, Vincenzi B, Perrone G, Santini D, Fornaro L, Vivaldi C, Tomasello G, Loupakis F, Lonardi S, Fassan M, Valmasoni M, Sarti D, Lorenzini P, Catalano V, Bisonni R, Del Prete M, Collina G, Magnani M. Glycolytic competence in gastric adenocarcinomas negatively impacts survival outcomes of patients treated with salvage paclitaxel-ramucirumab. Gastric Cancer 2020; 23:1064-1074. [PMID: 32372141 PMCID: PMC7567716 DOI: 10.1007/s10120-020-01078-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 04/23/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION For energy production, cancer cells maintain a high rate of glycolysis instead of oxidative phosphorylation converting glucose into lactic acid. This metabolic shift is useful to survive in unfavorable microenvironments. We investigated whether a positive glycolytic profile (PGP) in gastric adenocarcinomas may be associated with unfavorable outcomes under an anticancer systemic therapy, including the anti-angiogenic ramucirumab. MATERIALS AND METHODS Normal mucosa (NM) and primary tumor (PT) of 40 metastatic gastric adenocarcinomas patients who received second-line paclitaxel-ramucirumab (PR) were analyzed for mRNA expression of the following genes: HK-1, HK-2, PKM-2, LDH-A, and GLUT-1. Patients were categorized with PGP when at least a doubling of mRNA expression (PT vs. NM) in all glycolytic core enzymes (HK-1 or HK-2, PKM-2, LDH-A) was observed. PGP was also related to TP53 mutational status. RESULTS Mean LDH-A, HK-2, PKM-2 mRNA expression levels were significantly higher in PT compared with NM. 18 patients were classified as PGP, which was associated with significantly worse progression-free and overall survival times. No significant association was observed between PGP and clinical-pathologic features, including TP53 positive mutational status, in 28 samples. CONCLUSIONS Glycolytic proficiency may negatively affect survival outcomes of metastatic gastric cancer patients treated with PR systemic therapy. TP53 mutational status alone does not seem to explain such a metabolic shift.
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Affiliation(s)
- Annamaria Ruzzo
- Department of Biomolecular Sciences (DiSB), University of Urbino "Carlo Bo", Via Arco d'Augusto, 2, 61032, Fano, PU, Italy.
| | - Francesco Graziano
- Department of Onco-Hematology, Division of Oncology, Azienda Ospedaliera "Ospedali Riuniti Marche Nord", 61122, Pesaro, Italy.
| | - Irene Bagaloni
- Department of Biomolecular Sciences (DiSB), University of Urbino "Carlo Bo", Via Arco d'Augusto, 2, 61032, Fano, PU, Italy
| | | | | | - Giuseppe Aprile
- Department of Medical Oncology, San Bortolo General Hospital, AULSS8 Berica, Vicenza, Italy
| | - Elena Ongaro
- Department of Oncology, University and General Hospital, Udine, Italy
| | | | | | | | | | | | | | - Fotios Loupakis
- Department of Oncology, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Sara Lonardi
- Department of Oncology, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Matteo Fassan
- Surgical Pathology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Michele Valmasoni
- Clinica Chirurgica 3, Department of Surgical, Oncological and Gastroenterological Sciences (DISCOG), University of Padua, Padua, Italy
| | - Donatella Sarti
- Department of Onco-Hematology, Division of Oncology, Azienda Ospedaliera "Ospedali Riuniti Marche Nord", 61122, Pesaro, Italy
| | - Paola Lorenzini
- Department of Onco-Hematology, Division of Oncology, Azienda Ospedaliera "Ospedali Riuniti Marche Nord", 61122, Pesaro, Italy
| | - Vincenzo Catalano
- Department of Onco-Hematology, Division of Oncology, Azienda Ospedaliera "Ospedali Riuniti Marche Nord", 61122, Pesaro, Italy
| | | | | | - Guido Collina
- Area vasta 5, Ospedale "C. e G. Mazzoni" Ascoli Piceno, Ascoli Piceno, Italy
| | - Mauro Magnani
- Department of Biomolecular Sciences (DiSB), University of Urbino "Carlo Bo", Via Arco d'Augusto, 2, 61032, Fano, PU, Italy
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Palazzari E, Buonadonna A, Lauretta A, Navarria F, Ongaro E, Foltran L, Innocente R, Belluco C, Ubiali P, Canzonieri V, Urbani M, Colombo C, Bertola G, De Paoli A. PO-1112: Total neoadjuvant therapy in high risk rectal cancer: a feasibility pilot study. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01129-4] [Citation(s) in RCA: 1] [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] [Indexed: 11/26/2022]
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9
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Basile D, Polano M, Buriolla S, Gallois C, Cortiula F, Corvaja C, De Scordilli M, Michelotti A, Pelizzari G, Ongaro E, Casagrande M, Foltran L, Toffoli G, Pella N, Buonadonna A, Zaanan A, Fasola G, Aprile G, Taieb J, Puglisi F. 416P A novel prognostic tool based on lymphocyte ratios in patients with stage III colon cancer. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.527] [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: 11/16/2022] Open
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10
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Cremolini C, Antoniotti C, Stein A, Bendell J, Gruenberger T, Rossini D, Masi G, Ongaro E, Hurwitz H, Falcone A, Schmoll HJ, Di Maio M. Individual Patient Data Meta-Analysis of FOLFOXIRI Plus Bevacizumab Versus Doublets Plus Bevacizumab as Initial Therapy of Unresectable Metastatic Colorectal Cancer. J Clin Oncol 2020; 38:JCO2001225. [PMID: 32816630 DOI: 10.1200/jco.20.01225] [Citation(s) in RCA: 109] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2020] [Indexed: 12/15/2022] Open
Abstract
PURPOSE A proper estimation of the magnitude of the overall survival (OS) benefit from infusional fluorouracil, leucovorin, oxaliplatin, and irinotecan (FOLFOXIRI) plus bevacizumab versus doublets + bevacizumab is lacking because all trials that have investigated this regimen had primary end points other than OS. To test OS with higher power and to explore the interaction of treatment effect with main patient and disease characteristics, we performed an individual patient data (IPD) meta-analysis. PATIENTS AND METHODS IPD from 5 eligible trials were collected: CHARTA (ClinicalTrials.gov identifier: NCT01321957), OLIVIA (ClinicalTrials.gov identifier: NCT00778102), STEAM (ClinicalTrials.gov identifier: NCT01765582), TRIBE (ClinicalTrials.gov identifier: NCT00719797), and TRIBE2 (ClinicalTrials.gov identifier: NCT02339116). The primary end point was OS. Secondary end points were progression-free survival (PFS), objective response rate (ORR), R0 resection rate, grade 3/4 adverse events, and subgroup analyses according to clinical and molecular characteristics. RESULTS A total of 1,697 patients were randomly assigned to FOLFOXIRI + bevacizumab (n = 846) or doublets + bevacizumab (n = 851). Most (78%) had an Eastern Cooperative Oncology Group performance status of 0, and the median age was 61 years. After a median follow-up of 39.9 months, patients assigned to FOLFOXIRI + bevacizumab had significantly longer OS than those assigned to doublets + bevacizumab (median, 28.9 v 24.5 months; hazard ratio [HR], 0.81; 95% CI, 0.72 to 0.91; P < .001), with no significant heterogeneity among trials (P = .39; I2 = 2%). No significant interaction effect between treatment arm and investigated characteristics was demonstrated. Patients assigned to FOLFOXIRI + bevacizumab had longer PFS (median, 12.2 v 9.9 months; HR, 0.74; 95% CI, 0.67 to 0.82; P < .001), higher ORR (64.5% v 53.6%; P < .001), higher R0 resection rate (16.4% v 11.8%; P = .007), and higher rates of grade 3/4 neutropenia (45.8% v 21.5%; P < .001), febrile neutropenia (6.3% v 3.7%; P = .019), and diarrhea (17.8% v 8.4%; P < .001). CONCLUSION FOLFOXIRI + bevacizumab significantly and meaningfully improves survival of patients with metastatic colorectal cancer compared with doublets + bevacizumab and provides advantage in PFS, ORR, and R0 resection rate at the price of a moderate increase in toxicity. No increased benefit is observed among patients with BRAF-mutant tumors.
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Affiliation(s)
- Chiara Cremolini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, University Hospital of Pisa, Pisa, Italy
| | - Carlotta Antoniotti
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, University Hospital of Pisa, Pisa, Italy
| | - Alexander Stein
- Hematology-Oncology Practice Hamburg (HOPE), University Cancer Center Hamburg, Hamburg, Germany
| | - Johanna Bendell
- Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN
| | - Thomas Gruenberger
- Social Medical Center South, Department of Surgery, HPB Center Vienna Clinics and Sigmund Freud University, Medical School, Vienna, Austria
| | - Daniele Rossini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, University Hospital of Pisa, Pisa, Italy
| | - Gianluca Masi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, University Hospital of Pisa, Pisa, Italy
| | - Elena Ongaro
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, University Hospital of Pisa, Pisa, Italy
- Unit of Medical Oncology and Cancer Prevention, Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano (PN), Italy
| | | | - Alfredo Falcone
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, University Hospital of Pisa, Pisa, Italy
| | - Hans-Joachim Schmoll
- Department Internal Medicine IV-Hematology-Oncology, Martin-Luther-University, Halle (Saale), Germany
| | - Massimo Di Maio
- Department of Oncology, University of Turin, Mauriziano Hospital, Turin, Italy
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11
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Garattini SK, Bonotto M, Porcu L, Ongaro E, Gerratana L, Basile D, Parnofiello A, Pelizzari G, Cortiula F, Corvaja C, Casagrande M, Cardellino GG, Buonadonna A, Aprile G, Puglisi F, Fasola G, Pella N. Determinants of choice in offering drug holidays during first-line therapy for metastatic colorectal cancer. Future Oncol 2020; 16:2645-2660. [PMID: 32776795 DOI: 10.2217/fon-2020-0270] [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] [Indexed: 11/21/2022] Open
Abstract
Background: 'Drug holidays' (DH) for metastatic colorectal cancer (mCRC) were introduced to preserve quality of life. We studied factors associated to a DH offer in first line. Materials & methods: We retrospectively analyzed 754 consecutive patients treated with chemotherapy for mCRC in two Italian institutions between 2005 and 2017. Associations between baseline clinical-pathological factors and DH (56 or more days of treatment interruption) were investigated. Results: In 754 patients, previous metastasectomy, previous thermoablation and previous surgery of primary tumor were independently associated with DH. Excluding procedures or clinical trials: primary rectal cancer and resection of primary tumor were significantly associated to DH. Conclusions: DH was offered to patients with lower burden of disease, but further investigations are needed to safely guide a holiday strategy.
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Affiliation(s)
- Silvio Ken Garattini
- Department of Oncology, ASUFC University Hospital of Udine, 33100 Udine, Italy.,Department of Medicine, University of Udine, 33100 Udine, Italy
| | - Marta Bonotto
- Department of Oncology, ASUFC University Hospital of Udine, 33100 Udine, Italy
| | - Luca Porcu
- Department of Oncology, Laboratory of Methodology for Clinical Research, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy
| | - Elena Ongaro
- Department of Medical Oncology, Unit of Medical Oncology & Cancer Prevention, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
| | - Lorenzo Gerratana
- Department of Medicine, University of Udine, 33100 Udine, Italy.,Department of Medical Oncology, Unit of Medical Oncology & Cancer Prevention, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
| | - Debora Basile
- Department of Medicine, University of Udine, 33100 Udine, Italy.,Department of Medical Oncology, Unit of Medical Oncology & Cancer Prevention, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
| | - Annamaria Parnofiello
- Department of Oncology, ASUFC University Hospital of Udine, 33100 Udine, Italy.,Department of Medicine, University of Udine, 33100 Udine, Italy
| | - Giacomo Pelizzari
- Department of Medicine, University of Udine, 33100 Udine, Italy.,Department of Medical Oncology, Unit of Medical Oncology & Cancer Prevention, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
| | - Francesco Cortiula
- Department of Oncology, ASUFC University Hospital of Udine, 33100 Udine, Italy.,Department of Medicine, University of Udine, 33100 Udine, Italy
| | - Carla Corvaja
- Department of Medicine, University of Udine, 33100 Udine, Italy.,Department of Medical Oncology, Unit of Medical Oncology & Cancer Prevention, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
| | | | | | - Angela Buonadonna
- Department of Medical Oncology, Unit of Medical Oncology & Cancer Prevention, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
| | - Giuseppe Aprile
- Department of Oncology, Azienda ULSS8 Berica, 36100 Vicenza, Italy
| | - Fabio Puglisi
- Department of Medicine, University of Udine, 33100 Udine, Italy.,Department of Medical Oncology, Unit of Medical Oncology & Cancer Prevention, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy
| | - Gianpiero Fasola
- Department of Oncology, ASUFC University Hospital of Udine, 33100 Udine, Italy
| | - Nicoletta Pella
- Department of Oncology, ASUFC University Hospital of Udine, 33100 Udine, Italy
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12
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Di Nardo P, Guardascione M, Basile D, Foltran L, Ongaro E, Miolo G, Fanotto V, Lisanti C, Michele B, Parnofiello A, Cortiula F, Bertoli E, Buriolla S, De Scordilli M, Michelotti A, Puglisi F, Buonadonna A. P-246 Taxane cross-resistance: An exploratory analysis of second-line chemotherapy for metastatic gastric cancer. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.328] [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: 11/25/2022] Open
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13
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Basile D, Polano M, Buriolla S, Gallois C, Cortiula F, Corvaja C, de Scordilli M, Michelotti A, Parnofiello A, Gerratana L, Ongaro E, Andreuzzi E, Toffoli G, Buonadonna A, Mongiat M, Zaanan A, Aprile G, Canzonieri V, Taieb J, Puglisi F. Prognostic role of macrophage infiltration and monocyte-to-lymphocyte ratio in stage III colon cancer: The MIRROR study. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e16118] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16118 Background: Changes in peripheral blood cells composition may reflect immune microenvironment and its role in cancer growth. High monocyte-to-lymphocyte ratio (MLR) could be a marker of tumor’s recruitment of suppressive cells, showing a prognostic role. This study aimed to assess the prognostic impact of macrophage infiltration and MLR in stage III colon cancer (CC) patients (pts). Methods: This multicentric study retrospectively analyzed a consecutive cohort of 423 CC pts treated between 2008-2019 at the Cancer Centre of Aviano (Italy) (n = 300) and at the European Georges Pompidou Hospital of Paris (France) (n = 123). The association of MLR with disease-free survival (DFS) and overall survival (OS) was evaluated with Cox regression analyses. Random Forrest was implemented on python using h2oai. Performance was assessed in terms of accuracy (ACC) and Matthews Coefficient (MCC). Analyses was adjusted on classical prognostic factors of stage III CC such as pT, pN, grade, location, ECOG PS. Results: Overall, 77% had pT1-3, 30% pN2 and 73% G1-2 tumors. Interestingly, 25% had a lymphatic and vascular invasion, 42/230 (18%) had MSI status, 69/152(45%) and 19/114 (13%) were KRAS and BRAF mutant. 56% had CEA > 5. Pts were treated with fluoropyrimidine and oxaliplatin as adjuvant therapy. Notably, 130 cases were analyzed according to lymphocytic and macrophage infiltration (CD163, CD68, CD3, CD8). Of them, 78% had a CD163/CD8 ratio ≤3 and 74% a CD8/CD3 ratio ≤1.5. At median follow-up of 57 months, median DFS and OS were not reached, 31% of pts relapsed and 23% dead. By multivariate analysis, including statistically significant prognostic variables, CD163/CD8 ratio (HR 1.15, p = 0.039, 95%C.I. 1.1-1.32) and MLR > 0.45 (HR 2.98, p = 0.008, 95%C.I. 1.33-6.67) were associated with worse DFS. By multivariate analysis for OS, including statistically significant confounding variables, MLR > 0.45 (HR4.32, P = 0.012, 95%C.I. 1.37-9) and BRAF mutation predicted worse OS. According random survival forest for OS, CD68/CD3 were the first variable of importance (0.06), followed by MLR (0.009) and CD8 (0.007). Interestingly, high MLR followed by CEA, MSI, KRAS were the features linked with organotropism on liver (ACC 0.6 ±0.3), while high MLR, KRAS, pN, pT were mainly linked with lung colonization (ACC 0.6 ±0.2). Conclusions: High pre-treatment levels of MLR and CD163/CD8 ratio in stage III CC are independently associated with worse prognosis. The present study paves the way to a prospective validation of these promising cost-effective biomarkers.
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Affiliation(s)
- Debora Basile
- Department of Medicine (DAME), University of Udine; Department of Digestive Oncology, European Georges Pompidou, Paris, Udine, Italy
| | | | - Silvia Buriolla
- Scuola Di Specializzazione in Oncologia Medica, Universit Degli Studi Di Udine, Sesto Al Reghena, Italy
| | | | - Francesco Cortiula
- Azienda Sanitaria Universitaria Integrata di Udine, Dipartimento di Oncologia, Udine, Italy
| | - Carla Corvaja
- Department of Oncology, University Hospital of Udine - Santa Maria della Misericordia, Udine, Italy
| | - Marco de Scordilli
- Department of Medical Area, University of Udine; Department of Medical Oncology, IRCCS, CRO of Aviano, Udine, Italy
| | - Anna Michelotti
- Department of Medical Area, University of Udine; Department of Medical Oncology, IRCCS, CRO of Aviano, Udine, Italy
| | - Annamaria Parnofiello
- Department of Medical Area, University of Udine; Department of Medical Oncology, IRCCS, CRO of Aviano, Udine, Italy
| | - Lorenzo Gerratana
- Department of Medicine-Hematology and Oncology, Feinberg School of Medicine, Northwestern University; Department of Medicine (DAME), University of Udine, Chicago, IL
| | - Elena Ongaro
- Department of Oncology, Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico (CRO) di Aviano, IRCCS, Aviano, Italy
| | - Eva Andreuzzi
- Department of Research and Diagnosis, Division of Molecular Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Giuseppe Toffoli
- Experimental and Clinical Pharmacology, National Cancer Institute, Aviano, Italy
| | - Angela Buonadonna
- Oncologia Medica e Prevenzione Oncologica, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano (PN), Italy
| | - Maurizio Mongiat
- Department of Research and Diagnosis, Division of Molecular Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy, Aviano, Italy
| | - Aziz Zaanan
- Department of Medical Oncology, Saint Antoine Hospital, UPMC University Paris 06, Paris, France
| | - Giuseppe Aprile
- Dipartimento di Oncologia, Ospedale San Bortolo, Vicenza, Italy
| | | | - Julien Taieb
- Hôpital Européen Georges Pompidou, Paris, France
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14
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Cremolini C, Antoniotti C, Stein A, Bendell JC, Gruenberger T, Masi G, Ongaro E, Hurwitz H, Falcone A, Schmoll HJ, Di Maio M. FOLFOXIRI/bevacizumab (bev) versus doublets/bev as initial therapy of unresectable metastatic colorectal cancer (mCRC): A meta-analysis of individual patient data (IPD) from five randomized trials. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.4015] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4015 Background: Several randomized trials demonstrated that intensifying the upfront chemotherapy in combination with bev is beneficial for mCRC patients with an increased incidence of some adverse events. All trials had primary endpoints other than OS, and a proper estimation of the magnitude of the OS benefit from FOLFOXIRI/bev versus doublets (FOLFIRI or FOLFOX)/bev is currently lacking. Within each trial, subgroup analyses failed to identify predictors of benefit from the intensified therapy. To test OS with higher power compared to single trials, and to explore interaction of treatment effect with main patients’ and disease characteristics, we performed an IPD meta-analysis. Methods: IPD were collected from 5 randomized trials: CHARTA (NCT01321957), OLIVIA (NCT00778102), STEAM (NCT01765582, only combined FOLFOXIRI/bev and FOLFOX/bev arms), TRIBE (NCT00719797) and TRIBE2 (NCT02339116). Primary endpoint was OS. Secondary endpoints included PFS, objective response rate (ORR), R0 resection rate, G3/4 adverse events, and subgroup analyses. All statistical analyses were by intention-to-treat, stratified by trial. Results: 1697 pts randomized to FOLFOXIRI/bev (N=846) or doublets/bev (N=851) were included. Among pts in the doublets/bev group, 595 (70%) received FOLFOX/bev and 256 (30%) FOLFIRI/bev. At a median follow up of 39.9 mos, pts assigned to FOLFOXIRI/bev reported significantly longer OS than those assigned to doublets/bev (median OS 28.9 vs 24.5 months; HR 0.81 [95%CI 0.72-0.91], p<0.001), with no significant heterogeneity among trials (p=0.39; I2=2%). The estimated 5-yr OS was 22.3% vs 10.7% (p<0.001). No significant interaction effect between treatment arm and OS was demonstrated in terms of metastatic spread (liver-limited vs. not liver-limited p=0.665), primary side (p=0.656), and RAS/BRAF status (p=0.337). Pts assigned to FOLFOXIRI/bev achieved longer PFS (median PFS 12.2 vs 9.9 months; HR 0.74 [95%CI 0.67-0.82], p<0.001), higher ORR (64.5% vs 53.6%, p<0.001), higher R0 resection rate (16.4% vs 11.8%, p=0.007), and experienced higher rates of G3/4 neutropenia (p<0.001), febrile neutropenia (p=0.019), mucositis (p=0.024), nausea (p=0.016), and diarrhea (p<0.001). Conclusions: FOLFOXIRI/bev determines a clinically and statistically significant improvement of mCRC patients’ OS vs doublets/bev with a meaningful effect also on 5-yr OS, PFS, ORR and R0 resection rate. No significant heterogeneity among explored subgroups was found.
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Affiliation(s)
- Chiara Cremolini
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Carlotta Antoniotti
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Alexander Stein
- University Medical Center Hamburg-Eppendorf, Department of Oncology, Haematology, Stem Cell Transplantation and Pneumology, Hamburg, Germany
| | | | - Thomas Gruenberger
- Department of Surgery, Hepato-Pancreato-Biliary Center, Vienna Clinics, Social Mdical Center South - KFJ, Wien, Austria
| | - Gianluca Masi
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Elena Ongaro
- Department of Oncology, Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico (CRO) di Aviano, IRCCS, Aviano, Italy
| | | | | | | | - Massimo Di Maio
- Department of Oncology, A.O. Ordine Mauriziano Hospital, University of Turin, Turin, Italy
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15
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Fischer NW, Graziano F, Bagaloni I, Di Bartolomeo M, Lonardi S, Vincenzi B, Fornaro L, Ongaro E, Aprile G, Bisonni R, Prisciandaro M, Gariépy J, Loupakis F, Sarti D, Del Prete M, Catalano V, Magnani M, Ruzzo A. TP53 mutation analysis in gastric cancer and clinical outcomes of patients with metastatic disease treated with anti-angiogenic or standard chemotherapy regimens. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e16571] [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
e16571 Background: Current data support the angiogenic potential of cancer cells with mutant p53 and VEGF-A up-regulation in solid tumors. These findings have renewed interest in the p53 role as a predictive/prognostic factor in cancer therapy. We investigated TP53 mutations in gastric adenocarcinoma (GA) samples of metastatic patients (pts) who underwent anti-angiogenic Paclitaxel-Ramucirumab (PR) therapy. The analysis was also performed in a control group of pts who received first-line chemotherapy (CT) with platinum derivates and fluoropyrimidines. Methods: TP53 mutations were identified by next-generation sequencing in 110 GA primary tumors of two retrospective metastatic series including 48 pts who were treated with second-line PR and 62 pts who received first-line CT with Cisplatin or Oxaliplatin plus 5-Fluorouracil or Capecitabine. Detected TP53 mutations were classified for TP53 mutant-specific residual transcriptional activity scores ( TP53 RTAS) (Fischer NW et al JCI Insight 2018). TP53 RTAS results were used for stratifying pts in survival analyses. Primary end-point was overall survival (OS). Results: In the PR group, TP53 mutations were detected in 29 out of 48 tumor samples (60.4%) with 10 having TP53 RTAS 0%-to-<1%. In the CT group, TP53 mutations were found in 40 out of 62 tumor samples (64.5%) with 11 having TP53 RTAS 0%-to-<1%. In the PR group, the 10 cases with a TP53 mutation causing no residual or minimal activity ( TP53 RTAS 0%-to-<1%) showed better OS in comparison with pts in the remaining groups (wild-type and TP53 RTAS > 1%). This effect was retained in the multivariate model analysis (Hazard Ratio = 0.29, 95% confidence interval 0.17-0.85, p = 0.02). An opposite effect was seen in the CT group with the worst OS in carriers of TP53 RTAS 0%-to-<1% mutations (Hazard Ratio = 2.64, 95% confidence interval 1.17-5.95, p = 0.02). Notably, in the whole group of 110 pts, TP53 mutations (any type) occurred more frequently in the intestinal-type GA group (p = 0.02). Conclusions: Additional studies are warranted to explore the favorable role of TP53 mutations in cancer pts undergoing anti-angiogenic therapies. TP53 mutations frequently occur in GA and these findings would lead to novel tailored therapy strategies in this lethal disease.
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Affiliation(s)
| | - Francesco Graziano
- Department od Onco-Hematology, Azienda Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Irene Bagaloni
- Department of Biomolecular Sciences - University of Urbino, Fano, Italy
| | | | - Sara Lonardi
- Veneto Institute of Oncology (IOV)-IRCCS, Padua, Italy
| | - Bruno Vincenzi
- Policlinico Universitario Campus, Bio-Medico, Rome, Italy
| | | | - Elena Ongaro
- Department of Oncology, Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico (CRO) di Aviano, IRCCS, Aviano, Italy
| | - Giuseppe Aprile
- Department of Oncology, San Bortolo General Hospital, ULSS8 Berica-East District, Vicenza, Italy
| | | | - Michele Prisciandaro
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Fotios Loupakis
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Donatella Sarti
- Medical Oncology Unit, Azienda Ospedaliera Marche Nord, Pesaro, Italy
| | - Michela Del Prete
- Department of Medical Oncology, A.O. Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | | | - Mauro Magnani
- Department of Biomolecular Sciences - University of Urbino, Urbino, Italy
| | - Annamaria Ruzzo
- Department of Biomolecular Sciences - University of Urbino, Fano, Italy
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16
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Basile D, Garattini SK, Corvaja C, Montico M, Cortiula F, Pelizzari G, Gerratana L, Audisio M, Lisanti C, Fanotto V, Ongaro E, Iacono D, Cardellino GG, Foltran L, Pella N, Buonadonna A, Aprile G, Di Maio M, Fasola G, Puglisi F. The MIMIC Study: Prognostic Role and Cutoff Definition of Monocyte-to-Lymphocyte Ratio and Lactate Dehydrogenase Levels in Metastatic Colorectal Cancer. Oncologist 2020; 25:661-668. [PMID: 32202020 DOI: 10.1634/theoncologist.2019-0780] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 02/05/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Monocyte-to-lymphocyte ratio (MLR) and lactate dehydrogenase (LDH) levels are circulating biomarkers that provide information about tumor-related inflammation and immune suppression. This study aimed to evaluate the prognostic role of MLR and LDH in metastatic colorectal cancer (mCRC). MATERIAL AND METHODS This multicentric study analyzed a consecutive cohort of 528 patients with mCRC treated in 2009-2017. The whole population was randomly divided in training and validation cohort. The first was used to identify a threshold for MLR and to create the prognostic model with MLR and MLR-LDH combined (group 1: MLR-LDH low; group 2: MLR or LDH high; group 3: MLR-LDH high). The second cohort was used to validate the model. RESULTS At the median follow-up of 55 months, median overall survival (OS) was 22 months. By multivariate analysis, high MLR >0.49 (hazard ratio [HR], 2.37; 95% confidence interval [C.I.], 1.39-4.04), high LDH (HR, 1.73; 95% C.I., 1.03-2.90) in the first model, group 2 (HR, 2.74; 95% C.I.; 1.62-4.66), and group 3 (HR, 3.73; 95% C.I., 1.94-7.18) in the combined model, had a worse prognosis in terms of OS. These data were confirmed both in the validation set and then in the whole cohort. CONCLUSION MLR and LDH are circulating cost-effective biomarkers, readily available in clinical practice, that can be useful for predicting the prognosis of patients with mCRC. IMPLICATIONS FOR PRACTICE High monocyte-to-lymphocyte ratio (MLR) and lactate dehydrogenase (LDH) levels could be a sign of a tumor's recruitment of suppressive and inflammatory cells worsening prognosis of different types of cancer, including colorectal cancer (CRC). Currently, no data are available for metastatic CRC regarding a cutoff definition for MLR or the prognostic impact of MLR and MLR-LDH combined. The present study showed in the training cohort and confirmed in the validation and whole cohort that MLR is a reliable and independent laboratory biomarker, which is easy to use, to predict clinical outcomes in patients with mCRC. Moreover, MLR and composite MLR-LDH could potentially result in an incremental improvement in the prognostic value of these biomarkers, being used as stratification tools for patients with mCRC.
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Affiliation(s)
- Debora Basile
- Department of Medicine, University of Udine, Udine, Italy
- Department of Medical Oncology, Unit of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Silvio Ken Garattini
- Department of Medicine, University of Udine, Udine, Italy
- Department of Oncology, ASUIUD University Hospital of Udine, Udine, Italy
| | - Carla Corvaja
- Department of Medicine, University of Udine, Udine, Italy
- Department of Medical Oncology, Unit of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Marcella Montico
- Scientific Directorate, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Francesco Cortiula
- Department of Medicine, University of Udine, Udine, Italy
- Department of Oncology, ASUIUD University Hospital of Udine, Udine, Italy
| | - Giacomo Pelizzari
- Department of Medicine, University of Udine, Udine, Italy
- Department of Medical Oncology, Unit of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Lorenzo Gerratana
- Department of Medicine, University of Udine, Udine, Italy
- Department of Medical Oncology, Unit of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Marco Audisio
- Department of Oncology, University of Turin at Umberto I "Ordine Mauriziano" Hospital, Turin, Italy
| | - Camilla Lisanti
- Department of Medicine, University of Udine, Udine, Italy
- Department of Medical Oncology, Unit of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Valentina Fanotto
- Department of Medicine, University of Udine, Udine, Italy
- Department of Medical Oncology, Unit of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Elena Ongaro
- Department of Medical Oncology, Unit of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Donatella Iacono
- Department of Oncology, ASUIUD University Hospital of Udine, Udine, Italy
| | | | - Luisa Foltran
- Department of Medical Oncology, Unit of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Nicoletta Pella
- Department of Oncology, ASUIUD University Hospital of Udine, Udine, Italy
| | - Angela Buonadonna
- Department of Medical Oncology, Unit of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Giuseppe Aprile
- Department of Oncology, San Bortolo General Hospital, Vicenza, Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin at Umberto I "Ordine Mauriziano" Hospital, Turin, Italy
| | - Gianpiero Fasola
- Department of Oncology, ASUIUD University Hospital of Udine, Udine, Italy
| | - Fabio Puglisi
- Department of Medicine, University of Udine, Udine, Italy
- Department of Medical Oncology, Unit of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
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17
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Fanotto V, Zucchelli G, Germani M, Rossini D, Sensi E, Lupi C, Ugolini C, Antoniotti C, Marmorino F, Moretto R, Boccaccino A, Borelli B, Conca V, Ongaro E, Masi G, Fontanini G, Falcone A, Cremolini C. PIK3CA mutation in metastatic colorectal cancer (mCRC): Association with clinico-pathological features and outcome. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz246.108] [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: 11/13/2022] Open
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18
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Lisanti C, Basile D, Garattini S, Parnofiello A, Corvaja C, Cortiula F, Pelizzari G, Cattaneo M, Andreotti V, Bertoli E, Ongaro E, Iacono D, Foltran L, Casagrande M, Miolo G, Cardellino G, Fasola G, Pella N, Buonadonna A, Puglisi F. The SAFFO study: Sex-related prognostic role and cut-oFf deFinition of monocyte-to-lymphocyte ratio (MLR) in metastatic colOrectal cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz246.088] [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: 11/13/2022] Open
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19
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Garattini S, Bonotto M, Basile D, Porcu L, Ongaro E, Gerratana L, Cortiula F, Pelizzari G, Parnofiello A, bertoli E, Corvaja C, Lisanti C, Casagrande M, Iacono D, Cardellino G, Buonadonna A, Aprile G, Pella N, Puglisi F, Fasola G. Drug holidays and overall survival in patients treated for metastatic colorectal cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz246.056] [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: 11/13/2022] Open
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20
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Basile D, Pelizzari G, Corvaja C, Lisanti C, Bartoletti M, Buriolla S, Garattini S, Gerratana L, Bortot L, Cortiula F, Parnofiello A, Ongaro E, Borghi M, Miolo G, Cardellino G, Giaretta R, Schiavo G, Buonadonna A, Puglisi F, Aprile G. SUN-PO094: The Role of Nutritional Interventions in Surgically Treated Pancreatic Cancer Patients: Comparative Efficacy in a Network Meta-Analysis (NMA). Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32728-1] [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: 10/26/2022]
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21
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Basile D, Pelizzari G, Di Nardo P, Corvaja C, Ongaro E, Garattini S, Gerratana L, Lisanti C, Michele B, Bortot L, Buriolla S, Garutti M, Curtolo G, Bonotto M, Da Ros L, Torrisi E, Miolo G, Cardellino G, Pella N, Buonadonna A, Aprile G, Puglisi F. The role of sidedness in second-line therapy for RAS wild-type colorectal cancer: a network meta-analysis (NMA). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz155.287] [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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22
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Ongaro E, Cremolini C, Rossini D, Corti F, Pagani F, Morelli L, Urbani L, Masi G, Sposito C, Filippi B, Borelli B, Zucchelli G, Moretto R, Boccaccino A, Solaini L, de Braud F, Mazzaferro V, Falcone A, Cucchetti A, Pietrantonio F. Clinical and molecular determinants of extrahepatic disease progression in patients with metastatic colorectal cancer with liver-limited metastases deemed initially unresectable. ESMO Open 2019; 4:e000496. [PMID: 31231562 PMCID: PMC6555604 DOI: 10.1136/esmoopen-2019-000496] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 02/19/2019] [Accepted: 02/21/2019] [Indexed: 02/05/2023] Open
Abstract
Background No tools to predict the probability of extrahepatic disease progression (ePD) of initially unresectable, liver-limited metastatic colorectal cancer (mCRC) are currently available. To estimate the likelihood to develop ePD and to identify clinical and molecular factors that could predict extrahepatic progression-free survival (ePFS), we conducted an observational, retrospective, multicentre cohort study. Methods We retrospectively identified a cohort of 225 patients with initially unresectable liver-limited disease (LLD), treated from January 2004 to December 2017 with first-line doublets or triplet plus a biological agent at two Italian institutions. Results 173 (77%) patients experienced ePD which occurred within 1, 2 or 3 years from the diagnosis of mCRC in 15%, 49% and 66% of patients, respectively. Globally, 164 (73%) patients underwent a liver resection at some point of their disease history, and 54 (33%) of them underwent a subsequent locoregional treatment. Age > 70 years, locoregional nodal involvement at diagnosis of colorectal cancer and ≥4 liver metastases were significantly associated with higher risk of ePD while liver resections were associated with reduced risk of ePD. In the multivariable model, number of liver metastases (subdistribution HR, SHR 1.63, 95% CI 1.12 to 2.36; p = 0.01) and liver resections (SHR 0.43, 95% CI 0.29 to 0.63; p = 0.001) were still associated with ePD. Number of liver metastases < 4, no nodal involvement at diagnosis and liver resections were also associated with prolonged ePFS. Conclusions The identified clinical factors could help physicians in personalising the intensity and aggressiveness of liver-directed treatments in patients with mCRC with initially unresectable LLD.
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Affiliation(s)
- Elena Ongaro
- Unit of Medical Oncology 2, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.,Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy.,Department of Oncology, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Chiara Cremolini
- Unit of Medical Oncology 2, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.,Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Daniele Rossini
- Unit of Medical Oncology 2, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.,Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Francesca Corti
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Filippo Pagani
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Luca Morelli
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Lucio Urbani
- Department of General Surgery, Liver Metastasis Parenchyma Sparing Surgery Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Gianluca Masi
- Unit of Medical Oncology 2, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.,Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Carlo Sposito
- Department of Gastrointestinal and Hepatobilio-Pancreatic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Beatrice Filippi
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Beatrice Borelli
- Unit of Medical Oncology 2, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.,Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Gemma Zucchelli
- Unit of Medical Oncology 2, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.,Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Roberto Moretto
- Unit of Medical Oncology 2, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.,Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Alessandra Boccaccino
- Unit of Medical Oncology 2, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.,Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Leonardo Solaini
- Department of Medical and Surgical Sciences, DIMEC, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Filippo de Braud
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.,Department of Oncology and Hemato-oncology, Universityof Milan, Milan, Italy
| | - Vincenzo Mazzaferro
- Department of Gastrointestinal and Hepatobilio-Pancreatic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Alfredo Falcone
- Unit of Medical Oncology 2, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.,Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Alessandro Cucchetti
- Department of Medical and Surgical Sciences, DIMEC, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Filippo Pietrantonio
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.,Department of Oncology and Hemato-oncology, Universityof Milan, Milan, Italy
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23
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Rossini D, Pagani F, Pellino A, Dell'Aquila E, Liscia N, Bensi M, Germani MM, Masi G, Moretto R, Santini D, Salvatore L, Scartozzi M, Lonardi S, Zucchelli G, Ongaro E, Falcone A, Pietrantonio F, Cremolini C. Efficacy of retreatment with anti-EGFRs in mCRC is not predictable by clinical factors related to prior lines of therapy: A multi-institutional analysis. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.3540] [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
3540 Background: Retrospective analyses and phase 2 studies suggest that administering an anti-EGFR in advanced lines may be effective in mCRC pts who achieved benefit from a 1st-line anti-EGFR containing regimen. The identification of clinical features associated with benefit from anti-EGFR re-treatment (re-tx) in pts experiencing PD during 1st-line anti-EGFR (rechallenge) or after its interruption (reintroduction), is a major clinical need. Methods: A real-life data-base including a total of 5530 pts treated at 6 insitutions from December 2010 to October 2018 was queried. Pts retreated with anti-EGFRs, with RAS/ BRAF wild-type status on tissue samples, who had received a 1st-line anti-EGFR-based tx with at least SD as best response, and at least one further line of therapy before anti-EGFR re-tx, were included. The association with RECIST response (RR), PFS and OS was investigated for the following variables: RR (PR or CR vs SD) and PFS during 1st-line; time from the last anti-EGFR administration to 1st-line PD (i.e. re-introduction vs rechallenge); reason for anti-EGFR discontinuation in 1st-line (PD vs. other); number of anti-EGFR-free lines of therapy before re-tx; anti-EGFR free interval (time between the last anti-EGFR administration in 1st-line and the time of re-tx); primary tumor side; time from the diagnosis of metastatic disease to re-tx (≥ vs. < 18 mos). Results: Data from 86 patients were retrieved, 56 (65%) and 30 (35%) received anti-EGFR rechallenge or reintroduction, respectively. Median anti-EGFR free interval was 15.1 mos. The RR during re-tx was 19.8%, with a DCR of 46.5%. Median PFS and OS were 3.6 and 10.2 mos, respectively. No significant association of investigated features with RR and PFS was observed. No differences in RR or PFS were observed among patients receiving anti-EGFR re-tx as rechallenge or reintroduction (20.4% vs 23.1%, p = 0.99; median PFS: 3.49 vs 4.97 mos, p = 0.61). Patients with left-sided tumors had longer OS (HR: 0.50, 95%CI: 0.26-0.93, p = 0.005). Conclusions: Clinical factors that are generally believed to affect the efficacy of anti-EGFR re-tx are not confirmed in our series. Therefore, clinicians should not rely on those characteristics in their decision-making on anti-EGFR re-tx, and adequate studies for implementing liquid biopsy in clinical practice are urgently needed.
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Affiliation(s)
- Daniele Rossini
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Filippo Pagani
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Antonio Pellino
- Unit of Medical Oncology 1, Department of Clinical and Experimental Oncology, Veneto Institute of Oncology, IOV - IRCCS, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Emanuela Dell'Aquila
- Department of Medical Oncology, Campus Bio-Medico - University of Rome, Rome, Italy
| | - Nicole Liscia
- Medical Oncology Department, University Hospital, University of Cagliari, Cagliari, Italy
| | - Maria Bensi
- Fondazione Policlinico Universitario A. Gemelli-IRCCS-UOC Oncologia Medica, Rome, Italy
| | - Marco Maria Germani
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Gianluca Masi
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Roberto Moretto
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Daniele Santini
- Department of Medical Oncology, Campus Bio-Medico - University of Rome, Rome, Italy
| | - Lisa Salvatore
- Oncologia Medica, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, Roma, Italy
| | - Mario Scartozzi
- Medical Oncology Department, University Hospital, University of Cagliari, Cagliari, Italy
| | | | - Gemma Zucchelli
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Elena Ongaro
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Alfredo Falcone
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Filippo Pietrantonio
- Medical Oncology Department, Fondazione IRCSS - Istituto Nazionale dei Tumori, Milan, Italy
| | - Chiara Cremolini
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
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Basile D, Parnofiello A, Vitale MG, Cortiula F, Gerratana L, Fanotto V, Lisanti C, Pelizzari G, Ongaro E, Bartoletti M, Garattini SK, Andreotti VJ, Bacco A, Iacono D, Bonotto M, Casagrande M, Ermacora P, Puglisi F, Pella N, Fasola G, Aprile G, Cardellino GG. The IMPACT study: early loss of skeletal muscle mass in advanced pancreatic cancer patients. J Cachexia Sarcopenia Muscle 2019; 10:368-377. [PMID: 30719874 PMCID: PMC6463465 DOI: 10.1002/jcsm.12368] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 11/03/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Pancreatic cancer (PC) patients have multiple risk factors for sarcopenia and loss of skeletal muscle mass (LSMM), which may cause greater treatment toxicities, reduced response to cancer therapy, prolonged hospitalization, impaired quality of life, and worse prognosis. METHODS This is a retrospective study on advanced PC patients treated at the Department of Oncology of Udine, Italy, from January 2012 to November 2017. Among 162 patients who received chemotherapy, 94 consecutive patients with an available computed tomography (CT) scan were retrospectively analyzed. The primary objective of our study was to explore if an early LSMM ≥ 10% (measured at first radiological evaluation and compared with baseline) and/or baseline sarcopenia may impact prognosis. Baseline sarcopenia was defined according to Prado's criteria. Skeletal muscle area was measured as cross-sectional areas (cm2 ) using CT scan data through the Picture archiving and communication system (PACS) image system. RESULTS In the whole cohort, 48% of patients were ≤70 years old, and 50% had metastatic disease. At baseline, 73% of patients had sarcopenia, and 16% presented a visceral fat area ≥ 44 cm2 /m2 . Overall, 21% experienced an early LSMM ≥ 10%. Approximately 33% of sarcopenic patients at baseline and ~35% of patients with early LSMM ≥ 10% had a body mass index > 25 kg/m2 . Of note, 71% of patients were evaluated by a nutritionist, and 56% received a dietary supplementation (oral and/or parenteral). After a median follow-up of 30.44 months, median overall survival (OS) was 11.28 months, whereas median progression-free survival (PFS) was 5.72 months. By multivariate analysis, early LSMM ≥ 10% was significantly associated with worse OS [hazard ratio (HR): 2.16; 95% confidence interval (CI) 1.23-3.78; P = 0.007] and PFS (HR: 2.31; 95% CI 1.30-4.09; P = 0.004). Moreover, an exploratory analysis showed that inflammatory indexes, such as neutrophil-lymphocyte ratio variation, impact early LSMM ≥ 10% (odds ratio 1.31, 95% CI 1.06-1.61, P = 0.010). CONCLUSIONS Early LSMM ≥ 10% has a negative prognostic role in advanced PC patients. Further prospective investigations are needed to confirm these preliminary data.
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Affiliation(s)
- Debora Basile
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Annamaria Parnofiello
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Maria Grazia Vitale
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Francesco Cortiula
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Lorenzo Gerratana
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Valentina Fanotto
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Camilla Lisanti
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Giacomo Pelizzari
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Elena Ongaro
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Michele Bartoletti
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Silvio Ken Garattini
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Victoria Josephine Andreotti
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Anna Bacco
- Department of Endocrinology, University Hospital of Udine, Udine, UD, Italy
| | - Donatella Iacono
- Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Marta Bonotto
- Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | | | - Paola Ermacora
- Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Fabio Puglisi
- Department of Medicine (DAME), University of Udine, Udine, UD, Italy.,Unit of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano, PN, Italy
| | - Nicoletta Pella
- Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Gianpiero Fasola
- Department of Oncology, ASUIUD University Hospital of Udine, Udine, UD, Italy
| | - Giuseppe Aprile
- Department of Oncology, San Bortolo General Hospital, ULSS8 Berica, East District, Vicenza, VI, Italy
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25
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Cremolini C, Benelli M, Fontana E, Pagani F, Rossini D, Fucà G, Busico A, Conca E, Di Donato S, Loupakis F, Schirripa M, Lonardi S, Borelli B, Ongaro E, Eason K, Morano F, Casagrande M, Fassan M, Sadanandam A, de Braud F, Falcone A, Pietrantonio F. Benefit from anti-EGFRs in RAS and BRAF wild-type metastatic transverse colon cancer: a clinical and molecular proof of concept study. ESMO Open 2019; 4:e000489. [PMID: 30962964 PMCID: PMC6435314 DOI: 10.1136/esmoopen-2019-000489] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 02/05/2019] [Accepted: 02/06/2019] [Indexed: 12/22/2022] Open
Abstract
Objective Primary tumour location is regarded as a reliable surrogate of colorectal cancer biology. Sensitivity to anti-EGFRs (Epidermal Growth Factor Receptor) of metastatic transverse colon cancers (mTCCs) has usually been assumed similar to right-sided tumours; however, evidence about the clinical behaviour of mTCC is limited. Thus, to verify sensitivity of mTCC to anti-EGFRs we conducted the present study. Methods Patients with RAS/BRAF wild-type microsatellite stable (MSS) mTCC receiving anti-EGFR monotherapy, or in combination with irinotecan if clearly irinotecan-refractory, were included. Hypothesising an overall response rate (ORR) of 35%, 11 patients, of whom at least 3 were responders, were necessary to be able to reject the null hypothesis of an ORR of 5%, with α and β errors of 0.05 and 0.20. PRESSING panel and consensus molecular subtypes (CMS) were assessed on tumour samples, whereas in-silico data were obtained from TCGA dataset. Results Among nine eligible patients, four and three achieved response and disease stabilisation (ORR 44%). At a median follow-up of 23.1 months, median progression-free survival and overall survival were 7.3 (95% CI 3.9 to NA) and 15.0 months (95% CI 10.0 to NA), respectively. A MET amplification and an ERBB4 S303F substitution were detected in patients with rapid disease progression, while others had PRESSING panel-negative tumours with CMS2 or CMS4 subtypes. Conclusions RAS/BRAF wild-type MSS mTCCs may be sensitive to anti-EGFRs, as confirmed by molecular analyses.
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Affiliation(s)
- Chiara Cremolini
- Unit of Medical Oncology 2, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.,Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Matteo Benelli
- Bioinformatics Unit, Oncology Department, Hospital of Prato, Prato, Italy
| | - Elisa Fontana
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK.,Centre for Molecular Pathology, Royal Marsden NHS Foundation Trust, London, UK
| | - Filippo Pagani
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Daniele Rossini
- Unit of Medical Oncology 2, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.,Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Giovanni Fucà
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Adele Busico
- Department of Diagnostic Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elena Conca
- Department of Diagnostic Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Samantha Di Donato
- Medical Oncology Unit, Oncology Department, Hospital of Prato, Prato, Italy
| | - Fotios Loupakis
- Unit of Medical Oncology 1, Department of Clinical and Experimental Oncology, IRCCS Istituto Oncologico Veneto, Padova, Italy
| | - Marta Schirripa
- Unit of Medical Oncology 1, Department of Clinical and Experimental Oncology, IRCCS Istituto Oncologico Veneto, Padova, Italy
| | - Sara Lonardi
- Unit of Medical Oncology 1, Department of Clinical and Experimental Oncology, IRCCS Istituto Oncologico Veneto, Padova, Italy
| | - Beatrice Borelli
- Unit of Medical Oncology 2, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.,Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Elena Ongaro
- Unit of Medical Oncology 2, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.,Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.,Department of Oncology, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Katherine Eason
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - Federica Morano
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Mariaelena Casagrande
- Department of Oncology, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Matteo Fassan
- Unit of Surgical Pathology, Department of Medicine, University of Padova, Padova, Italy
| | - Anguraj Sadanandam
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK.,Centre for Molecular Pathology, Royal Marsden NHS Foundation Trust, London, UK
| | - Filippo de Braud
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Alfredo Falcone
- Unit of Medical Oncology 2, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.,Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Filippo Pietrantonio
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
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26
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Basile D, Gerratana L, Corvaja C, Pelizzari G, Garattini S, Lisanti C, Bartoletti M, Bortot L, Fanotto V, Ongaro E, Cortiula F, Parnofiello A, Vitale M, Da Ros L, Di Nardo P, Torrisi E, Guardascione M, Miolo G, Buonadonna A, Puglisi F. Monocyte-to-lymphocye ratio (MLR) and LDH level in metastatic colorectal cancer (mCRC) patients (pts). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy493.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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27
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Garattini S, Bonotto M, Porcu L, Ongaro E, Basile D, Cortiula F, Pelizzari G, Cattaneo M, Parnofiello A, Andreotti V, Corvaja C, Cardellino G, Ermacora P, Casagrande M, Iacono D, Pella N, Buonadonna A, Minisini A, Puglisi F, Fasola G. Determinants of oncologist’s choice in offering drug holidays during first line therapy for patients with metastatic colorectal cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy281.140] [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: 11/13/2022] Open
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28
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Basile D, Lisanti C, Borghi M, Bartoletti M, Gerratana L, Bortot L, Pelizzari G, Corvaja C, Ongaro E, Garattini S, Fanotto V, Parnofiello A, Cortiula F, Cattaneo M, Andreotti V, Bertoli E, Guardascione M, Miolo G, Puglisi F, Buonadonna A. The SLICE study: The prognostic role of visceral fat in metastatic colorectal cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy281.125] [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: 11/13/2022] Open
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29
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Lisanti C, Basile D, Garattini S, Pelizzari G, Parnofiello A, Cortiula F, Ongaro E, Cattaneo M, Corvaja C, Andreotti V, Bartoletti M, Casagrande M, Iacono D, Bonotto M, Ermacora P, Pella N, Buonadonna A, Puglisi F, Fasola G, Miolo G. The SENECA study: Prognostic role of serum biomarkers in elderly metastatic colorectal cancer patients. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy281.139] [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: 11/15/2022] Open
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30
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Antoniotti C, Ongaro E, Falcone A, Cremolini C. The Winding Roadmap of Biomarkers toward Clinic: Lessons from Predictors of Resistance to Anti-EGFRs in Metastatic Colorectal Cancer. Int J Mol Sci 2018; 19:E2298. [PMID: 30081606 PMCID: PMC6121538 DOI: 10.3390/ijms19082298] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 07/31/2018] [Accepted: 08/01/2018] [Indexed: 01/06/2023] Open
Abstract
In the evolving molecular landscape of metastatic colorectal cancer, optimizing available tools to select patients to receive anti-epidermal growth factor receptor (anti-EGFR) monoclonal antibodies is a modern challenge of colorectal oncologists. Several molecular biomarkers have been investigated in recent years as potential predictors of resistance to anti-EGFR agents in preclinical and clinical retrospective series. Nevertheless, none of them have been implemented in clinical practice due to the lack of a formal prospective demonstration. Here, we propose a literature review of molecular alterations associated with resistance to anti-EGFRs, underlining the reasons why their roadmap from laboratories to clinics was prematurely halted.
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Affiliation(s)
- Carlotta Antoniotti
- Department of Oncology, University Hospital of Pisa, 56126 Pisa, Italy.
- Department of Translational Research and New Technologies in Medicine, University of Pisa, 56126 Pisa, Italy.
| | - Elena Ongaro
- Department of Oncology, University Hospital of Pisa, 56126 Pisa, Italy.
- Department of Translational Research and New Technologies in Medicine, University of Pisa, 56126 Pisa, Italy.
- Department of Oncology, Azienda Sanitaria Universitaria Integrata S. Maria della Misericordia, 33100 Udine, Italy.
| | - Alfredo Falcone
- Department of Oncology, University Hospital of Pisa, 56126 Pisa, Italy.
- Department of Translational Research and New Technologies in Medicine, University of Pisa, 56126 Pisa, Italy.
| | - Chiara Cremolini
- Department of Oncology, University Hospital of Pisa, 56126 Pisa, Italy.
- Department of Translational Research and New Technologies in Medicine, University of Pisa, 56126 Pisa, Italy.
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31
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Ongaro E, Rossini D, Pietrantonio F, Morano F, de Braud F, Mazzaferro V, Corti F, Randon G, Raimondi A, Battaglia L, Morelli L, Urbani L, Masi G, Moretto R, Antoniotti C, Marmorino F, Borelli B, Zucchelli G, Boccaccino A, Cremolini C, Falcone A. Clinical and molecular determinants of extrahepatic disease progression (ePD) in initially unresectable, liver-limited metastatic colorectal cancer (mCRC). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy150.016] [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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32
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Giordano M, Moretto R, Giannini R, Zucchelli G, Pietrantonio F, Antoniotti C, Ugolini C, Morano F, Marmorino F, Sensi E, Belfiore A, Rossini D, Lupi C, Masi G, Borelli B, Ongaro E, Boccaccino A, Falcone A, Cremolini C, Fontanini G. Molecular characterization of immune microenvironment in colorectal cancers with microsatellite instability by digital RNA counting. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy150.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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33
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Ongaro E, Rossini D, Pietrantonio F, Morano F, De Braud FG, Mazzaferro V, Corti F, Randon G, Raimondi A, Battaglia L, Morelli L, Urbani L, Masi G, Moretto R, Antoniotti C, Marmorino F, Borelli B, Zucchelli G, Cremolini C, Falcone A. Clinical and molecular determinants of extrahepatic disease progression (ePD) in initially unresectable, liver limited metastatic colorectal cancer (mCRC). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e15511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Elena Ongaro
- Department of Oncology, Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Daniele Rossini
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | - Filippo Pietrantonio
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Federica Morano
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Filippo G. De Braud
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Vincenzo Mazzaferro
- Gastrointestinal and Hepatobilio-Pancreatic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Francesca Corti
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanni Randon
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandra Raimondi
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Luigi Battaglia
- Peritoneal Surface Malignancies Unit, Colon and Rectal Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Luca Morelli
- Department of Translational Research and New Technologies in Medicine and Surgery, General Surgery Unit, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Lucio Urbani
- General Surgery Unit, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Gianluca Masi
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | - Roberto Moretto
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | - Carlotta Antoniotti
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | - Federica Marmorino
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | - Beatrice Borelli
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | - Gemma Zucchelli
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | - Chiara Cremolini
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | - Alfredo Falcone
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
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34
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Moretto R, Giannini R, Zucchelli G, Giordano M, Pietrantonio F, Antoniotti C, Ugolini C, Morano F, Marmorino F, Sensi E, Belfiore A, Rossini D, Lupi C, Masi G, Borelli B, Ongaro E, Boccaccino A, Falcone A, Fontanini G, Cremolini C. The immune-profile of mismatch repair deficient (d MMR) colorectal cancers (CRCs) differs according to primary tumor sidedness. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e15593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Roberto Moretto
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | - Riccardo Giannini
- Department of Surgical, Medical, Molecular Pathology, and Critical Area, University of Pisa, Pisa, Italy
| | - Gemma Zucchelli
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | - Mirella Giordano
- Department of Surgical, Medical, Molecular Pathology, and Critical Area, University of Pisa, Pisa, Italy
| | - Filippo Pietrantonio
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Carlotta Antoniotti
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | - Clara Ugolini
- Unit of Pathological Anatomy, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Federica Morano
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Federica Marmorino
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | - Elisa Sensi
- Unit of Pathological Anatomy, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Antonino Belfiore
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy, Milan, Italy
| | - Daniele Rossini
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | - Cristiana Lupi
- Unit of Pathological Anatomy, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Gianluca Masi
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | - Beatrice Borelli
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | - Elena Ongaro
- Department of Oncology, Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Alessandra Boccaccino
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | - Alfredo Falcone
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | - Gabriella Fontanini
- Department of Surgical, Medical, Molecular Pathology, and Critical Area, University of Pisa, Pisa, Italy
| | - Chiara Cremolini
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
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35
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Ongaro E, Gerratana L, Cinausero M, Pelizzari G, Poletto E, Giangreco M, Andreetta C, Pizzolitto S, Di Loreto C, Minisini AM, Mansutti M, Russo S, Fasola G, Puglisi F. Comparison of primary breast cancer and paired metastases: biomarkers discordance influence on outcome and therapy. Future Oncol 2018. [PMID: 29527957 DOI: 10.2217/fon-2017-0384] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM Discordance between primary tumor and paired metastases biology has been widely detected in metastatic breast cancer. The aim of this study was to evaluate the prognostic impact of Ki67, estrogen receptor (ER), progesterone receptor (PR) and HER2 discordance. METHODS We retrospectively analyzed a cohort of 544 patients affected by metastatic breast cancer. Variation in ER, PR, Ki67 and HER2 expression between primary site and recurrence was tested through the McNemar test. RESULTS A significant variation was observed in respect to ER, PR and Ki67 status (12.65%, p = 0.0072; 49.71%, p < 0.0001; 35%, p < 0.0001, respectively). Among patients with ER or PR discordance, the driver of therapeutic decisions was the ER status. Moreover, we observed a therapy-related reduction of ER in taxanes or aromatase inhibitors-exposed patients (odds ratio: 3.59; 95% CI: 1.66-7.77; p = 0.001 and odds ratio: 2.07; 95% CI: 0.96-4.44; p = 0.06, respectively). CONCLUSION Biopsy of metastatic lesions may influence the decision-making process translating into better outcome.
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Affiliation(s)
- Elena Ongaro
- Department of Oncology, Azienda Sanitaria Universitaria Integrata S Maria della Misericordia, Pz.le S Maria della Misericordia 15, 33100 Udine (UD), Italy.,Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata Policlinico GB Rossi, Pz.le LA Scuro 10, 37134 Verona (VR), Italy
| | - Lorenzo Gerratana
- Department of Oncology, Azienda Sanitaria Universitaria Integrata S Maria della Misericordia, Pz.le S Maria della Misericordia 15, 33100 Udine (UD), Italy.,Department of Medicine (DAME), University of Udine, Pz.le Kolbe 3, 33100 Udine (UD), Italy
| | - Marika Cinausero
- Department of Oncology, Azienda Sanitaria Universitaria Integrata S Maria della Misericordia, Pz.le S Maria della Misericordia 15, 33100 Udine (UD), Italy.,Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata Policlinico GB Rossi, Pz.le LA Scuro 10, 37134 Verona (VR), Italy
| | - Giacomo Pelizzari
- Department of Oncology, Azienda Sanitaria Universitaria Integrata S Maria della Misericordia, Pz.le S Maria della Misericordia 15, 33100 Udine (UD), Italy.,Department of Medicine (DAME), University of Udine, Pz.le Kolbe 3, 33100 Udine (UD), Italy
| | - Elena Poletto
- Department of Oncology, Azienda Sanitaria Universitaria Integrata S Maria della Misericordia, Pz.le S Maria della Misericordia 15, 33100 Udine (UD), Italy
| | - Manuela Giangreco
- Department of Medicine (DAME), University of Udine, Pz.le Kolbe 3, 33100 Udine (UD), Italy.,Institute of Hygiene & Clinical Epidemiology, Azienda Sanitaria Universitaria Integrata S Maria della Misericordia, Pz.le S Maria della Misericordia 15, 33100 Udine (UD), Italy
| | - Claudia Andreetta
- Department of Oncology, Azienda Sanitaria Universitaria Integrata S Maria della Misericordia, Pz.le S Maria della Misericordia 15, 33100 Udine (UD), Italy
| | - Stefano Pizzolitto
- Department of Pathology, Azienda Sanitaria Universitaria Integrata S Maria della Misericordia, Pz.le S Maria della Misericordia 15, 33100 Udine (UD), Italy
| | - Carla Di Loreto
- Department of Medicine (DAME), University of Udine, Pz.le Kolbe 3, 33100 Udine (UD), Italy.,Institute of Pathology, Azienda Sanitaria Universitaria Integrata S Maria della Misericordia, Pz.le S Maria della Misericordia 15, 33100 Udine (UD), Italy
| | - Alessandro Marco Minisini
- Department of Oncology, Azienda Sanitaria Universitaria Integrata S Maria della Misericordia, Pz.le S Maria della Misericordia 15, 33100 Udine (UD), Italy
| | - Mauro Mansutti
- Department of Oncology, Azienda Sanitaria Universitaria Integrata S Maria della Misericordia, Pz.le S Maria della Misericordia 15, 33100 Udine (UD), Italy
| | - Stefania Russo
- Department of Oncology, Azienda Sanitaria Universitaria Integrata S Maria della Misericordia, Pz.le S Maria della Misericordia 15, 33100 Udine (UD), Italy
| | - Gianpiero Fasola
- Department of Oncology, Azienda Sanitaria Universitaria Integrata S Maria della Misericordia, Pz.le S Maria della Misericordia 15, 33100 Udine (UD), Italy
| | - Fabio Puglisi
- Department of Medicine (DAME), University of Udine, Pz.le Kolbe 3, 33100 Udine (UD), Italy.,Department of Clinical Oncology, CRO Aviano National Cancer Institute, Via Franco Gallini 2, 33081 Aviano (PN), Italy
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36
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Borelli B, Zucchelli G, Rossini D, Cremolini C, Antoniotti C, Moretto R, Marmorino F, Colombo C, Vannini F, Delliponti L, Spione M, Ongaro E, Masi G, Brunetti IM, Pfanner E, Salvatore L, Falcone A. A retrospective study of trifluridine/tipiracil in pretreated metastatic colorectal cancer patients in clinical practice. Colorectal Cancer 2018. [DOI: 10.2217/crc-2017-0023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Aim: RECOURSE trial has shown a benefit for trifluridine/tipiracil (also known as TAS-102) over placebo in chemorefractory metastatic colorectal cancer (mCRC) patients. We evaluated efficacy and safety of patients treated with trifluridine/tipiracil in compassionate use. Patients & methods: RETROTAS is a retrospective study designed to evaluate efficacy and safety of trifluridine/tipiracil in mCRC patients previously exposed or not a candidate to all available drugs. Results: A total of 85 mCRC patients were included. Our data showed that 37.6% of patients achieved disease control. Median progression-free survival was 2.3 months; at 16 months follow-up, median overall survival was 9.2 months. Conclusion: This real-life experience confirms the safety and efficacy of trifluridine/tipiracil, resulting as a valid option in chemorefractory mCRC treatment scenario.
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Affiliation(s)
- Beatrice Borelli
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Department of Translational Research & New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Gemma Zucchelli
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Department of Translational Research & New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Daniele Rossini
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Department of Translational Research & New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Chiara Cremolini
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Department of Translational Research & New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Carlotta Antoniotti
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Department of Translational Research & New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Roberto Moretto
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Department of Translational Research & New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Federica Marmorino
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Department of Translational Research & New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Camilla Colombo
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Department of Translational Research & New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Francesca Vannini
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Department of Translational Research & New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Laura Delliponti
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Department of Translational Research & New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Mario Spione
- Medical Affairs, Servier Italia SpA, Roma, Italy
| | - Elena Ongaro
- Department of Oncology, Azienda Sanitaria Universitaria Integrata S. Maria della Misericordia, Udine, Italy
| | - Gianluca Masi
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Department of Translational Research & New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Isa Maura Brunetti
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Department of Translational Research & New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Elisabetta Pfanner
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Department of Translational Research & New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Lisa Salvatore
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Department of Translational Research & New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Alfredo Falcone
- Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Department of Translational Research & New Technologies in Medicine, University of Pisa, Pisa, Italy
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Pietrantonio F, Fucà G, Morano F, Gloghini A, Corso S, Aprile G, Perrone F, De Vita F, Tamborini E, Tomasello G, Gualeni AV, Ongaro E, Busico A, Giommoni E, Volpi CC, Laterza MM, Corallo S, Prisciandaro M, Antista M, Pellegrinelli A, Castagnoli L, Pupa SM, Pruneri G, de Braud F, Giordano S, Cremolini C, Di Bartolomeo M. Biomarkers of Primary Resistance to Trastuzumab in HER2-Positive Metastatic Gastric Cancer Patients: the AMNESIA Case-Control Study. Clin Cancer Res 2017; 24:1082-1089. [PMID: 29208673 DOI: 10.1158/1078-0432.ccr-17-2781] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 10/27/2017] [Accepted: 11/30/2017] [Indexed: 01/12/2023]
Abstract
Purpose: Refining the selection of HER2-positive metastatic gastric cancer patient candidates for trastuzumab is a challenge of precision oncology. Preclinical studies have suggested several genomic mechanisms of primary resistance, leading to activation of tyrosine kinase receptors other than HER2 or downstream signaling pathways.Experimental Design: We carried out this multicenter, prospective, case-control study to demonstrate the negative predictive impact of a panel of candidate genomic alterations (AMNESIA panel), including EGFR/MET/KRAS/PI3K/PTEN mutations and EGFR/MET/KRAS amplifications. Hypothesizing a prevalence of candidate alterations of 30% and 0% in resistant and sensitive HER2-positive patients, respectively, 20 patients per group were needed.Results: AMNESIA panel alterations were significantly more frequent in resistant (11 of 20, 55%) as compared with sensitive (0% of 17) patients (P < 0.001), and in HER2 IHC 2+ (7 of 13, 53.8%) than 3+ (4 of 24, 16.7%) tumors (P = 0.028). Patients with tumors bearing no candidate alterations had a significantly longer median progression-free [5.2 vs. 2.6 months; HR, 0.34; 95% confidence interval (CI), 0.07-0.48; P = 0.001] and overall survival (16.1 vs. 7.6 months; HR, 0.38; 95% CI, 0.09-0.75; P = 0.015). The predictive accuracy of the AMNESIA panel and HER2 IHC was 76% and 65%, respectively. The predictive accuracy of the combined evaluation of the AMNESIA panel and HER2 IHC was 84%.Conclusions: Our panel of candidate genomic alterations may be clinically useful to predict primary resistance to trastuzumab in patients with HER2-positive metastatic gastric cancer and should be further validated with the aim of molecularly stratifying HER2-addicted cancers for the development of novel treatment strategies. Clin Cancer Res; 24(5); 1082-9. ©2017 AACR.
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Affiliation(s)
- Filippo Pietrantonio
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Giovanni Fucà
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Federica Morano
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Annunziata Gloghini
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Simona Corso
- University of Torino, Department of Oncology and Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | - Giuseppe Aprile
- Department of Oncology, ULSS8 Berica, San Bortolo General Hospital, Vicenza, Italy
| | - Federica Perrone
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Ferdinando De Vita
- Division of Medical Oncology, Department of Clinical and Experimental Medicine and Surgery, University of Campania 'Luigi Vanvitelli', School of Medicine, Naples, Italy
| | - Elena Tamborini
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Ambra Vittoria Gualeni
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elena Ongaro
- Department of Oncology, University and General Hospital, Udine, Italy
| | - Adele Busico
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elisa Giommoni
- Medical Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Chiara Costanza Volpi
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Maria Maddalena Laterza
- Division of Medical Oncology, Department of Clinical and Experimental Medicine and Surgery, University of Campania 'Luigi Vanvitelli', School of Medicine, Naples, Italy
| | - Salvatore Corallo
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Michele Prisciandaro
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Maria Antista
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandro Pellegrinelli
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Lorenzo Castagnoli
- Molecular Targeting Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Serenella M Pupa
- Molecular Targeting Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giancarlo Pruneri
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Filippo de Braud
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,Oncology and Haemato-Oncology Department, University of Milan, Università degli Studi di Milano, Milan, Italy
| | - Silvia Giordano
- University of Torino, Department of Oncology and Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | - Chiara Cremolini
- Unit of Medical Oncology 2, Azienda Ospedaliera-Universitaria Pisana, Pisa, Italy
| | - Maria Di Bartolomeo
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Ongaro E, De Maglio G, Gerratana L, Bonotto M, Garattini S, Basile D, Cattaneo M, Andreotti V, Cortiula F, Parnofiello A, Fanotto V, Pizzolitto S, Cardellino G, Casagrande M, Ermacora P, Giovannoni M, Iacono D, Puglisi F, Aprile G, Pella N, Fasola G. Mutational status and metastatic patteRn in a cohort Of ADvanced colorectal cancer patients: the ROAD study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx422.023] [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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De Maglio G, Ongaro E, Pella N, Ciani S, Cernic S, Giovannoni M, Ermacora P, Cardellino G, Iacono D, Aprile G, Pizzolitto S, Fasola G. How can molecular heterogeneity impact on treatment choice in advanced colorectal cancer? Ann Oncol 2017. [DOI: 10.1093/annonc/mdx422.031] [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: 11/13/2022] Open
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Basile D, Parnofiello A, Vitale M, Cortiula F, Garattini S, Gerratana L, Andreotti V, Ongaro E, Lisanti C, Bartoletti M, Bonotto M, Fanotto V, Cattaneo M, Iacono D, Bacco A, Ermacora P, Puglisi F, Aprile G, Pella N, Cardellino G, Fasola G. Early loss of skeletal muscle mass (LSMM) as prognostic factor in metastatic pancreatic cancer (PC) patients. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx425.017] [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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41
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Cortiula F, Basile D, Gerratana L, Bonotto M, Ongaro E, Garattini S, Fanotto V, Cattaneo M, Andreotti V, Parnofiello A, Cocconi R, Pecori D, Cardellino G, Casagrande M, Ermacora P, Giovannoni M, Iacono D, Puglisi F, Aprile G, Pella N, Fasola G. Blood stream infection in cancer patients—device management and epidemiology: the BSIDE study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx436.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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42
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Ongaro E, De Maglio G, Gerratana L, Bonotto M, Garattini S, Basile D, Cattaneo M, Andreotti V, Cortiula F, Parnofiello A, Fanotto V, Pizzolitto S, Cardellino G, Casagrande M, Puglisi F, Aprile G, Pella N, Fasola G. Mutational status and metastatic patteRn in a cohort Of ADvanced colorectal cancer (aCRC) patients (pts): The ROAD study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx393.078] [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: 11/13/2022] Open
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43
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Ongaro E, Buoro V, Cinausero M, Caccialanza R, Turri A, Fanotto V, Basile D, Vitale MG, Ermacora P, Cardellino GG, Nicoletti L, Fornaro L, Casadei-Gardini A, Aprile G. Sarcopenia in gastric cancer: when the loss costs too much. Gastric Cancer 2017; 20:563-572. [PMID: 28477106 DOI: 10.1007/s10120-017-0722-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 04/23/2017] [Indexed: 02/07/2023]
Abstract
Sarcopenia is a complex syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength. Malignancy is a major determinant of sarcopenia, and gastric cancer (GC) is among the most common causes of this phenomenon. As sarcopenia is a well-recognized poor prognostic feature in GC and has been associated with worse tolerance of surgical and medical treatments, members of the multidisciplinary team should be aware of the clinical relevance, pathogenic mechanisms, and potential treatments for this syndrome. The importance of sarcopenia is often underestimated in everyday practice and clinical trials, particularly among elderly or fragile patients. As treatment options are improving in all disease stages, deeper knowledge and greater attention to the metabolic balance in GC patients could further increase the benefit of novel therapeutic strategies and dramatically impact on quality of life. In this review, we describe the role of sarcopenia in different phases of GC progression. Our aim is to provide oncologists and surgeons dealing with GC patients with a useful tool for comprehensive assessment and timely management of this potentially life-threatening condition.
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Affiliation(s)
- Elena Ongaro
- Department of Oncology, University and General Hospital, Udine, Italy
| | - Vanessa Buoro
- Department of Oncology, University and General Hospital, Udine, Italy
| | - Marika Cinausero
- Department of Oncology, University and General Hospital, Udine, Italy
| | - Riccardo Caccialanza
- Clinical Nutrition Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Annalisa Turri
- Clinical Nutrition Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Valentina Fanotto
- Department of Oncology, University and General Hospital, Udine, Italy
| | - Debora Basile
- Department of Oncology, University and General Hospital, Udine, Italy
| | | | - Paola Ermacora
- Department of Oncology, University and General Hospital, Udine, Italy
| | | | - Laura Nicoletti
- Department of Oncology, San Bortolo General Hospital, Azienda ULSS8 Berica, East District, Viale Rodolfi 37, 36100, Vicenza, Italy
| | - Lorenzo Fornaro
- Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Andrea Casadei-Gardini
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, FC, Italy
| | - Giuseppe Aprile
- Department of Oncology, University and General Hospital, Udine, Italy.
- Department of Oncology, San Bortolo General Hospital, Azienda ULSS8 Berica, East District, Viale Rodolfi 37, 36100, Vicenza, Italy.
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Garattini SK, Basile D, Cattaneo M, Fanotto V, Ongaro E, Bonotto M, Negri FV, Berenato R, Ermacora P, Cardellino GG, Giovannoni M, Pella N, Scartozzi M, Antonuzzo L, Silvestris N, Fasola G, Aprile G. Molecular classifications of gastric cancers: Novel insights and possible future applications. World J Gastrointest Oncol 2017; 9:194-208. [PMID: 28567184 PMCID: PMC5434387 DOI: 10.4251/wjgo.v9.i5.194] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 12/04/2016] [Accepted: 03/17/2017] [Indexed: 02/05/2023] Open
Abstract
Despite some notable advances in the systemic management of gastric cancer (GC), the prognosis of patients with advanced disease remains overall poor and their chance of cure is anecdotic. In a molecularly selected population, a median overall survival of 13.8 mo has been reached with the use of human epidermal growth factor 2 (HER2) inhibitors in combination with chemotherapy, which has soon after become the standard of care for patients with HER2-overexpressing GC. Moreover, oncologists have recognized the clinical utility of conceiving cancers as a collection of different molecularly-driven entities rather than a single disease. Several molecular drivers have been identified as having crucial roles in other tumors and new molecular classifications have been recently proposed for gastric cancer as well. Not only these classifications allow the identification of different tumor subtypes with unique features, but also they serve as springboard for the development of different therapeutic strategies. Hopefully, the application of standard systemic chemotherapy, specific targeted agents, immunotherapy or even surgery in specific cancer subgroups will help maximizing treatment outcomes and will avoid treating patients with minimal chance to respond, therefore diluting the average benefit. In this review, we aim at elucidating the aspects of GC molecular subtypes, and the possible future applications of such molecular analyses.
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Basile D, Garattini SK, Bonotto M, Ongaro E, Casagrande M, Cattaneo M, Fanotto V, De Carlo E, Loupakis F, Urbano F, Negri FV, Pella N, Russano M, Brunetti O, Scartozzi M, Santini D, Silvestris N, Casadei Gardini A, Puzzoni M, Calvetti L, Cardarelli N, Aprile G. Immunotherapy for colorectal cancer: where are we heading? Expert Opin Biol Ther 2017; 17:709-721. [PMID: 28375039 DOI: 10.1080/14712598.2017.1315405] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION In the last few years, significant advances in molecular biology have provided new therapeutic options for colorectal cancer (CRC). The development of new drugs that target the immune response to cancer cells seems very promising and has already been established for other tumor types. In particular, the use of immune checkpoint inhibitors seems to be an encouraging immunotherapeutic strategy. Areas covered: In this review, the authors provide an update of the current evidence related to this topic, though most immunotherapies are still in early-phase clinical trials for CRC. To understand the key role of immunotherapy in CRC, the authors discuss the delicate balance between immune-stimulating and immune-suppressive networks that occur in the tumor microenvironment. Expert opinion: Modulation of the immune system through checkpoint inhibition is an emerging approach in CRC therapy. Nevertheless, selection criteria that could enable the identification of patients who may benefit from these agents are necessary. Furthermore, potential prognostic and predictive immune biomarkers based on immune and molecular classifications have been proposed. As expected, additional studies are required to develop biomarkers, effective therapeutic strategies and novel combinations to overcome immune escape resistance and enhance effector response.
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Affiliation(s)
- Debora Basile
- a Department of Oncology , University and General Hospital , Udine , Italy
| | | | - Marta Bonotto
- a Department of Oncology , University and General Hospital , Udine , Italy
| | - Elena Ongaro
- a Department of Oncology , University and General Hospital , Udine , Italy
| | | | - Monica Cattaneo
- a Department of Oncology , University and General Hospital , Udine , Italy
| | - Valentina Fanotto
- a Department of Oncology , University and General Hospital , Udine , Italy
| | - Elisa De Carlo
- a Department of Oncology , University and General Hospital , Udine , Italy
| | - Fotios Loupakis
- c Medical Oncology 1, Department of Medical and Experimental Oncology , IOV - IRCCS , Padova , Italy
| | - Federica Urbano
- b Medical Oncology B, Department of Dermatological Sciences, Radiology and Pathology , La Sapienza University , Rome , Italy.,c Medical Oncology 1, Department of Medical and Experimental Oncology , IOV - IRCCS , Padova , Italy
| | | | - Nicoletta Pella
- a Department of Oncology , University and General Hospital , Udine , Italy
| | - Marco Russano
- e Medical Oncology , Campus Biomedico University , Roma , Italy
| | - Oronzo Brunetti
- f Medical Oncology Unit , National Cancer Institute IRCCS "Giovanni Paolo II" , Bari , Italy
| | - Mario Scartozzi
- g Medical Oncology , University Hospital and University of Cagliari , Cagliari , Italy
| | - Daniele Santini
- e Medical Oncology , Campus Biomedico University , Roma , Italy
| | - Nicola Silvestris
- f Medical Oncology Unit , National Cancer Institute IRCCS "Giovanni Paolo II" , Bari , Italy
| | | | - Marco Puzzoni
- g Medical Oncology , University Hospital and University of Cagliari , Cagliari , Italy
| | - Lorenzo Calvetti
- i Department of Oncology , San Bortolo General Hospital , Vicenza , Italy
| | - Nadia Cardarelli
- i Department of Oncology , San Bortolo General Hospital , Vicenza , Italy
| | - Giuseppe Aprile
- a Department of Oncology , University and General Hospital , Udine , Italy.,i Department of Oncology , San Bortolo General Hospital , Vicenza , Italy
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Bonotto M, Garattini SK, Basile D, Ongaro E, Fanotto V, Cattaneo M, Cortiula F, Iacono D, Cardellino GG, Pella N, Fasola G, Antonuzzo L, Silvestris N, Aprile G. Immunotherapy for gastric cancers: emerging role and future perspectives. Expert Rev Clin Pharmacol 2017; 10:609-619. [PMID: 28349740 DOI: 10.1080/17512433.2017.1313113] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The broad use of immunotherapy is revolutionizing the treatment paradigms of many solid tumors. Although chemotherapy remains the treatment backbone for advanced gastric cancer, improvements in its molecular characterization and progresses in understanding its underpinning biology have supported clinical development of novel immunotherapies. However, the results of recent trials testing these new agents raise the question on how to identify the patients that could greatly benefit. Areas covered: This article summarizes the current understanding on the biology and the mechanisms underlying different clinical features of gastric cancers. Particularly, after a comprehensive literature search, we speculate whether specific molecular subsets of patients could derive more benefit from immunotherapy. Expert commentary: Most cancers may evade the immune response, which is normally regulated by a delicate balance between activating and inhibitory signals. For example, both CTLA-4 and PD-1, once linked to PD-L1/2, may inhibit T-cell signaling. The use of agent to harness the power of the immune system appears to be the ultimate frontier in gastric cancer treatment. While anti-CTLA-4 antibodies are minimally active, there is growing evidence for the efficacy of PD1/-L1 inhibitors. The search of predictive factors for immunotherapy will provide key hints towards the optimal use of these agents.
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Affiliation(s)
- Marta Bonotto
- a Department Oncology , University Hospital of Udine , Udine , Italy.,b Department of Medical Area , University of Udine , Udine , Italy
| | - Silvio Ken Garattini
- a Department Oncology , University Hospital of Udine , Udine , Italy.,b Department of Medical Area , University of Udine , Udine , Italy
| | - Debora Basile
- a Department Oncology , University Hospital of Udine , Udine , Italy.,b Department of Medical Area , University of Udine , Udine , Italy
| | - Elena Ongaro
- a Department Oncology , University Hospital of Udine , Udine , Italy.,b Department of Medical Area , University of Udine , Udine , Italy
| | - Valentina Fanotto
- a Department Oncology , University Hospital of Udine , Udine , Italy.,b Department of Medical Area , University of Udine , Udine , Italy
| | - Monica Cattaneo
- a Department Oncology , University Hospital of Udine , Udine , Italy.,b Department of Medical Area , University of Udine , Udine , Italy
| | - Francesco Cortiula
- a Department Oncology , University Hospital of Udine , Udine , Italy.,b Department of Medical Area , University of Udine , Udine , Italy
| | - Donatella Iacono
- a Department Oncology , University Hospital of Udine , Udine , Italy
| | | | - Nicoletta Pella
- a Department Oncology , University Hospital of Udine , Udine , Italy
| | - Gianpiero Fasola
- a Department Oncology , University Hospital of Udine , Udine , Italy
| | | | - Nicola Silvestris
- d Medical Oncology Unit , National Cancer Institute IRCCS "Giovanni Paolo II" , Bari , Italy
| | - Giuseppe Aprile
- a Department Oncology , University Hospital of Udine , Udine , Italy.,e Department of Oncology , General Hospital San Bortolo, ULSS8 Berica , Vicenza , Italy
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Gerratana L, Bonotto M, Bozza C, Ongaro E, Fanotto V, Pelizzari G, Puglisi F. Pertuzumab and breast cancer: another piece in the anti-HER2 puzzle. Expert Opin Biol Ther 2017; 17:365-374. [DOI: 10.1080/14712598.2017.1282944] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Lorenzo Gerratana
- Department of Medical and Biological Sciences, University of Udine, Udine, Italy
- Department Oncology, University Hospital of Udine, Udine, Italy
| | - Marta Bonotto
- Department of Medical and Biological Sciences, University of Udine, Udine, Italy
- Department Oncology, University Hospital of Udine, Udine, Italy
| | - Claudia Bozza
- Department of Medical and Biological Sciences, University of Udine, Udine, Italy
- Department Oncology, University Hospital of Udine, Udine, Italy
| | - Elena Ongaro
- Department of Medical and Biological Sciences, University of Udine, Udine, Italy
- Department Oncology, University Hospital of Udine, Udine, Italy
| | - Valentina Fanotto
- Department of Medical and Biological Sciences, University of Udine, Udine, Italy
- Department Oncology, University Hospital of Udine, Udine, Italy
| | - Giacomo Pelizzari
- Department of Medical and Biological Sciences, University of Udine, Udine, Italy
- Department Oncology, University Hospital of Udine, Udine, Italy
| | - Fabio Puglisi
- Department of Medical and Biological Sciences, University of Udine, Udine, Italy
- Department Oncology, University Hospital of Udine, Udine, Italy
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Fanotto V, Ongaro E, Rihawi K, Avallone A, Silvestris N, Fornaro L, Vasile E, Antonuzzo L, Leone F, Rosati G, Giuliani F, Bordonaro R, Scartozzi M, Maglio GD, Negri FV, Fasola G, Aprile G. HER-2 inhibition in gastric and colorectal cancers: tangible achievements, novel acquisitions and future perspectives. Oncotarget 2016; 7:69060-69074. [PMID: 27542243 PMCID: PMC5356612 DOI: 10.18632/oncotarget.11264] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 06/16/2016] [Indexed: 12/20/2022] Open
Abstract
HER-2 (ErbB-2, c-erbB2 or Her2/neu), a member of the HER-family, is directly involved in the pathogenesis and progression of several human cancers; as such, it is also often considered as a poor prognostic factor. Following the revolutionary impact of anti-HER-2 therapy in breast cancer patients, the role of HER-2 and its blockade has also been extensively evaluated in other tumor types, including gastric and colorectal adenocarcinoma. The aims of this review are to recall the important results achieved with the use of HER-2 inhibitors in both gastric and colorectal cancer, and to discuss on the updates available on the role of HER-2 as prognostic and predictive factor in these malignancies.
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Affiliation(s)
- Valentina Fanotto
- Department of Oncology, University and General Hospital, Udine, Italy
| | - Elena Ongaro
- Department of Oncology, University and General Hospital, Udine, Italy
| | - Karim Rihawi
- Department of Oncology, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Antonio Avallone
- Gastrointestinal Medical Oncology Unit, National Cancer Institute “Fondazione Giovanni Pascale”-IRCCS, Napoli, Italy
| | - Nicola Silvestris
- Department of Oncology, National CancerInstitute “Giovanni Paolo II”-IRCSS, Bari, Italy
| | - Lorenzo Fornaro
- Unit of Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Enrico Vasile
- Unit of Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | | | - Francesco Leone
- Department of Medical Oncology, University of Torino, Candiolo Cancer Institute-FPO-IRCCS, Torino, Italy
| | - Gerardo Rosati
- Medical Oncology Unit, San Carlo Hospital, Potenza, Italy
| | - Francesco Giuliani
- Department of Oncology, National CancerInstitute “Giovanni Paolo II”-IRCSS, Bari, Italy
| | | | - Mario Scartozzi
- Department of Oncology, University Hospital, Cagliari, Italy
| | | | | | - Gianpiero Fasola
- Department of Oncology, University and General Hospital, Udine, Italy
| | - Giuseppe Aprile
- Department of Oncology, University and General Hospital, Udine, Italy
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Aprile G, Bonotto M, Ongaro E, Garattini SK, Fanotto V, Basile D, Cattaneo M, Casagrande M, Ferrari L, Cardellino GG, Ermacora P, Pella N, Giovannoni M, Fasola G. Apatinib for gastric cancer: are we moving the antiangiogenic strategy any forward? Transl Cancer Res 2016. [DOI: 10.21037/tcr.2016.10.11] [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: 11/06/2022]
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Pietrantonio F, Caporale M, Morano F, Scartozzi M, Gloghini A, De Vita F, Giommoni E, Fornaro L, Aprile G, Melisi D, Berenato R, Mennitto A, Volpi CC, Laterza MM, Pusceddu V, Antonuzzo L, Vasile E, Ongaro E, Simionato F, de Braud F, Torri V, Di Bartolomeo M. HER2 loss in HER2-positive gastric or gastroesophageal cancer after trastuzumab therapy: Implication for further clinical research. Int J Cancer 2016; 139:2859-2864. [PMID: 27578417 DOI: 10.1002/ijc.30408] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [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: 05/30/2016] [Revised: 07/18/2016] [Accepted: 08/17/2016] [Indexed: 12/21/2022]
Abstract
Mechanisms of acquired resistance to trastuzumab-based treatment in gastric cancer are largely unknown. In this study, we analyzed 22 pairs of tumor samples taken at baseline and post-progression in patients receiving chemotherapy and trastuzumab for advanced HER2-positive [immunohistochemistry (IHC) 3+ or 2+ with in-situ hybridization (ISH) amplification] gastric or gastroesophageal cancers. Strict clinical criteria for defining acquired trastuzumab resistance were adopted. Loss of HER2 positivity and loss of HER2 over-expression were defined as post-trastuzumab IHC score <3+ and absence of ISH amplification, and IHC "downscoring" from 2+/3+ to 0/1+, respectively. HER2 IHC was always performed, while ISH was missing in 3 post-progression samples. Patients with initial HER2 IHC score 3+ and 2+ were 14 (64%) and 8 (36%), respectively. Loss of HER2 positivity and HER2 over-expression was observed in 32 and 32% samples, respectively. The chance of HER2 loss was not associated with any of the baseline clinicopathological variables. The only exception was in patients with initial IHC score 2+ versus 3+, for both endpoints of HER2 positivity (80 vs. 14%; p = 0.008) and HER2 over-expression (63 vs. 14%; p = 0.025). As already shown in breast cancer, loss of HER2 may be observed also in gastric cancers patients treated with trastuzumab-based chemotherapy in the clinical practice. This phenomenon may be one of the biological reasons explaining the failure of anti-HER2 second-line strategies in initially HER2-positive disease.
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Affiliation(s)
- F Pietrantonio
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - M Caporale
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - F Morano
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - M Scartozzi
- Medical Oncology Department, Azienda Ospedaliera Universitaria Cagliari, Presidio Policlinico Universitario "Duilio Casula", Cagliari, Italy
| | - A Gloghini
- Diagnostic pathology and laboratory medicine Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - F De Vita
- Medical Oncology Department, Seconda Università degli studi di Napoli, Naples, Italy
| | - E Giommoni
- Medical Oncology 1, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - L Fornaro
- U.O. Oncologia Medica 2 Universitaria, Ospedale S. Chiara - Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano, Tumori, Italy
| | - G Aprile
- Medical Oncology Department, University and General Hospital, Udine, Italy
| | - D Melisi
- Medical Oncology, Università degli studi di Verona, Italy
| | - R Berenato
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - A Mennitto
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - C C Volpi
- Diagnostic pathology and laboratory medicine Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - M M Laterza
- Medical Oncology Department, Seconda Università degli studi di Napoli, Naples, Italy
| | - V Pusceddu
- Medical Oncology Department, Azienda Ospedaliera Universitaria Cagliari, Presidio Policlinico Universitario "Duilio Casula", Cagliari, Italy
| | - L Antonuzzo
- Medical Oncology 1, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - E Vasile
- U.O. Oncologia Medica 2 Universitaria, Ospedale S. Chiara - Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano, Tumori, Italy
| | - E Ongaro
- Medical Oncology Department, University and General Hospital, Udine, Italy
| | - F Simionato
- Medical Oncology, Università degli studi di Verona, Italy
| | - F de Braud
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,Oncology Department, University of Milan, Italy
| | - V Torri
- Oncology Department, IRCCS-Mario Negri Institute for Pharmacological Rresearch, Milan, Italy
| | - M Di Bartolomeo
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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