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De Matteis E, Tumolo MR, Tarantino P, Ciccarese M, Grassi T, Bagordo F, De Giorgio MR, Rizzo E, Ronzino G. Prevalence and spectrum of germline BRCA1 and BRCA2 in a cohort of ovarian cancer patients from the Salento peninsula (Southern Italy): a matter of preventive health. Oncotarget 2024; 15:134-141. [PMID: 38386807 PMCID: PMC10883683 DOI: 10.18632/oncotarget.28561] [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: 11/24/2023] [Accepted: 01/23/2024] [Indexed: 02/24/2024] Open
Abstract
OBJECTIVES The aim of this exploratory, descriptive study was to characterize the deleterious BRCA1 and BRCA2 variants evaluated by genetic testing in a group of Ovarian cancer patients living in the Salento peninsula (Southern Italy). METHODS From June 2014 to July 2023, patients with histologically confirmed high-grade serous carcinoma, fallopian tube, or primary peritoneal cancer who were referred to Lecce Familial Cancer Clinic were considered. BRCA-mutation genetic testing was performed on these patients. Socio-demographic data and cancer epidemiology were assessed, and Next Generation Sequencing and Sanger DNA sequencing were performed. RESULTS The median age at the diagnosis of 332 ovarian cancer patients collected was 57 years. The pedigree analyses showed that 28.6% had familial cases and 39.7% had sporadic cases. Of the 319 patients submitted to genetic testing, 29.8% were carriers of BRCA1/2 mutation, 75.8% at BRCA1 and 24.2% at BRCA2 gene. Of the 21 BRCA1 mutations, the variant c.5266dupC was the most frequent alteration (28.4%). With respect to BRCA2, 13 mutations were found and the variant c.9676delT was the most frequently recorded (6.3%). CONCLUSIONS This study reveals that the prevalence of germline mutations in the BRCA1 and BRCA2 genes was higher than reported by other studies. A broader understanding of the prevalence and role of BRCA mutations in development, response to treatment, and prognosis represents an exciting and developing area of ovarian cancer treatment and prevention.
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Affiliation(s)
| | - Maria Rosaria Tumolo
- Department of Biological and Environmental Sciences and Technology, University of Salento, Lecce, Italy
| | - Paolo Tarantino
- U.O.C. Medical Genetics, “Vito Fazzi” Hospital, Lecce, Italy
| | | | - Tiziana Grassi
- Department of Biological and Environmental Sciences and Technology, University of Salento, Lecce, Italy
| | - Francesco Bagordo
- Department of Pharmacy-Pharmaceutical Sciences, University of Bari “Aldo Moro”, Bari, Italy
| | | | - Emanuele Rizzo
- Department of Biological and Environmental Sciences and Technology, University of Salento, Lecce, Italy
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Sordi E, Piscitelli P, Albanese C, Melcarne A, Tardio A, Quarta F, Greco E, Miani A, Falco A, De Matteis E, Congedo M, Civino A. Incidence of Non-Melanoma Skin Cancers in Salento (Southern Italy): A 15-Year Retrospective Analysis from the Cancer Registry of Lecce. Epidemiologia (Basel) 2023; 5:1-10. [PMID: 38534803 DOI: 10.3390/epidemiologia5010001] [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: 08/31/2023] [Revised: 12/04/2023] [Accepted: 12/13/2023] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Non-melanoma skin cancers (NMSCs) include basal cell carcinoma (BCC) and squamous-cell carcinoma (SCC), as well as a wide range of rare skin tumors. NMSCs is the most frequently diagnosed type of tumor among Caucasians. We aimed at estimating the incidence and mortality of NMSCs in the Salento area (Lecce province, Southern Italy), whose population is assumed to experience heavy and frequent sun exposure due to climatic/environmental factors, both for working and leisure activities. MATERIALS AND METHODS We computed the incidence of NMSCs in the Province of Lecce by examining the comprehensive real-world data collected by the local cancer registry, which covers all the 830,000 inhabitants, over a period of fifteen years (from 2003 to 2017), with a focus on the latest 5 years (2013-2017) for the analysis of the different histologic morphologies of these tumors. The incidence of NMSCs has been described in terms of absolute frequencies, crude rates and age-adjusted direct standardized rates (DSR). Joinpoint analysis was used to examine temporal trends in the incidence of NMSCs and estimate annual percent changes (APCs). RESULTS During the period of 2003-2017, the incidence of NMSCs reached a direct standardized rate (DSR) of 162.62 per 100,000 in men (mortality 1.57 per 100,000) and 89.36 per 100,000 in women (mortality 0.52 per 100,000), respectively. The incidence significantly increased among both men and women across the entire period. Basal cell carcinoma (BCC), with its different morphologies, represented about 67.6% of the NMSCs in men (n = 2139 out of a total of 3161 tumors observed between 2013 and 2017) and about 75.8% of the NMSCs in women (n = 1718 out of a total of 2264 tumors from 2013 to 2017), thus accounting for the vast majority of NMSCs. The results are consistent with the literature data carried out both at national and international level. CONCLUSIONS Proper monitoring of this phenomenon through timely reporting and recording of all new NMSC cases is necessary to develop new preventive strategies.
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Affiliation(s)
| | - Prisco Piscitelli
- Local Health Authority ASL Le, 73100 Lecce, Italy
- Department of Experimental Medicine, University of Salento, 73100 Lecce, Italy
| | - Carla Albanese
- Experimental Zooprophylactic Institute of Apulia and Basilicata (IZSPB), 71121 Foggia, Italy
| | | | - Anna Tardio
- Local Health Authority ASL Le, 73100 Lecce, Italy
| | | | - Enrico Greco
- Department of Chemical and Pharmaceutical Sciences, University of Trieste, 34100 Trieste, Italy
- Italian Society of Environmental Medicine (SIMA), 20123 Milan, Italy
| | - Alessandro Miani
- Italian Society of Environmental Medicine (SIMA), 20123 Milan, Italy
| | - Andrea Falco
- Department of Health Sciences, European University of Madrid, 28670 Madrid, Spain
| | | | | | - Adele Civino
- Local Health Authority ASL Le, 73100 Lecce, Italy
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Tumolo MR, Grassi T, Leo CG, Mincarone P, Bagordo F, Bodini A, Scoditti E, Panico A, Donno AD, Matteis ED, Canali V, Sabina S. miRNAs as biomarkers of musculoskeletal pain in long-distance runners: the MiMuS study protocol. Epigenomics 2023. [PMID: 37249028 DOI: 10.2217/epi-2023-0088] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
miRNAs are involved in the generation and progression of musculoskeletal pain, a condition that causes significant clinical, economic and social burden. In runners, the presence of musculoskeletal pain related to an inflammatory state or ongoing underlying tissue damage may result in poor training ability and performance. This study aims to evaluate the association between circulating and salivary miRNAs and pain in runners with and without musculoskeletal pain and to observe whether dysregulated miRNAs can distinguish between responders and nonresponders to a kinesiological intervention. The possible correlation between these miRNAs and inflammatory molecules, stress parameters and individual or behavioral characteristics will be evaluated. Finally, in silico analysis will be used to characterize miRNAs function. Ethics approval was obtained.
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Affiliation(s)
- Maria Rosaria Tumolo
- University of Salento, Department of Biological & Environmental Sciences & Technology, 73100 Lecce, Italy
- Institute of Clinical Physiology, National Research Council, Branch of Lecce, 73100 Lecce, Italy
| | - Tiziana Grassi
- University of Salento, Department of Biological & Environmental Sciences & Technology, 73100 Lecce, Italy
| | - Carlo Giacomo Leo
- Institute of Clinical Physiology, National Research Council, Branch of Lecce, 73100 Lecce, Italy
- MOVE-mentis s.r.l., 47522 Cesena, Italy
| | - Pierpaolo Mincarone
- MOVE-mentis s.r.l., 47522 Cesena, Italy
- Institute for Research on Population & Social Policies, National Research Council, Research Unit of Brindisi, 72100 Brindisi, Italy
| | - Francesco Bagordo
- Department of Pharmacy-Pharmaceutical Sciences, University of Bari 'Aldo Moro', 70125 Bari, Italy
| | - Antonella Bodini
- Institute for Applied Mathematics & Information Technologies 'E. Magenes', National Research Council, 20133 Milan, Italy
| | - Egeria Scoditti
- Institute of Clinical Physiology, National Research Council, Branch of Lecce, 73100 Lecce, Italy
| | - Alessandra Panico
- University of Salento, Department of Biological & Environmental Sciences & Technology, 73100 Lecce, Italy
| | - Antonella De Donno
- University of Salento, Department of Biological & Environmental Sciences & Technology, 73100 Lecce, Italy
| | | | | | - Saverio Sabina
- Institute of Clinical Physiology, National Research Council, Branch of Lecce, 73100 Lecce, Italy
- MOVE-mentis s.r.l., 47522 Cesena, Italy
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Patruno M, De Summa S, Resta N, Caputo M, Costanzo S, Digennaro M, Pilato B, Bagnulo R, Pantaleo A, Simone C, Natalicchio MI, De Matteis E, Tarantino P, Tommasi S, Paradiso A. Spectrum of Germline Pathogenic Variants in BRCA1/2 Genes in the Apulian Southern Italy Population: Geographic Distribution and Evidence for Targeted Genetic Testing. Cancers (Basel) 2021; 13:cancers13184714. [PMID: 34572941 PMCID: PMC8467705 DOI: 10.3390/cancers13184714] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/14/2021] [Accepted: 09/17/2021] [Indexed: 01/02/2023] Open
Abstract
Simple Summary BRCA1 and BRCA2 are two major high-penetrance breast/ovarian cancer predisposition genes, whose mutations can lead to high risk and early onset of breast and ovarian cancer. Numerous studies are focused on spectrum and prevalence of BRCA1/2 mutations worldwide. This is the first study that exclusively focused on native Apulian probands. We found that ten recurrent BRCA1/2 pathogenic variants account for more than half of the patients with proven HBOC syndrome from Apulia. Besides BRCA1 c.5266dupC, which is present in significant numbers in every Apulian province, the other PVs occur at a high frequency in some areas and not others. In-depth knowledge of the mutation spectrum of the target population and of the relatively small number of recurrent mutations is crucial to develop a specific cost-effective strategy for mutation screening and a program for breast–ovarian cancer control and prevention through more liberal, yet rational, genetic testing and counseling. Abstract BRCA1/2-associated hereditary breast and ovarian cancer is the most common form of hereditary breast and ovarian cancer and occurs in all ethnicities and racial populations. Different BRCA1/BRCA2 pathogenic variants (PVs) have been reported with a wide variety among populations. In this study, we retrospectively analyzed prevalence and geographic distribution of pathogenic germline BRCA1/2 variants in families from Apulia in southern Italy and evaluated the genotype–phenotype correlations. Data were collected from Oncogenetic Services present in Apulian hospitals and a shared database was built containing Apulian native probands (n = 2026) that had undergone genetic testing from 2004 to 2019. PVs were detected in 499 of 2026 (24.6%) probands and 68.5% of them (342 of 499) were in the BRCA1 gene. We found 65 different PVs in BRCA1 and 46 in BRCA2. There were 10 most recurrent PVs and their geographical distribution appears to be significantly specific for each province. We have assumed that these PVs are related to the historical and geopolitical changes that occurred in Apulia over time and/or to a “founder effect”. Broader knowledge of BRCA1/2 prevalence and recurring PVs in specific geographic areas could help establish more flexible genetic testing strategies that may enhance our ability to detect high-risk subjects.
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Affiliation(s)
- Margherita Patruno
- Center for Hereditary Tumors Research, Istituto Tumori Bari, Giovani Paolo II, IRCCS, 70124 Bari, Italy; (S.C.); (M.D.); (A.P.)
- Correspondence: (M.P.); (S.D.S.)
| | - Simona De Summa
- Molecular and Pharmacogenetics Diagnostic Laboratory, IRCCS-IstitutoTumori “Giovanni Paolo II”, 70124 Bari, Italy; (M.C.); (B.P.); (S.T.)
- Correspondence: (M.P.); (S.D.S.)
| | - Nicoletta Resta
- Medical Genetics Unit, Department of Biomedical Sciences and Human Oncology, “Aldo Moro” University of Bari, Policlinico Hospital Bari, 70124 Bari, Italy; (N.R.); (R.B.); (A.P.); (C.S.)
| | - Mariapia Caputo
- Molecular and Pharmacogenetics Diagnostic Laboratory, IRCCS-IstitutoTumori “Giovanni Paolo II”, 70124 Bari, Italy; (M.C.); (B.P.); (S.T.)
| | - Silvia Costanzo
- Center for Hereditary Tumors Research, Istituto Tumori Bari, Giovani Paolo II, IRCCS, 70124 Bari, Italy; (S.C.); (M.D.); (A.P.)
| | - Maria Digennaro
- Center for Hereditary Tumors Research, Istituto Tumori Bari, Giovani Paolo II, IRCCS, 70124 Bari, Italy; (S.C.); (M.D.); (A.P.)
| | - Brunella Pilato
- Molecular and Pharmacogenetics Diagnostic Laboratory, IRCCS-IstitutoTumori “Giovanni Paolo II”, 70124 Bari, Italy; (M.C.); (B.P.); (S.T.)
| | - Rosanna Bagnulo
- Medical Genetics Unit, Department of Biomedical Sciences and Human Oncology, “Aldo Moro” University of Bari, Policlinico Hospital Bari, 70124 Bari, Italy; (N.R.); (R.B.); (A.P.); (C.S.)
| | - Antonino Pantaleo
- Medical Genetics Unit, Department of Biomedical Sciences and Human Oncology, “Aldo Moro” University of Bari, Policlinico Hospital Bari, 70124 Bari, Italy; (N.R.); (R.B.); (A.P.); (C.S.)
| | - Cristiano Simone
- Medical Genetics Unit, Department of Biomedical Sciences and Human Oncology, “Aldo Moro” University of Bari, Policlinico Hospital Bari, 70124 Bari, Italy; (N.R.); (R.B.); (A.P.); (C.S.)
- Medical Genetics, National Institute of Gastroenterology “S. de Bellis” Research Hospital, Castellana Grotte, 70013 Bari, Italy
| | | | | | - Paolo Tarantino
- Medical Genetics Unit, “Vito Fazzi” Hospital, 73100 Lecce, Italy;
| | - Stefania Tommasi
- Molecular and Pharmacogenetics Diagnostic Laboratory, IRCCS-IstitutoTumori “Giovanni Paolo II”, 70124 Bari, Italy; (M.C.); (B.P.); (S.T.)
| | - Angelo Paradiso
- Center for Hereditary Tumors Research, Istituto Tumori Bari, Giovani Paolo II, IRCCS, 70124 Bari, Italy; (S.C.); (M.D.); (A.P.)
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Franiuk M, Molinari E, Battistuzzi L, Razzaboni E, De Matteis E, Turchetti D, Godino L, Chiorri C, Varesco L. Development and Validation of an Italian Adaptation of the Psychosocial Aspects of Hereditary Cancer Questionnaire. Front Psychol 2021; 12:697300. [PMID: 34354641 PMCID: PMC8329440 DOI: 10.3389/fpsyg.2021.697300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/30/2021] [Indexed: 11/18/2022] Open
Abstract
Individuals that attend cancer genetic counseling may experience test-related psychosocial problems that deserve clinical attention. In order to provide a reliable and valid first-line screening tool for these issues, Eijzenga and coworkers developed the Psychosocial Aspects of Hereditary Cancer (PAHC) questionnaire. The aim of this work was to develop an Italian adaptation of the PAHC (I-PACH). This prospective multicenter observational study included three stages: (1) development of a provisional version of the I-PAHC; (2) pilot studies aimed at testing item readability and revising the questionnaire; and (3) a main study aimed at testing the reliability and validity of the final version of the I-PAHC with the administration of a battery comprising measures of depression, anxiety, worry, stress, and life problems to 271 counselees from four cancer genetic clinics. Adapting the original PAHC to the Italian context involved adding two further domains and expanding the emotions domain to include positive emotions. While most of the items were found to be easy to understand and score, some required revision to improve comprehensibility; others were considered irrelevant or redundant and therefore deleted. The final version showed adequate reliability and validity. The I-PAHC provides comprehensive content coverage of cancer genetic-specific psychosocial problems, is well accepted by counselees, and can be considered a sound assessment tool for psychosocial issues related to cancer genetic counseling and risk assessment in Italy.
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Affiliation(s)
- Marzena Franiuk
- Unit of Hereditary Cancer, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Elena Molinari
- UOSD Physical Medicine and Rehabilitation, IRCCS Giannina Gaslini Institute, Genova, Italy
| | - Linda Battistuzzi
- Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Genoa, Italy
| | | | | | - Daniela Turchetti
- Department of Medical and Surgical Sciences, Center for Studies on Hereditary Cancer and U.O. Genetica Medica, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy
| | - Lea Godino
- Department of Medical and Surgical Sciences, Center for Studies on Hereditary Cancer and U.O. Genetica Medica, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy
| | - Carlo Chiorri
- Department of Educational Sciences, University of Genova, Genova, Italy
| | - Liliana Varesco
- Unit of Hereditary Cancer, IRCCS Ospedale Policlinico San Martino, Genova, Italy
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Cecere SC, Musacchio L, Bartoletti M, Salutari V, Arenare L, Lorusso D, Ronzino G, Lauria R, Cormio G, Naglieri E, Scollo P, Marchetti C, Raspagliesi F, Greggi S, Cinieri S, Bergamini A, Orditura M, Valabrega G, Scambia G, Martinelli F, De Matteis E, Cardalesi C, Loizzi V, Perniola G, Carella C, Scandurra G, Giannone G, Pignata S. Cytoreductive surgery followed by chemotherapy and olaparib maintenance in BRCA 1/2 mutated recurrent ovarian cancer: a retrospective MITO group study. Int J Gynecol Cancer 2021; 31:1031-1036. [PMID: 33990353 DOI: 10.1136/ijgc-2020-002343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 04/06/2021] [Accepted: 04/08/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The role of cytoreductive surgery in the poly-ADP ribose polymerase inhibitors era is not fully investigated. We evaluated the impact of surgery performed prior to platinum-based chemotherapy followed by olaparib maintenance in platinum-sensitive BRCA-mutated recurrent ovarian cancer. METHODS This retrospective study included platinum-sensitive recurrent ovarian cancer BRCA-mutated patients from 13 Multicenter Italian Trials in Ovarian cancer and gynecological malignancies centers treated between September 2015 and May 2019. The primary outcomes were progression-free survival and overall survival. Data on post-progression treatment was also assessed. RESULTS Among 209 patients, 72 patients (34.5%) underwent cytoreductive surgery followed by platinum-based chemotherapy and olaparib maintenance, while 137 patients (65.5%) underwent chemotherapy treatment alone. After a median follow-up of 37.3 months (95% CI: 33.4 to 40.8), median progression-free survival in the surgery group was not reached, compared with 11 months in patients receiving chemotherapy alone (P<0.001). Median overall survival was nearly double in patients undergoing surgery before chemotherapy (55 vs 28 months, P<0.001). Post-progression therapy was assessed in 127 patients: response rate to chemotherapy was 29.2%, 8.8%, and 9.0% in patients with platinum-free interval >12 months, between 6 and 12 months, and <6 months, respectively. CONCLUSION Cytoreductive surgery performed before platinum therapy and olaparib maintenance was associated with longer progression-free survival and overall survival in BRCA-mutated platinum-sensitive relapsed ovarian cancer patients. In accordance with our preliminary results, the response rate to chemotherapy given after progression during olaparib was associated with platinum-free interval.
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Affiliation(s)
- Sabrina Chiara Cecere
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy
| | - Lucia Musacchio
- Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy.,Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, Sapienza, University of Rome, Rome, Italy
| | - Michele Bartoletti
- Unit of Medical Oncology and Cancer Prevention, Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano, CRO, Aviano, Italy.,Department of Medicine, University of Udine, Udine, Italy
| | - Vanda Salutari
- Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Laura Arenare
- Clinical Trial Unit, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
| | - Domenica Lorusso
- Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy.,Department of Life Science and Public Health, Catholic University of Sacred Heart, Largo Agostino Gemelli, Rome, Italy.,Gynecologic Oncology Unit, Fondazione Istituto Nazionale Tumori IRCCS, Milan, Italy
| | | | - Rossella Lauria
- Division of Medical Oncology, Azienda Ospedaliera Universitaria Federico II, Napoli, Campania, Italy
| | - Gennaro Cormio
- Gynecologic Oncology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy
| | - Emanuele Naglieri
- Medical Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Paolo Scollo
- Medical Oncology Unit, Cannizzaro Hospital, Catania, Italy
| | - Claudia Marchetti
- Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | | | - Stefano Greggi
- Gynecologic Oncology, National Cancer Institute, Institute for Hospitalization and Care Scientific Foundation Pascale, Napoli, Campania, Italy
| | - Saverio Cinieri
- Division of Medical Oncology, Ospedale "Senatore Antonio Perrino", Brindisi, Brindisi, Italy
| | - Alice Bergamini
- Department of Obstetrics and Gynecology, IRCCS, San Raffaele Hospital, Milan, Italy.,Università Vita Salute San Raffaele, Milan, Italy
| | - Michele Orditura
- Università degli Studi della Campania Luigi Vanvitelli, Napoli, Campania, Italy
| | - Giorgio Valabrega
- Candiolo Cancer Institute, FPO- IRCCS, Candiolo (TO), Italy.,Department of Oncology, University of Turin, Torino, Piemonte, Italy
| | - Giovanni Scambia
- Department of Women and Child Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy.,Department of Life Science and Public Health, Catholic University of Sacred Heart, Largo Agostino Gemelli, Rome, Italy
| | - Fabio Martinelli
- Gynecologic Oncology Unit, Fondazione Istituto Nazionale Tumori IRCCS, Milan, Italy
| | | | - Cinzia Cardalesi
- Division of Medical Oncology, Azienda Ospedaliera Universitaria Federico II, Napoli, Campania, Italy
| | - Vera Loizzi
- Gynecologic Oncology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy
| | - Giorgia Perniola
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, Sapienza, University of Rome, Rome, Italy
| | - Claudia Carella
- Interventional Oncology Unit with Integrated Section of Translational Medical Oncology, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | | | - Gaia Giannone
- Candiolo Cancer Institute, FPO- IRCCS, Candiolo (TO), Italy.,Department of Oncology, University of Turin, Torino, Piemonte, Italy
| | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy
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Cortesi L, Venturelli M, Caggia F, Marcheselli L, Gozzi A, Zambelli A, Guarneri V, Musolino A, Fiorio E, Bisagni G, Rocca A, Arcangeli V, De Matteis E, Rizzo S, Michelotti A. Abstract OT-31-01: A phase II study to evaluate the efficacy and safety of pembrolizumab plus carboplatin in BRCA-related metastatic breast cancer: PEMBRACA trial. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ot-31-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Considering the high proportion of tumor-infiltrating lymphocytes (TILs) in BRCA-related breast cancer, we expect that PD-1 pathway is highly expressed and PD-1 antagonist pembrolizumab could provide clinical activity in this kind of tumor. Furthermore, BRCA-related breast cancers are known to be more sensitive to platinum-derived drugs. Thus the association between Pembrolizumab and Carboplatin in metastatic BRCA-related breast cancer seems to be active in this setting of patients. This study will evaluate the safety and the efficacy of Pembrolizumab associated with Carboplatin in BRCA mutated or with unknown mutations metastatic breast cancer patients.
Study and Statistical DesignThis is a national multicenter two-stage single arm phase II study, enrolling BRCA mutated or with unknown mutations metastatic breast cancer patients. The sample size has been estimated by using the two-stage Simon’s design. In the first stage, 20 subjects will be enrolled. If, after first stage ≤11 responses (r1) will be observed, accrual will terminate and the experimental regimen will be rejected. Otherwise if 12 or more responses will be seen then the accrual will continue to the second stage of an additional 33 subjects (total, 53 subjects). At the second stage if 33 or less responses out of 53 subjects will be observed the treatment will be rejected. With the null hypothesis (p0) being equal 0.55 with a type I (alfa) error of 0.10 (10%) and a type II (beta) error of 0.20 (power=80%) and the alternative hypothesis (p1) is 0.70, (response rate 70%), we expect to reach an overall response rate (ORR) ≥ 70% by the combination of Pembrolizumab plus Carboplatin. We also expect to reach a median Time to Progression (TTP) and Overall Survival (OS) of five and fifteen months respectively. The Disease Control Rate (DCR) will be expected as ≥ 80% by the combination of Pembrolizumab plus Carboplatin
Study TreatmentCarboplatin at area under the time-concentration curve 6 (AUC 6) intravenously once every 3 weeks in combination with Pembrolizumab 200 mg intravenously every 3 weeks will be administered for six courses and then only Pembrolizumab alone will continue until occurrence of unacceptable toxicities or disease progression.
Eligibility CriteriaIn order to be eligible for participation in this trial, the subject, aged ≥ 18 years, must have metastatic confirmed breast cancer, with a disease progression by radiological techniques within 12 months prior to signing informed consent, and a documented mutation in BRCA1 or BRCA2 genes that is predicted to be deleterious or suspected deleterious or with unknown significance. The subject must have measurable disease based on RECIST 1.1 and have a performance status of 0 or 1 on the Eastern Cooperative Oncology Group (ECOG) Performance Scale. Prior chemotherapy with anthracyclines and taxanes has to be administered in neoadjuvant or adjuvant setting. In case of luminal tumors hormonal treatments for advanced disease can be administered before. The life expectancy must be greater than 3 months and the subject must demonstrate adequate organ function by screening labs performed within 10 days of treatment initiation.
Objectives and HypothesisThe primary end-point will be the ORR, evaluated according to RECIST criteria. Secondary objectives will be the TTP, the duration of response (DOR ), the DCR, and the OS. The safety of the combination will be evaluated according to the worst toxicity grade reported throughout the whole treatment period.The Exploratory Objective will be the evaluation of ORR, TTP, DOR, and DCR based on irRECIST. Biological parameters of CD8/TILs and PD-L1 will be considered in the metastatic biopsy.
Target AccrualThe first subject was enrolled in January 2019 and recruitment is ongoing. Enrollment of the first 20 subjects is expected to complete in Q2 2021.
Citation Format: Laura Cortesi, Marta Venturelli, Federica Caggia, Luigi Marcheselli, Annita Gozzi, Alberto Zambelli, Valentina Guarneri, Antonino Musolino, Elena Fiorio, Giancarlo Bisagni, Andrea Rocca, Valentina Arcangeli, Elisabetta De Matteis, Sergio Rizzo, Andrea Michelotti. A phase II study to evaluate the efficacy and safety of pembrolizumab plus carboplatin in BRCA-related metastatic breast cancer: PEMBRACA trial [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr OT-31-01.
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Affiliation(s)
- Laura Cortesi
- 1Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Marta Venturelli
- 1Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Federica Caggia
- 1Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Luigi Marcheselli
- 1Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Annita Gozzi
- 1Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Alberto Zambelli
- 2Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | | | | | - Elena Fiorio
- 5Azienda Ospedaliero Universitaria Integrata, Verona, Italy
| | | | - Andrea Rocca
- 7Scientific Institute Romagnolo for the Study and Treatment of Cancer (IRST) IRCCS, Meldola, Italy
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8
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Capoluongo E, De Matteis E, Cucinotto I, Ronzino G, Santonocito C, Tornesello A, De Giorgio MR, Lucci Cordisco E, Minucci A, Genuardi M. A new founder BRCA1 haplotype identified in the Puglia region is associated with a specific age-related cancer onset in three unrelated families. Clin Chem Lab Med 2020; 59:e95-e98. [PMID: 32396136 DOI: 10.1515/cclm-2020-0389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 04/23/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Ettore Capoluongo
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli Federico II - CEINGE, Biotecnologie Avanzate, Naples, Italy
| | | | - Iole Cucinotto
- Medical Affairs Italy, Galapagos Biopharma, Milan, Italy
| | | | - Concetta Santonocito
- Molecular and Genomic Diagnostics Laboratory, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | | | | | - Angelo Minucci
- Molecular and Genomic Diagnostics Laboratory, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maurizio Genuardi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Genetica Medica, Rome, Italy.,Istituto di MEdicina Genomica Univarsità Cattolica del Sacro Cuore, Rome, Italy
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9
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Lorusso D, Bologna A, Cecere SC, De Matteis E, Scandurra G, Zamagni C, Arcangeli V, Artioli F, Bella M, Blanco G, Cardalesi C, Casartelli C, De Vivo R, Di Napoli M, Gisone EB, Lauria R, Lissoni AA, Loizzi V, Maccaroni E, Mangili G, Marchetti C, Martella F, Naglieri E, Parolin V, Ricciardi G, Ronzino G, Salutari V, Scarfone G, Secondino S, Spagnoletti I, Tasca G, Tognon G, Guarneri V. Sharing real-world experiences to optimize the management of olaparib toxicities: a practical guidance from an Italian expert panel. Support Care Cancer 2020; 28:2435-2442. [PMID: 32048043 DOI: 10.1007/s00520-020-05320-4] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 01/17/2020] [Indexed: 11/28/2022]
Abstract
Olaparib is the first poly(ADP-ribose) polymerase inhibitor approved as maintenance therapy of recurrent ovarian cancer (OC) patients with a BRCA mutation. To achieve the maximum clinical benefit, adherence to olaparib must be persistent. However, in clinical practice, this is challenged by the frequent suboptimal management of toxicities. In view of the expanding use of olaparib also in Italy, physicians must learn how to adequately and promptly manage drug toxicities not to unnecessarily interrupt or reduce the dose. The experts agreed that nausea,vomiting, anemia, and fatigue are the most frequent events experienced by OC patients on olaparib, and that these toxicities usually develop early during treatment, are mainly of grade 1-2 and transient and can be managed with simple non-pharmacological interventions. By sharing their real-world experiences, the panel prepared, for each toxicity, an algorithm organized by grade and besides the procedures indicated in the local label, included supportive care interventions based also on nutritional and lifestyle modifications and psycho-oncology consultation. Moreover, in view of the tablet entry into the Italian market, the full and reduced dosages of capsules and tablets were compared. This practical guidance is intended to be a tool to support especially less-experienced physicians in the management of these complex patients, with the aim to help preventing the worsening of patients' conditions and the unnecessary interruption/reduction of olaparib dosage, which may jeopardize treatment efficacy.
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Affiliation(s)
- Domenica Lorusso
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.
| | - Alessandra Bologna
- Oncologia Medica, IRCCS Arcispedale S. Maria Nuova, Viale Risorgimento, 80, 42123, Reggio Emilia, Italy
| | - Sabrina Chiara Cecere
- Oncologia Clinica Sperimentale Uro-Ginecologica, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Via Mariano Semmola, 53, 80131, Naples, Italy
| | | | - Giusy Scandurra
- Multidisciplinary Breast Unit, Azienda Ospedaliera Cannizzaro, Via Messina, 829, 95126, Catania, Italy
| | - Claudio Zamagni
- Medical Oncology Unit, S.Orsola-Malpighi Hospital, Viale Ercolani 4/2, Bologna, Italy
| | - Valentina Arcangeli
- U.O. Oncologia, Ospedale Infermi Rimini, AUSL Romagna, viale Settembrini 2, 47923, Rimini, Italy
| | - Fabrizio Artioli
- Oncology Dept., Carpi and Mirandola Hospitals, Via G. Molinari 2, 41012, Carpi, Italy
| | - Mariangela Bella
- Medical Oncology Unit, University Hospital of Parma, Viale Antonio Gramsci, 14, 43126, Parma, Italy
| | - Giusi Blanco
- Oncology Unit, Ist. Oncologico del Mediterraneo, Via Penninazzo, 7, Viagrande, 95029, Catania, Italy
| | - Cinzia Cardalesi
- Dept. of Clinical and Surgical Medicine, Federico II University Hospital, Via Pansini 5, 80131, Naples, Italy
| | - Clelia Casartelli
- Medical Oncology Unit, Ospedale Valduce, Via Dante Alighieri, 11, 22100, Como, Italy
| | - Rocco De Vivo
- Medical Oncology Unit, AULSS 8 Vicenza, viale Rodolfi, 37, 36100, Vicenza, Italy
| | - Marilena Di Napoli
- Oncologia Clinica Sperimentale Uro-Ginecologica, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Via Mariano Semmola, 53, 80131, Naples, Italy
| | - Emanuele Baldo Gisone
- Dept of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Via del Ponte, 19, 21100, Varese, Italy
| | - Rossella Lauria
- Dept. of Clinical and Surgical Medicine, Federico II University Hospital, Via Pansini 5, 80131, Naples, Italy
| | - Alberto Andrea Lissoni
- Dept of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy.,Clinic of Obstetrics and Gynecology, San Gerardo Hospital, Via Pergolesi 33, 20900, Monza, Italy
| | - Vera Loizzi
- Dept of Biomedical Sciences and Medical Oncology, University of Bari "Aldo Moro", Piazza Umberto I 1, 70124, Bari, Italy
| | - Elena Maccaroni
- Clinica Oncologica, AOU Ospedali Riuniti Ancona, via Conca 71, , 60020, Ancona, AN, Italy
| | - Giorgia Mangili
- Obstetrics and Gynecology, San Raffaele Hospital, Via Olgettina Milano, 60, 20132, Milan, Italy
| | - Claudia Marchetti
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Francesca Martella
- Breast Unit, Ospedale S.M. Annunziata, USL Toscana Centro, Via dell'Antella, 58, Bagno a Ripoli, 50012, Florence, Italy
| | - Emanuele Naglieri
- Division of Medical Oncology, IRCCS Istituto Oncologico Giovanni Paolo II, Viale Orazio Flacco, 65, 70124, Bari, Italy
| | - Veronica Parolin
- Breast Uni, Azienda Ospedaliera Universitaria Integrata, Piazzale Aristide Stefani, 1, 37126, Verona, Italy
| | - Giusy Ricciardi
- Medical Oncology, AO Papardo, Contrada Papardo, 98158, Messina, Italy
| | - Graziana Ronzino
- Dept. of Oncology, Vito Fazzi Hospital, Piazzetta Muratore, 73100, Lecce, Italy
| | - Vanda Salutari
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Giovanna Scarfone
- Dept of Obstetrics, Gynecology and Neonatology, IRCCS Fondazione Cà Granda, Ospedale Maggiore Policlinico, via F. Sforza 28, Milan, Italy
| | - Simona Secondino
- Fondazione IRCCS Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Ilaria Spagnoletti
- Medical Oncology Unit, Ospedale Sacro Cuore di Gesù, Fatebenefratelli, Viale Principe di Napoli, 14/A, 82100, Benevento, Italy
| | - Giulia Tasca
- Division of Medical Oncology 2, Istituto Oncologico Veneto, Via Gattamelata, 64, 35128, Padua, Italy
| | - Germana Tognon
- UO Ostetricia e Ginecologia-ASST degli Spedali Civili di Brescia, Università degli Studi, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Valentina Guarneri
- Division of Medical Oncology 2, Istituto Oncologico Veneto, Via Gattamelata, 64, 35128, Padua, Italy
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10
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Cecere SC, Giannone G, Salutari V, Arenare L, Lorusso D, Ronzino G, Lauria R, Cormio G, Carella C, Scollo P, Ghizzoni V, Raspagliesi F, Di Napoli M, Mazzoni E, Marchetti C, Bergamini A, Orditura M, Valabrega G, Scambia G, Maltese G, De Matteis E, Cardalesi C, Loizzi V, Boccia S, Naglieri E, Scandurra G, Pignata S. Olaparib as maintenance therapy in patients with BRCA 1–2 mutated recurrent platinum sensitive ovarian cancer: Real world data and post progression outcome. Gynecol Oncol 2020; 156:38-44. [DOI: 10.1016/j.ygyno.2019.10.023] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/17/2019] [Accepted: 10/19/2019] [Indexed: 11/25/2022]
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11
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Toss A, Venturelli M, Molinaro E, Pipitone S, Barbieri E, Marchi I, Tenedini E, Artuso L, Castellano S, Marino M, Tagliafico E, Razzaboni E, De Matteis E, Cascinu S, Cortesi L. Hereditary Pancreatic Cancer: A Retrospective Single-Center Study of 5143 Italian Families with History of BRCA-Related Malignancies. Cancers (Basel) 2019; 11:cancers11020193. [PMID: 30736435 PMCID: PMC6406586 DOI: 10.3390/cancers11020193] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 02/03/2019] [Accepted: 02/05/2019] [Indexed: 01/07/2023] Open
Abstract
The identification of BRCA mutations plays a crucial role in the management of hereditary cancer prevention and treatment. Nonetheless, BRCA-testing in pancreatic cancer (PC) patients is not universally introduced in clinical practice. A retrospective analysis was conducted, firstly, to evaluate the rate of BRCA-positive families among those presenting a family history of PC besides breast and/or ovarian cancer. Secondly, the relationship between BRCA pathogenic variants and PC risk was evaluated. Finally, the characteristics of PC developed in BRCA families were described. Among 5143 family trees reporting breast and/or ovarian cancer cases, 392 showed a family history of PC. A total of 35 families (24.5% selected by the Modena Criteria and 21.3% by the NCCN Criteria) were positive to BRCA testing. Among the BRCA1 mutations, 36.8% were found within a region defined by c.3239–c.3917, whilst 43.7% of BRCA2 mutations were located within c.7180–c.8248. This study confirmed that an increase in the rate of positive tests in families with PC when associated to breast and/or ovarian tumors. Moreover, this analysis indicated two possible Pancreatic Cancer Cluster Regions that should be verified in future research. Finally, PC in families with breast and/or ovarian cancer history, particularly in BRCA families, were diagnosed at younger age and showed better one-year overall survival.
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Affiliation(s)
- Angela Toss
- Department of Oncology and Hematology, University Hospital of Modena, 41124 Modena, Italy.
| | - Marta Venturelli
- Department of Oncology and Hematology, University Hospital of Modena, 41124 Modena, Italy.
| | - Eleonora Molinaro
- Department of Oncology and Hematology, University Hospital of Modena, 41124 Modena, Italy.
| | - Stefania Pipitone
- Department of Oncology and Hematology, University Hospital of Modena, 41124 Modena, Italy.
| | - Elena Barbieri
- Department of Oncology and Hematology, University Hospital of Modena, 41124 Modena, Italy.
| | - Isabella Marchi
- Department of Oncology and Hematology, University Hospital of Modena, 41124 Modena, Italy.
| | - Elena Tenedini
- Centre for Genome Research, University of Modena and Reggio Emilia, 41124 Modena, Italy.
- Clinical Genomics Laboratory, Department of Laboratory Medicine and Pathology, University Hospital of Modena, 41124, Modena, Italy.
| | - Lucia Artuso
- Centre for Genome Research, University of Modena and Reggio Emilia, 41124 Modena, Italy.
- Clinical Genomics Laboratory, Department of Laboratory Medicine and Pathology, University Hospital of Modena, 41124, Modena, Italy.
| | - Sara Castellano
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41124 Modena, Italy.
| | - Marco Marino
- Clinical Genomics Laboratory, Department of Laboratory Medicine and Pathology, University Hospital of Modena, 41124, Modena, Italy.
| | - Enrico Tagliafico
- Centre for Genome Research, University of Modena and Reggio Emilia, 41124 Modena, Italy.
- Clinical Genomics Laboratory, Department of Laboratory Medicine and Pathology, University Hospital of Modena, 41124, Modena, Italy.
| | - Elisabetta Razzaboni
- Department of Oncology and Hematology, University Hospital of Modena, 41124 Modena, Italy.
| | | | - Stefano Cascinu
- Department of Oncology and Hematology, University Hospital of Modena, 41124 Modena, Italy.
| | - Laura Cortesi
- Department of Oncology and Hematology, University Hospital of Modena, 41124 Modena, Italy.
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12
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Cortesi L, Canossi B, Battista R, Pecchi A, Drago A, Dal Molin C, Toss A, De Matteis E, Marchi I, Torricelli P, Cascinu S. Breast ultrasonography (BU) in the screening protocol for women at hereditary-familial risk of breast cancer: has the time come to rethink the role of BU according to different risk categories? Int J Cancer 2018; 144:1001-1009. [PMID: 30098212 DOI: 10.1002/ijc.31794] [Citation(s) in RCA: 14] [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: 02/04/2018] [Revised: 07/12/2018] [Accepted: 08/01/2018] [Indexed: 11/07/2022]
Abstract
This article evaluates the breast cancer (BC) screening efficacy of biannual ultrasound (US) in three different risk categories. In a single-center, prospective, nonrandomized comparison study, BRCA mutation carriers and women with high risk (HR) or intermediate risk (IR) received mammography (MMG), ultrasound, (US) and Magnetic Resonance Imaging (MRI), scheduled according to the risk categories. Single and combined sensitivity were evaluated in specific groups of risk and the US performance at six-monthly interval was notably considered. Among 2,313 asymptomatic women at different risk (136 mutation carriers, 1,749 at HR and 428 at IR) 211 developed a BC, of which 193 (91.5%) were screen detected BC (SDBC) and 18 (8.5%) were interval BC (IBC). The SDBC detection rate (DR) was 11.2 per 1.000 person-years (37.9, 8.5 and 16.1 for BRCA, HR and IR, respectively); 116 BC were detected by MMG (DR = 6.6 × 1,000 persons-years), 62 by US (DR = 3.6 × 1,000 persons-years) and 15 by MRI, that was applied only in 60 BRCA women (DR = 37 × 1,000 persons-years). At the six-monthly US, 52 BC were detected (DR = 3.0 × 1,000 persons/years), of which 8 were BRCA-related. The most sensitive technique was MRI (93.7%) followed by MMG (55%) and US (29.4%). Combined sensitivity for MMG plus US was 100% in HR and 80.4% for IR women (p < 0.01). In BRCA mutated patients, MRI alone with annual US performed after six months, could be offered. In HR patients, MMG plus biannual US provide the most sensitive diagnosis and for IR group an annual MMG could be sufficient.
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Affiliation(s)
- Laura Cortesi
- Department of Oncology and Haematology, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Barbara Canossi
- Department of Diagnostic Imaging, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Rachele Battista
- Department of Diagnostic Imaging, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Annarita Pecchi
- Department of Diagnostic Imaging, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Antonella Drago
- Department of Diagnostic Imaging, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Chiara Dal Molin
- Department of Diagnostic Imaging, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Angela Toss
- Department of Oncology and Haematology, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Elisabetta De Matteis
- Department of Oncology and Haematology, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Isabella Marchi
- Department of Oncology and Haematology, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Pietro Torricelli
- Department of Diagnostic Imaging, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Stefano Cascinu
- Department of Oncology and Haematology, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
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Toss A, Grandi G, Cagnacci A, Marcheselli L, Pavesi S, De Matteis E, Razzaboni E, Tomasello C, Cascinu S, Cortesi L. The impact of reproductive life on breast cancer risk in women with family history or BRCA mutation. Oncotarget 2018; 8:9144-9154. [PMID: 27880720 PMCID: PMC5354721 DOI: 10.18632/oncotarget.13423] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 09/13/2016] [Accepted: 11/08/2016] [Indexed: 12/29/2022] Open
Abstract
Reproductive history and exogenous hormonal exposures are acknowledged risk factors for breast cancer in the general population. In women at increased breast cancer risk for genetic predisposition or positive family history, data regarding these risk factors are limited or conflicting, and recommendations for these categories are unclear. We evaluated the characteristics of reproductive life in 2522 women at increased genetic or familial breast cancer risk attending our Family Cancer Center. Breast cancers in BRCA mutation carriers were more likely to be hormone receptor negative, diagnosed at 35 years or before and multiple during the lifetime than tumors in women at increased familial risk, while the distribution of invasive cancers and HER2 positive tumors was similar in the different risk groups. At least one full-term pregnancy (HR 0.27; 95% CI 0.12–0.58; p = 0.001), breastfeeding either less (HR 0.24; 95% CI 0.09–0.66; p = 0.005) or more (HR 0.25; 95% IC 0.08–0.82; p = 0.022) than one year and late age at menopause (HR 0.10; 95% CI 0.01–0.82; p = 0.033) showed to be protective factors in BRCA mutation carriers, while in women at increased familial risk early age at first full-term pregnancy (HR 0.62; 95% IC 0.38–0.99; p = 0.048) and late menarche (HR 0.61; 95% CI 0.42–0.85; p = 0.004) showed to be the main protective factors. Finally, for the entire population, combined hormonal contraceptives demonstrated to do not increase breast cancer risk. The results of our study suggest that women at high familial risk and mutation carries develop tumors with different clinical-pathological characteristics and, consequently, are influenced by different protective and risk factors.
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Affiliation(s)
- Angela Toss
- Department of Oncology and Haematology, Azienda Ospedaliero-Universitaria Policlinico, University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanni Grandi
- Department of Obstetrics Gynecology and Pediatrics, Obstetrics and Gynecology Unit, Azienda Ospedaliero-Universitaria Policlinico, University of Modena and Reggio Emilia, Modena, Italy
| | - Angelo Cagnacci
- Department of Obstetrics Gynecology and Pediatrics, Obstetrics and Gynecology Unit, Azienda Ospedaliero-Universitaria Policlinico, University of Modena and Reggio Emilia, Modena, Italy
| | - Luigi Marcheselli
- Department of Oncology and Haematology, Azienda Ospedaliero-Universitaria Policlinico, University of Modena and Reggio Emilia, Modena, Italy
| | - Silvia Pavesi
- Department of Obstetrics Gynecology and Pediatrics, Obstetrics and Gynecology Unit, Azienda Ospedaliero-Universitaria Policlinico, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Elisabetta Razzaboni
- Department of Oncology and Haematology, Azienda Ospedaliero-Universitaria Policlinico, University of Modena and Reggio Emilia, Modena, Italy
| | - Chiara Tomasello
- Department of Oncology and Haematology, Azienda Ospedaliero-Universitaria Policlinico, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Cascinu
- Department of Oncology and Haematology, Azienda Ospedaliero-Universitaria Policlinico, University of Modena and Reggio Emilia, Modena, Italy
| | - Laura Cortesi
- Department of Oncology and Haematology, Azienda Ospedaliero-Universitaria Policlinico, University of Modena and Reggio Emilia, Modena, Italy
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14
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Collovà E, Sebastiani F, De Matteis E, Generali D, Aurilio G, Boccardo F, Crispino S, Cruciani G. Use of metronomic chemotherapy in oncology: Results from a national Italian survey. Tumori 2018; 97:454-8. [DOI: 10.1177/030089161109700407] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims and background Metronomic chemotherapy refers to the administration of low doses of cytotoxic agents over a prolonged period of time with no or only short drug-free intervals. It is designed to overcome acquired tumor resistance to chemotherapy and reduce neo-angiogenesis despite a lower toxicity than with standard chemotherapy. The role of metronomic chemotherapy remains controversial, and its optimal therapeutic use has not yet been defined. Methods and study design The present survey was designed as a short questionnaire and was sent to the medical oncologists registered with Medikey, a national database listing all the Italian oncology specialists linked with the Italian Council of Medical Oncology Hospital Consultants (Collegio Italiano Primari Oncologi Medici Ospedalieri, CIPOMO) and the Italian Association of Medical Oncology (Associazione Italiana di Oncologia Medica, AIOM). The questionnaire was completed on a voluntary basis and it was totally anonymous. Results The questionnaire was sent to 3,289 oncologists, and 191 (5.8%) actively participated in the survey. Seventy-two percent of responders declared that they had administered a regimen of metronomic chemotherapy at least once. Metronomic chemotherapy is commonly used in advanced breast cancer patients, and inmost cases it was prescribed after failure of at least two lines of treatment. Oral agents such as cyclophosphamide, capecitabine, methotrexate and vinorelbine were the most commonly prescribed drugs. Nearly 60% of responders was believed to have significantly less toxicity with metronomic chemotherapy than with standard chemotherapy. Conclusions The sample of oncologists who participated in the survey is small but it appears to be representative of the Italian medical oncology community. The answers to the questionnaire indicate a significant interest in metronomic chemotherapy, which is apparently widely prescribed. This is the first large national survey on the use of metronomic chemotherapy. Considering the results, larger research on metronomic chemotherapy is strongly warranted.
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Affiliation(s)
- Elena Collovà
- Division of Medical Oncology, Hospital of Legnano, Legnano, Milan
| | - Federica Sebastiani
- Department of Oncology, Hematology and Respiratory Diseases, Policlinico di Modena, Modena
| | - Elisabetta De Matteis
- Department of Oncology, Hematology and Respiratory Diseases, Policlinico di Modena, Modena
| | - Daniele Generali
- Breast Unit, Molecular Medicine Center, Istituti Ospitalieri di Cremona, Cremona
| | | | - Francesco Boccardo
- Istituto Nazionale per la Ricerca sul Cancro e Università di Genova, Genoa
| | - Sergio Crispino
- Istituto Toscano Tumori, Dipartimento Oncologico USL7, Siena
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15
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Cortesi L, De Matteis E, Cirilli C, Marcheselli L, Proietto M, Federico M. Outcome Evaluation in Pre-Trastuzumab Era between Different Breast Cancer Phenotypes: A Population-Based Study on Italian Women. Tumori 2018; 98:743-50. [DOI: 10.1177/030089161209800611] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Aims and background Based on estrogen receptor (ER), progesterone receptor (PgR) and Her2/neu (HER2) expression, four breast cancer subtypes have been distinguished: luminal A (ER and/or PgR/HER2–, Ki67 <14%), luminal B (ER and/or PgR/HER2–, Ki67 ≥14% or ER and/or PgR/HER2), triple-negative (ER-/PgR-/HER2–), and HER2 (ER-/PgR-/HER2). Our aim was to evaluate the prognosis of these phenotypes in the pre-trastuzumab era in a large cohort of Italian women. Methods and study design We studied 2347 breast cancer patients, in stage I-II, registered by the Modena Cancer Registry from 1999 to 2006 in the Modena province, Italy. Overall survival, disease-free survival and second non-mammary tumors were evaluated. Results A total of 1868 luminal A (79.6%), 195 luminal B (8.3%), 205 triple-negative (8.7%) and 79 HER2 (3.4%) patients were identified. A better prognosis was observed for luminal A than for luminal B, HER2 and triple-negative subtypes (5-year overall survival, 91% vs 89% vs 87% vs 86%, respectively, P <0.001). Disease-free survival for pT1a and pT1b tumors was worse in HER2 (82%) than in triple-negative (90%), luminal B (95%) and luminal A (97%) (P = 0.013). Finally, luminal B patients had a significantly higher rate of second non-mammary tumors than the other groups. Conclusions In the pre-trastuzumab era, luminal A patients showed a better 5-year overall survival than luminal B, HER2 and triple-negative patients, but in terms of disease-free survival, HER2 subtype represented an unfavorable group over time, whereas the triple-negative group had an increased risk of relapse in the first 42 months and then decreased. Among each prognostic factor, ER <10%, Ki67 >14% and HER2 overexpression are considered as risk factors, but only HER2 positivity seems to preserve the role over time.
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Affiliation(s)
- Laura Cortesi
- Department of Oncology and Hematology, University of Modena and Reggio Emilia
| | | | | | - Luigi Marcheselli
- Department of Oncology and Hematology, University of Modena and Reggio Emilia
| | - Manuela Proietto
- Department of Oncology and Hematology, University of Modena and Reggio Emilia
| | - Massimo Federico
- Department of Oncology and Hematology, University of Modena and Reggio Emilia
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Cortesi L, De Matteis E, Toss A, Marchi I, Medici V, Contu G, Xholli A, Grandi G, Cagnacci A, Federico M. Evaluation of Transvaginal Ultrasound plus CA-125 Measurement and Prophylactic Salpingo-Oophorectomy in Women at Different Risk Levels of Ovarian Cancer: The Modena Study Group Cohort Study. Oncology 2017; 93:377-386. [PMID: 28848147 DOI: 10.1159/000479155] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 07/03/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of transvaginal ultrasound (TVU) and serum CA-125 measurement in women at different risk of developing ovarian cancer/fallopian tube cancer (OC/FTC) and the incidence of primary peritoneal cancer (PPC) after risk-reducing salpingo-oophorectomy (RRSO). METHODS Between 2002 and 2014, 661 women at different risk of OC/FTC/PPC due to a family history or BRCA1/2 gene mutation were offered TVU and CA-125 measurement or RRSO as prevention strategies. The detection rate of OC/FTC/PPC was evaluated, and the sensitivity and specificity for CA-125 measurement and TVU were calculated. Survival and event analysis was performed for diagnosed patients. RESULTS After a median follow-up of 112 months, 12 OC/FTC/PPC cases were detected (2.6/1,000 persons/year). The screening sensitivity was 70%, with 73% for BRCA carriers. Six (50%) of 12 cancers were stage I or II. Among 41 women who underwent RRSO, 2 BRCA1 carriers developed a PPC (4.9%). At 61-month follow-up, overall and event-free survival were 75 and 64%, respectively. CONCLUSIONS The cancer detection rate in women with BRCA mutation or a strong family history supports the effectiveness of our surveillance program for early diagnosis. Screening for women at lower risk of OC/FTC is not recommended. A residual risk of PPC after RRSO remains for BRCA1 carriers.
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Affiliation(s)
- Laura Cortesi
- Department of Oncology and Hematology, University Hospital Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
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Ciccarese M, Fabi A, Moscetti L, Cazzaniga ME, Petrucelli L, Forcignanò R, Lupo LI, De Matteis E, Chiuri VE, Cairo G, Febbraro A, Giordano G, Giampaglia M, Bilancia D, La Verde N, Maiello E, Morritti M, Giotta F, Lorusso V, Latorre A, Scavelli C, Romito S, Cusmai A, Palmiotti G, Surico G. Dose intensity and efficacy of the combination of everolimus and exemestane (EVE/EXE) in a real-world population of hormone receptor-positive (ER+/PgR+), HER2-negative advanced breast cancer (ABC) patients: a multicenter Italian experience. Breast Cancer Res Treat 2017; 163:587-594. [PMID: 28353061 DOI: 10.1007/s10549-017-4213-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 03/20/2017] [Indexed: 02/08/2023]
Abstract
AIM This retrospective analysis focused on the effect of treatment with EVE/EXE in a real-world population outside of clinical trials. We examined the efficacy of this combination in terms of PFS and RR related to dose intensity (5 mg daily versus 10 mg daily) and tolerability. METHODS 163 HER2-negative ER+/PgR+ ABC patients, treated with EVE/EXE from May 2011 to March 2016, were included in the analysis. The primary endpoints were the correlation between the daily dose and RR and PFS, as well as an evaluation of the tolerability of the combination. Secondary endpoints were RR, PFS, and OS according to the line of treatment. Patients were classified into three different groups, each with a different dose intensity of everolimus (A, B, C). RESULTS RR was 29.8% (A), 27.8% (B) (p = 0.953), and not evaluable (C). PFS was 9 months (95% CI 7-11) (A), 10 months (95% CI 9-11) (B), and 5 months (95% CI 2-8) (C), p = 0.956. OS was 38 months (95% CI 24-38) (A), median not reached (B), and 13 months (95% CI 10-25) (C), p = 0.002. Adverse events were stomatitis 57.7% (11.0% grade 3-4), asthenia 46.0% (6.1% grade 3-4), hypercholesterolemia 46.0% (0.6% grade 3-4), and hyperglycemia 35.6% (5.5% grade 3-4). The main reason for discontinuation/interruption was grade 2-3 stomatitis. CONCLUSIONS No correlation was found between dose intensity (5 vs. 10 mg labeled dose) and efficacy in terms of RR and PFS. The tolerability of the higher dose was poor in our experience, although this had no impact on efficacy.
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Affiliation(s)
| | - Alessandra Fabi
- Department of Medical Oncology, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Luca Moscetti
- Department of Oncology/Haemathology, University Hospital, Modena, Italy
| | | | | | | | | | | | | | - Giuseppe Cairo
- Medical Oncology Unit, "Vito Fazzi" Hospital, Lecce, Italy
| | - Antonio Febbraro
- Medical Oncology Unit, "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy
| | - Guido Giordano
- Medical Oncology Unit, "Sacro Cuore di Gesù Fatebenefratelli" Hospital, Benevento, Italy
| | | | | | - Nicla La Verde
- Department of Oncology, "ASST Fatebenefratelli Sacco", Milan, Italy
| | - Evaristo Maiello
- Department of Medical Oncology, "Casa Sollievo Della Sofferenza" Hospital, San Giovanni Rotondo, FG, Italy
| | - Maria Morritti
- Department of Medical Oncology, "Casa Sollievo Della Sofferenza" Hospital, San Giovanni Rotondo, FG, Italy
| | - Francesco Giotta
- Department of Medical Oncology, "Giovanni Paolo II" Institute, Bari, Italy
| | - Vito Lorusso
- Department of Medical Oncology, "Giovanni Paolo II" Institute, Bari, Italy
| | - Agnese Latorre
- Department of Medical Oncology, "Giovanni Paolo II" Institute, Bari, Italy
| | - Claudio Scavelli
- Medical Oncology Unit, "S. Cuore di Gesù" Hospital, Gallipoli, LE, Italy
| | - Sante Romito
- Oncology Unit, "Ospedali Riuniti" Hospital, Foggia, Italy
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Sebastiani F, Cortesi L, Sant M, Lucarini V, Cirilli C, De Matteis E, Marchi I, Negri R, Gallo E, Federico M. Increased Incidence of Breast Cancer in Postmenopausal Women with High Body Mass Index at the Modena Screening Program. J Breast Cancer 2016; 19:283-291. [PMID: 27721878 PMCID: PMC5053313 DOI: 10.4048/jbc.2016.19.3.283] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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: 01/21/2016] [Accepted: 06/18/2016] [Indexed: 11/30/2022] Open
Abstract
Purpose We conducted a study to evaluate the relationship between body mass index (BMI) and the risk of breast cancer (BC) and outcome in a population of 14,684 women aged 55 to 69 years eligible to participate in the Mammography Screening Program (MSP) in the Province of Modena, Italy. Methods The study population was drawn from women who underwent mammography screening between 2004 and 2006 in the Province of Modena. Women were subdivided into obese, overweight, and normal-weight categories according to BMI and followed until July 31, 2010, to evaluate the BC incidence. The clinicopathological characteristics of BC were also evaluated in different groups of patients classified according to BMI. After BC diagnosis, patients were followed for a median period of 65 (range, 2–104) months. Second events (recurrences and second tumors) were recorded, and the 5-year event-free survival (EFS) was calculated. Results After a period of 73 months, 366 cases of BC were diagnosed. Compared with normal-weight women, obese women had a significantly higher incidence of BC (relative risk [RR], 1.32; p=0.040) (RR=1), larger tumors (27% of tumors were larger than T2 size), and more nodal involvement (38.5% of tumors were node-positive). Furthermore, a significantly higher rate of total events was seen in obese women compared with overweight and normal-weight patients, respectively (17.9% vs. 11.4% vs. 10.8%, p=0.032). The 5-year EFS was 89.0%, 89.0%, and 80.0% for normal-weight, overweight, and obese patients, respectively. Conclusion We observed a significantly higher risk of BC in obese women among those eligible to participate in the MSP in the Province of Modena. Finally, obese women had more second events and poorer EFS compared to nono bese women.
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Affiliation(s)
- Federica Sebastiani
- Department of Diagnostic and Clinical Medicine and Public Health, University of Modena and Reggio Emilia, Modena, Italy
| | - Laura Cortesi
- Department of Oncology, Hematology, and Respiratory Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Milena Sant
- Department of Preventive and Predictive Medicine, National Tumor Institute, Milan, Italy
| | - Valeria Lucarini
- Department of Oncology, Hematology, and Respiratory Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Claudia Cirilli
- Department of Oncology, Hematology, and Respiratory Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Elisabetta De Matteis
- Department of Oncology, Hematology, and Respiratory Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Isabella Marchi
- Department of Oncology, Hematology, and Respiratory Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Rossella Negri
- Department of Radiology, University of Modena and Reggio Emilia, Modena, Italy
| | - Ennio Gallo
- Department of Radiology, University of Modena and Reggio Emilia, Modena, Italy
| | - Massimo Federico
- Department of Diagnostic and Clinical Medicine and Public Health, University of Modena and Reggio Emilia, Modena, Italy
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Toss A, De Matteis E, Rossi E, Casa LD, Iannone A, Federico M, Cortesi L. Ovarian cancer: can proteomics give new insights for therapy and diagnosis? Int J Mol Sci 2013; 14:8271-90. [PMID: 23591842 PMCID: PMC3645742 DOI: 10.3390/ijms14048271] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 03/11/2013] [Accepted: 04/02/2013] [Indexed: 12/24/2022] Open
Abstract
The study of the ovarian proteomic profile represents a new frontier in ovarian cancer research, since this approach is able to enlighten the wide variety of post-translational events (such as glycosylation and phosphorylation). Due to the possibility of analyzing thousands of proteins, which could be simultaneously altered, comparative proteomics represent a promising model of possible biomarker discovery for ovarian cancer detection and monitoring. Moreover, defining signaling pathways in ovarian cancer cells through proteomic analysis offers the opportunity to design novel drugs and to optimize the use of molecularly targeted agents against crucial and biologically active pathways. Proteomic techniques provide more information about different histological types of ovarian cancer, cell growth and progression, genes related to tumor microenvironment and specific molecular targets predictive of response to chemotherapy than sequencing or microarrays. Estimates of specificity with proteomics are less consistent, but suggest a new role for combinations of biomarkers in early ovarian cancer diagnosis, such as the OVA1 test. Finally, the definition of the proteomic profiles in ovarian cancer would be accurate and effective in identifying which pathways are differentially altered, defining the most effective therapeutic regimen and eventually improving health outcomes.
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Affiliation(s)
- Angela Toss
- Department of Oncology & Haematology, University of Modena and Reggio Emilia, Modena 41125, Italy; E-Mails: (A.T.); (E.D.M.); (M.F.)
| | - Elisabetta De Matteis
- Department of Oncology & Haematology, University of Modena and Reggio Emilia, Modena 41125, Italy; E-Mails: (A.T.); (E.D.M.); (M.F.)
| | - Elena Rossi
- ProteoWork Lab, the Department of Biomedical Sciences, University of Modena and Reggio Emilia, Modena 41125, Italy; E-Mails: (E.R.); (L.D.C.); (A.I.)
| | - Lara Della Casa
- ProteoWork Lab, the Department of Biomedical Sciences, University of Modena and Reggio Emilia, Modena 41125, Italy; E-Mails: (E.R.); (L.D.C.); (A.I.)
| | - Anna Iannone
- ProteoWork Lab, the Department of Biomedical Sciences, University of Modena and Reggio Emilia, Modena 41125, Italy; E-Mails: (E.R.); (L.D.C.); (A.I.)
| | - Massimo Federico
- Department of Oncology & Haematology, University of Modena and Reggio Emilia, Modena 41125, Italy; E-Mails: (A.T.); (E.D.M.); (M.F.)
| | - Laura Cortesi
- Department of Oncology & Haematology, University of Modena and Reggio Emilia, Modena 41125, Italy; E-Mails: (A.T.); (E.D.M.); (M.F.)
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +39-059-4224-334; Fax: +39-059-4224-152
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Cortesi L, De Matteis E, Cirilli C, Marcheselli L, Proietto M, Federico M. Outcome evaluation in pre-trastuzumab era between different breast cancer phenotypes: a population-based study on Italian women. Tumori 2013. [PMID: 23389361 DOI: 10.1700/1217.13498] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS AND BACKGROUND Based on estrogen receptor (ER), progesterone receptor (PgR) and Her2/neu (HER2) expression, four breast cancer subtypes have been distinguished: luminal A (ER and/or PgR/HER2-, Ki67 <14%), luminal B (ER and/or PgR/HER2-, Ki67 ≥14% or ER and/or PgR/HER2), triple-negative (ER-/PgR-/HER2-), and HER2 (ER-/PgR-/HER2). Our aim was to evaluate the prognosis of these phenotypes in the pre-trastuzumab era in a large cohort of Italian women. METHODS AND STUDY DESIGN We studied 2347 breast cancer patients, in stage I-II, registered by the Modena Cancer Registry from 1999 to 2006 in the Modena province, Italy. Overall survival, disease-free survival and second non-mammary tumors were evaluated. RESULTS A total of 1868 luminal A (79.6%), 195 luminal B (8.3%), 205 triple-negative (8.7%) and 79 HER2 (3.4%) patients were identified. A better prognosis was observed for luminal A than for luminal B, HER2 and triple-negative subtypes (5-year overall survival, 91% vs 89% vs 87% vs 86%, respectively, P <0.001). Disease-free survival for pT1a and pT1b tumors was worse in HER2 (82%) than in triple-negative (90%), luminal B (95%) and luminal A (97%) (P = 0.013). Finally, luminal B patients had a significantly higher rate of second non-mammary tumors than the other groups. CONCLUSIONS In the pre-trastuzumab era, luminal A patients showed a better 5-year overall survival than luminal B, HER2 and triple-negative patients, but in terms of disease-free survival, HER2 subtype represented an unfavorable group over time, whereas the triple-negative group had an increased risk of relapse in the first 42 months and then decreased. Among each prognostic factor, ER <10%, Ki67 >14% and HER2 overexpression are considered as risk factors, but only HER2 positivity seems to preserve the role over time.
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Affiliation(s)
- Laura Cortesi
- Department of Oncology and Hematology, University of Modena and Reggio Emilia, Via del Pozzo 71, Modena, Italy.
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Razzaboni E, Toss A, Cortesi L, Marchi I, Sebastiani F, De Matteis E, Federico M. Acceptability and adherence in a chemoprevention trial among women at increased risk for breast cancer attending the Modena Familial Breast and Ovarian Cancer Center (Italy). Breast J 2012; 19:10-21. [PMID: 23252601 DOI: 10.1111/tbj.12045] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Chemoprevention for women at risk for breast cancer has been shown to be effective, but in actual practice, women's uptake of chemoprevention has been poor. We explored factors that influence acceptability, adherence, and dropout in the International Breast (Prevention) Intervention Study during our first 3 years of activity at the Modena Familial Breast and Ovarian Cancer Center. We evaluated socio-demographic characteristics, health status, adherence, and side effect intensity. Semi-structured interviews analyzed reasons for accepting/refusing/stopping the trial. A total of 471 postmenopausal women were invited to participate, of which 319 declined to participate (68%), 137 accepted to participate (29%), and 15 participants did not make a final decision (3%). Breast cancer-related worries and trust in our preventive and surveillance programs were the most frequent reasons for accepting. Side effect-related worry was the most frequent reason for refusing. General practitioners' and family members' opinions played an important role in the decision-making process. Adherence significantly decreased after a 12-month follow-up, but it remained unchanged after 24- and 36-month follow-ups. Mild/moderate side effects reported by women did not change after 12 months of treatment. Forty percent of women withdrew from the study due to complaints of side effects. We concluded that chemoprevention trials are difficult medical experiments and that the process of deciding about whether or not to participate is based mainly on beliefs and values. This study has important clinical implications. During counselling with prospective participants, it is important to emphasize the potential benefits and to promote an informed choice. How participants make decisions, their belief systems, and their perception of risk are all factors that should be investigated in future research.
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Affiliation(s)
- Elisabetta Razzaboni
- Department of Oncology and Haematology, Hereditary Breast and Ovarian Cancer Center, University of Modena and Reggio Emilia, Italy.
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Cortesi L, Matteis ED, Cirilli C, Filieri E, Pecchi A, Battista R, Canossi B, Torricelli P, Federico M. MRI before initial surgery outside of clinical trials: the real world! Eur J Radiol 2012; 81 Suppl 1:S21-3. [DOI: 10.1016/s0720-048x(12)70009-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cortesi L, Pecchi A, De Matteis E, Filieri E, Battista R, Canossi B, Torricelli P, Federico M. MRI in high risk women: benefits and problems. Eur J Radiol 2012; 81 Suppl 1:S19-20. [DOI: 10.1016/s0720-048x(12)70008-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Collovà E, Sebastiani F, De Matteis E, Generali D, Aurilio G, Boccardo F, Crispino S, Cruciani G. Use of metronomic chemotherapy in oncology: results from a national Italian survey. Tumori 2012. [PMID: 21989433 DOI: 10.1700/950.10397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS AND BACKGROUND Metronomic chemotherapy refers to the administration of low doses of cytotoxic agents over a prolonged period of time with no or only short drug-free intervals. It is designed to overcome acquired tumor resistance to chemotherapy and reduce neo-angiogenesis despite a lower toxicity than with standard chemotherapy. The role of metronomic chemotherapy remains controversial, and its optimal therapeutic use has not yet been defined. METHODS AND STUDY DESIGN The present survey was designed as a short questionnaire and was sent to the medical oncologists registered with Medikey, a national database listing all the Italian oncology specialists linked with the Italian Council of Medical Oncology Hospital Consultants (Collegio Italiano Primari Oncologi Medici Ospedalieri, CIPOMO) and the Italian Association of Medical Oncology (Associazione Italiana di Oncologia Medica, AIOM). The questionnaire was completed on a voluntary basis and it was totally anonymous. RESULTS The questionnaire was sent to 3,289 oncologists, and 191 (5.8%) actively participated in the survey. Seventy-two percent of responders declared that they had administered a regimen of metronomic chemotherapy at least once. Metronomic chemotherapy is commonly used in advanced breast cancer patients, and in most cases it was prescribed after failure of at least two lines of treatment. Oral agents such as cyclophosphamide, capecitabine, methotrexate and vinorelbine were the most commonly prescribed drugs. Nearly 60% of responders was believed to have significantly less toxicity with metronomic chemotherapy than with standard chemotherapy. CONCLUSIONS The sample of oncologists who participated in the survey is small but it appears to be representative of the Italian medical oncology community. The answers to the questionnaire indicate a significant interest in metronomic chemotherapy, which is apparently widely prescribed. This is the first large national survey on the use of metronomic chemotherapy. Considering the results, larger research on metronomic chemotherapy is strongly warranted.
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Affiliation(s)
- Elena Collovà
- Division of Medical Oncology, Hospital of Legnano, Milan, Italy.
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Razzaboni E, Tazzioli G, Andreotti A, De Matteis E, Cortesi L, Federico M. Prophylactic Surgery to Reduce the Risk of Developing Breast Cancer:Issues and Clinical Implications. CWHR 2012. [DOI: 10.2174/157340412799079237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Cortesi L, De Matteis E, Rashid I, Cirilli C, Proietto M, Rivasi F, Federico M. Distribution of second primary malignancies suggests a bidirectional effect between breast and endometrial cancer: a population-based study. Int J Gynecol Cancer 2010; 19:1358-63. [PMID: 20009890 DOI: 10.1111/igc.0b013e3181b9f5d5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION The aim of this study was to investigate the incidence of second primary tumors in patients with breast cancer (BC), with particular regard to bidirectional risk for endometrial cancer (EC). METHODS A total of 7512 and 343 patients with first and second primary BC, respectively, were referenced to the expected number of cases calculated using the standardized incidence ratio (SIR) over the same period, to evaluate the observed and expected ratio between the groups. Data on tamoxifen use were also considered. RESULTS A total of 499 women with primary BC developed a second tumor. The total SIR, that is, the ratio between observed second primary cancer among patients with BC and the expected primary cancers in the general population, was significantly higher (SIR = 1.23; 95% confidence interval, 1.12-1.34; P = 0.007), particularly for melanoma (2.25), EC (2.15), ovarian cancer (1.74), hematologic malignancies (1.36), and bilateral BC (1.25). A greater risk of BC after thyroid (2.22) and EC (1.62) was also observed. Furthermore, the risk of developing EC was higher in patients treated with tamoxifen (SIR = 2.50 vs 1.34). CONCLUSIONS Bidirectional risk of endometrial cancer was not exclusively related to tamoxifen use.
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Affiliation(s)
- Laura Cortesi
- Dipartimento di Oncologia ed Ematologia, Università di Modena e Reggio Emilia, Modena, Italy.
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Cortesi L, Barchetti A, De Matteis E, Rossi E, Della Casa L, Marcheselli L, Tazzioli G, Lazzaretti MG, Ficarra G, Federico M, Iannone A. Identification of protein clusters predictive of response to chemotherapy in breast cancer patients. J Proteome Res 2010; 8:4916-33. [PMID: 19739612 DOI: 10.1021/pr900239h] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
An attempt for the identification of potential biomarkers predictive of response to chemotherapy (CHT) in breast cancer patients has been performed by the use of two-dimensional electrophoresis and mass spectrometry analysis. Since growth and progression of tumor cells depend also on stromal factors in the microenvironment, we choose to investigate the proteins secreted in Tumor Interstitial Fluid (TIF) and in Normal Interstitial Fluids (NIF). One-hundred and twenty-two proteins have been analyzed and a comparison was also made between the proteomic profile of responders versus nonresponders to CHT. At baseline, proteins isolated in TIF and NIF of all the 28 patients show significant differences in expression. Two clusters of proteins, differentially expressed in TIF with respect to NIF were found. Most significant is the decreased expression in TIF of CRYAB. In the protein metabolism group, also FIBB was found decreased. Some proteins involved in energy pathways were overexpressed (PGAM-1, ALDO A, PGK1, G3Pcn), while some other were down-regulated (CAH2, G3Pdx, PRDX6, TPIS). The same trend was observed for signal transduction proteins, with 14-3-3-Z overexpressed, and ANXA2 and PEBP 1 down-regulated. Moreover, an analysis has been conducted comparing protein expression in interstitial fluids of responders and nonresponders, irrespective of TIF or NIF source. This analysis lead us to identify two clusters of proteins with a modified expression, which might be predictive of response to CHT. In responders, an increase in expression of LDHA, G3Pdx, PGK1sx (energy pathways), VIME (cell growth and maintenance) and 14-3-3-Z (signal transduction), coupled with a decreased expression of TPIS, CAH 2, G3Psx, PGK 1dx (energy pathways), TBB5 (cell growth and maintenance), LDHB and FIBB (protein metabolism), was found. We observed that CHT modifies the expression of these cluster proteins since, after treatment, their expression in TIF of responder is generally decreased. Patients not responding to CHT show an unchanged expression pattern in TIF, with the exception of protein 14-3-3-Z, which is overexpressed, and a decreased expression in NIF of several cluster proteins. In conclusion, the identification of protein clusters associated with response to CHT might be important for predicting the efficacy of a specific antineoplastic drug and for the development of less empiric strategies in choosing the therapy to be prescribed to the single patient.
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Affiliation(s)
- Laura Cortesi
- Department of Oncology & Haematology, University of Modena and Reggio Emilia, Modena, Italy
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